Peri-operative care

Question 1

What % surgical pt get PONV?

Answer 1

25%

Question 2

Input vomiting centre recieves to caues PONV? (3)

Answer 2

Higher cortical centres (memory/fear)
Stomach/ SI - direct surgical effects
Chemoreceptor trigger zone - anaesthetic Dx/opioids

Question 3

RF PONV (12)

Answer 3

F
Obesity
Non-smoker 
Prev Hx PONV
Surgeries - abdo/gynae/ENT
Incr duration surgery 
GA
Use of inhalation agents 
Post op pain 
Post op opioid analgesia 
Post op dehydration 
Post of HoTN

Question 4

Dose cyclizine PONV

Answer 4

50mg/8hr IV/IM/PO

Question 5

Dose prochlorprerazine PONV

Answer 5

12.5mg/6hr IM

Question 6

Dose ondansetron PONV

Answer 6

4mg/8hr PO/IV

Question 7

Dose dexamethasone PONV

Answer 7

8mg IV

Question 8

Which other antiemetic is dexamethasone commonly used with?

Answer 8

Cyclizine

Question 9

What type of Dx is cyclizine

Answer 9

Anti-histamine

Question 10

C/I Cyclizine (4)

Answer 10

HF
BPH
Hepatic disease
Renal disease

Question 11

What condition can prochlorperazine not be given in?

Answer 11

Parkinsons

Question 12

What is the most effective anti-emetic?

Answer 12

Ondansetron

Question 13

Caution ondansetron (3)

Answer 13

Hepatic impairment
QT prolongation
Pregnancy/breast feeding

Question 14

What L O2 does nasal cannulae deliver ?

Answer 14

2-4L/min

Question 15

What L O2 does Hudson face mask deliver?

Answer 15

5-10L/min

Question 16

Venturi mask - blue

Answer 16

24%. 2-4L/min

Question 17

Venturi mask - white

Answer 17

28%. 4-6L/min

Question 18

Venturi mask - yellow

Answer 18

35%. 8-10L/min

Question 19

Venturi mask - red

Answer 19

40%/ 10-12L/min

Question 20

Venturi mask - green

Answer 20

60% . 12-15L/min

Question 21

Limits pulse oximetry (4)

Answer 21

Can’t distinguish between CO + O
Doesn’t reflect O2 carrying capacity of blood
If vv pulsations (e.g. in tricusp regurg), probe may read them as aa saats
Affected by nail polish

Question 22

How long before surgery should you stop Warfarin?

Answer 22

10 days

Question 23

What INR is safe to do surgery

Answer 23

<1.5

Question 24

When should LMWH be stopped before surgery?

Answer 24

Evening before

Question 25

When should clopidogrel be stopped before surgery?

Answer 25

7 days before

Question 26

When should COCP be stopped before surgery?

Answer 26

4 w

Question 27

When can COCP be restarted after surgery?

Answer 27

At least 2w after pt has started mobilising

Question 28

Rate post-op fl

Answer 28

1L 1st 4 hr
1L first 6hr
500ml over final 5h

Question 29

post op Fluids and pyrexia

Answer 29

Increase by 10% for every extra degree pyrexia