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CST > Post op scenarios management > Flashcards

Post op scenarios management Flashcards

1
Q

Risk factors for anastomotic leak

A

Can be categorised into:

Patient-related:
Modifiable: smoking, alcohol excess, increased BMI, corticosteroids, malnutrition
Non-modifiable: male, diabetes,

Pathology related

  • autoimmune
  • collagen disorders
  • vascular insufficiency
  • inflammatory bowel disease
  • tumour size >3cm
  • radiotherapy and advanced disease

Technical factors

  • operator experience
  • site: small bowel good, colo-rectal bad
  • tension
  • blood supply
  • emergency surgery

Post-operative
-ionotrope use

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2
Q

Patient related risk factors for anastomotic leak

A

Patient-related:
Modifiable: smoking, alcohol excess, increased BMI, corticosteroids, malnutrition
Non-modifiable: male, diabetes,

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3
Q

Pathology related risk factors for anastomotic leak

A

Pathology related

  • autoimmune
  • collagen disorders
  • vascular insufficiency
  • inflammatory bowel disease
  • tumour size >3cm
  • radiotherapy and advanced disease
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4
Q

Technical factors for anastomotic leak

A

Technical factors

  • operator experience
  • site: small bowel good, colo-rectal bad
  • tension
  • blood supply
  • emergency surgery
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5
Q

Traditional sepsis 6

A

Take

  1. Blood cultures prior to antibiotics
  2. Serum lactate and FBC
  3. Accurate UO using indwelling catheter

Give

  1. Broad spectrum antibiotics
  2. High-flow oxygen
  3. Fluid resuscitation if lactate >4 or hypotensive at 30ml/kg

WITHIN FIRST HOUR

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6
Q

New 1 hour care bundle for sepsis

A

Measure lactate level. Re-measure if initial lactate is > 2 mmol/L

Obtain blood cultures prior to administration of antibiotics

Administer broad-spectrum antibiotics

Rapidly administer 30 ml/kg crystalloid for hypotension or lactate ≥ 4 mmol/L

Apply vasopressors if patient is hypotensive during or after fluid resuscitation to maintain MAP ≥ 65 mm Hg

Strong recommendation, moderate quality of evidence

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7
Q

Surviving sepsis campaign

A

Published 2004

Paramount in the management of patients with sepsis is the concept that sepsis is a medical emergency. As with polytrauma, acute myocardial infarction, and stroke, early identification and appropriate immediate management in the initial hours after development of sepsis improves outcomes

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8
Q

Define sepsis

A

Life-threatening organ dysfunction caused by a dysregulated host immune response

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9
Q

Define septic shock

A

End organ dysfunction or cellular/metabolic dysfunction caused by the dysregulated host immune response

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10
Q

Management of emergency surgery

A

1) A to E assessment and management
- fluids, antibiotics, oxygen, catheter, NG tube

2) Contact theatre coordinator and assess if space on CEPOD list
3) Escalate to registrar and inform of need for surgery
4) Book on CEPOD
5) G&S, cross-match
6) Inform anaesthetics for anaesthetic strategy
7) Book HDU beds/ post op level of care

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11
Q

Risk factors for abdominal aortic aneurysm

A

Old age

Male

Smoking

Hypertension

Atherosclerosis

Connective tissue disease: Marfans, Ehlers-Danlos

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12
Q

Abdominal aortic aneurysm screening programme

A

All men over age 65

<3cm –> discharge

3 - 4.4cm = 2 yearly follow-up

4.5 - 5.4 = 3 monthly follow-up

> 5.5 = repair

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13
Q

Differentials for macroscopic haematuria

A

Painless

  • bladder cancer
  • renal cell cancer ( + loin pain)
  • prostate cancer
  • renal parenchymal disease

Painful

  • renal stones
  • UTI/ pyelo
  • trauma: instrumentation or catheterisation
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14
Q

Management of painless haematuria

A

A –> E approach
-assess need for fluids and transfusion

Urine dip +MCS

ECG, bloods, PSA

Full examination including DRE

Three way catheter with washout +/- irrigation

Imaging: CT KUB, or intravenous urogram

Refer to urology: one-stop clinic triple assessment

  • CT KUB
  • Cystoscopy
  • Clinical examination
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15
Q

Management of renal cell carcinoma

A

MDT**: they will discuss in align with patient preference

Local tumours: nephrectomy

  • partial nephrectomy if one kidney
  • usually laparoscopic

Advanced tumours: immunotherapy

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16
Q

Define abscess

A

Pus-filled epitheliased cavity

17
Q

Define NCEPOD

A

National Confidential Enquiry into Postoperative Deaths is a government sponsored scheme which aims to reduce perioperative morbidity and mortality

18
Q

Define NCEPOD classification

A

4 level classification system used to categorise urgency of procedure

  1. Emergency
  2. Urgent
  3. Scheduled
  4. Elective
19
Q

NCEPOD classification of appendicectomy

A

NCEPOD classification = 2

URGENT

20
Q

NCEPOD classification 1

A

= EMERGENCY

A) Lifesaving

B) Limb or organ saving

Immediate surgery within minutes of deciding

e.g. 
Ruptured abdominal aortic aneurysm
Major trauma to abdomen/thorax
Fracture with major neurovascular deficit
Compartment syndrome
21
Q

NCEPOD classification 2

A

=URGENT

Acute onset or deterioration of condition that threatens life, limb, or organ. Or a procedure that fixes fractures and relieves distressing symptoms.

Hours of deciding

e.g.
Critical limb ischaemia
Compound fractures
Acute appendicitis
Perforated bowel with peritonitis
22
Q

NCEPOD classification 3

A

=SCHEDULED / EXPEDITED

Within days

Not life or limb threatening

23
Q

NCEPOD classification 4

A

= ELECTIVE

24
Q

Diagnostic intracompartmental pressure for compartment syndrome

A

> 40 mmHg

25
Q

Compartments of lower limb

A

Anterior

Lateral

Deep posterior

Superficial posterior

26
Q

Pain on passive dorsiflexion

A

= posterior compartments affected

27
Q

Pain on plantarflexion

A

= anterior compartment affected

28
Q

Acute compartment syndrome delta pressure

A

ACS delta pressure = diastolic blood pressure ‒ measured compartment pressure

ACS delta pressure <20 to 30 mmHg indicates need for fasciotomy (we use <30 mmHg)

29
Q

Normal size of small bowel and large bowel

A

3 6 9

<3cm = Small bowel

<6cm = Larger bowel

<9cm = Caecum

30
Q

Signs of strangulation

A

Persistent pain

Guarding

Peritonitis

Raised lactate

Leucocytosis

Tachycardia

Acidosis

31
Q

Valvulae conniventes

A

= small bowel

32
Q

Houstra

A

= large bowel

CST (2 decks)

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