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Surgery - DONE > GENERAL PRINCIPLES > Flashcards

GENERAL PRINCIPLES Flashcards

1
Q

What are the components of a pre op assessment?

A
  • Are they fit for surgery
  • Haemostatic competence (are they going to bleed?)
  • Coagulation screen: APTT, PT
  • Group and save
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2
Q

What can cause a prolonged PT?

A
  • Warfarin
  • Vitamin K deficiency
  • Liver disease
  • Factor VII deficiency

-

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3
Q

What causes a prolonged APTT?

A
  • Factor VIII deficiency (haem A)
  • Factor IX deficiency (haem B)
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4
Q

What causes both a prolonged APTT and PT?

A
  • DIC
  • Massive transfusion
  • Liver disease
  • DOAC
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5
Q

What is the difference between primary, reactive and secondary bleeding?

A

Primary = Bleeding in intra-operative period

Reactive = Within 24 hours of op

Secondary = 7-10 days post op due to erosion of vessel from spreading infection

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6
Q

What are the clinical features of haemorrhagic shock?

A
  • Tachycardia
  • Dizziness
  • Agitation
  • Raised resp rate
  • Hypotension is a late sign
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7
Q

What is the management of haemorrhagic shock?

A
  • A to E
  • IV access (18G cannula)
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8
Q

What steps of managment in haemorrhagic shock are there?

A

Read op notes - looking for sites of bleeding

Apply pressure to bleeding site

Urgent senior surgical review

Urgent blood tranfusion

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9
Q

What are the two types of delerium?

A
  • Hypoactive (most common) - lethagy and reduced motor activity
  • Hyperactive (most recognised) - agitation and increased motor activity
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10
Q

What are some risk factors for delerium?

A

> 65 years old

Co-morbidities

Underlying dementia

Renal impairment

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11
Q

What are some common causes for dementia?

A
  • Hypoxia (post-op)
  • Infection (UTI / LRTI)
  • Drug withdrawal (alcohol)
  • Dehydration/pain
  • Contipation/urinary retention
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12
Q

How to assess a patient with delerium?

A
  • Collateral history
  • Onset and course of confusion
  • Previous episodes
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13
Q

What scoring systems are there for delerium?

A
  • Abbreviated mental test
  • Mini mental state examination
  • Confusional assessment method
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14
Q

Name some questions in the abbreviated mental test?

A

Age

Time (to nearest hour)

DOB

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15
Q

What is included in a confusion screen?

A

Bloods - FBC, U&Es, Calcium, TFTs, glucose

Blood cultures

Urinalysis/CXR

CT head

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16
Q

How should patients with delerium be managed?

A

Abx for infection, nasal oxygen if hypoxic, laxatives for constipation

  • Nursed in quiet area with regular routine
  • Oral haloperidol
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17
Q

What are some risk factors for post-op vomiting and nausea?

A
  • Female
  • Younger age
  • Motion sickness
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18
Q

What areas in brainstem control vomiting?

A

Vomiting centre in the medulla oblongata

Chemoreceptor trigger zone (located outside BBB in 4th ventricle)

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19
Q

What are the neurotransmitters in each area of vomiting process?

A

CTZ: Dopamine (peripheral) and 5HT3 receptors

Vomiting centre: Histamine and 5HT3 receptors

(The CTZ acts on the vomiting centre)

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20
Q

What are the conservate treatments of PONV?

A
  • Fluid hydration
  • Analgesia
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21
Q

What should patients with PONV and impaired gastric emptying be given as an anti-emetic?

A
  • Metoclopramide or domperidone (prokinetic, dopamine antagonists)
22
Q

Other than pro-kinetics, what else can patients with PONV and bowel obstruction be given?

A

Hyoscine (anti-muscarinic) to help reduce secretions

23
Q

What should patients with PONV and metabolic/biochemical imbalance e.g. uraemia be given?

A

Metoclopramide

24
Q

What should patients with opiod-induced N&V be given?

