MTB Flashcards
The number 1 limiting factor prior to surgery is
history of cardiovascular disease.
Ejection fraction <? : increased risk for noncardiovascular surgery
35
must defer surgery 6 months and stress patient at that time
MI
if you have this, medically optimize patient with ACE inhibitors, beta blockers, and spironolactone to decrease mortality
CHF (JVD, lower extremity edema)
tool used to estimate a patient’s risk of perioperative cardiac complications based on
History of ischemic heart disease
History of CHF
History of cerebrovascular disease (stroke/TIA)
History of diabetes requiring preoperative insulin use
Chronic** kidney disease** **(creatinine >2 mg/dL) vascular, intraperitoneal, or intrathoracic surgery
Revised Cardiac Risk Index (RCRI)
RCRI score >2 indicates risk for cardiac death, Give beta blockade
system assesses the fitness of patients before surgery based on
Healthy person
Mild systemic disease
Severe systemic disease
Severe systemic disease that is threat to life
moribund person who is not expected to survive surg
A declared brain-dead person whose organs are being removed for donor purposes
American Society of Anesthesiologists (ASA)
scores >3 require preoperative assessmen need optimization
An obese 57-year-old man presents for preoperative evaluation after he decides to have an elective inguinal hernia repair. His medical history is significant for hypertension, diabetes mellitus type 2, and elevated cholesterol. Physical examination reveals a grade 3/6 systolic ejection murmur. How many risk factors does this patient have?
4(>45, HTN,Diabetes, cholostral,)
murmuers are not risk factors
If the patient is age <35withno history of cardiac disease what is needed before surg
EKG
Surg following tests are required regardless of age if ..
EKG
Stress testing to evaluate for ischemic coronary lesions
Echocardiogram only if there is a history of structural disease and to assess ejection fraction (not part of routine testing)
patient has a history of cardiac disease
A 61-year-old man is due to undergo his first screening colonoscopy. His medical history is significant for hypertension. Current medications are lisinopril and amlodipine. The patient denies headache and chest pain. Blood pressure today is 160/100 mm Hg. What is the next step in management?
Controlling hypertension to under 140/90 mmHg
Consultations of any kind are always wrong on the USMLE exam.
A 61-year-old man is due to undergo his first screening colonoscopy. His medical history is significant for hypertension. Current medications are lisinopril and amlodipine. The patient denies headache and chest pain. Blood pressure today is 160/100 mm Hg. What is the next step in management?
Controlling hypertension to under 140/90 mmHg
Consultations of any kind are always wrong on the USMLE exam.
Patients with ……. Have the patient quit smoking for 6–8 weeks prior to surgery and use nicotine replacement therapy (bupropion or varenicline)
known lung disease
Patients with known …. disease require adequate hydration; otherwise, hypoperfusion due to volume loss during surgery of this organ can lead to increased mortality. Give fluids before and during surgery
renal
atient is on dialysis, dialyze the patient 24 hours prior to surgery.
“A 71-year old man is undergoing femoropopliteal bypass for severe claudication of the left leg, which causes unbearable pain with exercise. His medical history is significant for insulin-dependent DM type 2 and a remote appendectomy. What preoperative testing is recommended?”
“BMP + EKG + thallium stress test”
“diabetes and age >70. , he needs a workup, including a stress test. ”
what are the ABC of truma
- “Airway: in any trauma, the primary step (facial trauma require a cricothyroidotomy) and cervical spine injury require an orotracheal tube intubation with flexible bronchoscopy to reduce risk of further injury to cervical spine
- Breathing: goal is to keep oxygen saturation >90%
- Circulation: insert 2 large-bore IVs and begin aggressive fluid resuscitation to prevent shock”
“Systemic inflammatory response syndrome (SIRS) is a global inflammatory state that yields objective findings before sepsis and shock set in” “There are 4 SIRS criteria. The presence of ≥2 indicates SIRS.” what are the 4
- “Temperature <36 C (96.8 F) or >38 C (100.4 F)
- Heart rate >90 BPM
- Tachypnea >20 breaths/min or PCO2 <32 mm Hg
- WBC <4,000 cells/mm3 or >12,000 cells/mm3”
“Interpretation of SIRS criteria:
2 criteria = ?
2 criteria + source of infection = ?
2 criteria + source of infection + organ dysfunction = ?
2 criteria + source of infection + organ dysfunction + hypotension = ?
SIRS
Sepsis
severe sepsis
septic shock
** tachycardia and hypotension plus** following
“Brain: confusion
Kidney: increased BUN:creatinine ratio
Liver: elevated AST and ALT
Heart: chest pain and shortness of breath
Blood: increased lactic acid”
shock
**type of shock **
– we have massive hemprage and was terated with fluids and pressers. **she is pale and cold **
low CVP(central,venus,pressure)
low CO
high SVR (to acompencate low BP)
high HR (to acompencate low CO)
low PCEP (low volume so…)
Hypovolemic shock
focuse on CO (it is low)
**type of shock **
– she had MI **she is pale and cold **
high CVP(central,venus,pressure)
Low CO
high SVR (to acompencate low BP)
high HR (to acompencate low CO)
high PCWP (backs up .)
cardiogenic shock
focuse on PCWP here (high)
**type of shock **
– we have spinal injury and was terated with fluids and pressers. **she is warm **
low CVP(central,venus,pressure)
low CO
low SVR (to acompencate low BP)
high HR (to acompencate low CO)
low PCWP (low volume so…)
nurogenic shock
focus on PCWP (it is low)
**type of shock **
– we have infection of ecoli or staph terated with Abx fluids and pressers. she is warm and fainth
low CVP(central,venus,pressure)
high CO
low SVR (to acompencate low BP)
high HR (to acompencate low CO)
No change PCWP (low volume so…)
septic shock
focus on PCWP (no change)
