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EMed/Surg FINAL (ASL 👵🏼🐈🌭) > General Surgery (Lauren 🌭) > Flashcards

General Surgery (Lauren 🌭) Flashcards

1
Q

When you get a call from the ED that they need a surgical consult, what information are you going to get about the patient before you go see them?
(CAN PROBABLY IGNORE THIS CARD)

A

PMH

Vitals

Labs

Imaging

Notes from prior visits if available

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2
Q

Why is it important to know about someone’s previous knee replacement or dental procedures if you are consulted for a gallbladder surgery?
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A

Anesthesia tolerance

BLEEDING history

Prosthetic knee can affect where the grounding pad for the bovie is placed

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3
Q

If a patient says they only drink 2 beers a night and haven’t done meth in 2 years, what should you think about that?
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A

They are lying

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4
Q

What do we want to know about someone’s family history before taking them to the OR?
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A

Bleeding disorders

Clotting Disorders

History of malignant hyperthermia

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5
Q

Why do we need to ask about UTI symptoms before bringing someone into the OR?
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A

Surgeons don’t like to operate on people with UTIs because it messes up their postop infection stats

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6
Q

Why do we need to ask about someone’s acid reflux before taking them back to the OR?
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A

Anesthesia will need to know to look out for aspirations

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7
Q

Why do we need to test someone’s neck ROM before taking them to the OR?

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A

Can affect intubation if they cant move their neck

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8
Q

What is the “Natural history of a disease”

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A

The course of the disease if it were left untreated

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9
Q

Urgency (increases/decreases) risk

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A

Increases

Limits how much pre-op preparation you can do

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10
Q

Why does it matter if someone is a chronic alcoholic?

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A

They can have withdrawal symptoms if they need to be admitted to the hospital

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11
Q

Ideally, your patient should quit smoking ____ weeks prior to elective surgery

(CAN PROBABLY IGNORE THIS CARD)

A

8

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12
Q

Why do we care about someone’s musculoskeletal conditions before taking them to the OR?

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A

They could have decreased mobility and if you’re moving their arms/legs around during surgery you could really hurt them

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13
Q

Which medications should a patient continue to take before surgery?

A

Meds that have significant withdrawal symptoms that do NOT affect anesthesia

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14
Q

Should a patient keep taking all their cardiovascular meds before surgery?

A

Yes

EXCEPT for ACEs and ARBs 24 hrs before non-heart surgery***

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15
Q

Which really common medications NEED to be stopped 24 hours before a non-cardiac surgery?

A

ACEs and ARBs.

These will INCREASE mortality

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16
Q

Should you keep taking your statins before surgery?

A

YES**

Statins reduce peri-op mortality

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17
Q

When should a patient stop taking their antiplatelet meds before surgery?

A

7-10 days before

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18
Q

Should patients keep taking their herbal supplements and vitamins before surgery?

A

No, just discontinue them.

Some of them can increase bleeding risk

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19
Q

Do you we care about someone’s blood sugar before surgery?

A

Yes, tight glycemic control reduces mortality, infection and complications.

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20
Q

At Phoenix Indian Hospital, patient’s blood glucose must be less than _____ for elective surgery

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A

300

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21
Q

A patient should be NPO after __________ before surgery

CAN PROBABLY IGNORE THIS CARD

A

Midnight

Although now some places say clear liquids are ok up to 2 hours before

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22
Q

Procedures with a HIGH risk have a mortality of _____%

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A

Over 5

CABG, AAA repair, etc

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23
Q

Procedures with intermediate risk have mortality of _______

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A

1-5%

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24
Q

Procedures with Low risk have mortality of _____%

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A

Less than 1%

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25
Q

SURGERY=______

A

RISK

EVERY SURGERY.

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26
Q

Emergent nature _______risk for operative mortality in low-moderate risk patients

(CAN PROBABLY IGNORE THIS CARD)

A

Doubles

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27
Q

What is the ASA classification?

A

It indicates your degree of sickness prior to anesthesia.

Ties the OUTCOME to your health, not a predictor of operative risk

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28
Q

What is the range of ASA scores?

A

1-6

1= healthy, fit, nonsmoker

6= brain dead patient whose organs are being removed for transplant

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29
Q

What is the risk assessment tool used for someone with liver disease?

A

MELD score

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30
Q

What risk assessment tool is used to calculate someone’s risk for DVT?