A

Ondansetron (5HT3 receptor antagonist)

OR

Cyclizine (H1 Histamine receptor antagonist)

25
Q

What are the steps in the WHO analgesic ladder?

A
  • Simple analgesics (paracetamol/NSAIDs)
  • Weak opiates (codeine or tramadol)
  • Stronger optiates (morphine)
26
Q

What can be used for neuropathic pain?

A

Amitriptyline / gabapentin

27
Q

Name some NSAIDs, how do they work?

A

Ibuprofen/diclofenac - inhibit synthesis of prostaglandins - reducing potential inflammation

28
Q

What are some side effects of NSAIDs?

A

I-GRAB

Interactions e.g. with warfarin

Gastric ulceration (consider PPI)

Renal inpairment (use sparingly here)

Asthma sensitivity

Bleeding risk (due to effect on platelets)

29
Q

Name some strong opiates, how do they work?

A

Morphine, oxycodone, fentanyl

Activate opiod receptors

30
Q

What are some side effects of opiates? How is this managed?

A

Constipation / nausea (laxatives and anti-emetics given concurrently)

Sedation, confusion, respiratory distress

31
Q

Why should strong and weak opiates not be prescribed together?

A

Competitively inhibit the same receptor

32
Q

What is patient controlled analgesia?

Name a pro and a con

A

Iv pumps which provide bolus of analgesia when button pressed

Pro - Tailored analgesia, risk of overdose negligible

Con - Cumbersome, not suitable for learning difficulties

33
Q

What can cause post op fever?

A

Pneumonia, UTI, Surgical site infection, infected IV lines

34
Q

How to source the infection in post op sepsis?

A
  • Urine dip and culture
  • Chest X-ray
  • Surgical wound swabs
  • LP
  • Stool culture
35
Q

What are the seven C’s for pyrexia in a surgical patient?

A

Chest (infection)

Cut (wound infection)

Catheter (UTI)

Collections (abdomen, pelvic etc.)

Calves (DVT)

Cannula (infection, if applicable)

Central line (infection, if applicable)

36
Q

What does the term VTE encompass?

A

DVT and PE

37
Q

What are the 3 points in Virchow’s triad?

A
  • Abnormal blood flow (recent immobility)
  • Abnormal blood components (smoking, sepsis, malinancy)
  • Abnormal vessel wall (atheroma)
38
Q

What are the risk factors for VTE?

A
  • Age
  • Previous VTE
  • Smoking
  • Pregnancy
  • Recent surgery
39
Q

How does a DVT present?

A

Unilateral leg pain and swelling

Pyrexia

Pitting oedema

40
Q

What is the wells criteria?

A

Score greater than 1 indicates DVT

41
Q

What is the treatment for a DVT?

A

DOAC e.g. apixaban, rivaroxaban (factor Xa inhibitors)

and dabigatran (direct thrombin inhibitor)

42
Q

How does a PE present?

A

Sudden onset SOB

Pleuritic chest pain

Cough

Haemoptysis

43
Q

What Well’s score indicates a PE?

A

Greater than 4

44
Q

What are the 2 types of thromboprophylaxis?

A

Mechanical: Antiembolic stockings, intermittent penumatic conpression

Pharmacological: LMWH (unless poor renal function the UFH)

45
Q

What are some common organisms in HAP>

A

E. Coli

S. Aureus (MRSA)

S. Pneumoniae

46
Q

How would a GI anastomotic leak present?

A

Abdo pain and fever

47
Q

How would an anastomotic leak be investigated?

A

CT scan with contrast

48
Q

How is an anastomic leak treated?

A

NBM + broad spectum abx + surgery

49
Q

What are some factors in the VTE risk assessment?

A

Cancer?

Age >60?

Dehydration?

Obesity?

Personal history of VTE?

50
Q

What form part of the pre-op surgical checklist?

A

Confirmed identity?

Site marked?

Consented?

Allergies?

Risk of blood loss >500ml?

All team members introduced?

Surgery - DONE (9 decks)

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