Module 5 Week 4 Flashcards
the most common endocrinopathy
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Diabetes Mellitus (DM)
defined as a blood glucose above 200 mg/dL in the absence of known diabetes
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Critical illness-induced hyperglycemia
Diabetics have an increased risk of
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CAD, hypertension, congestive heart failure, and perioperative MI
The incidence of silent ischemia is increased in patients with
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DM
Characterized by severe dehydration, hyperglycemia, and hyperosmolarity
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nonketotic hyperosmolar state
Target HgA1c for type 1 diabetics
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<7.5%
Target HgA1c for type 2 diabetics
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<7%
Initiation of β-blockers prior to the day of surgery should be considered in diabetic patients with at least
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two other risk factors for an adverse cardiac event
Preoperative blood glucose should be kept below
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<200mg/dL
How long before surgery should oral hypoglycemics be held
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Held on the Day of surgery
During surgery patients on insulin drips should have their BG checked at what frequency?
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Every 1-2 Hours
Hypothyroidism can lead to the development of
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hypothermia, hypoglycemia, hypoventilation, hyponatremia, and heart failure
In cases where the patient has a large thyroid mass that may distort the airway what should be done
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a chest x-ray should be obtained looking for evidence of tracheal deviation or narrowing
Patients with hyperparathyroidism often have
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Hypercalcemia
Preoperative consideration for patients with hyperparathyroidism
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Evaluation of serum calcium level
General clinical manifestation of hyperthyroidism
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Weight loss; heat intolerance; warm, moist skin
Cardiovascular clinical manifestation of hyperthyroidism
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Tachycardia, atrial fibrillation, congestive heart failure
Neurologic clinical manifestation of hyperthyroidism
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Nervousness, tremor, hyperactive reflexes
Musculoskeletal clinical manifestation of hyperthyroidism
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Muscle weakness, bone resorption
GI clinical manifestation of hyperthyroidism
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Diarrhea
Hematologic clinical manifestation of hyperthyroidism
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Anemia, thrombocytopenia
General clinical manifestation of hypothyroidism
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Cold intolerance
Cardiovascular clinical manifestation of hypothyroidism
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Bradycardia, congestive heart failure, cardiomegaly, pericardial or pleural effusion
Neurologic clinical manifestation of hypothyroidism
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Slow mental function, minimal reflexes
Musculoskeletal clinical manifestation of hypothyroidism
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Large tongue, amyloidosis
GI clinical manifestation of hypothyroidism
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Delayed gastric emptying
Renal clinical manifestation of hypothyroidism
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Impaired free water clearance
General clinical manifestation of Hyperparathyroidism
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Hyperparathyroidism
Cardiovascular clinical manifestation of Hyperparathyroidism
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Hypertension, heart block
Neurologic clinical manifestation of Hyperparathyroidism
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Weakness, lethargy, headache, insomnia, apathy, depression
Musculoskeletal clinical manifestation of Hyperparathyroidism
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Bone pains, arthritis, pathologic fractures
GI clinical manifestation of Hyperparathyroidism
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Anorexia, nausea, vomiting, constipation, epigastric pain
Renal clinical manifestation of Hyperparathyroidism
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Polyuria, hematuria
Clinical presentation of patients with a pheochromocytoma
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intermittent hypertension, headache, diaphoresis, and tachycardia
most obvious manifestation of long-term high-dose steroid treatment
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Cushing syndrome
Clinical manifestation of Cushing Syndrome
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moon facies, striations of the skin, truncal obesity, hypertension, easy bruisability, and hypovolemia
Liver disease is associated with decreased plasma protein production, thereby affecting
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drug binding, volume of distribution, metabolism and clearance
__________ accompanies liver failure
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Coagulopathy
Specific risk factors for Liver Disease
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previous blood transfusions, illicit drug use, or excessive alcohol intake
Signs of underlying liver disease
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jaundice, spider nevi, ascites, hepatosplenomegaly, or palmar erythema
Severity of hepatic disfunction is assessed by using
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the Model for End-Stage Liver Disease (MELD) score
Acceptable preoperative hemoglobin level for patients without systemic disease
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7 g/dL
Top 10 risk factors for aspiration
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Emergency Surgery, Inadequate anesthesia, Abdominal pathology, obesity, opioid medication, neurological deficit, Lithotomy, difficult intubation/airway, Reflux, Hiatal Hernia
Minimum fasting period for Clear liquids
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At least 2 hours
Minimum fasting period for Breast milk
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At least 4 hours
Minimum fasting period for Infant formula, nonhuman milk and light meal
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At least 6 hours
ERAS prep interventions
- targeted pt edu
- carb loading
- less fasting time
- warming
- selective Bowel prep
ERAS intra-op interventions
- epidural if possible
- warming
- no tubes or drains
- short acting anesthetics
- MIS sx
ERAS POST OP
- regular analgesia such as NSAIDs
- preemptive pain and nausea management
- early feeding
- nutritional supplements
- early mobilization
What is the esophageal doppler also used for preop?
You can assess SV and assess pt fluid status
What can you use to replace volume loss?
Crystalloids 3:1
Colliods 1:1
EABL= EBl × HCTstart - HCTallowable
÷ HCTstart
This will give you the amount of blood that can be lost before CONSIDERING transfusion