LESSONS LEARNED: WEEK 1 Flashcards
When this reaction occurs, pts can experience a variety of symptoms including dyspnea, flank pain, renal failure, DIC, and possibly death.
Acute hemolytic transfusion reaction
A syndrome characterized by respiratory distress associated at times with hypoxemia, cyanosis, fever, and new infiltrates on chest xray that develop w/in 6 hours of transfusion of any blood products.
Transfusion related acute lung injury
TRALI is a syndrome characterized by neutrophil priming and activation within the lung parenchyma following exposure to inflammatory components in donor blood products which leads to diffuse endotherlial dysfunction and non cardiogenic pulmonary edema. Pts often present with acute onset dyspnea, hypoxemia, fever, and cyanosis post transfusion/within minutes to hours
What is the next best step in a pt who sustained injuries from a MVA, is having ab pain, is hemodynamically unstable, and on imaging shows signs of a hemoperitoneum?
Exploratory Laparotomy
Pts who suffer from blunt abdominal trauma may have a splenic laceration or rupture. In stable pts, minor splenic injuries can be tx’d nonoperatively but in unstable pts, repair/splenectomy is indicated.
A pt who sustained a C7/T1 subluxation and sensation and touch is absent below the midchest, why might the pt be hypotensive/the bp does not improve even with transfusions?
Neurogenic Shock due to spinal cord injury.
The neurogenic shock following a TBI or spinal cord injury due
Obese female w/worsening headache, it is somewhat releived with standing, and has some vision changes and papilledema on ocular exam. What are you concerned for?
Idiopathic intracranial hypertension,
confirm w/lumbar puncture
What margins are we looking at for first time excision of a BCC?
5mm-1cm
In peripheral artery disease, what is normally an indicator for amputation?
Gangrene
What can you use to assess a pt’s risk of MACCE (major adverse cardiovasc and cerebrocasc events) perioperatively?
Revised Cardiac Risk Index or the American College of Surgeons National Surgical Quality Improvement Program
Explain the diff between thrombosis and embolism
Thrombosis is when a blood clot, or thrombus, forms in a blood vessel. An embolus is when a clot, fat, air bubble, or other feature travels through blood vessels, with a risk of lodging elsewhere. Both can block blood flow and increase the risk of a heart attack or stroke.
Embolism=ACUTE symptoms
Thrombosis=more chronic, insidious worsening
What can you sue to help calculate risk of bleeding with anticoagulation?
HAS-BLED score
Why might anticoagulation with heparin be prederable in pts with hx of recent surgery or malignancy?
Heparin has a short half life and has greater ease of reversal of anticoag (readily available reversal agent)
Most likely cause of new irregular cardiac rythm is a pt who sustained a MVA
Blunt Cardiac Injury
Always be on the look out for tamponade and hypovolemic shock in these pts tho
Why are pts with OSA at risk for cor pulmonale?
Because pts w/OSA (untreated) may develop pulmonary htn tht leads to cor pulmonale
Hypercapnia that is not compensated (evident by acidemia) and hypoxemia in the setting of resp distress indicates _______________________ and requires ________________________ to manage/tx
respiratory failure–> intubate, ventilate
What changes on PO2, PCO2, and A-a gradient can ou expect in a pt w/hypoventilation?
DECREASE PO2
INCREASE PCO2 (you may see acidosis)
NORMAL A-a on ABG
Etiologies: obesity hypoventilation syndrome, central vercous system depressants, and neuromuscular disorders impacting the diaphragm
Bowel sounds in the lungs fields in a pt who sustained a MVA is concerning for…
Diaphragm rupture due to sudden increase in intraabdominal pressure
Common causes of post-op fever
atelectasis, pneumonia, UTI, surg site infection, intrathoracic or intraabdominal infections related to surgery
transmural inflammation of gi tract
crohn disease
autosomal dominant genetic syndrome resulting from the biallelic loss of function of the PAC gene. It is charaterized by the presence of thousands of adenomatous polyps arizing after puberty.
