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Surgery Finals > Perioperative > Flashcards

Perioperative Flashcards

1
Q

What pre-op checks must you do on every patient?

A

OP CHECS

  • Operative fitness (cardioresp)
  • Pills
  • Consent
  • History (MI, asthma, HTN, jaundice, anaesthetic complications, DVT, anaphylaxis)
  • Ease of intubation: neck arthritis, dentures, loose teeth
  • Clexane
  • Site (correct and marked)
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2
Q

How should you manage HRT/OCP prescribing perioperatively?

A

Stop 4 weeks before a major surgery/leg surgery

Restart 2 weeks post op if mobile

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3
Q

What blood tests should you do preoperatively?

A
  • FBC
  • U+E
  • G+S
  • clotting
  • glucose
  • Plus:
    • LFTs if liver disease, EtOH, jaundice
    • TFTs if thyroid disease
    • Se electrophoresis if west indies, med, africa
  • Cross match
    • 4 units for gastrectomy
    • 6 units for AAA
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4
Q

How long should patients be NBM for before an op?

A

≥2h clear fluids, ≥6h solids

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5
Q

What kinds of bowel preps are there?

A
  • Stimulant e.g. picolax: picosulfate and magnesium citrate
  • Osmotic e.g. Klean Prep: macrogol
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6
Q

What are the risks of bowel preps?

A
  • Liquid bowel contents spilled during surgery
  • Electrolyte disturbance
  • Dehydration
  • Increased rate of post op anaestomotic leak
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7
Q

When should you give antibiotic prophylaxis?

A

GI surgery (20% post op infection if elective) and djoint replacement; give it 15-60 mins before surgery

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8
Q

What prophylactic antibiotics do you give for biliary surgery?

A

Cef 1.5g + metronidazole 500mg IV

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9
Q

What prophylactic antibiotics do you give for CR or appendicectomy surgery?

A

Cef + met TDS

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10
Q

What prophylactic antibiotics do you give for vascular surgery?

A

co amoxiclav 1.2g IV TDS

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11
Q

What prophylactic antibiotics do you give for MRSA positive patients before surgery?

A

vancomycin

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12
Q

How do you manage DVT risk in surgical patients?

A
  • Low risk: early mobilisation
  • Medium risk: early mobilisation + TEDS + 20mg enoxaparin
  • High risk: early mobilisation + TEDS + 40mg enoxaparin + intermittent compression boots perioperatively
  • Start prophylaxis at 1800 post op
  • May continue medical prophylaxis at home up to 1 month
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13
Q

What are the ASA grades?

A
  1. Normally healthy
  2. Mild systemic disease
  3. Severe systemic disease which limits activity
  4. Systemic disease which is a constant threat to life
  5. Moribund: not expected to survive 24h even with operation
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14
Q

How do you manage a permanent pacemaker/ICD in surgery?

A

Can be reset/triggered by diathermy. Change pacemaker to fixed pace and switch off ICD + attach external defibrillator pads

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15
Q

Why is diabetes a surgical risk?

A
  • Surgery increases stress hormones which antagonise insulin
  • NBM
  • Increased risk of infection and poor wound healing
  • IHD and PVD common
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16
Q

How do you generally manage IDDM patients in surgery?

A
  • Put them first on the list and inform surgeon and anaesthetist
  • May use GKI infusion
  • Sliding scale may not be needed for minor ops; consult diabetic specialist nurse
  • ±stop long acting insulin night before
  • Omit AM insulin if morning surgery
  • Start sliding scale
    • 5% dex with 20mmol KCl 125ml/hr
    • Infusion pump with 50u actrapid
    • Check CPG hourly and adjust insulin
  • Check glucose hourly aiming for 7-11mM
  • Post op
    • continue sliding scale until eating
    • Switch to SC regimen around a meal
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17
Q

How do you manage NIDDM patients in surgery?

