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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)

17
Q

How do we reduce risk of VTE following surgery?

A

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

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

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

20
Q

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

A

Ondansetron, cyclizine, dexamethasone

21
Q

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

A

Ondansetron, prochlorperazine, cyclizine

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
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

surgery block (6 decks)

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