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Emergency Medicine > PAs in Surgery > Flashcards

PAs in Surgery Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

ASA Classifications range from __ to ___ to predict…

A

1-6 (from normal to organ donor)

predict operative risk

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2
Q

The Mallampati score ranges from class ___ to ____ and describes…

A

class 1 to 4

soft palate visualization

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3
Q

Pre-op labs… (7)

A

CBC
Lytes
PT/INR
Preg

+/- UA, BUN/Cr, CXR (> 50 yo)

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4
Q

the below patient should have a pre-operative ____

Men > 45, women > 55
cardiac dz
diuretic use
hx DM, HTN
major surgical procedure
A

ECG

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5
Q

cigarette smoking should be ceased _____ before surgery

A

2 mo

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6
Q

Pulm risk assessment labs/studies… (3)

A

CXR, PFTs, ABGs

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7
Q

The cardiac risk factor score totals ____ points. > ____ warrants concern

A

53 points

> 10 concerning

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8
Q

elevated _____ is a/w increased post-op infx

A

glucose & A1c

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9
Q

Post op DM attempts to maintain sugar between…

A

150-200

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10
Q

at what frequency should blood sugar be monitored post-op in DM?

A

q6hrs

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11
Q

Pre and post-op steroid regimen for adrenal insufficiency…

A

pre-op: 100mg hydrocotisone

post-op 100mg QD tapered over 5 days

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12
Q

MC patient position

used for many general surgery procedures

A

supine

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13
Q

which position?

increased exposure to pelvic organs

used to place central lines

A

trendelenburg

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14
Q

which position?

enhances exposure to abdominal viscera

A

reverse trendelenburg

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15
Q

which position?

used for spinal surg

A

prone

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16
Q

which position?

used for thoracotomy, nephrectomy, retroperitoneal approach

A

lateral

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17
Q

General surgery covers from ____ to _____

A

diaphragm to pelvis

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18
Q

what causes referred post-op shoulder pain after laparooscopy?

A

diaphragm stretch and CO2

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19
Q

The below procedures usually use what approach?

cholecystectomy
appendectomy
inguinal hernia repair
ventral hernia repair
nissen fundoplication
A

laparoscopy

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20
Q

The camera during laparoscopy shouldn’t come in contact with…

A

the bowel

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21
Q

8 procedures surgical PAs commonly perform

A 
art lines and IVs
central lines
drain removal
foleys
NG tubes
bedside CT
I & D
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22
Q

how often should wounds be checked post-op?

A

daily

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23
Q

I&Os should be checked with what frequency post-op day 1?

A

q 4-6 hours

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24
Q

if fever post-op day 3-5, what must be r/o?

A

infx

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25
Q

the below would cause a ____ post-op fever…

meds
blood products
malignant hyperthermia

A

immediate (hours)

26
Q

the below would cause a ____ post-op fever…

nosocomial infx
UTI
apiration pneumonia

A

acute (1st weeks)

27
Q

the below would cause a ____ post-op fever…

SSI
central line infx
abx diarrhea

A

subacute (1-4 weeks)

28
Q

the below would cause a ____ post-op fever…

infection/abscess

A

delayed ( > 1 mo)

29
Q

workup for fever 48 hours post-op or temps > 102… (4)

A

CBC
UA
Cx blood, urine, sputum
CXR

30
Q

4 common causes of post-op fever w/in 0-48 hours

A

atelectasis
infx (GAS)
leakage of bowel anastomosis
aspiration pneumonia

31
Q

tx of post-op aspiration pneumonia

A

pulm toilet

abx

32
Q

tx of post-op wound infx

A

open wound

abx

33
Q

tx of post-op atelectasis (4)

A

spirometry, cough, deep breathing, ambulation

34
Q

The below usually occur as a fever after post-op day ___

UTI
wound infx
catheter infx
abscess
DVT
A

day 3

35
Q

Wound dressings on clean surgical wounds should be left in place for how long?

A

48hours

36
Q

_______ wounds are packed open to promote hemostasis and drainage. wet/moist dressings should be changed _____

A

contaminated wounds

changed 8-12 hours

37
Q

MC agent of post-op wound infx

A

group A strep

38
Q

3 common pathogens of post-op wound infx

A

staph, strep, G-

39
Q

post-op drains help prevent…

A

seroma/hematoma

40
Q

post-op patient p/w:

sudden drainage of pink, serosanguineous salmon colored peritoneal fluid

A

fascial wound dehiscence

41
Q

fascial wound dehiscence occurs between days __ and __ post-op

A

5-8

42
Q

optimum time for parenteral prophylactic abx?

A

30-60 min prior to incision

43
Q

what abx are commonly used for prophylaxis during most operations?

A

1st/2nd gen cephalosporins

44
Q

MC cause of fever in first 48 hours after surgery?

A

atelectasis

45
Q

post-op patient presents with:

abd. pain
fever
leukocytosis
tachycardia
ill appearing
A

intra-abdominal infx

46
Q

workup for suspected intra-abdominal infx

A

CXR (free air, pleural effusion)

CT abd

US

47
Q

Patient presents with:

fever
chills
tachy
leukocytosis
hypotension
A

bacteremia

48
Q

evaluation of bacteremia…

A

blood cx x 2
catheter cx

inspection of IV sites

49
Q

to prevent bacteremia, IV lines should be changed…

A

q 3 days

50
Q

5 types of debridement…

A 
sharp
mechanical
autolytic
enzymatic
biologic
51
Q

What type of debridement?

Uses body’s own enzymes to liquefy necrotic debris and
maintain moist wound environment

A

autolytic

52
Q

can autolytic debridement be used for infected wounds?

A

no

53
Q

enzymatic debridement is best used on…

A

eschar/necrotic tissue

54
Q

enzymatic debridement requires a ____dressing

A

second

55
Q

What is a strategy of mechanical debridement?

A

wet to dry dressing

56
Q

2 painful types of debridement

A

mechanical, sharp

57
Q

this is best used for debridement of large wounds that are infected with necrotic tissue

A

sharp surgical debridement

58
Q

______ has the below characteristics:

–
Enhances granulation
–
Clears heavy exudate and
infectious material
–
Increases perfusion to the
wound bed
–
Stretching initiates cell
proliferation
A

negative pressure wound therapy

59
Q

_______ is contraindicated in presence of:

–
Necrotic tissue
–
Untreated Osteomyelitis
–
Fistula to body cavity
–
Malignancy in wound
–
Exposed artery or vein
A

negative pressure wound therapy

60
Q

lab studies for wound infx…

A

CBC, ESR

Emergency Medicine (12 decks)

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