A
  • If glucose control poor (fasting >10mM) treat as IDDM
  • Omit oral hypoglycaemics on morning of surgery
  • Eating post op: resume oral hypoglycaemics with meal
  • Not eating post op:
    • Check fasting glucose on morning of surgery
    • Start insulin sliding scale
    • Consult specialist team re: restarting PO treatment
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18
Q

How do you manage diet controlled diabetics in surgery?

A

Usually not a problem; they might be briefly insulin dependent post op so monitor CPG

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19
Q

Why do steroids increase postop risk?

A

Reduced neutrophil and fibroblast function

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20
Q

What are the risks of steroid usage perioperatively?

A
  • Poor wound healing including anastomotic leak
  • Infection
  • Adrenal crisis (Addison’s)
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21
Q

How do you manage steroid prescribing perioperatively?

A
  • If you can wean the dose pre op, do
  • Need to increase steroid to cope with stress
  • Consider cover if high dose steroids within last year
  • Major surgery: hydrocortisone 50-100mg IV with pre med then 6-8 hourly for 3 days (until back on oral steroids)
  • Minor: as for major but hydrocortisone only for 24h
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22
Q

What are the risks of operating on jaundiced patients?

A
  • Obstructive jaundice: increased risk of post op renal failure
  • Coagulopathy
  • Increased infection risk may cause cholangitis
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23
Q

How do you manage jaundiced patients preoperatively?

A
  • Avoid morphine in pre med
  • Check clotting and consider pre op vit K
  • Give 1L NS pre op (unless CCF) -> moderate diuresis
  • Urinary catheter to monitor output
  • Prophylaxis: cef and met
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24
Q

How do you manage jaundiced patients intraoperatively?

A

Hourly urine output monitoring and NS titrated to output

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25
Q

How do you manage jaundiced patients postoperatively?

A

Intensive monitoring of fluid status and consider CVP + frusemide if poor output despite NS

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26
Q

How do you classify surgical risk in liver disease?

A

Child’s Classification of Surgical Risk in Hepatic Dysfunction (graded A-C)

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27
Q

How do you generally manage anticoagulated patients perioperatively?

A
  • Very minor surgery can be done without stopping warfarin if INR <3.5
  • Avoid epidural, spinal, regional blocks if anticoagulated
  • In general continue aspirin/clopidogrel unless high risk of bleeding then stop 7d before surgery
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28
Q

How do you manage low risk anticoagulated patients e.g. AF?

A

Stop warfarin 5d pre op; need INR <1.5 and restart next day

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29
Q

How do you manage high risk anticoagulated patients perioperatively e.g. valves, recurrent VTE?

A
  • Need bridging with LMWH
  • Stop warfarin 5d pre op and start LMWH
  • Stop LMWH 12-18h pre op and restart 6h post op
  • Restart warfarin next day
  • Stop LMWH when INR >2
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30
Q

How do you manage anticoagulated patients needing emergency surgery?

A
  • Discontinue warfarin
  • Vit K 0.5mg slow IV
  • Request FFP or PCC to cover surgery
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31
Q

What are the perioperative risks with COPD/smoking?

A
  • Basal atelectasis
  • Aspiration
  • Chest infection
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32
Q

What are the 3 main aims of anaesthesia?

A

Hypnosis, analgesia, muscle relaxant

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33
Q

What would be the drugs used in a typical anaesthetic regimen?

A
  • Induction: IV propofol
  • Muscle relaxation: either -
    • Depolarising: suxamethonium
    • Non-depolarising: vecuronium, atracurium
  • Airway: ET tube, LMA
  • Maintenance: usually a volatile agent added to N2O/O2 mix e.g. halothane, enflurane
  • End of anaesthesia: change inspired gas to 100% O2, reverse paralysis with neostigmine and atropine (prevent muscarinic side effects)
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34
Q

What drugs are included in operative pre medication?