A

CAPRINI

Tells you what to do for them in post-op

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31
Q

The most frequent cause of non surgical perioperative morbidity and mortality is _____

A

MI
💔
***

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32
Q

How do we assess the functional capacity of EVERY patient before surgery, so we know what other kinds of pre-op testing to do?

A

Exercise capacity

Ex:

1 MET= walking around house, using the toilet, feeding yourself

4 METs= climbing stairs, golf, heavy housework, run short distance

10 METs= strenuous sports like swimming, football, basketball, skiing ⛷

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33
Q

At age _____, perioperative mortality increases SIGNIFICANTLY

A

80

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34
Q

_______ is the best method of cardiac risk assessment

A

History

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35
Q

The most common SOURCE of perioperative morbidity and mortality are the _______

A

Lungs

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36
Q

what is the 3rd most common perioperative complication?

A

Pneumonia*******

He had this in RED

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37
Q

How can you prevent pneumonia intraoperatively?

A

Suction when extubating them

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38
Q

How can you avoid pneumonia post operatively?

A

Incentive spirometry. (Makes them inhale and prevents atelectasis)

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39
Q

When do you need to do PFTs before surgery?

A

To optimize asthma (?)

SOB with unknown cause

Lung resection surgery

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40
Q

Most cases of Obstructive Sleep Apnea are ___________

A

Undiagnosed

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41
Q

true or false:

Most patients who ARE diagnosed with sleep apnea are compliant with their CPAP

A

False

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42
Q

Why do we care if someone has sleep apnea?

A

Increases perioperative morbidity and mortality

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43
Q

What is the name of the scoring tool used to determine if someone has sleep apnea (even if they have never been diagnosed)

A

STOP BANG

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44
Q

Closer the surgery is to the _______, the higher the risk of pulmonary complications

A

Diaphragm

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45
Q

What is the best predictor of a patients bleeding risk?

A

Prior history of bleeding

Dental extractions, surgery, childbirth, family history

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46
Q

What did he find in that lady’s stomach that he is writing a paper about?

A

a BEZOAR

Big chunk of hair and clay. Lady was eating her hair, and then became iron deficient so she started eating clay too

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47
Q

The CAPRINI score stratifies a patient’s risk for VTE, and provides validated recommendations for:

A

Who should be discharged with continued prophylaxis

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48
Q

EVERY single surgical patient will have low ________

A

Albumin

**

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49
Q

Why is albumin low in every single surgical patient?

A

Albumin is a reverse acute phase reactant

Aka it goes DOWN in inflammation

50
Q

Why would you do an intraoperative cholangiogram when you do a gallbladder removal?

A

It allows you to see if there’s a filling defect in the biliary tree aka if there’s a stone in the common bile duct that needs to come out

51
Q

When you’re in the OR, don’t touch the _________

A

Mayo tray

52
Q

In the OR, what is the name of the person who starts the foley, preps the skin, documents everything, etc

A

Circulating RN

53
Q

In the OR, who is the person that hates you the most

A

Surgical tech/“scrub tech”

54
Q

What is the FIRST thing you need to do when you walk into the OR?

A

Write your name and title on the whiteboard

55
Q

When do you need to wear a mask into the OR room?

A

From the time equipment is opened to the closure of the incision

56
Q

If you contaminate yourself, what should you do?

A

Call yourself out

57
Q

Once you’re scrubbed in, is your back sterile?

A

No.

Must do weird roll around the other person if you want to switch places with them. (Back can not face the patient)

58
Q

What happens during the “Surgical Timeout”

A

ALL OR team members pause!!

You do a checklist!

59
Q

What things are on the checklist that is done during the surgical timeout?

A
  1. Correct patient
  2. Allergies
  3. Consent signed
  4. History and physical
  5. Procedure verification
  6. Site verification
  7. Required supplies
  8. Special equipment
  9. Antibiotics given
  10. Safety precautions
  11. Radiology exams, if applicable
60
Q

What are the NEVER EVENTS that are serious, preventable, and a threat to public safety?

A

Wrong site surgery

Retention of foreign body after surgery

Surgery on the wrong patient

Wrong surgery performed

Intraopreative death on ASA 1 patient

61
Q

When do you count all the sponges, tools, etc?

A

Before surgery

During surgery

After surgery

62
Q

What gas is used to fill up the abdomen before a laparoscopic surgery

A

CO2

63
Q

Whose job is it to insert the ports for a laparoscopic surgery?

A

Yours

64
Q

What is the test of choice for gallstones?

