op care Flashcards
when to stop warfarin before surgery
- 5 days. interim LMWH
what INR needs to be corrected preop
1.4
when to blood transfuse preop
<90 or <100 hb and elderly, CVD, Resp disease
when to give plt preop
- <50
when to stop doac pre surgery
- minor surgery = 24hrs
- major = 48hrs
when to stop therapeutic dose LMWH preop
- 48hrs , if high risk then heparin infusion
when to stop clopi/aspirin/dipyradimole preop
7 days
when should you consult haematolgy before stopping anti plts preop
- if stent <1yr
when to stop cocp preop and when to restart
- 4 weeks
- 2 weeks after
when do you do a group and save vs a x match preop
- g and S if blood loss not expected
how long should you delay surgery after MI
- 6 months
what HTN BP is needed to delay susrgery
180 S, or 110 DS
ideally, how long before surgery shld patients stop smoking
- 8 weeks , worst case = 12hrs
How logn to delay surgery if infection
- 6 weeks
what HBA1C would mean surgery can only go ahead if urgent
> 10% aka more than 80mmol
when to stop MOAI before surgery
- 2 weeks before
how to supress MRSA in a carrier
if found in nose - mupirocin tds 5days
if found in skin - chlorhexidine gluconate OD 5 days - apply esp to axilla, groin and eprineum
what abx are given in mrsa
- vancomycin
- teiciplanin
- linezolid
what surgery usually gets abx preop
- GI
classification of surgical procedures according to wound infection risk
clean; incising uninfected skin without opening viscus
clean contaminated - intra op breahc of viscus but not colon
contaminated
- breach of viscus + spillage or opening of colon
dirty - site pre contaminated with pus, faeces etc
what size sutures are normally good for skin
3-0
4-0
how long after can you remove sutures on face and neck and scalp
- 5 days
- earlier in kids
how long after sutures on abdomen or proximal limbs can you remove them
- 10 days
how long after sutures on distale xtremities can you remove them
- 14 days
what are the different levels of ICU care?
L1 = Ward based carel. Normal; pt on IV/o2
L2 - HDU - single organ support
L3 - ICU = multi organ support
what type of fluid is not recommended for surgical patients
- dextrose
what type of fluid is preferred in surgical patients
- hartmanns
if a patient is oedematous and hypovolaemic, what would you do first
- deal with hypovolaemia
Symptoms and cause of TRALI
- SOB
- Hypotension
- fever
- abdo/ chest pain
- agitation
cause = ABO incompatibility
6hrs post transfusion
rx = fluids and stop
complciation - DIC/AKI
what happens to bp in TACO-
Hypertensive
what does a high anion gap indicate =
- metabolic acidosis (too much h+)
causes of high gap metabolic acidosis
- lactic acidosis
- uraemia
- ketones e.g. DKA/ ETOH
- Drugs/toxin e.g. aspirin, SNP
Normal gap metabolic acidosis
- renal tubular acidosis due to loss of bicarc
- diarrhoea
- high output ileostomy
- pancreatic fistula
- too mcuh saline
in pregnancy, when is the highest risk of miscarriage durign surgery
- first trimester ; can be induced by GA
causes of post op pyrexia
- wind = resp. = day 1-2
- water = uti = 3-4
- walk = VTE = 4-6
- wound = site infected = 5-7
- what did i do = iatrogenic/ drugs = 7+
most common cause of pyrexia 48hrs post op
- response to surgery
what is malignant hyperpyrexia
- response to halogenated anaesthetic and paralytcis es- succinylcholine. linked to RYR gene
rx malignant hyperpyrexia
- dantrolene - depression of excitation contraction coupling of skeetal muscle by binding RYR
also associated with TRALI and non haemolytic transfusion reaction
what are the parameters in qsofa
- hypotension
- AMTS
- Tachypnoea
what can you see on CXR with TRALI
- bilateral infitlrates.
pao2/fi02 = <300 , PAWP <18
what abx do you give to wound infections
- no pre existing infection? think straph e.g. fluclox
- immunocompromised = macrolides . metro/ cefuroxime. vanc if MRSSA ?
what foods promote wound healing
- fats and carbs
pressure ulcer staging
- intact skin, non blanching redness in local area. dark pigment
2 = partial thickness loss of dermis = shallow open ulcer with red/pink wound bed. / looks like serum blister
3 = full thickness. subcut fat.
4 = full thickness with exposed bone, tendon or muscle +/- sloughing
5- unstageable. full thick with bas e= necrotic