A
  • 7 As
  • Anxiolytics and amnesia e.g. temazepam
  • Analgesics e.g. opioids, paracetamol, NSAIDs
  • Anti emetics e.g. odansetron 4mg/metoclopramide 10mg
  • Antacids e.g. lansoprazole
  • Anti-sialogue e.g. glycopyrolate (decreases secretions)
  • Antibiotics
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35
Q

What agent might you use for regional anaesthesia and why would you use regional over general?

A

Bupivicaine (long acting). Use for minor procedures, unsuitable for GA

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36
Q

What are some contraindications to nerve or spinal blocks?

A

Local infection or clotting abnormality

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37
Q

What are some potential complications of anaesthesia?

A
  • Propofol induction - cardiorespiratory depression
  • Intubation
    • Oropharyngeal injury with laryngoscope
    • Oesophageal intubation
  • Loss of pain sensation
    • Urinary retention
    • Pressure necrosis
    • Nerve palsies
  • Loss of muscle power
    • Corneal abrasion
    • No cough -> atelectasis and pneumonia
  • Malignant hyperpyrexia from halothane or suxamethonium
  • Anaphylaxis
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38
Q

What is malignant hyperpyrexia, what causes it and how do you treat it?

A
  • Rare complication precipitated by halothane or suxamethonium
  • AD inheritance
  • Rapid rise in temperature and masseter spasm
  • Treat with dantrolene and cooling
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39
Q

What are some common anaesthetic triggers for anaphylaxis?

A

Antibiotics, colloid, NM blockers like vecuronium

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40
Q

Why are analgesics necessary in surgery?

A
  • Humanitarian
  • Autonomic activation causes arteriolar constriction, decreased wound perfusion and therefore poor healing
  • Patients might not mobilise leading to VTE and decreased function
  • Decreased respiratory excursion and cough can cause atelectasis and pneumonia
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41
Q

What drugs are commonly given as a PCA?

A

Morphine, fentanyl

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42
Q

What drug is commonly given through an epidural?

A

Bupivicaine

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43
Q

Describe the analgesic ladder for post op pain relief

A
  1. Non opioid ± adjuvants
    • Paracetamol
    • NSAIDS:
      • Ibuprofen 400mg/6h PO max
      • Diclofenac 50mg PO/75mgIM
  2. Weak opioid + non opioid ± adjuvants; add:
    • Codeine
    • Tramadol
    • Dihydrocodeine
  3. Strong opioid + non opioid ± adjuvants; add:
    • Morphine: 5-10mg/2h max
    • Oxycodone
    • Fentanyl
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44
Q

What are the 2 main cautions when using spinal/epidural anaesthesia?

A

Respiratory depression and neurogenic shock causing hypotension

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45
Q

What are the aims of ERAS?

A
  • Opimise pre op preparation
  • Avoid iatrogenic problems like ileus
  • Minimis adverse physiological/immunological responses to surgery
    • Raised cortisol and low insulin (absolute or relative_
    • Hypercoagulability
    • Immunosuppression
  • Increase speed of recovery and expedite return to function
  • Recognise abnormal recovery and allow early intervention
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46
Q

What are the pre-op components of ERAS?

A
  • Aggressive physical optimisation (hydration, BP, anaemia, DM, comorbidities)
  • Smoking cessation ≥4 weeks before op
  • Admission on day of surgery
  • Avoid prolonged fast
  • Carb loading prior to surgery e.g. carb drinks to reduce early catabolic response
  • Fully informed patient encouraged to participate in recovery
  • Avoid opiates and epidurals (GIT effects, early mobilisation)
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47
Q

What are the intra op components of ERAS?

A
  • Short acting anaesthetic agents
  • Epidurals
  • Minimally invasive techniques
  • Avoid drains and NGTs where possible
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48
Q

What are the post op components of ERAS?