A

Ultrasound

65
Q

What is the diagnosis:

Thickened gallbladder wall

Pericholecystic fluid

Leukocytosis

RUQ tenderness

Fever

A

Acute cholecystitis

66
Q

What is the diagnosis:

RUQ pain after a fatty meal

Gallstones on ultrasound

+/- Nausea/vomiting

A

Symptomatic cholelithiasis

67
Q

How many episodes of Symptomatic cholelithiasis can a patient have before they are referred for surgery?

A

1

68
Q

What procedure is recommended for all of these diagnoses:

Acute cholecystitis

Symptomatic cholelithiasis

Biliary pancreatitis

Gallbladder polyps

A

Cholecystectomy

69
Q

What are the complications of cholecystectomy?

A

Bile leak

Retained CBD stone

70
Q

Why would we do an open approach for simple procedures instead of a laparoscopic?

A

If they have adhesions, or a history of radiation therapy, etc

71
Q

What are the complications of appendectomy?

A

Bleeding

Infection

Ileus

72
Q

If you have acute appendicitis, can you just take antibiotyics and skip the surgery?

A

No it doesn’t work

73
Q

What are the symptoms of diverticulitis?

A

LLQ pain

Fever

Rectal bleeding?

RLQ pain?

If complicated: abscess, fistula, obstruction, bleeding, perforation

74
Q

What is the treatment for diverticulitis?

A

NPO

Antibiotics

Supportive care

Colonoscopy after acut epidosde to confirm diagnosis

Elective colectomy if repetitive episodes

75
Q

If you know you have diverticulosis, should you avoid nuts and seeds?

A

NO

OLD WIVES TALE

NOT HELPFUL

76
Q

What is the difference between neoadjuvant and adjuvant chemotherapy?

A

Neoadjuvant= before surgery

Adjuvant= after surgery

77
Q

What are the 2 types of colon resections that can be done for colon cancer?

A

LAR (Lower Anterior Resection)

APR (AbdominoPelvic Resection)

78
Q

APR or LAR:

Done to remove rectal cancers

A

Both

79
Q

APR or LAR:

Used to remove cancers well above the anus⬆️

A

LAR

80
Q

APR or LAR:

Used to remove cancers close to the anus

A

APR

81
Q

APR or LAR:

Preserves the sphincter, colon is re-anastomosed

A

LAR

82
Q

APR or LAR:

Sphincter is removed and a permananet colostomy is made

A

APR

83
Q

APR or LAR:

Provides a better quality of life

A

LAR

LAuRen will improve the quality of your life :

84
Q

When do prophylactic antibiotics need to be given before surgery?

A

Within 1 hour of incision time

85
Q

Should you remove hair before doing surgery?

A

NO!

If it is removed, youre doing it with clippers in pre-op

(Although according to someone else who met with Ms. Sears, you ARE supposed to shave the hair with a razor)

(This person was Megan. I bet this will not be a question due to this discrepency -Shelby)

Also how many times can we add notes to this card as a group? 🧾

(I didn’t put Megan’s name in case she wanted to remain anonymous for some reason. Write back soon!
Your friend,
Lauren)

dear lauren, u r g8! hope you have a kickass summer! dont ever change. ILY -shelby

86
Q

How should a patient prep their skin at home?

A

Shower with chlorhexidine soap the night before

87
Q

Fluid (overload/depletion) is a big problem in post-op

A

Overload (iatrogenic because YOU gave them a shitload of fluids.)

88
Q

If your surgical patient wakes up the next day with swollen legs and crackles in her lungs, what do you think is the problem

A

She is fluid overloaded because you gave too much fluid during surgery

89
Q

How can a patient prevent hernias after surgery?

A

No heavy lifting

90
Q

In what order do the parts of the GI tract come back to life after surgery?

A

24 hrs- small intestine

36 hrs- stomach

48 hrs- Right colon

72 hrs- left colon

91
Q

“If the gut works, ________”

A

Use it.

Aka don’t do feeding tubes, enteral nutrtion, etc if they can eat normally

92
Q

When you’re counseling your patient about pain, you need to tell them to have (unrealistic/realistic) goals

A

Realistic

93
Q

Which day after surgery is usually the worst for pain

A

Day 3

94
Q

What drugs are the mainstay of pain control after surgery

A

Opioids

95
Q

What are your options for non-narcotic pain control after surgery?

