High Yield Surgery

Question 1

when can you absolutely not do surgery

Answer 1

DKA
Skyhigh glucose –> too much infection

Low nutritional status is also not great

severe liver failure

Question 2

Signs of low nutrition

Answer 2

albumin < 3
↓ Transferrin
wt loss < 20 %

Question 3

Severe liver failure and surgery

Answer 3

*PT-INR
LFTs
ammonia

Question 4

Best time to quit smoking before surgery

Answer 4

2 months is best for wound healing

Question 5

Goldman’s index measures?

Answer 5

pts risk during surgery

CHF is the biggest predictor of bad outcome
EF under 35% is a no go

Question 6

Goldman’s index MI timing

Answer 6

6 month after MI needs more workup

Question 7

Aortic Stenosis murmur

Answer 7

Late systolic, crescendo-decrescendo murmur that radiates

to carotids. ↑ with squatting, ↓ with decr preload

Question 8

Meds to stop 2 weeks before surgery

Answer 8

metformin
Vitamin E
Aspirin/ NSAIDs

Question 9

Take ________ of insulin, if diabetic before surgery

Answer 9

½ the morning dose

Question 10

Warfarin d/c timing before surgery

Answer 10

Warfarin (5 days) – drop INR to <1.5 (can use vit K)

Question 11

What is the worry if BUN > 100 before surgery?

Answer 11

There is an increased risk of post-op bleeding

*uremic platelet dysfunction.

Normal platelets but ↑ bleeding time

Question 12

Ventilator assist control

Answer 12

TV and Rate set

set TV and rate but if pt takes a breath, vent gives the volume.

Question 13

Ventilator Pressure support

Answer 13

gives TV
Weaning setting

pt rules rate but a boost of
pressure is given

Question 14

Ventilator C-Pap

Answer 14

needs resp drive

pt must breathe on own but + pressure given all the time.

Question 15

Ventilator PEEP

Answer 15

used in ARDS and CHF

pressure given at the end of
cycle to keep alveoli open

Question 16

Ventilator –> If PaCO2 is low (pH is high)?

Answer 16

Decr rate or TV

better to do TV (less dead space problems)

Question 17

Ventilator–> If PaCO2 is high (pH is low)?

Answer 17

Incr rate or TV

better to do TV (less dead space problems)

Question 18

When to use 3% saline?

Answer 18

Symptomatic (Seizures), < 110
RATE .5-1 mEq/ hour

concern for Central Pontine Myelinolysis.

Question 19

Numbness, Chvostek or Troussaeu, prolonged

QT interval.

Answer 19

↓Ca

get EKG

Question 20

Bones, stones, groans, psycho. Shortened QT

interval.

Answer 20

↑ Ca

get EKG

Question 21

Paralysis, ileus, ST depression, U waves

Answer 21

Hypo- K

give K (kidneys!)

max 40mEq/hr

Question 22

Peaked T waves, prolonged PR and QRS, sine

waves

Answer 22

Hyper- K

Give Ca-gluconate then insulin + glc, kayexalate, albuterol and sodium bicarb.

Last resort = dialysis

Question 23

Maintenance IVFs

Answer 23

D51/2NS + 20KCl (if peeing)
up to 10 kg– 100mL/kg/day
Next 10kg – 50mL/kg/day
over 20- 20mL/kg/day

Question 24

escharotomy

Answer 24

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.

Question 25

Patient w/ confusion, HA, cherry red skin?

Answer 25

CO poison

Check carboxyHb
 (pulse ox = worthless)

100% O2 Rx

Question 26

hypercoagulable, Edema, HTN, & foamy pee

Answer 26

Nephrotic syndrome- loosing protein including clotting factors

Question 27

most common inherited hypercoagulable state

Answer 27

Factor 5

Question 28

What’s special about ATIII def?

Answer 28

Heparin won’t work

ATIII def= hypercoagulable state

Question 29

HIT rx

Answer 29

d/c heparin

rx= Leparudin or agatroban

Question 30

Isolated decr in plts?

Answer 30

ITP

Question 31

Normal plts but ↑ bleeding time & PTT?

Answer 31

vWD

Question 32

Low plts, Incr PT, PTT, BT, low fibrinogen, high D-dimer and schistocytes

Answer 32

DIC!! Caused by gram negative sepsis, carcinomatosis, OB stuff

Question 33

Burn Rx: Doesn’t penetrate eschar and can cause leukopenia?

Answer 33

silver Sulfadiazine

NO PO or IV abx. Give topical.

Question 34

Burn Rx: Penetrates eschar but hurts like hell?

Answer 34

Mafenide

NO PO or IV abx. Give topical.

Question 35

Burn Rx: Doesn’t penetrate eschar and causes hypoK and HypoNa?

Answer 35

Silver Nitrate

NO PO or IV abx. Give topical.

Question 36

Chemical burn, what to do?

Answer 36

Irrigate >30min prior to ER

Question 37

Electrical Burn, best 1st step?

Answer 37

EKG

if abnormal 48 hours of telemetry (also if LOC)

Question 38

If affected extremity is extremley tender, numb,

white, cold with barely dopplerable pulses?

Answer 38

Compartment syndrome!!

5 Ps or compartment pressure >30mmHg

May require fasciotomy. (at bedside!)