A
  • Aggressive treatment of pain and nausea
  • Early mobilisation and physio
  • Early resumption of oral intake including carb drinks from 6h
  • Early discontinuation of IV fluids
  • Remove drains and urinary catheters ASAP
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49
Q

Who is ERAS unsuitable for?

A
  • Some IDDM
  • Pre existing significantnutritional compromise
  • Cognitive impairment
50
Q

Define sterilisation

A

Removal of all viable microorganisms, vegetative and spores

51
Q

Define disinfection

A

Removal of actively dividing vegetative microorganisms

52
Q

Define antisepsis

A

Process whereby the risk of medical cross infection by microorganisms is reduced

53
Q

What are some general surgical complications?

A
  • Immediate (<24h)
    • Intubation -> oropharyngeal trauma
    • Surgical trauma to local structures
    • Primary or reactive haemorrhage
  • Early (1d-1month)
    • Secondary haemorrhage
    • VTE
    • Urinary retention
    • Atelectasis and pneumonia
    • Wound infection and dehiscence
    • Antibiotic association colitis (AAC)
  • Late (>1 month)
    • Scarring
    • Neuropathy
    • Failure or recurrence
54
Q

How do you classify haemorrhage?

A
  • Primary: continuous bleeding starting during surgery
  • Reactive: bleeding at the end of surgery or early post op, secondary to increased cardiac output and BP
  • Secondary: bleeding >24h post op, usually due to infection
55
Q

What are the causes of post op urinary retention?

A
  • Drugs: opioids, epidural/spinal, anti-AChM
  • Pain: sympathetic activation causes sphincter contraction
  • Psychogenic: hospital environment
56
Q

What are the risk factors for post op urinary retention?

A
  • Male
  • Old age
  • Neuropathy e.g. DM, EtOH
  • BPH
  • Surgery: hernia, anorectal
57
Q

How do you manage post op urinary retention?

A
  • Conservative
    • Privacy
    • Ambulation
    • Void to running taps or in hot bath
    • Analgesia
  • Catheterise ± gent 2.5 mg/kg IV stat
  • TWOC: trial without catheter
    • If failed, may be sent home with a silicone catheter and urology follow up
58
Q

What is pulmonary atelectasis and why does it happen?

A

Mucus plugging and absorption of distal air causes a lung collapse - happens after almost every GA

59
Q

What are the causes of atelectasis?

A
  • Pre op smoking
  • Anaesthetics
  • Increased mucus production
  • Decreased mucociliary clearance
  • Pain inhibits respiratory excursion and cough
60
Q

How does atelectasis present?

A
  • Within first 48 hours
  • Mild pyrexia
  • Dyspnoea
  • Dull bases with reduced air entry
61
Q

How is atelectasis managed?

A

Good analgesia to aid coughing and chest physio

62
Q

When does wound infection present and what are the usual organisms?

A

5-7d post op with S aureus and coliforms

63
Q

What is the difference between clean, contaminated and dirty?

A
  • Clean: incise uninfected skin without opening viscus
  • Clean/contaminated: intra op breach of viscus (not colon)
  • Contaminated: breach of viscus + spillage or opening of colon
  • Dirty: site already contaminated - faeces, pus, trauma
64
Q

What are the risk factors for wound infection?

A
  • Preoperative
    • Old age
    • Comorbidities e.g. DM
    • Pre existing infection e.g. appendix perforation
    • Patient colonisation e.g. nasal MRSA
  • Operative
    • Op classification and wound infection risk
    • Duration
    • Technical: pre op antibiotics, asepsis
  • Post operative
    • Contamination of wound from staff
65
Q

How is wound infection managed?

A

Regular dressing, antibiotics, abscess drainage

66
Q

How does wound dehiscence present?

A

About 10 days post op, preceded by serosanguinous discharge from wound

67
Q

What are the risk factors for wound dehiscence?

