Peri Op

Question 1

Pre op ass

Answer 1

PMHx
Gen exam- CVS, RS, GI, MSK, skin etc. Neuropathy. Infec. Hydration status.
Airway- obese, neck and mouth size and movem, soft tiss swell
Ix- FBC, UE, LFT, Ca, clotting and pl func, cross match, group and save, urinalysis, CXR somet, spirom, ECG, sickle cell, preg.
Limb- soft tiss defects, vasc status, ROM and musc func, XRs.
Pre op tx- Ab.
Post op monit- obs, wound, NV, drainage, PK, infec preven, early movem, physio. Kidn func. DVT, PE. Urinary output. Chest infec.

Question 2

Routine peri op

Answer 2

Teicoplanin plus gentamycin AB when anaes
Catheter if spinal cont diamorphine, done on anaes.
VTE prophylaxis- risk ass, comp stockings, dalteparin start 8-12 hr post surg and contin dur admiss only, asp for 5 wk with lansoprazole.
If high risk then start warfarin same day post op. Aim for INR 2-2.5, dalteparin til reach this.
PK- dur op diamorphine, marcaine. Post op diclofenac, paracetamol, codeine, morphine, tramadol.
Bone protection- ?bisphosphonates.

Question 3

kidney risk

Answer 3

Blood loss/dehyd- pre renal AKI
Intrinsic renal- gentamycin
Post renal- urin reten

Question 4

INR

Answer 4

Stop warfarin ?5 d bef.
Give vit K
Target INR 1.5

Question 5

Fluids

Answer 5

Hartmanns sodium lactate, and saline NaCl to incr BP- stay in vess more.
Water plus gluc and NaCl plus gluc are for maint. Leak into EC sp and intracellul so give eg for NBM bef surg.

Question 6

Warfarin

Answer 6

Stop warfarin 5d before
Stat dalteparin 3d bef
Warf reasons- AF, CVA, valve repl, DM.