Perioperative and Postoperative Care Flashcards

1
Q

What are the 4 types of surgery?

A

Immediate
Urgent
Expedited
Elective

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2
Q

What are the aims of the pre-assessment clinic?

A
reduce cancellations
reduce bad days
addresses patient risks
optimise patients prior to surgery
helps prevent complications
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3
Q

What is involved when a patient attends pre-assessment clinic?

A
Hx:
PMH in full
drugs & allergies
previous general anaesthetics
exercise tolerance

examination: ABCDE

ASA Grade –> follow national guidelines - traffic light system to see what tests need to be run eg renal function

grade of surgery
-1 = minor whilst 4 = major +

Identify risks - P-POSSUM

Determine level of post-op care

Inform patient

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4
Q

What is the ASA grade?

A
ASA Grade - determine co-morbidities
1 = healthy patient
2 = mild systemic disease
3 = severe systemic disease
4 = severe systemic disease + threat to life
5 = moribund aka death within 24hrs
6 = brain dead --> organ donation
suffix E = emergency
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5
Q

When is an echocardiogram performed at pre-assessment clinic?

A

if heart murmur + cardiac symptom
OR
signs of HF

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6
Q

When must a patient stop eating food prior to surgery?

A

6 hrs for food
4 hrs for breast milk
2hrs for clear fluids

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7
Q

How are incidents reported?

A

Datix

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8
Q

What is the WHO surgical sign-in?

A

Before the patient undergoes anaesthesia;
the patient must confirm his/her identity
the site of operation
what procedure is to be carried out and that he/she has consented for the procedure.

The site of operation must be marked if applicable.
Then the presence or absence of allergies must be checked
the amount of expected blood loss discussed
an anaesthetic safety check must be completed.

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9
Q

What is the WHO time-out?

A

Before the surgical procedure begins (i.e. before the first incision);
All the people in the room must introduce themselves by name and role.
The surgeon and anaesthetist must then confirm the name of the patient and the procedure taking place, and any anticipated critical events, and consent form
These clinicians also discuss the need for antibiotics and imaging

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10
Q

What is the WHO surgical sign-out?

A

Before the patient leaves the operating room;
The instrument, sponge and needle counts are checked
The equipment is checked
The specimens are checked and appropriately labelled. The surgeon, anaesthetist and nursing staff then must discuss any key concerns for recovery management of the patient.

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11
Q

What is NatSSIPs?

A

= National Safety Standards for Invasive Procedures

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12
Q

What is monitored post-op?

A

Vital signs
fluid balance
blood results

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13
Q

What medications are given post-op?

A

VTE prophylaxis
Prophylactic Abx
analgesia

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14
Q

Beyond medication and obvs, what else is involved in post-op care?

A

nutrition
wound cleaning
physiotherapy

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15
Q

What are some general surgical complications?

A

haemorrhage
VTE
wound complication
SIRS = systemic inflammatory response syndrome

can be immediate/early/late

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16
Q

What do these acronyms stand for?

a. PARS
b. MEWS
c. NEWS
d. PHTLS + ATLS

A

a. patients at-risk score
b. modified early warning score
c. national early warning score
d. pre-hospital trauma life support + advanced trauma life support

17
Q

What is SOFA

A

SOFA = sequential organ failure assessment (for sepsis)
a change of two point –> sepsis

qSOFA = quick version - 2/3 indicates sepsis;
RR >22
altered mental state
SBP <100

18
Q

What is Red Flag Sepsis?

A
AVPU
acute confusion
RR >25
O2 <92%
HR >130
SBP <90
No UO in the last 18 hrs
recent chemo 
non-blanching rash
19
Q

How do you treat sepsis?

A

Septic Six - Give 3 Take 3
Give; IV Fluids, Abx, high flow O2
Take; UO, blood culture, lactate measure