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Surgery Block > Peri-Operative Care > Flashcards

Peri-Operative Care Flashcards

1
Q

How much fluid do we give to children for resuscitation?

A

20ml/kg in <15 mins

10ml/kg in Trauma

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2
Q

How do we give maintenance fluids for children?

A

4ml/kg/h for their first 10kg
2ml/kg/h for the next 10kg
Then 1ml/kg/h every kg after

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3
Q

How do you calculate a child’s 24h fluid deficit?

A

%dehydration x their weight (kg) x 10

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4
Q

What are some signs to look for in a dehydrated patient?

A

Dry mucous membranes, reduced skin turgor, low urine output, orthostatic hypotension, increased cap refill, tachycardia, low BP

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5
Q

What are some signs of fluid overload to look for in a patient?

A

Raised JVP, peripheral/sacral oedema, pulmonary oedema

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6
Q

Which fluid would you not use in a hyperkalaemic patient?

A

Hartmann’s

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7
Q

What are some complications of blood product transfusions?

A

Transfusion related acute lung injury, transfusion associated circulatory overload, iron overload, hyperkalaemia, allergic reaction

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8
Q

In which patients would NSAIDs be inappropriate or contraindicated?

A

Patients with asthma, renal impairment, heart disease, uncontrolled hypertension, stomach ulcers

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9
Q

What are the key side-effects of opioids?

A

Constipation, pruritus, nausea, altered mental state, respiratory depression

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10
Q

What are some non-pharmacological options for chronic pain management detailed in NICE guidelines?

A

Supervised group exercise programs, acceptance and commitment therapy, CBT, acupuncture

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11
Q

What questionnaire can be used to assess likelihood of neuropathic pain?

A

DN4 questionnaire

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12
Q

What are the four first line treatments for neuropathic pain?

A

Amitriptyline, duloxetine, gabapentin, pregabalin

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13
Q

What is first line medication for trigeminal neuralgia?

A

Carbamazepine

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14
Q

How long must a woman stop taking an oestrogen containing contraception or HRT before surgery?

A

4 weeks- to reduce risk of VTE

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15
Q

How would a patient’s steroid regime (on long term steroids) change following surgery?

A

Double their normal does for a couple days once E/D

Additional IV hydrocortisone at induction and immediately post op

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16
Q

How does the stress of surgery alter blood glucose levels?

A

It will cause blood sugar levels to rise however fasting may lead to hypoglycaemia (greater risk)

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17
Q

How do we reduce risk of VTE following surgery?

A

LMWH/DOAC, intermittent pneumatic compression, anti-embolic compression stockings, early mobilisation

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18
Q

How long does a patient need to fast before surgery as a general rule?

A

6 hours for food

2 hours for clear fluids

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19
Q

What are some risk factors for post-op nausea and vomiting?

A

Female, young, non-smoker, history of motion sickness, use of post operative opiates, use of volatile anaesthetics

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20
Q

What are prophylactic anti-emetics given at the end of surgery?

A

Ondansetron, cyclizine, dexamethasone

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21
Q

What are some examples of rescue anti-emetics used in post op period if nausea and vomiting occur?

A

Ondansetron, prochlorperazine, cyclizine

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22
Q

How can you define major haemorrhage

A
  • loss of more than one blood volume within 24 hours
  • lost 50% total blood volume <3 hours
  • losing >150ml/min
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23
Q

What questions would you ask to assess bleeding risk before surgery?

A

Personal history: excessive bleeding or bruising, excess bleeding after previous procedures, known bleeding disorder
FHx
DHx: anticoagulants, anti platelets, warfarin

24
Q

What blood test can you do to assess coagulation?

A

PT, APTT, thrombin time, fibrinogen level, anti Xa, factor assays, platelet count

25
Q

When would you stop an anti-platelet drug before surgery?

A

5 days before

26
Q

When would you stop warfarin before surgery?

A

5 days

27
Q

When would you stop a DOAC before surgery?

A

Roughly 2 days before if normal renal function

28
Q

What fluid loss is not included on fluid balance chart? How much is this?

A

Insensible losses which is usually 800ml

29
Q

What things do you want to check in patients notes before you prescribe then fluids post op?

