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Surgery (bpa) > High-Yield Surgery > Flashcards

High-Yield Surgery Flashcards

1
Q

What to monitor with Toradol? Tylenol?

A

NSAID

  • SCr, Hgb
  • 15mg IV q 6hr

Tylenol - LFTs

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2
Q

Surgery progress note

A

24hr interval: fever, chills, SOB, CP, eating, NGT output, BMs, foley

Plan:

  • pain mgmt
  • I&Os
  • DVT ppx
  • pulm toilet
  • labs
  • functional status
  • PO status
  • diet
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3
Q

Post Op Infection

A

PNA, UTI, wound infection (cellulitis, central line infection)

5-7d out –> abscess

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4
Q

Causes of fever

A

Wind: atelectasis, PNA (POD 1-2)
Water: UTI, esp w/foley (POD 2-3)
Wound: incision site, cellulitis, abscess (after 72hr, POD 5-7)
Walking: DVT, PE, thrombophlebitis (after 72hr)
Wonder drug: drug reaction
Whole blood: transfusion reaction

Work up:

  • <48hr postop does not need workup
  • > 48hr postop: CXR, blood culture x2, urine culture
  • fever >1wk is a serious complication unless drug allergy
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5
Q

Fluids

A 
Resuscitative fluid (postop) = lactated ringer
Maintenance: D5 1/2NS + KCl
IV Fluids + TPN + Lipids = 100cc/hr
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6
Q

Electrolyte goals for surgery

A

K+5

  • tablet KCl is C.I. w/SBO
  • if dumping, liquid >tablet

Phos 3
Mg 2
- if 1.5 give 2mg Mg sulfate; 1.2 give 4mg Mg sulfate

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7
Q

Preop abx

A

Flagyl + Neomycin

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8
Q

Pancreatitis Etiologies

A

I GET SMASHED

Idiopathic
Gallstones
EtOH
Trauma/Trigs
Steroids
Mumps
Autoimmune
Scorpion bite
Hyperlipidemia/HyperCa
ERCP
Drugs
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9
Q

Voiding trial

A

Give 8hr to void after removing foley

Bladder scan if no void; if >600 = straight cath

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10
Q

Diagnostic imaging first lines

A 
Appendicitis: abd CT (US in kids, pregnancy) 
Chronic pancreatitis: ERCP
Gallbladder: US
Diverticulosis: barium enema
Diverticulitis: CT scan
Achalasia: barium swallow
Zenker's diverticulum: barium swallow
UGIB: endoscopy
PE: pulmonary angiogram
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11
Q

Courvisier’s sign

A

palpable, nontender gallbladder

indicates compression or obstruction of distal CBD d/t mass = pancreatic cancer

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12
Q

Trosseau’s sign

A

hypercoagulable state created by malignancy

migratory thrombophlebitis throughout body

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13
Q

Whipple procedure

A

Pancreatic cancer

Pancreatoduodenectomy

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14
Q

Most common kinds of cancer

A

Colon: Adenocarcinoma
Gallbladder: Adenocarcinoma
Pancreas: Adenocarcinoma (ductal) - CA 19-9
Prostate: Adenocarcinoma (MC cancer in men U.S.)
Liver HCC (AFP levels)
Renal: renal cell carcinoma
Small bowel: carcinoid tumors (ileum)
Esophageal: SCC
Anal: SCC
Vulvar: SCC (risk - lichen sclerosis)
Bladder cancer: transitional cell carcinoma (smoking)
Breast: IDC
Carcinoid tumors tend to be in appendix
Thyroid: papillary carcinoma (radiation = risk)

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15
Q

Coagulation cascade

A

common pathway: II, V, X

PT: coumadin
- extrinsic, common pathways (VII)

PTT: heparin
- intrinsic pathway (VIII, IX, XI, XII)

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16
Q

Bowel obstruction

A

1 = adhesions (western nations)

Worldwide - hernias

Other: malignancy

17
Q

Ogilvie’s syndrome

A

Idiopathic pseudo-obstruction
Enormous dilation of right colon w/out obstruction

Mgmt:

  • bowel rest
  • IVF
  • rectal decompression tube via scope
18
Q

MC Vascular procedure

A

CEA

19
Q

Renal cell carcinoma triad

A

MC solid renal tumor

Flank pain
Hematuria
Palpable mass

20
Q

Sutures

A

Vicryl: absorbable
Nylon: non-absorbable

21
Q

Malignant hyperthermia

A

IV dantrolene

22
Q

Gastric ulcers should…

A

undergo bx for risk of carcinoma

23
Q

Ileus causes

A

laparotomy
hypoK
narcotics
intraperitonal infection

24
Q

Virchow’s node

A

Left supraclavicular

25
Q

Sister mary joseph node

A

Umbilical

26
Q

Necrotizing fascitis

A

Renal impairment - hallmark

  • WBC > 14
  • BUN > 15
  • HypoNa < 135
27
Q

Pressure ulcers

A

Stage I: intact skin w/blanching erythema
Stage II: partial-thickness skin loss - breakdown of dermis from abrasion, blister, shallow ulcer crater
Stage III: full thickness skin loss extending SubQ but not beyond fascia
Stage IV: full thickness, SubQ loss, extending to muscle tendon, bones, joint

28
Q

Factors affecting perioperative mortality (Goldman’s index)

A
  1. CHF (EF <35% - no surgery)
  2. MI w/in 6mo (Check ECG, stress test, cath, reperfusion)
  3. Arrhythmia
  4. Age > 70
  5. Emergent surgery
  6. AS, poor medical condition, surgery in chest/abd
    - always check for AS murmur [late systolic, crescendo, decrescendo murmur radiating to carotids, increased w/squatting]
29
Q

Meds to stop prior to surgery

A

Aspirin, NSAIDs, Vit E: 2wk
Warfarin: 5d, drop INR to 1.5 (use Vit K if needed)
1/2 AM dose of insulin if diabetic [lactic acid risk w/metformin]
CKD on dialysis: dialyze 24hr preop
BUN>100: increased risk of postop bleed secondary to uremic platelet dysfunction

30
Q

Ventilation Settings

A

Assist control: set tidal volume and rate but if pt takes a breath vent gives the volume

Pressure support: pt rules rate but a boost of pressure is given; important for weaning

CPAP: pt must breathe on own but positive pressure given at all times

PEEP: pressure given at end of cycle to keep alveoli open; used w/ARDS and CHF

31
Q

Ventilation - best tests to evaluate management

A

ABG

PaO2 low: increase FiO2
PaO2 high: decrease FiO2
PaCO2 low (high pH): decrease rate or TV
PaCO2 high (low pH): increase rate or TV

TV is more efficient to change
- more air goes into function space vs. increasing rate is getting more air into dead space

32
Q

Fluids & Nutrition

A

Maintenance IVF: D5 1/2NS + 20KCl
4:2:1 rule when calculating cc/hr

Daily requirements: 100mL/kg/d for first 10kg, 50mL/kg/d for next 10kg, 20mL/kg/d for all kg above 20

Enteral feeds are best: keep gut mucosa intact and prevent bacterial translocation

TPN indication:

  • gut cannot absorb nutrients secondary to physical or functional loss
  • risks: acalculus cholecystitis, zinc deficiency, hyperglycemia, liver dysfunction, electrolyte problems
33
Q

HIT

A

postop, decreased Plt, clots

Tx: agatroban (synthetic heparin)

34
Q

DIC

A

low Plt, increased PT/PTT, low fibrogen, high d-dimer, schistocytes

35
Q

Lung Cancer

A

Low PTH –> hypercalcemia –> SCC
[SIADH from small cell carcinoma]

Peripheral: adenocarcinoma, large cell
Central: squamous, small cell

Small cell = no surgery -> chemo, radio-sensitive
Non-small cell = surgery - adenocarcinoma, squamous, large cell

36
Q

Right-sided murmurs get louder with

A

inspiration

Surgery (bpa) (19 decks)

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