General Surgery Flashcards
What can be used to reverse warfarin?
Vitamin K (takes 6-12 hours)
Prothrombin complex concentrate
Fresh frozen plasma
What is the preoperative management for patients on warfarin?
Stabilise INR between 1.5-2.5 OR
Cease 2 days prior to operation and cover with heparin
What is the perioperative management for patients on heparin?
Cease 12 hours prior to operation and recommence afterwards
What can be given to reverse heparin?
Protamine (may precipitate thrombosis)
What precautions should be taken when operating on a patient with a pacemaker or ICD?
ICD: suspect arrhythmia detection
Pacemaker: place in triggered or asynchronous mode
Avoid monopolar diathermy (bipolar is okay)
What is Virchow’s Triad?
Stasis
Hypercoagulability
Endothelial Injury
What investigation should be ordered if the clinical probability of PE is high?
Spiral CT
List 5 general surgical risks.
DVT Infection (wound, chest, urine, blood) Bed sores Urinary retention Reactions to anaesthetic Bleeding Nerve/structure (iatrogenic) damage
Which antibiotics would be appropriate for the following:
(a) Staph Aureus
(b) E. Coli
(c) Pseudomonas
(d) MRSA
(a) Amoxicillin, Penicillin
(b) Cephalosporin
(c) Cephalosporin
(d) Vancomycin
What is normal urinary output?
At least 0.5mL/min/hour
What are the components of granulation tissue?
Neutrophils/macrophages
Fibroblasts
Type III collagen (later replaced by Type I)
New blood vessels
What are possible causes of fever in the post-operative patient?
Seven C’s: catheter, chest, central venous line, cannula, cut, collection (pus), calves (DVT)
What are the main differences between LMWH and UFH?
Comparatively, LMWH:
- Requires no APTT monitoring
- Can be given once daily and as outpatient
- Cannot be fully reversed by protamine
- Has longer half-life (longer offset)
- Is more predictable (less plasma protein binding)