A
  • Pre op
    • Old age
    • Smoking
    • Obesity, malnutrition, cachexia
    • Comorbs: BM, uraemia, chronic cough, cancer
    • Drugs: steroids, chemo, radio
  • Operative factors:
    • length and orientation of incision
    • Closure: follow Jenkin’s Rule
    • Suture material
  • Post op factors
    • Increased IAP e.g. prolonged ileus -> distension
    • Infection
    • Haematoma/seroma formation
68
Q

What is Jenkin’s rule?

A

Suture length = 4x length of wound,

69
Q

How is wound dehiscence managed?

A
  • Replace abdo contents and cover with sterile soaked gauze
  • IV antibiotics: cef and met
  • Opioid analgesia
  • Call senior and arrange theatre
  • Repair in theatre:
    • Wash bowel
    • Debride wound edges
    • Close with deep non absorbable sutures (e.g. nylon)
  • May need vac dressing or grafting
70
Q

What are the complications of cholecystectomy?

A
  • Conversion to open (5%)
  • CBD injury (0.3%)
  • Bile leak
  • Retained stones (needing ERCP)
  • Fat intolerance/loose stools
71
Q

What are the complications of inguinal hernia repair?

A
  • Early
    • Haematoma/seroma formation (10%)
    • Intra abdominal injury (lap)
    • Infection (1%)
    • Urinary retention
  • Late
    • Recurrence (<2%)
    • Ischaemic orchitis (0.5%)
    • Chronic groin pain/paraesthesia (5%)
72
Q

What are the complications of appendicectomy?

A
  • Abscess formation
  • Fallopian tube trauma
  • Right hemicolectomy (e.g. for carcinoid, caecal necrosis)
73
Q

What are the complications of colonic surgery?

A
  • Early
    • Ileus
    • AAC
    • Anastomotic leak
    • Enterocutaneous fistulae
    • Abdominal or pelvic abscess
  • Late
    • Adhesions -> obstruction
    • Incisional hernia
74
Q

What are the causes of post op ileus?

A
  • Bowel handling
  • Anaesthesia
  • Electrolyte imbalance
75
Q

How does post op ileus present?

A
  • Distension
  • Conspitation ± vomiting
  • Absent bowel sounds
76
Q

How is post op ileus treated?

A

IV fluids, NGT, TPN if prolonged

77
Q

What are the complications of anorectal surgery?

A
  • Anal incontinenece
  • Stenosis
  • Anal fissure
78
Q

What are the complications of small bowel surgery?

A

Short gut syndrome (if ≤250cm)

79
Q

What are the complications of splenectomy?

A
  • Gastric dilatation (secondary gastric ileus) - prevent with NGT
  • Thrombocytosis -> VTE
  • Infection: encapsulated organisms
80
Q

What are the complications of arterial surgery?

A
  • Thrombosis and embolisation
  • Anastomotic leak
  • Graft infection
81
Q

What are the complications of aortic surgery?

A
  • Gut ischaemia
  • Renal failure
  • Aorto-enteric fistula
  • Anterior spinal syndrome (paraplegia)
  • Emboli -> distal ischaemia (trash foot)
82
Q

What are the complications of breast surgery?

A
  • Arm lymphoedema
  • Skin necrosis
  • Seroma
83
Q

What are the complications of urological?

A
  • Sepsis (instrumentation with infected urine)
  • Uroma: extravasation of urine
84
Q

What are the complications of prostatectomy?

A
  • Urinary incontinence
  • Erectile dysfunction
  • Retrograde ejaculation
  • Prostatitis
85
Q

What are the complications of thyroidectomy?

A
  • Wound haematoma -> tracheal obstruction
  • Recurrent laryngeal nerve trauma -> hoarse voice
    • Transient in 1.5%
    • Permanent in 0.5%
    • R commonest (more medial)
  • Hypoparathyroidism -> hypocalcaemia
  • Thyroid storm
  • Hypothyroidism
86
Q

What are the complications of tracheostomy?

