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
What Wells’ score is diagnostic of a PE / DVT?
> 4 = likely (CTPA or V/Q scan)
< or equal to 4 = unlikely (D dimer)
What are the contraindications of CTPA?
pregnancy
contrast medial allergy
end stage renal failure
If a CTPA is delayed for pt w ? PE, what management can be completed?
empirical anticoagulation (LMWH)
oxygenation
fluid rescusitation
best imaging for patient with suspected biliary tree obstruction
MRCP
first line imaging for patient with suspected biliary tree obstruction
USS typically precedes MRCP
most important blood test to take for a patient with a long lie
CK myoglobin (? rhabdomyolysis)
complications of rhabdomyolysis
compartment syndrome
hyperkalaemia
Reactive haemorrhage presentation
breathlessness 12 hours post procedure
tachycardia, tachypnea, hypotension
no fever
no chest pain
reactive haemorrhage pathophysiology
slipped sutures
missed bleeding vessels (intraoperative hypotension / vasoconstriction)
Skin changes associated with chronic venous insufficiency
haemosiderin deposition
atrophie blanche
lipodermatosclerosis
venous eczema
Analgesia contraindicated in anal fissures
co-codamol (> constipation)
Scoring criteria for acute pancreatitis
Glascow-Imrie
PANCREAS
scoring criteria for upper GI bleeds
Glascow-Blatchford = identifies pt who can be safely discharged before ODG Rockall = prognosis following ODG findings + clinical presentation
