pestana: pre-op, post-op Flashcards
worst single finding predicting high cardiac risk
JVD
most common cause of increased pulmonary risk in surgery
smoking
how does smoking increase risk physiologically
high PCO2 (not low O2)
low FEV1
two clinical findings and 3 lab values that predict operative mortality in patients with liver disease
encephalopathy
ascites
INR
bilirubin
serum albumin
severe nutritional depletion is defined as
loss of 20% of body weight over a couple months
serum albumin <3
anergy to skin antigens
serum transferrin<200 mg/dL
how many days should you wait for preoperative nutritional support to undernourished patient?
7-10 ideal
4-5 significant
can you do surgery if someone is in a diabetic coma?
no- contraindication!
symptoms of malignant hyperthermia
fever over 104
metabolic acidosis
hypercalcemia
treat malignant hyperthermia
IV dantrolene
100% oxygen
correct acidosis
cooling blankets
bacteremia is seen within how many minutes of invasive prodcedures
30-45 minutes
gas gangrene is seen in how long after invasive prodedure
within hours
postop causes of fever in usual range 101-103
atelectasis pneumonia UTI deep venous thrombophlebitis wound infection deep abscess
most common source of post op fever on first post op day
atelectasis
pneumonia happens in how many days if atelectasis not resolved
3
when do UTIs start post op?
day 3
when does deep thrombophlebiis start post op
day 5
when does wound infection start post op?
day 7
when does deep abscess start post op
day 10-15
diagnostic and treatment of deep thrombophlebitis
diagnostic: doppler studies of deep leg and pelvic veins
treat: heparin–>warfarin
diagnostic of wound inf.
sonogram
diagnostic of deep abscess
CT
how is MI triggered most likely during surgery?
hypotension
when would MI happen post op?
day 2-3
most reliable diagnostic test for MI
troponin
PE happens when post op?
day 7
presentation of PE
pleuritic pain, sudden onset
SOB
anxious, diaphoretic, tachycardic
diagnostic test for PE
spiral CT with intravenous dye (CT angio)
treat PE
heparin
therapy of aspiration if symptomatic
lavage and removal of acid and matter (bronchoscopy)
bronchodilators, resp support
what is the first thing to consider when post op patient becomes confused/disoriented?
hypoxia
check blood gas, give resp support
therapy for ARDS
PEEP (dont do too much!)
common source of coma in cirrhotic patient with bleeding esophageal varices who undergoes a portocaval shunt
ammonia intoxication
low urinary output defined as
<0.5 mL/kg/L
most common causes of low urinary output post op and diagnostic test
fluid deficit or acute renal failure
give bolus of 500 ml IV in 10-20 minutes
- if dehydrated–>respond
- renal failure–>no response
or measure urinary sodium
- dehydration: <10-20 mEq/L
- renal failure: >40 mEq/L or FENa>1
is paralytic ileus expected the first few days after abdominal surgery
yes
what if ileus not resolved after day 5-7, think…and how should be diagnosed and treated
early mechanical bowel obstruction (adhesions)
diagnose: CT
treat: surgery
ogilvie syndrome seen in which population
elderly sedentary patients who have become durther immobilized from surgery
manage ogilvie syndrome
fluids, electrolyte correction
c-scope: suck out air
air fluid levels in GI tract indicate
normally water and air mixed from normal peristlasis
but if small bowel obstructed, tract gets tired,
–> liquid goes to bottom and air goes to top
wound dehiscence seen which day post op? and how does it look
day 5
wound intact but pink fluid soaks dressing
evsiceration
complication of dehiscence
skin opens up and abdominal contents rush out
emergency closing!
type of fluid to fix hypernatremia
D5 1/2 saline (if developed slowly)
D5 1/3 saline (if developed fast)
every ___ mEq/L that the serum sodium concentration is above 140 represents 1 L of water lost
3
causes of hypernatremia
slow: lost water
fast: osmotic diuresis, diabetes insipidus
hyponatremia causes
SIADH (slow)
losing large amounts of isotonic fluid (fast)
fixing hyponatremia if fast developing or slow
fast: slow 3% or % saline
slow: water restriction
causes of hypokalemia: slow vs fast
slow: GI fluid loss, urine loss (diuretics, aldosterone)
fast: correction of DKA
speed limit of IV K+ adminstration
10 mEq/h
hyperkalemia causes: slow vs fast
slow: renal failure, aldosterone antagonists
fast: K+ dumped into cells from crushing injuries, dead tissue, acidosis
treatment of hyperkalemia:
hemodialysis, NG suction
50% dextrose and insulin
IV calcium- quickest, cardioprotective
what forms of bicarbonate can help treat metabolic acidosis (besides treating cause of metabolic acidosis)?
lactate, acetate
what is inevitable with longstanding acidosis of whichever etiology?
renal loss of K+
how to treat metabolic alkalosis
5-10 mEq/h KCl