A
  • Stenosis
  • Mediastinitis
  • Surgical emphysema
87
Q

What are the complications of fracture repair?

A
  • Mal/non union
  • Osteomyelitis
  • AVN
  • Compartment syndrome
88
Q

What are the complications of hip replacement?

A
  • Deep infection
  • VTE
  • Dislocation
  • Nerve injury: sciatic, SGN
  • Leg length discrepancy
89
Q

What are the complications of cardiothoracic surgery?

A
  • Pneumo/haemothorax
  • Infection: mediastinitis, empyema
90
Q

What are the causes of post-op pyrexia?

A
  • Early: 0-5 days post op
    • Blood transfusion
    • Physiological: SIRS from trauma: 0-1d
    • Pulmonary atelectassi: 24-48 hours
    • Infection: UTI, superficial thrombophlebitis, cellulitis
    • Drug reaction
  • Delayed: >5d post op
    • Pneumonia
    • VTE (5-10d)
    • Wound infection (5-7d)
    • Anastomotic leak (7d)
    • Collection (5-20d)
91
Q

What investigations should you do in a patient with post op pyrexia?

A
  • Urine: dip and MC+S
  • Bloods: FBC, CRP, cultures ± LFTs
  • Cultures: wound swabs, CVP tip
  • CXR
92
Q

What are the causes of post op pneumonia?

A
  • Anaesthesia causing atelectasis
  • Pain decreasing cough
  • Surgery causing immunosuppression
93
Q

How do you treat post op pneumonia?

A

Chest physio (encourage cough), good analgesia, antibiotics

94
Q

How does a collection present?

A
  • Malaise
  • Swinging fever, rigors
  • Localised peritonitis
  • Shoulder tip pain (if subphrenic)
95
Q

Where are some common locations for collections?

A
  • Pelvic (present 4-10 days post op)
  • Subphrenic (7-21d post op)
  • Paracolic gutters
  • Lesser sac
  • Hepatorenal recess (Morrison’s space)
  • Small bowel (interloop spaces)
96
Q

What investigations should you do if you suspect a collection?

A

FBC, CRP, cultures

US, CT

Diagnostic lap

97
Q

How do you treat a collection?

A

Antibiotics, drainage/washout

98
Q

What is cellulitis?

A

Acute infection of the subcutaneous connective tissue

99
Q

What are the common causative organisms of cellulitis?

A

Beta haemolytic streps and staph aureus

100
Q

How does cellulitis present?

A
  • Pain, swelling, erythema, warmth
  • Systemic upset
  • ± lymphadenopathy
101
Q

How do you treat cellulitis?

A
  • Benpen IV
  • Pen V and fluclox PO
102
Q

How common is DVT in surgical patients?

A

25-50%

103
Q

What are the risk factors for DVT?

A

Virchow’s triad:

  • Blood contents
    • Surgery increases platelets and fibrinogen
    • Dehydration
    • Malignancy
    • Old age
  • Blood flow
    • Surgery
    • Immobility
    • Obesity
  • Vessel wall
    • Damage to veins (especially pelvic)
    • Previous VTE
104
Q

How does DVT present?

A
  • 5-10d post op
  • 65% below knee are asymptomatic
  • Calf warmth, tenderness, erythema, swelling
  • Mild pyrexia
  • Pitting oedema
105
Q

What are the differentials for DVT?

A

Ruptured Baker’s cyst, cellulitis

106
Q

What investigations should you do in DVT?

A
  • D dimer: sensitive but not specific
  • Compression US (clot incompressible)
  • Thrombophilia screen if
    • No precipitating factors
    • Recurrent DVT
    • Family history
107
Q

How do you diagnose DVT?

A
  • Assess probability with Wells’ score
  • Low probability - do a D dimer
    • Negative excludes DVT
    • Positive do a compression Us
  • Medium/high probability do a compression US
108
Q

How do you treat DVT?