A

Ketorolac (Toradol)

IV Tylenol

NSAIDs

Regional anesthesia (nerve blocks): TAP

Lidocaine patches (used a lot but are placebos)

Acupuncture/guided imagery (watching relaxing YouTube videos lol)

Cannabis

96
Q

If the PACU nurse calls you and says your patient is having a lot of pain after surgery, you should:

A.) tell her to give him some more morphine and to stop bothering you on your lunch break’

B.) go see the patient because pain can be a sign of complication

A

B.

Pain can indicate:

Compartment syndrome (maybe due to all the FLUID you gave them)

Post-op bleed

Hematoma

DVT

MI

97
Q

True or false:

Atelectasis causes post-op fever

A

TRUE

98
Q

What can be done to prevent atelectasis after surgery?

A

Incentive spirometry

99
Q

Do post op conditions satisfy Virchow’s triangle (and thus increase the risk for DVT)?

A

Yes

stasis, vessel injury, hypercoagulability

100
Q

How do you treat postoperative ileus?

A

Early feeding

Ambulation

Avoid narcotics

(It will wake up with time)

101
Q

What is this:

“An inherited hypermetabolism involving skeletal muscle after exposure to succinylcholine”

A

Malignant hyperthermia

102
Q

Does malignant hyperthermia run in families?

A

Yes. Make sure you ask family hx

103
Q

What is succinylcholine?

A

Anesthesia drug.

Can cause malignant hyperthermia

104
Q

What’s the big deal if your patient gets malignant hyperthermia?

A

They get rhabdomyolysis, cerebral edema, DIC, and DEATH

105
Q

What will be the first sign that something is going wrong when your patient develops malignant hyperthermia?

A

Increased CO2

106
Q

What is the antidote for malignant hyperthermia?

A

Dantrolene

107
Q

If you want to look at Stones, Bones, Gas, or Mass, you should use:

A) CT

B) X-ray

A

B) X ray

108
Q

Becoming proficient at bedside ultrasound is an (MUST/option)

A

MUST

109
Q

What is an ileostomy?

A

Connect ileum to abdominal wall

110
Q

What is an End ileostomy?

A

Entire colon is removed and your GI tract ends at the hole in your stomach.

Permanent. (Obviously, since your entire COLON AND RECTUM WERE REMOVED)

111
Q

What is a loop ileostomy?

A

A LOOP of your ileus is brought to the skin and they make a hole in your belly for your poop to come out of.

TEMPORARY

112
Q

Which one is permanent:

A.) End Ileostomy

B.) Loop Ileostomy

A

A.) End ileostomy

113
Q

What is a colostomy?

A

Connects colon to the abdominal wall.

Can be temporary OR permanent

114
Q

What is Hartman’s Procedure?

A
  1. ) remove diseased rectosigmoid colon
  2. ) close the anorectal stump (tie off anus) lol
  3. ) End colostomy
115
Q

What are the indications for Hartman’s procedure?

A

Ulcerative COlitis

REcto-sigmoid cancers

Sigmoid volvulus

Rectal injuries 🐹

116
Q

most small bowel obstructions are managed:

A.) surgically

B.) Medically

A

B.) Medically.

NPO, fluids, NG tube, etc

117
Q

What is the NON-OPERATIVE management for small bowel obstruction that is sufficient for like 82% of patients who have SBO

A

NG tube

NPO

IV Fluids/electrolyte replacement

Continuous reassessment

118
Q

Ok he included Phoenix Indian Hospital’s SBO proticocol and he made some stuff red but he never talked about it in class. For completeness, I will list it here for you.

A
  1. Insert NG tube and place to low intermittent suction
  2. Keep head of bed to at least 30 degrees
  3. Flush NG tube q2h with 30mL of tap water. Flush blue sump port with 30 mL air q2h
  4. Foley catheter
  5. I/O’s
  6. 2 hrs after NG tube placement, give 90mL of UNDILUTED gastrograffin via NG tube. Clamp NG tube for 1 hr then return to low intermittent wall suction
  7. Obtain portable KUB 8hrs after gastrograffin administration
  8. KUB at 24 hrs after gastrograffin administration
  9. If contrast has reached the colon, start clear liquid diet
  10. Constant reassessment
  11. Dont say i never did anything nice for you
119
Q

On your surgery rotation:

Dont examine the patient like a ________. Examine the patient like a ________.

A

Surgeon

Student

120
Q

What kinds of things make diverticulitis “Complicated”

A

Abscess

Phlegmon

Fistula

Obstruction

Bleeding

Perforation

EMed/Surg FINAL (ASL 👵🏼🐈🌭) (1 decks)

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