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.