A
  • Therapeutic LMWH: enoxaparin 1.5mg/kg/24h SC
  • Start warfarin using Tait model: 5mg OD for first 4d
  • Stop LMWH when INR 2.5
  • Duration
    • Below knee: 6-12 weeks
    • Above knee: 3-6 months
    • Ongoing cause: indefinite
  • And consider graduated compression stockings to prevent post-phlebitic syndrome
109
Q

How can you prevent DVT?

A
  • Pre op
    • VTE risk assessment
    • TED stockings
    • Aggressive optimisation especially hydration
    • Stop OCP 4 weeks prior
  • Intra op
    • Minimise length of surgery
    • Use minimal access surgery where possible
    • Intermittent pneumatic compression boots
  • Post op
    • LMWH
    • Early mobilisation
    • Good analgesia
    • Physio
    • Adequate hydration
110
Q

What are some causes of post op dyspnoea?

A
  • Previous lung disease
  • Atelectasis, aspiration, pneumonia
  • LVF
  • PE
  • Pneumonthorax e.g. due to CVP line insertion
  • Pain -> hypoventilation
111
Q

What are the causes of reduced urine output post op?

A
  • Post renal
    • Commonest cause
    • Blocked/malsited catheter
    • Acute urinary retention
  • Pre renal: hypovolaemia
  • Renal: NSAIDs, gentamicin
  • Anuria is usually blocked or malsited catheter
  • Oliguria is usually inadequate fluid replacement
112
Q

How do you manage reduced urine output post op?

A
  • Information:
    • Operative history
    • Obs chart: urine output
    • Drug chart: nephrotoxins
  • Examination
    • Assess fluid status
    • Examine for palpable bladder
    • Inspect drips, drains, stomas, CVP
  • Action
    • Flush with 50ml NS and aspirate back
    • Fluid challenge
113
Q

What are the causes of post op nausea and vomiting?

A
  • Obstruction
  • Ileus
  • Emetic drugs like opioids
114
Q

How is post op nausea and vomiting managed?

A

Consider NGT and AXR

Give odansetron 4mg IV TDS

115
Q

What are the common causes of post op hyponatraemia?

A
  • SIADH: pain, nausea, opioids, stress
  • Overadministration of IV fluids
116
Q

How do you treat post op hyponatraemia?

A

Look at pre op level and correct slowly:

  • Acute: 1mM/h
  • Chronic: 15mM/d
117
Q

How do you manage post op hypotension?

A
  • IMMEDIATE: tild bed head down, give O2, assess fluid status
  • Hypovolaemia: fluid challenge of 250-500ml colloid over 15-30 mins
  • Haemorrhage: back to theatre
  • Sepsis: fluid challenge and start antibiotics
  • Overload: frusemide
  • Neurogenic: NA infusion
118
Q

What are some causes of post op hypotension?

A
  • Cardiogenic
    • MI
    • Fluid overload
  • Hypovolaemia
    • Inadequate replacement
    • Haemorrhage
  • Obstructive
    • PE
  • Distributive
    • Sepsis
    • Neurogenic shock
119
Q

What are some causes of post op hypertension?

A

Pain, urinary retention, previous HTN

120
Q

How do you treat post op hypertension?

A

Treat the cause but can use labetalol 50mg IV every 5 mins (200mg max)

121
Q

What are the common causes of acute confusional state?

A
  • Drugs: opiates, sedatives, L-DOPA
  • Eyes, ears and other sensory deficits
  • Low O2 states: MI, stroke, PE
  • Infection
  • Retention: stool or urine
  • Ictal
  • Under-hydration/nutrition
  • Metabolic: Na, AKI, glucose, EtOH withdrawal
122
Q

How do you treat acute confusional state?

A
  • May need sedation: midazolam/haldol
  • Nurse in a well-lit environment
  • Treat cause

Surgery Finals (12 decks)

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