Final_Week 1 Flashcards
What are the recommended fasting times in hours for different infant milk preparations?
- Clear liquids (2 hours)
- Breast milk (4 hours)
- infant formula (6 hours)
- nonhuman milk (6 hours)
What are the major clinical predictors of increased periop CV risk that should be evaluated more closely during preop period?
- CV dx
- DM
- CVA dx
Noncardiac surgery should be delayed _____ following MI without coronary intvn
at least 60 days
General NPO guidelines
Up to \_\_\_\_ hours before surgery Clear liquids: 2 Breast milk: 4 Light meal/non-human milk: 6 Heavy meal (fried/fatty/meat): 8
Why do we say NPO after MN for adults?
Patients can be:
- unreliable
- not truthful
- gastric emptying varies
- cases can be moved earlier
- multiple instructions are difficult to remember/follow
Massive transfusion is defined as
transfusion of 10 units of PRBCs in 24h
Class I Hemorrhage:
Blood loss, S/S, Tx
- blood loss of up to 15% of blood volume or up to about 750 mL (70-kg M)
- s/s: minimal-none
- Tx: not reqd
Class II Hemorrhage:
Blood loss, S/S, Tx
- blood loss of 15%–30% of blood volume or ~ 750–1500 mL
- s/s: Tachycardia, tachypnea, decreased pulse pressure, not a significant decrease in SBP. Subtle CNS changes (anxiety), Urine output only minimally decreased
- Tx: Depends
Class III Hemorrhage:
Blood loss, S/S, Tx
- blood loss of 30%–40% of blood volume or ~ 1.5-2L.
- s/s: classic signs - marked tachycardia, tachypnea, systolic HOTN, significant changes in mental status, oliguria.
- Tx: req transfusion
Least amount of blood loss that causes decrease in SBP
Class III Hemorrhage
MTP ideal ratio
1:1:1 plasma:platelets:pRBCs
MTP ideal ratio is associated with
improved hemostasis, decreased mortality d/t exsanguination at 24h
> 2L blood loss
Class IV hemorrhage
70kg
Class IV Hemorrhage:
Blood loss, S/S, Tx
- blood loss > 40% of blood volume or > 2L
- immediately life threatening
- S/S: Marked tachycardia, significant/sustained HOTN, narrow pulse pressure, negligible urine output, markedly depressed mental status, cold pale skin
- Tx: req transfusion of blood products + immediate control of bleeding source
Loss of ______ blood volume results in ______
> 50% blood volume
results in LOC, bradycardia
major risks of perioperative CV issues
- Unstable coronary syndromes (unstable or severe angina, acute/recent < 3months MI)
- Decompensated HF
- significant arrhythmia (Mobitz II, 3rd degree HB, sympt. ventricular arrhythmia, SVT)
- severe valvular disease
Delay elective surgery if HTN
SBP > 200
DBP > 115
Proceed with elective surgery if HTN
SBP < 180
DBP < 110
BOOTS
*difficult to mask ventilate Beard Obese (BMI > 26) Old (age > 55) Toothless Snoring (OSA, hx snoring)
surviving sepsis tx
- CVP: 8 – 12 mm Hg
- MAP: 65 mmHg+
- U/O: 0.5 mL/kg/hr+
- SCVO2 of 70% or SVO2 of 65%
- Normalization of lactate •Identify septic source
- Antibx
- Fluid resuscitation
- Vasopressors & inotropes
- Steroids?
- Hgb target: 7 – 9 g/dL
- Avoid ARDS
- Blood glucose 180 mg/dL or less
STOP-BANG
High OSA risk >/=3 Low risk < 3 Stop: Snoring, Tired, Observed (anyone saw you stop breathing at night), bP (tx for HTN) B: BMI > 35 A: Age > 50 N: Neck circumf. > 40 cm G: Gender = M
Lethal triad
hypothermia, acidosis, and coagulopathy
One MET is defined as
the amount of oxygen consumed while sitting at rest and is equal to 3.5ml O2 per kg bodyweight per min
A patient’s self-reported inability to perform average levels of exercise (i.e., 4 to 5 METs) suggests
increases the risk of perioperative complications.
METs are used to
help determine whether additional preanesthetic evaluation should be performed and may predict perioperative outcomes