A

Intra op blood loss, anaesthetic chart, U+Es, drug chart, current, fluid balance chart, fluid prescription

30
Q

How do sodium and potassium levels change from the stress response from surgery?

A

Increased water and sodium retention, more potassium excreted

31
Q

How many grams of glucose is in a litre of 5% dextrose solution?

A

50g

32
Q

What electrolyte imbalances are commonly seen with vomiting?

A

Hypokalaemia, alkalosis, low Cl-

33
Q

If a patient is nil by mouth for more than 3 days what should you consider?

A

Total parenteral nurition

34
Q

What electrolyte imbalances re commonly seen with diarrhoea?

A

Hypokalaemia, acidosis

35
Q

What makes up to AMT (abbreviated mental test)?

A

Age, time, where they are, year, home address, recognition of two persons/objects, date of birth, year of Second World War, name of current monarch, count back from 20

36
Q

what bloods are included in a confusion screen?

A

B12, folate, thyroid, FBC, U+Es, Calcium, glucose,

37
Q

What investigations other than bloods can be considered in a confusion screen?

A

Wound swabs/blood cultures, urinalysis, CXR, CT head (only if relevant)

38
Q

What are common causes of delirium post-operatively?

A

Hypoxia, constipation, pain, infection, dehydration, drugs, urinary retention

39
Q

What are the 3 categories a post-surgical haemorrhage can be put into?

A

Primary bleeding- occur intraoperatively
Reactive bleeding- occurs within 24 hours of operation
Secondary bleeding- occurs 7-10 days post-op

40
Q

What are clinical features of haemorrhagic shock?

A

Tachycardia, dizziness, agitation, raised resp rate, decreased urine output
Hypotension is a late sign (do not assume patient not bleeding because of normal BP)

41
Q

Generally how would you manage a post-surgical haemorrhage?

A

A-E assessment, apply pressure to bleeding site if possible, senior review, fluid resuscitation and blood products

42
Q

What are risk factors for post-op nausea and vomiting?

A

Female, younger age, previous PONV or motion sickness, opioid analgesia, non-smoker
Long op time, poor post op pain management
Overuse of bag and valve mask ventilation (gastric dilation)

43
Q

What are some alternative causes of nausea and vomiting in a post operative patient?

A

Infection, bowel obstruction/ileus, metabolic causes (hypercalcaemia, uraemia, DKA), medications, raised ICP, anxiety

44
Q

What are some conservative measures to manage post op N+V?

A

Adequate hydration, analgesia and consider NG tube insertion

45
Q

What anti-emetics are preferred for opioid induced post-op N+V?

A

Ondansetron or cyclizine

46
Q

What are some complications of poor post-op pain management?

A

Longer recovery- reluctance to mobilise
Not breathing deep enough- atelectasis, hospital acquired pneumonia

47
Q

What are side effects of NSAIDs (using the mnemonic I-GRAB)?

A

I- interactions with other meds like warfarin
G- gastric ulceration (consider PPI cover when long term)
R- renal impairment (use sparingly with poor renal function)
A- asthma insensitivity (trigger in 10% of asthmatics)
B- bleeding risk (from effect on platelet function)

48
Q

What are some examples of weak and strong opioids?

A

Weak- Codeine
Strong- Morphine, fentanyl, oxycodone

49
Q

When giving opioids what other meds should you consider prescribing concurrently?

A

Laxatives and anti-emetics

50
Q

Why would you not give weak and strong opioids in combination?

A

They competitively inhibit the same receptors so will weaken effects of eachother

51
Q

Why should renal function be checked when prescribing analgesia?

A

NSAIDs best avoided in poor renal function
Certain opioids like morphine best avoided as wont be excreted and more likely to overdose

52
Q

How long does morphine take to work through different routes?

A

Orally- 20 minutes
IV- 2-3 minutes
IM- 15 minutes

53
Q

What are some non-pharmacological treatment options for neuropathic pain?

A

TENS machine, capsaicin cream

54
Q

What are the most common infections seen post-operatively?

A

Infected IV or central lines
1-2 days post-op: respiratory source
3-5: resp or urinary source
5-7 surgical site infection/abscess formation

55
Q

Other than infection what can cause pyrexia in a post-op patient?

A

Drug induced reaction

Surgery Block (6 decks)

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