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Family > pestana: pre-op, post-op > Flashcards

pestana: pre-op, post-op Flashcards

1
Q

worst single finding predicting high cardiac risk

A

JVD

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2
Q

most common cause of increased pulmonary risk in surgery

A

smoking

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3
Q

how does smoking increase risk physiologically

A

high PCO2 (not low O2)

low FEV1

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4
Q

two clinical findings and 3 lab values that predict operative mortality in patients with liver disease

A

encephalopathy
ascites

INR
bilirubin
serum albumin

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5
Q

severe nutritional depletion is defined as

A

loss of 20% of body weight over a couple months

serum albumin <3

anergy to skin antigens

serum transferrin<200 mg/dL

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6
Q

how many days should you wait for preoperative nutritional support to undernourished patient?

A

7-10 ideal

4-5 significant

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7
Q

can you do surgery if someone is in a diabetic coma?

A

no- contraindication!

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8
Q

symptoms of malignant hyperthermia

A

fever over 104
metabolic acidosis
hypercalcemia

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9
Q

treat malignant hyperthermia

A

IV dantrolene
100% oxygen
correct acidosis
cooling blankets

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10
Q

bacteremia is seen within how many minutes of invasive prodcedures

A

30-45 minutes

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11
Q

gas gangrene is seen in how long after invasive prodedure

A

within hours

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12
Q

postop causes of fever in usual range 101-103

A 
atelectasis
pneumonia
UTI
deep venous thrombophlebitis
wound infection
deep abscess
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13
Q

most common source of post op fever on first post op day

A

atelectasis

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14
Q

pneumonia happens in how many days if atelectasis not resolved

A

3

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15
Q

when do UTIs start post op?

A

day 3

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16
Q

when does deep thrombophlebiis start post op

A

day 5

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17
Q

when does wound infection start post op?

A

day 7

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18
Q

when does deep abscess start post op

A

day 10-15

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19
Q

diagnostic and treatment of deep thrombophlebitis

A

diagnostic: doppler studies of deep leg and pelvic veins
treat: heparin–>warfarin

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20
Q

diagnostic of wound inf.

A

sonogram

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21
Q

diagnostic of deep abscess

A

CT

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22
Q

how is MI triggered most likely during surgery?

A

hypotension

23
Q

when would MI happen post op?

A

day 2-3

24
Q

most reliable diagnostic test for MI

A

troponin

25
Q

PE happens when post op?

A

day 7

26
Q

presentation of PE

A

pleuritic pain, sudden onset
SOB

anxious, diaphoretic, tachycardic

27
Q

diagnostic test for PE

A

spiral CT with intravenous dye (CT angio)

28
Q

treat PE

A

heparin

29
Q

therapy of aspiration if symptomatic

A

lavage and removal of acid and matter (bronchoscopy)

bronchodilators, resp support

30
Q

what is the first thing to consider when post op patient becomes confused/disoriented?

A

hypoxia

check blood gas, give resp support

31
Q

therapy for ARDS

A

PEEP (dont do too much!)

32
Q

common source of coma in cirrhotic patient with bleeding esophageal varices who undergoes a portocaval shunt

A

ammonia intoxication

33
Q

low urinary output defined as

A

<0.5 mL/kg/L

34
Q

most common causes of low urinary output post op and diagnostic test

A

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
35
Q

is paralytic ileus expected the first few days after abdominal surgery

A

yes

36
Q

what if ileus not resolved after day 5-7, think…and how should be diagnosed and treated

A

early mechanical bowel obstruction (adhesions)

diagnose: CT
treat: surgery

37
Q

ogilvie syndrome seen in which population

A

elderly sedentary patients who have become durther immobilized from surgery

38
Q

manage ogilvie syndrome

A

fluids, electrolyte correction

c-scope: suck out air

39
Q

air fluid levels in GI tract indicate

A

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

40
Q

wound dehiscence seen which day post op? and how does it look

A

day 5

wound intact but pink fluid soaks dressing

41
Q

evsiceration

A

complication of dehiscence

skin opens up and abdominal contents rush out

emergency closing!

42
Q

type of fluid to fix hypernatremia

A

D5 1/2 saline (if developed slowly)

D5 1/3 saline (if developed fast)

43
Q

every ___ mEq/L that the serum sodium concentration is above 140 represents 1 L of water lost

A

3

44
Q

causes of hypernatremia

A

slow: lost water
fast: osmotic diuresis, diabetes insipidus

45
Q

hyponatremia causes

A

SIADH (slow)

losing large amounts of isotonic fluid (fast)

46
Q

fixing hyponatremia if fast developing or slow

A

fast: slow 3% or % saline
slow: water restriction

47
Q

causes of hypokalemia: slow vs fast

A 
slow: GI fluid loss, 
urine loss (diuretics, aldosterone)

fast: correction of DKA

48
Q

speed limit of IV K+ adminstration

A

10 mEq/h

49
Q

hyperkalemia causes: slow vs fast

A

slow: renal failure, aldosterone antagonists
fast: K+ dumped into cells from crushing injuries, dead tissue, acidosis

50
Q

treatment of hyperkalemia:

A

hemodialysis, NG suction

50% dextrose and insulin

IV calcium- quickest, cardioprotective

51
Q

what forms of bicarbonate can help treat metabolic acidosis (besides treating cause of metabolic acidosis)?

A

lactate, acetate

52
Q

what is inevitable with longstanding acidosis of whichever etiology?

A

renal loss of K+

53
Q

how to treat metabolic alkalosis

A

5-10 mEq/h KCl

Family (42 decks)

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