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The Great Surgery Deck > Evidence-Based Surgery (PCS CPGs) > Flashcards

Evidence-Based Surgery (PCS CPGs) Flashcards

1
Q

Antibiotic prophylaxis for:

Biliary, breast and gastroduodenal surgery

A

Cefazolin 1g IV single dose

Alt: Cefuroxime 1.5 g IV

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2
Q

Antibiotic prophylaxis for:

Colorectal surgery

A
  1. Co-amoxiclav 1.2g IV
  2. Cefoxitin 2g IV
  3. Ampi-sul 1.5g IV
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3
Q

Antibiotic prophylaxis for:

CSF shunting

A

Cloxacillin 1g IV

Alt: Oxacillin 1g IV

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4
Q

Antibiotic prophylaxis for:

Cranial procedures other than CSF shunting

A

Cefuroxime 1.5g IV

Alt: Cefazolin 1g IV + Genta 80 mg

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5
Q

Antibiotic prophylaxis for:

TCV Surgeries

A

Cefazolin 1g IV

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6
Q

Antibiotic prophylaxis for:

Orthopedic procedures

A

Ceftraxone 2g IV

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7
Q

Antibiotic prophylaxis for:

Transurethral resection of the prostrate

A

Gentamicin 80mg IV within 2 hours before surgery

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8
Q

Antibiotic prophylaxis for:

Elective groin hernia sugery and groin hernia repair

A

NO prophylaxis recommended!

A TRAP!

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9
Q

in adult patients not undergoing immediate laparotomy, ___ is the imaging modality of choice to determine presence of an intra-abdominal infection.

A

CT scan

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10
Q

Patient was diagnosed to have a periappendiceal phlegmon. Patient has stable vital signs. Is there room for conservative management, i.e. antimicrobial tx without source control?

A

HIGHLY selected patients with MINIMAL physiologic derangement and a WELL-CIRCUMSCRIBED focus of infection may be treated conservatively.

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11
Q

Are blood cultures routinely ordered in patients presenting with community-acquired intraabdominal abscess?

A

NO. They do NOT provide additional clinically relevant information.

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12
Q

Which antibiotic is NOT to be used in the local setting in the management of intraabdominal abscess, due to high resistance rates? Which antibiotics that are traditionally used to cover for anaerobes are NOT recommended locally?

A

Ampicillin-sulbactam
Aminoglycosides also NOT recommended (too toxic when safer alternatives exist)

NOT recommended anti-anaerobes:
Cefotetan
Clindamycin

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13
Q

What are antibiotics of choice for adult patients with mild to moderate community acquired intraabdominal abscesses?

A 
As single agents:
Ticarcillin-clavulanic acid
Cefoxitin
Ertapenem
Moxifloxacin
Tigecycline

Combinations of Metronidazole +
Cefax/Cefu/Cefot/Levo/Cipro

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14
Q

For community-acquired infections, do we need to cover for:

  1. Enterococcus
  2. Candida
A

NO!

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15
Q

If the following are isolated in high risk intra-abdominal infections, what is the antibiotic of choice?

  1. Candida albicans
  2. Candida albicans in a critically ill patient
  3. Enterococci
A
  1. Fluconazole
  2. Echinocandins
  3. Ampi, Pip-Tazo, Vanco
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16
Q

How long is antimicrobial therapy for intraabdominal infections?

A

4 - 7 days

17
Q

What is the “recommended imaging procedure for patients with suspected appendicitis”

A

Helical CT of the abdomen and pelvis with IV (not oral or rectal) contrast

18
Q

What is the management of a patient with “well-circumscribed periaapendiceal abscess”?

A

Percutaneous drainage or operative drainage. Appendectomy is DEFERRED.

19
Q

What is the first imaging technique used for suspected acute cholecystitis or cholangitis?

A

Ultrasonography

20
Q

Recommended agennts for uncomplicated acute cholecystitis

A

Cefazolin 1g IV q8
Cefuroxime 1.5g IV q8
Cefoxitin 2g IV q8

FOXy URO got some AZz.

If allergic, FQ + Metro

21
Q

Antibiotic of choice for patient with cholangitis

A

Ciprofloxacin 200mg IV BID

Ceftazidime 1g IV + Ampi 500mg IV QID + Metronidazole 500mg IV

22
Q

When to give prophylactic antibiotics?

A

Within 1 hour prior to surgical incision

23
Q

When to give additional doses of prophylactic antibiotics?

A

1-2x the half life of the drug

Cefox: 3h
Metro/Cipro: 6h

24
Q

Preoperative glucose should be <__.

A

200mg/dL

25
Q

What is the recommendation re: hair removal prior to surgery?

A

CLIPPING PRIOR to surgery ONLY if hair interferes with incision

26
Q

To reduce infection, operative time for colorectal surgery should be less than ____ hr.

A

3 hours

27
Q

Treatment of Skin and Soft Tissue Infections

Impetigo / Cutaneous Abscess

A

Incision and breaking of pus; breaking up of loculations

28
Q

Treatment of Skin and Soft Tissue Infections

Furuncles (Boils) / Carbuncles

A

Small furuncles: Moist heat
Large furuncles / All carbuncles: Incision and drainage

NO antibiotics unless with:

  1. Cellulitis
  2. Fever
29
Q

Treatment of Skin and Soft Tissue Infections

Cellulitis / Erysipelas

A

Penicillin

Roxithromycin is equivalent.

30
Q

Treatment of Skin and Soft Tissue Infections

MRSA infection

A

Doxycycline
Clindamycin
TMP-SMX
Rifampin

Always culture lesions and perform susceptibility testing.

31
Q

Treatment of Skin and Soft Tissue Infections

Necrotizing infections / Fourniere’s gangrene

A

Surgical debridement!
Do repeat debridement 24 - 36h after initial and daily thereafter.

Antibiotics:
Ampi - aerobic, E. coli, G+
Clinda - anaerobes, aerobic G+ cocci
Metro - enteric G- anaerobes

For Streptococcal TSS:
Clinda + Pen

32
Q

Treatment of Skin and Soft Tissue Infections

Surgical site infections

A 
Open incision.
Evacuate infected material.
Change dressing.
Let wound heal by secondary intention
NO antibiotics!
33
Q

Treatment of Skin and Soft Tissue Infections

Antibiotic of choice in px with neutropenia with G+ organisms

A

Vancomycin

34
Q

Which of the following are accepted routine local maneuvers to prevent catheter-associated UTI? (

A. Daily meatal cleansing with povidone iodine solution
B. Polyantibiotic ointment
C. Green soap or water
D. Catheter irrigation with antimicrobials

A

NONE of the above!

There are no generally accepted routine local maneuvers.

35
Q

Recommended site for central venous catheter placement

A

Subclavian

> Femoral, jugular

36
Q

Is antibiotics prophylaxis needed for intubated patients requiring tracheostomy

A

YES!

37
Q

What is the appropriate timing of tracheostomy in patients on prolonged mechanical ventilation

A

Within the FIRST WEEK in critically ill adult patients

38
Q

What signs on physical examination have been documented to be associated with increased perioperative cardiac morbidity and mortality?

A

S3 heart sound
Neck vein engorgement
Rales

(Signs of CHF)

39
Q

Which of the following confers the higher cardiac risk?

A. Thoracic surgery
B. Emergency surgery
C. Vascular surgery
D. Abdominal surgery

A

B and C

The Great Surgery Deck (5 decks)

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