Green Pance Book Flashcards
What history should be taken from a patient in an emergent situation?
AMPLE:
Allergies
Medications
Past medical history
Last meal
Events preceding the emergency
On top of food and medication allergies, what other allergies should you ask about?
Anesthesia and anesthetic agents
Latex, tape or surgical appliances
What medications can increase bleeding tendencies?
Aspirin, warfarin, alochol, NSAIDs, chemo agents, and antibiotics
What is the most important preoperative evaluation that can be performed by the surgical team?
History and physical exam
When should a CBC be done pre-operatively?
if the patient has signs and sx compatible with anemia or if loss of blood during the procedure is anticipated to be significant
Should serum electrolytes be done for patients without medical problems?
No
When should serum electrolytes be done pre-operatively?
Patients taking certain medications (warfarin, digoxin) due to K+ abnormalities and toxicity
But better used as a postoperative evaluation
When should pre-operative serum creatinine generally be taken?
For any patient over the age of 40
When should blood glucose be taken pre-operatively?
In patients with a personal of FH of diabetes or those who will undergo bypass grafting for PVD, AAA repair, or CABG
Are hepatic enzymes routine for pre-operative labs?
Not indicated in healthy patients
Order if clinical signs and sx indicate hepatic dysfunction
When is an ECG recommended pre-operatively?
All patients over 40 years old
When should a chest radiography be done pre-operatively?
May be indicated in patients over the age of 60
Should be performed in all patients who have a history of significant pulm or cardiac disease
When is spirometry indicated pre-operatively?
Patients being evaluated for thoracic and upper abdominal surgery and for patietns with a history of smoking and dyspnea
Also indicated in abdominal surgery if pulmonary disease is poorly controlled or if disease extent is not clear
When is arterial blood gas indicated pre-operatively?
Only if there is any indication of severe underlying cardiopulm disease or to confirm acid-base disturbance
What test should be done prior to going right to ABG?
Pulse oximetry- the oxygen sat can tell you enough info in the pre-operative patient
When is a PG test indicated pre-operatively?
ALL women of childbearing age
What is Virchow’s triad?
Stasis, intimal damage,and hypercoagulability
Patients at risk for DVT
DVT is thought to start at the induction of anesthesia in elective surgery cases, so prophylaxis should be done ________
pre-operatively
What defines a malnourished patient?
Someone who has lost more than 10% of his/her lean body mass and/or has not had adequate nutritional intake for more than 7 days
What are risks of malnutrition?
greater incidence of infection, immune dysfunction, wound complications, and operative morbidity and mortality
What are the clinical features of malnutrition?
Weight loss, reducation of subcutaneous fat stores, and wasting
Decreased cognitive function with severe
Subtle changes in skin, hair
What is important to establish the diagnosis of malnutrition?
Nutrition history and anthropometric measures (BMI, pre-illness “dry” weight)
What are the cardiovascular impacts of malnutrition?
Decreased myocardial mass, stroke volume, and CO
What are the respiratory system effects of malnutrition?
Catabolism of major muscles of respiration, with decreased vital capacity and difficulty extubation of patient
What are the GI effects of malnutrition?
GI tract will develop atrophy of villi, with overgrowth of bacteria and mucosal dysfunction that may result in bacterial translocation and subsequent multi-organ dysfunction
What are the effects on the immune system from malnutrition?
Impaired cell-mediated and humoral immunity
What are the effects of healing from malnutrition?
Poor wound healing with increased incidence of wound infection, dehiscence, and evisceration
What is the treatment for malnutrition?
It aims at replacement of caloric and nitrogen requirements necessary to maintain nutritional homeostasis or at preventionof catabolism and promotion of anabolism
Nutrional replacement via enteral route to maintain GI viability and aid in prevention of multisystem organ dysfunction
Another option is peripheral or central catheters and the infusion of IV hyperlimentation
What is the primary survey for a trauma?
ABC
Airway
Breathing
Circulation
What is the most common indication for intubation?
Altered mental status
What is the perferred type of intubation?
Orotracheal intubation
Hypotension, tracheal deviation away from the side of the injury, jugular vein distension, lack of or decreased breath sounds on affected side, hyperresonance on the affected side, and subcutaneous emphysema
All associated with what?
Tension pneumothorax
What is the treatment for a tension pneumothorax?
Emergent needle decompression
Should you completely cover an open chest wound with dressing?
NO–This may convert the wound into a tension pneumothorax
What type of breathing is seen with flail chest?
Paradoxical breathing
What should be done after the primary survey is complete?
Secondary surgery: identify any occult injuries
How are most penetrating chest traumas (95%) managed?
tube thoracostomy
remaining 5%: must be evaulated regarding clinical indications for operative intervention
What is mostly used to detect intra-abdominal injury?
FAST
Focused
Assessment
with
Sonography
for
Trauma
What does the FAST examination evalulate?
The abdominal cavity for air or fluid collection in the perihepatic, perisplenic, pericardial, and pelvic regions
What needs to be done immediately with a penetrating abdominal trauma if a patient is exhibiting signs of shock, peritoneal irritation, or evisceration?
Laparotomy
When is selective laparotomy done?
In a hemodynamically stable patient without any of the indicated signs after a FAST exam; however if the FAST exam reveals air or free fluid, lapartomy is indicated
What is the workup for a stable patient with a penetrating flank trauma?
CT with IV and oral contrast
What should you be looking for in a patient with a possible vascular injury?
Signs of arterial injury: pulsatile mass or hemorrhage, expanding hematoma, significant hemorrhage, presence of thrill or bruit, or acute ischemia to involved extremity
Does the presence of a pulse distal to the injury rule out signficant vascular injury?
NO!
What diagnostic tests can be used to determine arterial injury?
Arteriography and the ABI
What scale is used in triage and prognosis of head trauma?
Glasgow Coma Scale
What are the 3 components of the Glasgow coma scale?
Eye opening, verbal, and motor
When should patients with a TBI be managed with intracranial pressure monitoring and inbutation to protect airway?
All patients with head trauma, an abnormal CT of the head, and a Glasgow coma score of 8 or lower
What are the associated sx seen with a basilar skull fracture?
Rhinorrhea, otorrhea, racoon eyes, battle’s sign, and hemotympanum
What causes an epidural hematoma?
Injury to the middle meningeal artery
What can be seen with a epidural hematoma?
A brief period of unconsciousness followed by a lucid interval
What is the triad seen with a brain herniation?
coma, fixed and dilated pupils, and decebrate posturing
How do you diagnose an epidural hematoma? What is the treatment?
Diagnosis: CT
Treatment: emegent craniotomy
What causes a subdural hematoma?
Injury to bridging veins
What type of subdural hemtoma is seen more commonly in alcoholics and elderly?
Chronic
How do you diagnose a subdural hematoma? How do you evaluate the clot once the diagnosis is established?
CT is diagnostic
Burr holes over the hematoma are indicated to evaluate the clot
