Pestana PeriOp Care Flashcards
What is the greatest Cardiac risk Factor for Surgery? Second greatest?
JVP Distension. Recent (6mo) MI.
What is the greatest Pulmonary risk factor for surgery? How do you prepare for surgery?
Smoking. 8 weeks cessation and pulmonary therapy.
What are the predictors of Hepatic risk for surgery?
Bilirubin. Albumin. Prothrombin time. Encephalopathy/Ascites.
What are predictors of Nutritional risk for surgery?
Loss of 20% body weight, serum albumin <200mg/dL, anergy to skin antigens.
Tachycardia, muscle rigidity, and Fever >104 developing after onset of anesthesia.
Treatment? What electrolyte is elevated?
Malignant Hyperthermia - IV Dantrolene, 100% O2, correction of acidosis, and cooling blankets. Calcium.
Fever>104 developing during surgery.
Treatment? Potential complications?
Bacteremia (often during Urinary Tract procedure) - Blood Cultures x3 and empiric antibiotics. If severe wound pain develops post/op, consider gas gangrene.
Fever on POD 1. Tests and treatment?
Atelectasis. Listen to the lungs, get CXR - if you see infiltrates, treat with spirometry (bronchoscopy if bad).
Fever on POD 1-3. Tests and treatment?
Atelectasis progressed to pneumonia. CXR - will show infiltrates. Sputum cultures and treat with antibiotics.
Fever on POD 3. Tests and treatment?
UTI. Urinalysis, urine cultures, and antibiotics.
Fever on POD 5. Tests and treatment?
Deep Thrombophlebitis. Doppler studies of deep leg and pelvic veins. LMWH.
Fever on POD 5-7. Tests and treatment?
Wound infection. CBC. Antibiotics for cellulitis. D&I for abscess.
Fever on POD 7-15. Tests and treatment?
Deep abscess, usually subphrenic, pelvic, or subhepatic. Sonogram or CT scan and percutaneous drainage.
Chest pain on POD 0-3. Symptoms? Tests?Treatment? Treatments to avoid?
MI. Crushing chest pain (not always), diaphoresis, dyspnea, syncope.
ST depression and T wave flattening on EKG. Elevated troponins (best test). PCI. DONT USE THROMBOLYTICS!
Chest pain on POD 7. Symptoms? Tests?Treatment?
PE. Sudden pleuritic chest pain, dyspnea, diaphoresis, distended JVP.
ABG and CT angio. LMWH and greenfield filter.
Combative, well fed patient during awake intubation develops pulmonary failure/pneumonia? Treatment?
Aspiration. Lavage and bronchoscopy. Bronchodilators, potentially ventilator.
Post of patient becomes confused and disoriented? Tests and treatment?
Hypoxia. Check for sepsis, ABG, provide respiratory support.
Septic post op patient develops respiratory distress? Tests and treatment? Complications with treatment?
ARDS. Check ABG and CXR. Correct sepsis. Ventilate with PEEP, but DON’T USE EXCESSIVE VOLUMES –> barotrauma.
Alcoholic patient gets combative, confused, and hallucinates on POD 2-3? Treatment?
DT, which can be fatal. IV benzodiazopenes (Ativan).
Post op patient develops confusion, convulsions, and coma. Charts note rapid weight gain and [Na]<120? Treatment?
Hypervolemic Hyponatremia. 500ml of 3% saline or mannitol.
Neurological post op patient develops confusion, lethargy, and coma? Chart shows rapid weight loss, rising [Na]. Treatment?
Central Diabetes Insipidus. D5(1/2)NS to replace water.
Cirrhotic patient undergoing a portocaval shunt falls into a coma?
Ammonium intoxication
Patient voids zero urine after surgery? Treatment?
Mechanical issue. Unkink the catheter.
Patient voids <0.5ml/kg/hr after surgery who is not in shock? Three diagnostic approaches?
Either Renal failure or low fluids.
- Fluid bolus, renal failure will not respond.
- Urinary [Na], renal failure will have >40mEg/L (high)
- FeNa, >1 in renal failure
Patient a few days after abdominal surgery has absent bowel sounds, no passage of gas/feces, and painless mild distension? Check what electrolyte? What medication exacerbates this issue?
Normal paralytic ileus, check his potassium. Morphine.
Patient one week after surgery has absent bowel sounds, no passage of gas/feces, and painless mild distension? Tests and Treatment?
Bowel obstruction. Xray (dilated loops and air fluid levels in small bowel). CT scan. Correct surgically.
Old patient who develops tense abdominal distension and massively dilated colon a few days after surgery for a broken hip? Tests and Treatment?
Ogilvie syndrome. Xray and CT scan to rule out obstruction. IV neostigmine and rectal tube.
Pink fluid leaks out of wound on POD5-7 s/p open laparotomy? Treatment?
Wound dehiscence. Bound the abdomen and prepare for reoperation.
Patient s/p open laparotomy gets out of bed and his guts fall out of his skin? Treatment?
Evisceration. Emergency abdominal closure.
Do higher or lower GI fistulas leak greater volumes?
High
Fistulas will heal by themselves unless…
They have F.R.I.E.N.D.S.
Foreign Body. Radiation. Infection. Epithelialization. Neoplasm. Distal obstruction. Patient is on steroids.
