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Clin Specialties Surgery Exam > Lecture 4: Operative Process > Flashcards

Lecture 4: Operative Process Flashcards

1
Q

What is the general rule for NPO guidelines prior to surgery?

A

Nothing to eat or drink after midnight prior to surgery (except sips of water/meds)

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2
Q

In general how long before surgery should NG tubes be stopped?

A

8 hours prior to surgery

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3
Q

What is the one exception for stopping feeding tubes 8 hours prior to surgery?

A

If the feeding tube is post-pyloric

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4
Q

What is the timeframe that a SSI must occur within?

A

Within 30 days or 90 days if a prosthetic was implanted

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5
Q

What are the 4 criteria that define an SSI? (only 1 is needed to make a Dx)

A
  1. Purulent exudate
    • culture
  3. Reopened wound d/t signs of infection
  4. Surgeon’s diagnosis
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6
Q

What are the 2 major differences between SSIs and colonization?

A

SSI - bacteria elicit a host response, impedes wound healing

Colonization - bacteria DONT elicit a host response, usually doesnt impede would healing in healthy pts

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7
Q

What are the 2 MC organisms that cause SSIs?

A
  1. Staph aureus

2. Staph epidermis

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8
Q

What is the difference between clean-contaminated (CC) and contaminated wounds?

A

CC - body tracts are entered under controlled conditions

Contaminated - body tracts are entered under UNcontrolled conditions (breaks in sterile technique & inflammation present)

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9
Q

What are 1st generation cephalosporins (Cefazolin/Ancef) used for in ABX prophylaxis?

A

Clean-contaminated wounds

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10
Q

What type of ABX do you use if you need added Gram (-) anaerobic coverage?
- in what types of procedures are these needed?

A

2nd & 3rd generation cephalosporins alone

Needed in Abdominal procedures

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11
Q

In general is routine prophylaxis with Vancomycin recommended?

A

NO

- unless severe type 1 allergy to PCN

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12
Q

What are the 3 situations that prophylaxis with Vancomycin is appropriate?

A
  1. Hospitals where MRSA is freq cause of SSIs
  2. Pts w/known MRSA colonization
  3. Pts at high risk for MRSA (nursing home, recent hospitalization)
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13
Q

When should ABX prophylaxis be administered?

What is the exception?

A

Within 60 minutes of the surgical incision

Give Fluroquinolones & Vancomycin 120 minutes before (longer infusion time)

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14
Q

What is the duration for ABX prophylaxis?

A

Single dose OR no longer than 24 hours

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15
Q

If a patient has an indwelling catheter or drain is ABX prophylaxis necessary?

A

NO

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16
Q

When should you consider performing pre-op staph aureus screening?

A

Cardiac or Ortho procedures, Immunocompromised

high risk for complications if S. aureus infection develops

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17
Q

What is the Universal Protocol designed to prevent and what are its 3 elements?

A

Prevent wrong person, time, procedure

Elements

  1. Pre-procedure verification process
  2. Mark procedure site
  3. Time Out
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18
Q

What are the guidelines for surgical markings?

A

Made by surgeon
Mark must be:
- unambiguous (surgeon’s initials)
- near site w/surgical marker that wont be washed off after surgery prep
- must designate L/R, multiples levels or structures

“X” cannot be used!

19
Q

How do you evaluate airway assessment in a preoperative patient?

A 
"LEMON"
L - Look (general impression)
E - Evaluate (using 3-3-2 rule) 
M- Mallampati Score (good is <3)
O - Obstruction/obesity 
N - Neck Mobility
20
Q

What are the factors associated with a difficult airway for mask ventilation?

A

BMI >30, beard, edentulous, age >55, Mallampati >3, poor mandibular protrusion, male, airway mass

21
Q

What are the factors associated with a difficult airway for laryngoscopy/ intubation?

A

Prior difficult intubation, Mallampati >3, intubate w/out NMBA, male, large neck, cant extend neck

22
Q

What are the components of a surgical time out prior to incision?

A
  1. Team members introduce themselves by name/role
  2. Surgeon, anesthetist, nurse confirm right pt, site, procedure
  3. Surgeon, anesthetist, nurse address anticipated events
  4. Confirmation of ABX prophylaxis w/in last 60 min
  5. Essential imaging displayed
23
Q

What are the 3 main types of anesthesia?

A
  1. General
  2. Regional
  3. MAC (Monitored Anesthesia Care)
24
Q

What types of procedures use general anesthesia and what are the main IV agents used?

A

Abdominal, Head, & Neck procedures

Propofol, Ketamine, Etomidate

25
Q

How does general anesthesia differ from the other two types?

A

It involves airway management and affects the entire body

26
Q

What is the most common IV agent used for general anesthesia and what are its S/E?

A

Propofol

  • hypotension
  • Resp depression
  • painful injection
27
Q

Why are IV adjuvants used in general anesthesia?

A
  • Reduce dose of hypnotic/sedative
  • blunt airway reflexes (gag reflex)
  • minimize pain of injections
28
Q

What are the 3 MC used IV adjuvants?

A

Opioids (fentanyl)
Lidocaine
Benzos: Versed/midazolam - for anxiety

29
Q

What are the three phases of anesthesia?

A
  1. Induction
  2. Maintenance
  3. Emergence
30
Q

What type of agents are used during the induction phase?

A

fast acting IV agents

31
Q

Why are inhaled agents used during the maintenance phase and what are they (3)?

A

They are volatile/irritative, causing post-op N/V so they’re given after pt is asleep

  1. Sevoflurane
  2. Desflurane
  3. Nitrous Oxide
32
Q

What inhaled agents is used as an adjuvant?

A

Nitrous Oxide

33
Q

What types of agents in general anesthesia relax striated muscle and are used for paralysis?

A

NMBA (Neuromuscular Blockade Agents)

34
Q

What drug/type of NMBA is used for RSI (rapid sequence intubation)?

A

Succinylcholine

depolarizing NMBA

35
Q

What is true of non-depolarizing NMBAs but not true for depolarizing NMBAs?

A

Non-depolarizing NMBAs have a reversal agent, depolarizing NMBAs do not

36
Q

How is maintenance usually accomplished?

A

inhaled agent + NO + opioid + muscle relaxant

37
Q

How do you mitigate autonomic hyper-responsiveness (HTN, tachycardia, bronchospasm) in the emergence phase of anesthesia?

A

Beta blockers, lidocaine, narcotics

38
Q

Where is spinal anesthesia administered and what procedures is it used for?

A

injected into subdural space at L3-4/L4-5

Total hip/knee surgery

39
Q

Where is epidural anesthesia administered and what procedures is it used for?

A

injected b/t ligamentum flavum & dura

Childbirth (works until it’s stopped)

40
Q

What are the risks/complications of regional anesthesia?

A

Epidural hematoma/abscess, urinary retention, spinal HA

41
Q

What types of procedures is MAC used for and what does it enable that other anesthesia types dont?

A

Used for short painful procedures (debridement, breast Bx, peds procedures, colonoscopy)

It enables spontaneous breathing the entire time (no complete LOC, just sedation)

42
Q

What kind of ABX coverage do you need to add if you give Vancomycin?

A

Gram negative coverage

43
Q

When are ketamine and etomidate preferred for induction of anesthesia

A

When pt is hemodynamically unstable

44
Q

What is a dirty wound?

A

Old traumatic wound or existing infection (pus, perforated viscera)

Clin Specialties Surgery Exam (13 decks)

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