Peri-Operative Care Flashcards
On a patient with insulin-dependent DM and no other PMx, when should their surgery be scheduled for?
First on the list, in the morning
What is the target CBG for a pt on VRII during the peri-operative period?
6-10 mmol/L
although 6-12 is acceptable
When should a patient be transitioned back to their established insulin regime from VRII?
After the first normal SC insulin dose given AND pt can eat and drink normally w/o n/v
hypovolaemia definition
water and sodium loss from ECF compartment
eg. haemorrhage
dehydration definition
loss of water across all compartments proportional to their % of TBW
> hypernatraemia
information in history to help assess fluid status
thirsty
recent oral intake
abnormal losses: vom, diarrhoea, drains, burns etc.
abnormal distribution: sepsis, third spacing
BO / urinary frequency
overload sx (PND / orthopnoea / SOB)
O/E findings to help assess fluid status
baseline obs
hypovolaemia signs: CRT v, dry muc membranes, cold
fluid overload signs: bibasal crackles, peripheral oedema, ^ JVP
other sources of info to help assess fluid status
surgery notes: blood loss / transfusions daily weights fluid charts stool charts blood tests: U+Es, FBC, VBG
routine maintenance per day
25-30 ml/kg/day water
1 mmol/kg/day potassium + sodium + chloride
50-100 g/day glucose
indications for less fluid prescription
renal impairment heart failure old frail = 20-25 ml/kg/day (not 25-30 ml/kg/day)
how should maintenance fluids be prescribed for obese patients?
ideal bodyweight should be used
what electrolytes are lost in vomiting?
20-60 mmol/L Na 14 mmol/L K 140 mmol/L Cl 60-80 mmol/L H > hyperchloraemia / hypokalaemic / metabolic acidosis req supplemental K + Cl
what electrolytes are lost in diarrhoea?
30-140 mmol/L Na
30-70 mmol/L K
20-80 mmol/L HCO3
first line Abx for post-operative LRTI
Co-amoxiclav 1.2g TDS IV for 7 days
- of protein wall synthesis & - of beta-lactamase
management of analgesia induced nausea
antiemetic
alternative analgesia
