MTB 2 CK - Surgery Flashcards
What ejection fraction cut off is associated with an increased risk for non cardiovascular surgery?
less than 35%
Patient recently experienced a myocardial infarction 5 months ago and wants to schedule a cholecystectomy next week. Management and why?
Defer surgery for another month and stress test that patient prior to surgery. Current guidelines recommend deferring surgery for at least 6 months after an MI followed by stress testing.
Patient needs a total knee replacement and has signs of JVD and lower extremity edema. What is needed in this patient’s surgical management?
Review of medications to ensure the patient is on the following drugs for his CHF. (all decrease mortality)
- ACE inhibitors.
- beta blockers.
- spironolactone.
What tests should be required for all patients with cardiac disease prior to surgery?
- EKG.
- Stress testing. (ischemic lesions)
- Echocardiogram. (structural disease and ejection fraction)
For men at what age are we at risk for cardiovascular complications?
45 years old
For patients with lung disease what is needed for management?
- Pulmonary function testing for vital capacity evaluation.
2. Smoking cessation for 6-8 weeks prior to surgery and use of nicotine patch.
For patients with renal disease what is necessary in management?
- Adequate hydration.
2. Dialysis 24 hours prior to surgery for those who need dialysis.
Patient with severe claudication needs a femoral-popliteal bypass. What testing needs to be done preoperatively?
- BMP.
- EKG.
- Thallium stress test.
Patient presents with severe facial trauma and is in need of an airway. What is contraindicated and what needs to be done?
Intubating with an orotracheal tube is contraindicated.
Perform a cricothyroidotomy.
Patient presents with a cervical spine injury and needs an airway. What do you do?
Intubate with orotracheal tube using a flexible bronchoscopy.
What is the oxygen saturation goal for a patient?
greater than 90%
What variables are a concert for airway compromise?
- altered mental status.
- facial trauma.
- apnea.
When evaluating whether or not to intubate a patient what variables guide your decision making?
- Is there a risk for a compromised airway such as AMS, facial trauma and apnea?
- Is there facial trauma?
- Is there a cervical spine injury?
What define SIRS?
Two of the following needs to be present.
- HR over 90
- Temp below 36 or above 38.
- RR over 20 or PCO2 of less than 32.
- WBC below 4 or above 12.
How does one define the following:
- Sepsis.
- Severe sepsis.
- septic shock.
- Sepsis is SIRS and an identified source of infection.
- Severe sepsis is sepsis with organ dysfunction.
- Septic shock is severe sepsis with hypotension.
What are signs f shock other than changes in vitals?
- Brain - confusion.
- Heart - chest pain and shortness of breath.
- Liver - elevated transaminases.
- Renal - elevated BUN/Cr ratio.
- Blood - increased lactate.
What variables are important when evaluating shock?
- signs and symptoms.
- CVP.
- CO.
- Wedge pressure.
- Response to fluids.
What is the treatment for hypovolemic shock and neurogenic shock?
Fluids and pressors.
Motor vehicle collision, abdominal pain that radiates to the back, and ecchymosis on the flank 2 days later. Diagnosis?
Hemorrhagic pancreatitis.
Elevated blood pressure and tearing midepigastric pain.
aortic dissection.
Brusing around the umbilicus. Name of finding? Causes?
Cullen sign
- hemorrhagic pancreatitis.
- abdominal aortic aneurysm.
Bruising in the flank Name of finding and cause?
Grey Turner sign.
Retroperitoneal hemorrhage.
What signs correlate with splenic rupture?
- Kehr sign - pain in the left shoulder.
2. Balance sign - dull percussion on the left and shifting dullness on the right.
With abdominal trauma if a bleeding is suspected, how does one evaluate such a problem?
- FAST scan first to evaluate for an intraabdominal bleed.
- CT scan to evaluate for a retroperitoneal bleed, especially if a splenic rupture is suspected despite a negative FAST scan.