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CP3 SURGERY > GEN SURG part 3 > Flashcards

GEN SURG part 3 Flashcards

1
Q

What are the 2 main causes of hypovolaemic shock?

A

Haemorrhage

Dehydration

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2
Q

E.g.s of distributive shock (3)

A

Sepsis
Anaphylaxis
Neurogenic shock

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3
Q

Causes of cardiogenic shock (4)

A

MI
Arryhthmias
Valve dysfunction
Metabolic disturbance

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4
Q

Causes of obstructive shock (3)

A

Massive PE
Cardiac tamponade
Tension pneumothorax

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5
Q

CO =

A

SV x HR

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6
Q

BP =

A

CO x SVR

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7
Q

MAP =

A

Diastolic BP + (systolic-diastolic) /3

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8
Q

What are the 3 essential features of any kind of shock?

A

Fall in BP by at least 40mmHg
TachyC
Tachypnoea

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9
Q

Other features of hypovolaemic/cardiogenic shock

A

Cold pale clammy pt
Rapid thready pulse
Pulse P = narrow b/c vasoconstriction

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10
Q

Other features of septic shock

A

Patient = flushed
Hot + sweaty w/ rapid ‘bounding’ pulse
Pulse P = wide b/c vasodilation

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11
Q

Effect of shock - cerebral

A

Autoregulation over MAP 50-100

Below this pt becomes agitated, confused, drowsy, then unresponsive

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12
Q

Effect of shock - respiratory

A

Incr RR due to metabolic acidosis

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13
Q

Effect of shock - renal

A

Autoreg 70-170 MAP

Below this - oliguria –> toxic build up

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14
Q

Effect of shock - GI

A

Decr gut motility + nutrient absorption

Decreased ability to sustain norm flora –> infections

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15
Q

MEWS score >3 =

A

Urgent med review

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16
Q

MEWS score >5 =

A

Critical care teams involved

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17
Q

What is SIRS?

A

Systemic inflammation response syndrome

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18
Q

SIRS criteria

A 
2+ new from: 
T >38.3 or <36 
RR >20
HR >90
WCC <4 or >12
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19
Q

What is septic shock a result of?

A

Over activation of the immune system b/c infective causes

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20
Q

Acute Mx of sepsis

A 
Sepsis 6 within 1 hr 
O2
IV fl (500ml crystalloid stat) 
IV Abx 
Serum lactate - urgent Sr review if >4
Cultures 
Catheterise
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21
Q

When to Tx - ‘suspected sepsis)

A 
New alteration in mental state 
RR >25
HR >130
SBP <90 or >40 
Not passed urine for 18 prevhrs 
Mottled, ashen, cyanosed skin, or non-blanching rash
22
Q

Acute Mx of anaphylactic shock

A 
A-E 
Remove cause 
Adrenaline 0.5mg IM + repeat ev 5 mins 
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
Raise feet off bed to help restore circulation 
Serum trypase to confirm ddiag
23
Q

mx class 1 hypovolaemic shock

A

Crystalloids

24
Q

mx class 2 hypovolaemic shock

A

Consider giving blood

25
Q

Mx class 3 hypovolaemic shock

A

give blood, consider surgical mx

26
Q

Mx class 4 hypovolaemic shock

A

Will need sugrical mx

27
Q

initial Mx cardiogenic shock

A 
A-E 
IV diamorphine 2.5-5mg 
Assess for pulm oedema 
Consider Swan-Ganz catheter + art line 
If pulm cap wedge pressue = low - give 100mg plasma ev 15mins 
If ok - give inotropic support
28
Q

Mx neurogenic shock

A

Fluid resus + vasopressors

29
Q

What is the difference between neurogenic shock and spinal shock

A

Neurogenic = inhibition of sympathic outflow from spinal cord –> VD
Spinal shock = concussion of spinal cord –> flaccid arreflexia which resolves as soft tissue swelling decreases

30
Q

Reflexes in spinal shock

A

None below level of injury

May be priaprism

31
Q

What is the triad of death?

A

Coagulopathy
Hypothermia
Metaolic acidosis

32
Q

What is a superficial incisional SSI

A

INfection of skin and sct tissue of incision

33
Q

What is a deep incisional SSI

A

Infection involving deep tissues such as mm/fascial layers

34
Q

What is an organ/space SSI

A

Infection involving any site involved in the operation other than the incision

35
Q

What is impetigo

A

Superficial purulent infection caused by staph/strep w/ a characteristic golden crust on an erythematous base

36
Q

What is ecythma

A

Purulent ski infection caused by staph/strep, ulceration under a crust

37
Q

What i s ecythma assoc w/

A

Poor hygiene + malnutrition

38
Q

What is erythrasma

A

Mild itchy eruption betw toes or in flexures, caused for corynebacterium
Tx = TO miconazole or PO erythromycin

39
Q

What is folliculitis

A

Caused by staph, pustules heal in 7-10 days in superficial folliculitis w/ PO fluclox

40
Q

Staph Scalded skin syndrome

A

Fever
Irritable + skin tenderness before erythema
Skin blistering develops after 24-48 hr b/c toxins from S aureus

41
Q

Mx scalded skin syndrome

A

Take swab

+ immediate IV fluclox + supportive measures

42
Q

What is anaerobic gangrene caused by

A

Clostridium perfringens found in soil/faeces

43
Q

Pathohpysiology of anaerobic gangrene

A

Arise from trivial injury

Intiially gas in tissues w/ oedema + spreading gangrene + systemic upset

44
Q

Tx anaerobic gangrene

A

REsus

Aggressive debridement + IV penicillin + metronidazole

45
Q

Pathophys synergistic gangrene

A

Aerobes + synergistic anaerobes infect initial wound/surgical site, –> severe wound pain + (g) in tissues
May be extensive subdermal gangrene

46
Q

Tx synergistic gangrene

A

Debridement, ABx + systemic support

47
Q

Steps in reviewing someone with a fever post op

A

Review obs + UO
Inspect wound for superficial infection/haematoma
Inspect cannula sites for thrombophlebitis/infection
Examine chest to excl infection, infarction, acute HF
Examine legs for DVT
Consider sources of infection - GI/urine

48
Q

Common locations intra-abodominal abscess

A

Alongsidee the organ
Pelvic
Subphrenic

49
Q

Features - intra-abominal abscess (5)

A 
Malaise 
Anorexia 
Swinging pyrexia 
TachyC
Possible mass
50
Q

Ix intra-abdominal abscess

A

CT abdo/pelvis

51
Q

Mx intra-abdo abscess

A

iv abx

radiological guided draining

52
Q

HOw to drain an abscess

A

Under GA + strong analgesia
Point of max fluctuance = incised
Small - dry dressing
Deep -antiseptic ribbon gauze + packing to keep open until they have filled w/ granulation tissue

CP3 SURGERY (19 decks)

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