Familial adenomatous polyposis
AD inheritence w/mutation in SMAD4 or BMPR1A genes general manifests w/in first two decades of life w/painless hematochezia and rectal bleeding due to polyps. Most often hamartomatous polyps.
Juvenile Polyposis Syndrome
Pts w/UC should undergo colonoscopy screenings starting when?
8 yrs after dx
Pts w/progressive dysphagia should undergo an EGD to evaluate. Who needs a barrium swallow test prior to the EGD?
Pts w/ hx suggesting a leson that is a risk for esophageal perforation like cancer, radiotherapy to esophagus, or clinical features of a zenker diverticulum.
Pt w/ medhx of UC presenting w/ high fever, tachy, hypotn, leukocytosis, enlarged dialated bowel, and impaired colonic motility is concerning for…
Toxic megacolon
Who is at risk for toxic megacolon?
Condition w/colonic inflammation including UC, crohn, infections including c.diff, enteric gram negative bacteria, cytomegalovirus, entamoeba histolytica, and ischemic injury
Elderly pt presenting w/ abdominal pain, distention, constipation, and vomitting. Xray shows dialated air filled sigmoid colon and CT shows whirl of sigmoid colon around its mesenteric attachment. What is the cause?
Sigmoid volvulus, a rotation of the large bowel around its mesentery. Happens in elderly debilitated patients, casues large bowel obstruction.
Charcot’s triad
Fever, RUQ pain, and jaundice–> CHOLANGITIS
Reynold’s pentad is charcot’s triad w/ shock and altered mental status tacked on
What is cholangitis?
inflammation of the bile duct system commonly secondary to cholodocolethiasis
Why doesn’t cholesystitis typically present w/jaundice?
Because it does not block the common bile duct
Signs/symptoms of an esophageal perforation
mediastinitis and pleural effusion which present aschest pain, fever, tachycard/ypnea, diaphoresis, plueritic chest pain.
How can you differentiate congenital biliary atresia from benign cause of neonatal jaundice?
Benign etiologies improve bt the second to third week of life whereas biliary atresia with persist and often worsen within the first 8 weeks of life
What procedure do we use to treat congenital biliary atresia?
Kasai procedure (hepatoportoenterosotomy)
Present with progressively worsening neonatal jaundice, pale stool, dark urine, poor weight gain, and in bad untreated cases cirrhosis, coagulopathy, and portal htn.
Congenital Biliary Atresia
How do we differentiate pre vs post renal acute kidney injury?
FRactionally excrented sodium
prerenal is <1% and >2% un intrinsic kidney injury like in tubular necrosis
How are urethral injuries evaluated?
Retrograde urethography
True of False: tyroid malignancies typically do not excrete thyroxine
true, if you are looking at a nodule and the pt has increased T4, start thinking about a toxic adenoma not a carcinoma
Pts who get a thyroidectomy are at risk for what?
Hypoparathyroidism and subsequent hypocalcenuka which results in perioral paresthesia, carpopedal spasm, laryngospasm, prolonged QT, Chvostek sign, and trousseau sign
Chvostek sign
refers to a twitch of the facial muscles that occurs when gently tapping an individual’s cheek
trousseaus sign
sign for latent tetany, a carpopedal spasm induced by ischemia secondary to the inflation of a sphygmomanometer cuff, commonly on an individual’s arm, to 20 mmHg over their systolic blood pressure for 3 minutes.
Cut off point for hyponatremia
135
Peaked t waves
hyperkalemia
How do you start managing hyperkalemia?
Admin of iv calcium to prevent cardiac cell excitability and start meds that cause transfer of potassium out of the serium through the urine or stool (insulin, albuterol, sodium bicarb)
Main causes of post op hypotension
bleeding, under rescuscitation during the procedure, adverse effects of medication, and sepsis
