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SURGERY ROTATION! > Green Pance Book > Flashcards

Green Pance Book Flashcards

1
Q

What history should be taken from a patient in an emergent situation?

A

AMPLE:

Allergies

Medications

Past medical history

Last meal

Events preceding the emergency

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2
Q

On top of food and medication allergies, what other allergies should you ask about?

A

Anesthesia and anesthetic agents

Latex, tape or surgical appliances

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3
Q

What medications can increase bleeding tendencies?

A

Aspirin, warfarin, alochol, NSAIDs, chemo agents, and antibiotics

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4
Q

What is the most important preoperative evaluation that can be performed by the surgical team?

A

History and physical exam

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5
Q

When should a CBC be done pre-operatively?

A

if the patient has signs and sx compatible with anemia or if loss of blood during the procedure is anticipated to be significant

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6
Q

Should serum electrolytes be done for patients without medical problems?

A

No

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7
Q

When should serum electrolytes be done pre-operatively?

A

Patients taking certain medications (warfarin, digoxin) due to K+ abnormalities and toxicity

But better used as a postoperative evaluation

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8
Q

When should pre-operative serum creatinine generally be taken?

A

For any patient over the age of 40

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9
Q

When should blood glucose be taken pre-operatively?

A

In patients with a personal of FH of diabetes or those who will undergo bypass grafting for PVD, AAA repair, or CABG

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10
Q

Are hepatic enzymes routine for pre-operative labs?

A

Not indicated in healthy patients

Order if clinical signs and sx indicate hepatic dysfunction

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11
Q

When is an ECG recommended pre-operatively?

A

All patients over 40 years old

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12
Q

When should a chest radiography be done pre-operatively?

A

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

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13
Q

When is spirometry indicated pre-operatively?

A

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

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14
Q

When is arterial blood gas indicated pre-operatively?

A

Only if there is any indication of severe underlying cardiopulm disease or to confirm acid-base disturbance

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15
Q

What test should be done prior to going right to ABG?

A

Pulse oximetry- the oxygen sat can tell you enough info in the pre-operative patient

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16
Q

When is a PG test indicated pre-operatively?

A

ALL women of childbearing age

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17
Q

What is Virchow’s triad?

A

Stasis, intimal damage,and hypercoagulability

Patients at risk for DVT

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18
Q

DVT is thought to start at the induction of anesthesia in elective surgery cases, so prophylaxis should be done ________

A

pre-operatively

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19
Q

What defines a malnourished patient?

A

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

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20
Q

What are risks of malnutrition?

A

greater incidence of infection, immune dysfunction, wound complications, and operative morbidity and mortality

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21
Q

What are the clinical features of malnutrition?

A

Weight loss, reducation of subcutaneous fat stores, and wasting

Decreased cognitive function with severe

Subtle changes in skin, hair

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22
Q

What is important to establish the diagnosis of malnutrition?

A

Nutrition history and anthropometric measures (BMI, pre-illness “dry” weight)

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23
Q

What are the cardiovascular impacts of malnutrition?

A

Decreased myocardial mass, stroke volume, and CO

24
Q

What are the respiratory system effects of malnutrition?

A

Catabolism of major muscles of respiration, with decreased vital capacity and difficulty extubation of patient

25
Q

What are the GI effects of malnutrition?

A

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

26
Q

What are the effects on the immune system from malnutrition?

A

Impaired cell-mediated and humoral immunity

27
Q

What are the effects of healing from malnutrition?

A

Poor wound healing with increased incidence of wound infection, dehiscence, and evisceration

28
Q

What is the treatment for malnutrition?

A

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

29
Q

What is the primary survey for a trauma?

A

ABC

Airway

Breathing

Circulation

30
Q

What is the most common indication for intubation?

A

Altered mental status

31
Q

What is the perferred type of intubation?

A

Orotracheal intubation

32
Q

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?

A

Tension pneumothorax

33
Q

What is the treatment for a tension pneumothorax?

A

Emergent needle decompression

34
Q

Should you completely cover an open chest wound with dressing?

A

NO–This may convert the wound into a tension pneumothorax

35
Q

What type of breathing is seen with flail chest?

A

Paradoxical breathing

36
Q

What should be done after the primary survey is complete?

A

Secondary surgery: identify any occult injuries

37
Q

How are most penetrating chest traumas (95%) managed?

A

tube thoracostomy

remaining 5%: must be evaulated regarding clinical indications for operative intervention

38
Q

What is mostly used to detect intra-abdominal injury?

A

FAST

Focused

Assessment

with

Sonography

for

Trauma

39
Q

What does the FAST examination evalulate?

A

The abdominal cavity for air or fluid collection in the perihepatic, perisplenic, pericardial, and pelvic regions

40
Q

What needs to be done immediately with a penetrating abdominal trauma if a patient is exhibiting signs of shock, peritoneal irritation, or evisceration?

A

Laparotomy

41
Q

When is selective laparotomy done?

A

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

42
Q

What is the workup for a stable patient with a penetrating flank trauma?

A

CT with IV and oral contrast

43
Q

What should you be looking for in a patient with a possible vascular injury?

A

Signs of arterial injury: pulsatile mass or hemorrhage, expanding hematoma, significant hemorrhage, presence of thrill or bruit, or acute ischemia to involved extremity

44
Q

Does the presence of a pulse distal to the injury rule out signficant vascular injury?

A

NO!

45
Q

What diagnostic tests can be used to determine arterial injury?

A

Arteriography and the ABI

46
Q

What scale is used in triage and prognosis of head trauma?

A

Glasgow Coma Scale

47
Q

What are the 3 components of the Glasgow coma scale?

A

Eye opening, verbal, and motor

48
Q

When should patients with a TBI be managed with intracranial pressure monitoring and inbutation to protect airway?

A

All patients with head trauma, an abnormal CT of the head, and a Glasgow coma score of 8 or lower

49
Q

What are the associated sx seen with a basilar skull fracture?

A

Rhinorrhea, otorrhea, racoon eyes, battle’s sign, and hemotympanum

50
Q

What causes an epidural hematoma?

A

Injury to the middle meningeal artery

51
Q

What can be seen with a epidural hematoma?

A

A brief period of unconsciousness followed by a lucid interval

52
Q

What is the triad seen with a brain herniation?

A

coma, fixed and dilated pupils, and decebrate posturing

53
Q

How do you diagnose an epidural hematoma? What is the treatment?

A

Diagnosis: CT

Treatment: emegent craniotomy

54
Q

What causes a subdural hematoma?

A

Injury to bridging veins

55
Q

What type of subdural hemtoma is seen more commonly in alcoholics and elderly?

A

Chronic

56
Q

How do you diagnose a subdural hematoma? How do you evaluate the clot once the diagnosis is established?

A

CT is diagnostic

Burr holes over the hematoma are indicated to evaluate the clot

57
Q
A

SURGERY ROTATION! (4 decks)

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