Gen Surg Flashcards
numer one limiting factor prior to surgery is….
hx of cardiovascular disease
history of CV disease predisposing to surgery complications
- EF
if had a recent MI and surgery
must defer surgery for 6 months and stress the patient at that interval
patient has CHF and needs surgery for something else
give the drugs that decrease mortality:
ACE inhibitors, beta blockers, spironolactone
cardiovascular risk factor if male
male older than 45yo
patient with CV risk factors– what needs to be done before surgery
- bp meds adjusted
- daily finger sticks monitored
- insulin regimen adjusted
- stress test with ECG
(possibly ECHO if murmur)
preop assessment if under 35yo and no hx of cardiac disease
EKG ONLY
preop assessment if hx of cardiac disease and ANY AGE
- EKG
- stress testing– evaluate for ischemic coronary lesions
- ECHO for structural disease, and for ejection fraction
preop assessment PFT’s necessary for…
known lung disease
smoking history
preop patient is a smoker– what suggestions
quit smoking for 6-8weeks before surgery and use nicotine patch in meantime
preop assessment patient with renal disease
- give fluids before and during surgery
- if patient is on dialysis, dialyze pt 24hrs before surgery
ABC’s: airway
- no facial trauma= orotracheal tubes
- facial trauma= cricothyroidotomy
- C-spine injury= orotracheal tube with flexible bronchoscopy
ABC’s: breathing
O2 sats above 90%= ideal
ABC’s: circulation
insert 2 large bore IV cannulas and being aggressive fluid resuscitation to prevent hypovolaemic shock
cool skin, shock
cardiogenic or hypovolaemic shock
cardiogenic vs. hypovolaemic shock
PCWP/LVEDP:
cardio: increased
hypo: decreased
warm skin, shock
neurogenic, anaphylactic, septic
CO change in neurogenic shock
decreased CO
CO change in anaphylactic and septic shock
increased CO
PCWP change anaphylactic vs. septic shock
anaphylactic: decreased
septic: no change
sepsis definition
2/4 and infection source
SIRS criteria
2/4
- bp: less than 36, greater than 38
- HR: greater than 90bpm
- resp: tachypnea>20breaths/min, or O2 sats
severe sepsis
2/4 + infection source + organ dysfunction
septic shock definition
2/4 + infection source + organ dysfunction + HYPOtn