passmed all Flashcards
New onset AF with feculent material in the wound drain
anastomotic leak
carotid endarterectomy surgery could injure what nerve
hypoglossal nerve
upper limb fracture repairs could injure what nerves
ulnar and median nerves
legs in lloyd davies position - legs out injures what nerve
common peroneal
why does an ileus occur post GI surgery
due to fluid sequestration and loss of electrolytes
what is malignant hyperthermia
occurs post suxamethonium injection as well as some antipsychotics
hyperpyrexia
muscle ridigity
excessive release of calcium from sarcoplasmic reticulum
auto dom
ck raised and contracture tests with caffeine and halothane
how do we manage malignant hyperthermia
dantrolene - prevents calcium release from the sarcoplasmic reticulum
one day insulin regime should be reduced by how much before surgery
Surgery / diabetes: once-daily insulin dose should generally be reduced by 20% on the day before and the day of surgery
is blood loss is unlikely in surgery what shuld you do
group and save eg lower segement c section or lap chol
if chance of transfusion is liekly what shoudl do
vcross match 2 units eg salpinectomy for ruptured ectopic or total hip replacement
if chance of transfusion is definite what should you do
cross match 4-6 units eg total gastrectomy oophorecgomy, elective AAA repair, cystectomy, hepatectomy
anyone in pred in moderate surgery and above need to be given what drug
hydrocortisone
how would you get access for chemo
Hickman line50%
A Hickman line is the most reliable long term option. Most Hickman lines are inserted under local anaesthesia with image guidance. They have a cuff that usually becomes integrated with the surrounding tissues. This requires a brief dissection during line removal.
peripherally stbael what access
20G peripheral cannula
Excessive infusions of any intravenous fluid carry the risk of development of tissue oedema and potentially cardiac failure. Excessive administration of sodium chloride is a recognised cause of
hyperchloraemic acidosis and therefore Hartmans solution may be preferred where large volumes of fluid are to be administered.
what drug not in penumonothax
NO
how can you assess oesophageal intubation
capnogrpahy - monitor end-tidal CO2
anastomic leak defintive mx
straight back to surgery
common presnetation post surgery of drowsy, with low ish blood pressure and high hr
hypovolaemia due to blood loss or dehydration
need to provide fluid challnege with NAcl
post op ileus what shoudl you check daily
electroyltes
Monitoring of electrolytes daily is important because abnormal fluid shifts can occur in the immobile bowel, causing derangement of multiple electrolytes. Potassium in particular can be lost in these fluid shifts, and also hypomagnesaemia can cause hypokalaemia so daily monitoring of electrolytes (including calcium and magnesium) until bowel function returns is the most important of these investigations
which commonly used anaethetic which potentiates GABAa preferred in pt with cardiac apthology as causes less hypotension but can cuase adrneal suppresion
etomidate
ketamine can be used in anastehtics when is it good
Acts as a dissociative anaesthetic.
* Doesn’t cause a drop in blood pressure so useful in trauma
side effects of ketamine
hallucinations and disorientation
ketamine moa
blocks NMDA receptors
