op care Flashcards

1
Q

when to stop warfarin before surgery

A
  • 5 days. interim LMWH
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2
Q

what INR needs to be corrected preop

A

1.4

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3
Q

when to blood transfuse preop

A

<90 or <100 hb and elderly, CVD, Resp disease

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4
Q

when to give plt preop

A
  • <50
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5
Q

when to stop doac pre surgery

A
  • minor surgery = 24hrs

- major = 48hrs

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6
Q

when to stop therapeutic dose LMWH preop

A
  • 48hrs , if high risk then heparin infusion
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7
Q

when to stop clopi/aspirin/dipyradimole preop

A

7 days

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8
Q

when should you consult haematolgy before stopping anti plts preop

A
  • if stent <1yr
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9
Q

when to stop cocp preop and when to restart

A
  • 4 weeks

- 2 weeks after

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10
Q

when do you do a group and save vs a x match preop

A
  • g and S if blood loss not expected
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11
Q

how long should you delay surgery after MI

A
  • 6 months
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12
Q

what HTN BP is needed to delay susrgery

A

180 S, or 110 DS

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13
Q

ideally, how long before surgery shld patients stop smoking

A
  • 8 weeks , worst case = 12hrs
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14
Q

How logn to delay surgery if infection

A
  • 6 weeks
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15
Q

what HBA1C would mean surgery can only go ahead if urgent

A

> 10% aka more than 80mmol

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16
Q

when to stop MOAI before surgery

A
  • 2 weeks before
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17
Q

how to supress MRSA in a carrier

A

if found in nose - mupirocin tds 5days

if found in skin - chlorhexidine gluconate OD 5 days - apply esp to axilla, groin and eprineum

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18
Q

what abx are given in mrsa

A
  • vancomycin
  • teiciplanin
  • linezolid
19
Q

what surgery usually gets abx preop

A
  • GI
20
Q

classification of surgical procedures according to wound infection risk

A

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

21
Q

what size sutures are normally good for skin

A

3-0

4-0

22
Q

how long after can you remove sutures on face and neck and scalp

A
  • 5 days

- earlier in kids

23
Q

how long after sutures on abdomen or proximal limbs can you remove them

A
  • 10 days
24
Q

how long after sutures on distale xtremities can you remove them

A
  • 14 days
25
Q

what are the different levels of ICU care?

A

L1 = Ward based carel. Normal; pt on IV/o2

L2 - HDU - single organ support

L3 - ICU = multi organ support

26
Q

what type of fluid is not recommended for surgical patients

A
  • dextrose
27
Q

what type of fluid is preferred in surgical patients

A
  • hartmanns
28
Q

if a patient is oedematous and hypovolaemic, what would you do first

A
  • deal with hypovolaemia
29
Q

Symptoms and cause of TRALI

A
  • SOB
  • Hypotension
  • fever
  • abdo/ chest pain
  • agitation

cause = ABO incompatibility
6hrs post transfusion

rx = fluids and stop

complciation - DIC/AKI

30
Q

what happens to bp in TACO-

A

Hypertensive

31
Q

what does a high anion gap indicate =

A
  • metabolic acidosis (too much h+)
32
Q

causes of high gap metabolic acidosis

A
  • lactic acidosis
  • uraemia
  • ketones e.g. DKA/ ETOH
  • Drugs/toxin e.g. aspirin, SNP
33
Q

Normal gap metabolic acidosis

A
  • renal tubular acidosis due to loss of bicarc
  • diarrhoea
  • high output ileostomy
  • pancreatic fistula
  • too mcuh saline
34
Q

in pregnancy, when is the highest risk of miscarriage durign surgery

A
  • first trimester ; can be induced by GA
35
Q

causes of post op pyrexia

A
  • 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+
36
Q

most common cause of pyrexia 48hrs post op

A
  • response to surgery
37
Q

what is malignant hyperpyrexia

A
  • response to halogenated anaesthetic and paralytcis es- succinylcholine. linked to RYR gene
38
Q

rx malignant hyperpyrexia

A
  • dantrolene - depression of excitation contraction coupling of skeetal muscle by binding RYR

also associated with TRALI and non haemolytic transfusion reaction

39
Q

what are the parameters in qsofa

A
  • hypotension
  • AMTS
  • Tachypnoea
40
Q

what can you see on CXR with TRALI

A
  • bilateral infitlrates.

pao2/fi02 = <300 , PAWP <18

41
Q

what abx do you give to wound infections

A
  • no pre existing infection? think straph e.g. fluclox

- immunocompromised = macrolides . metro/ cefuroxime. vanc if MRSSA ?

42
Q

what foods promote wound healing

A
  • fats and carbs
43
Q

pressure ulcer staging

A
  1. 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