Gen Surg Flashcards
ASA grades
1: no problems
2: minor
3: severe with functional limitations
4: severe and life-threatening
5: moribund
6: brain-dead
first on op list vs last on op list
diabetics, infection
rule for dual antiplatelets
Stop 10 days prior to surgery
Resume day after surgery unless contraindication
DOACs and surgery
No specific reversal agent
Usually need to wait 24 hours for elective surgery
(for dabigatran can wait 12h)
INR threshold for elective surgery
1.5
when should anticoag be stopped
5 days before surgery (continue to give lmwh in interim)
when should therapeutic dose lmwh be stopped
48h before surgery
fasting rules for surgery
6h food
2h clear fluids
if INR too high and on warfarin (elective surgery)
give 5-10 mg IV vit K
repeat INR after 6h
if still too high, d/w haematology re: giving PCC
if INR too high due to liver disease (elective surg)
give 10 mg IV vit K
repeat INR after 6h
if still high d/w haem re: FFP/ cryoprecipitate
when should UH be stopped
4h
when should antiplatelets never be stopped before talking to cardiologist
stents within 1 year
when should insulin be stopped?
avoid morning dose (no long-acting)
when should oral hypoglycaemics be stopped?
avoid on day of op if short-acting
3 days before if long-acting
metformin: 2 days before + withhold 2 days after
when should cocp be stopped/ restarted?
stopped 4 weeks before
started 2 weeks after
what should be avoided on day of op?
ACEi, diuretics
What is re-feeding syndrome? When does it occur?
What are the hallmarks?
How do you avoid?
occurs 24-72h after reintroduction of nutrition in someone who has had little food for over 5 days
large shifts in electrolytes. hallmark is low phosphate
in pts at high risk, check U&Es, bone profile, mg
administer thiamine, vit B, multivits
feed slowly
5 Ws of post-op fever
wind (atelectasis) water (UTI) wound (infection) walking (DVT) wonder drugs (drug fever)
when to return to work post- elective surgery
light work: 1-2 weeks
minimal lifting: 2-3 weeks
heavy labour: 6 weeks
