PERI-OPERATIVE CARE Flashcards
Who should receive CMV negative blood?
Pregnancy
Intrauterine transfusion
Neonates (<28 days)
Who should receive irradiated blood products?
1st, 2nd degree donor blood
Hodgkin’s lymphoma
H Stem cell transplant recently
Alemtuzumab therapy
Fludarabine
Intra-uterine infusion
Smallest cannula blood transfusion can be given through?
16G
Constituents of cryoprecipitate, which is given in DIC, VWBd and massive haemorrhage:
Fibrinogen, VWBf, VIII and fibronectin
2 main electrolyte abnormalities in PRC transfusion:
Hypocalcaemia
Hyperkalaemia
Types of transfusion reaction, including whether they are acute or delayed:
Acute:
Acute haemolytic
TACO
TRALI
Anaphylaxis
Delayed:
GvHD
Infection
Iron overload e.g. thalassaemia patients
Blood test results in an acute haemolytic reaction:
Reduced Hb and haptoglobin
High LDH
High Br
Positive DAT test
Patient factors for PONV:
Female
Younger age
Non-smoker
Previous PONV / motion sickness
Opioids
Surgical factors for PONV:
Long surgery
Middle ear / intracranial
Gynae
Poor post op pain control
Intrabd
Anaesthetic factors for PONV:
Spinal
Opioids
Gas induction e.g. sioflurance
Dehydration / bleeding
Overuse of BVM causing gastric dilation
Opioid induced PONV typically responds well to:
Ondansetron (5HT3r antagonitst)
Cyclizine (H1r antagonist)
Patients with impaired gastric emptying / stasis should be trialled on?
Prokinetic agent e.g. metoclopramide (dopamine antagonist) or domperidone (dopamine antagonist)
Unless bowel obstruction suspected!
Metoclopramide is a good anti-emetic of choice in which situations?
Metabolic or biochemical imbalances
Where does the vomiting centre receive input from?
Vestibular centre
Chemoreceptor trigger zone e.g. chemo
GI tract
Sight, smell, pain
The most common cause of pyrexia in a post-operative patient is infection. The specific post-operative day which the fever develops may indicate the source of infection:
1-2 = resp
3-5 = resp / UTI
5-7 = SSI / abscess
Always consider lines / catheters etc
Define PUO, and give 4 potential causes:
> 38 degrees for 3 weeks or more with at least 1 week of inpatient investigation
Malignancy
Infection unknown
Connective tissue / vasculitits
Drug reaction
A SOFA score of 2 or higher indicates likely sepsis in a patient with known or suspected infection. Which parameters does it measure?
Pao2
Platelets
Bilirubin
MAP and vasopressor requirement
GCS
Creatinine
Urine output
What is the shortened version of the SOFA criteria?
RR>22
altered mental state
SBP <=100
ERAS protocol points
Pre education, clear fluids until 2 hr prior, minimally invasive surgery, goal direted fluids.
Optimise health and medical conditions.
Multimodal / opioid sparing pain
Early intake post surgery, optimised nutrition
Good pain control
Which types of surgery should antibiotic prophylaxis be given in?
Clean + prosthesis
Clean cont
Contaminated
Single dose IV <60 mins before incision
