PAs in Surgery Flashcards
ASA Classifications range from __ to ___ to predict…
1-6 (from normal to organ donor)
predict operative risk
The Mallampati score ranges from class ___ to ____ and describes…
class 1 to 4
soft palate visualization
Pre-op labs… (7)
CBC
Lytes
PT/INR
Preg
+/- UA, BUN/Cr, CXR (> 50 yo)
the below patient should have a pre-operative ____
Men > 45, women > 55 cardiac dz diuretic use hx DM, HTN major surgical procedure
ECG
cigarette smoking should be ceased _____ before surgery
2 mo
Pulm risk assessment labs/studies… (3)
CXR, PFTs, ABGs
The cardiac risk factor score totals ____ points. > ____ warrants concern
53 points
> 10 concerning
elevated _____ is a/w increased post-op infx
glucose & A1c
Post op DM attempts to maintain sugar between…
150-200
at what frequency should blood sugar be monitored post-op in DM?
q6hrs
Pre and post-op steroid regimen for adrenal insufficiency…
pre-op: 100mg hydrocotisone
post-op 100mg QD tapered over 5 days
MC patient position
used for many general surgery procedures
supine
which position?
increased exposure to pelvic organs
used to place central lines
trendelenburg
which position?
enhances exposure to abdominal viscera
reverse trendelenburg
which position?
used for spinal surg
prone
which position?
used for thoracotomy, nephrectomy, retroperitoneal approach
lateral
General surgery covers from ____ to _____
diaphragm to pelvis
what causes referred post-op shoulder pain after laparooscopy?
diaphragm stretch and CO2
The below procedures usually use what approach?
cholecystectomy appendectomy inguinal hernia repair ventral hernia repair nissen fundoplication
laparoscopy
The camera during laparoscopy shouldn’t come in contact with…
the bowel
8 procedures surgical PAs commonly perform
art lines and IVs central lines drain removal foleys NG tubes bedside CT I & D
how often should wounds be checked post-op?
daily
I&Os should be checked with what frequency post-op day 1?
q 4-6 hours
if fever post-op day 3-5, what must be r/o?
infx
the below would cause a ____ post-op fever…
meds
blood products
malignant hyperthermia
immediate (hours)
the below would cause a ____ post-op fever…
nosocomial infx
UTI
apiration pneumonia
acute (1st weeks)
the below would cause a ____ post-op fever…
SSI
central line infx
abx diarrhea
subacute (1-4 weeks)
the below would cause a ____ post-op fever…
infection/abscess
delayed ( > 1 mo)
workup for fever 48 hours post-op or temps > 102… (4)
CBC
UA
Cx blood, urine, sputum
CXR
4 common causes of post-op fever w/in 0-48 hours
atelectasis
infx (GAS)
leakage of bowel anastomosis
aspiration pneumonia
tx of post-op aspiration pneumonia
pulm toilet
abx
tx of post-op wound infx
open wound
abx
tx of post-op atelectasis (4)
spirometry, cough, deep breathing, ambulation
The below usually occur as a fever after post-op day ___
UTI wound infx catheter infx abscess DVT
day 3
Wound dressings on clean surgical wounds should be left in place for how long?
48hours
_______ wounds are packed open to promote hemostasis and drainage. wet/moist dressings should be changed _____
contaminated wounds
changed 8-12 hours
MC agent of post-op wound infx
group A strep
3 common pathogens of post-op wound infx
staph, strep, G-
post-op drains help prevent…
seroma/hematoma
post-op patient p/w:
sudden drainage of pink, serosanguineous salmon colored peritoneal fluid
fascial wound dehiscence
fascial wound dehiscence occurs between days __ and __ post-op
5-8
optimum time for parenteral prophylactic abx?
30-60 min prior to incision
what abx are commonly used for prophylaxis during most operations?
1st/2nd gen cephalosporins
MC cause of fever in first 48 hours after surgery?
atelectasis
post-op patient presents with:
abd. pain fever leukocytosis tachycardia ill appearing
intra-abdominal infx
workup for suspected intra-abdominal infx
CXR (free air, pleural effusion)
CT abd
US
Patient presents with:
fever chills tachy leukocytosis hypotension
bacteremia
evaluation of bacteremia…
blood cx x 2
catheter cx
inspection of IV sites
to prevent bacteremia, IV lines should be changed…
q 3 days
5 types of debridement…
sharp mechanical autolytic enzymatic biologic
What type of debridement?
Uses body’s own enzymes to liquefy necrotic debris and
maintain moist wound environment
autolytic
can autolytic debridement be used for infected wounds?
no
enzymatic debridement is best used on…
eschar/necrotic tissue
enzymatic debridement requires a ____dressing
second
What is a strategy of mechanical debridement?
wet to dry dressing
2 painful types of debridement
mechanical, sharp
this is best used for debridement of large wounds that are infected with necrotic tissue
sharp surgical debridement
______ has the below characteristics:
– Enhances granulation – Clears heavy exudate and infectious material – Increases perfusion to the wound bed – Stretching initiates cell proliferation
negative pressure wound therapy
_______ is contraindicated in presence of:
– Necrotic tissue – Untreated Osteomyelitis – Fistula to body cavity – Malignancy in wound – Exposed artery or vein
negative pressure wound therapy
lab studies for wound infx…
CBC, ESR
