High Yield Surgery Flashcards
when can you absolutely not do surgery
DKA
Skyhigh glucose –> too much infection
Low nutritional status is also not great
severe liver failure
Signs of low nutrition
albumin < 3
↓ Transferrin
wt loss < 20 %
Severe liver failure and surgery
*PT-INR
LFTs
ammonia
Best time to quit smoking before surgery
2 months is best for wound healing
Goldman’s index measures?
pts risk during surgery
CHF is the biggest predictor of bad outcome
EF under 35% is a no go
Goldman’s index MI timing
6 month after MI needs more workup
Aortic Stenosis murmur
Late systolic, crescendo-decrescendo murmur that radiates
to carotids. ↑ with squatting, ↓ with decr preload
Meds to stop 2 weeks before surgery
metformin
Vitamin E
Aspirin/ NSAIDs
Take ________ of insulin, if diabetic before surgery
½ the morning dose
Warfarin d/c timing before surgery
Warfarin (5 days) – drop INR to <1.5 (can use vit K)
What is the worry if BUN > 100 before surgery?
There is an increased risk of post-op bleeding
*uremic platelet dysfunction.
Normal platelets but ↑ bleeding time
Ventilator assist control
TV and Rate set
set TV and rate but if pt takes a breath, vent gives the volume.
Ventilator Pressure support
gives TV
Weaning setting
pt rules rate but a boost of
pressure is given
Ventilator C-Pap
needs resp drive
pt must breathe on own but + pressure given all the time.
Ventilator PEEP
used in ARDS and CHF
pressure given at the end of
cycle to keep alveoli open
Ventilator –> If PaCO2 is low (pH is high)?
Decr rate or TV
better to do TV (less dead space problems)
Ventilator–> If PaCO2 is high (pH is low)?
Incr rate or TV
better to do TV (less dead space problems)
When to use 3% saline?
Symptomatic (Seizures), < 110
RATE .5-1 mEq/ hour
concern for Central Pontine Myelinolysis.
Numbness, Chvostek or Troussaeu, prolonged
QT interval.
↓Ca
get EKG
Bones, stones, groans, psycho. Shortened QT
interval.
↑ Ca
get EKG
Paralysis, ileus, ST depression, U waves
Hypo- K
give K (kidneys!)
max 40mEq/hr
Peaked T waves, prolonged PR and QRS, sine
waves
Hyper- K
Give Ca-gluconate then insulin + glc, kayexalate, albuterol and sodium bicarb.
Last resort = dialysis
Maintenance IVFs
D51/2NS + 20KCl (if peeing)
up to 10 kg– 100mL/kg/day
Next 10kg – 50mL/kg/day
over 20- 20mL/kg/day
escharotomy
An escharotomy is a surgical procedure used to treat full-thickness (3o) circumferential burns. In full-thickness burns, both the epidermis and the dermis are destroyed along with sensory nerves in the dermis.
Patient w/ confusion, HA, cherry red skin?
CO poison
Check carboxyHb (pulse ox = worthless)
100% O2 Rx
hypercoagulable, Edema, HTN, & foamy pee
Nephrotic syndrome- loosing protein including clotting factors
most common inherited hypercoagulable state
Factor 5
What’s special about ATIII def?
Heparin won’t work
ATIII def= hypercoagulable state
HIT rx
d/c heparin
rx= Leparudin or agatroban
Isolated decr in plts?
ITP
Normal plts but ↑ bleeding time & PTT?
vWD
Low plts, Incr PT, PTT, BT, low fibrinogen, high D-dimer and schistocytes
DIC!! Caused by gram negative sepsis, carcinomatosis, OB stuff
Burn Rx: Doesn’t penetrate eschar and can cause leukopenia?
silver Sulfadiazine
NO PO or IV abx. Give topical.
Burn Rx: Penetrates eschar but hurts like hell?
Mafenide
NO PO or IV abx. Give topical.
Burn Rx: Doesn’t penetrate eschar and causes hypoK and HypoNa?
Silver Nitrate
NO PO or IV abx. Give topical.
Chemical burn, what to do?
Irrigate >30min prior to ER
Electrical Burn, best 1st step?
EKG
if abnormal 48 hours of telemetry (also if LOC)
If affected extremity is extremley tender, numb,
white, cold with barely dopplerable pulses?
Compartment syndrome!!
5 Ps or compartment pressure >30mmHg
May require fasciotomy. (at bedside!)
