Post Operative Management Flashcards
Factors which are likely to lead to renal failure post op? (7)
Elderly, PVD, High BMI, COPD, Vasopressors, Nephrotoxics, Emergency operation
Malnourishment is described as
BMI<18.5, unintentional loss>10% 3 months, BMI <20 and weight loss 5% over 3 months
2 main sites bleeding post colorectal surgery
Spleen and pre sacral veins
How are low anterior resections routinely defunctioned?
Loop ileostomy
Which area has the lowest leak rate?
Ileocolic and small bowel anastomosis
Name a depolarising neuromuscular blocker
Suxamethonium
What electrolyte effect can suxamethonium have?
increase K
Deficiency in which enzyme effects breakdown of suxomethonium?
pseudocholinesterase
Which muscle relaxant releases histamine?
atracarium
First line for neuropathic pain?
amitriptyline / pregabalin
How do you treat acute dystonic reaction?
procyclidine
Benefits of propofol?
antiemetic, rapid anaesthesia
FEV1/FVC for obstructive
<70%
FEV1/FVC for restrictive
> 70%
What is the main factor in cryoprecipitate?
Factor 8
Massive transfusion complications (6)
Hypothermia, Hypocalcaemia, Hyperkalaemia, Delayed transfusion reaction, Transfusion related lung injury, Coagulopathy
How should t1dm and their insulin be managed perioperatively?
insulin in t1dm should not be stopped and omission of 1 meal is likely to require a variable rate insulin infusion
Which drug is used in a HER2+ve breast cancer?
Tranlizumab - herceptin
What amount of Na and K is require daily?
50-100mmol of Na and 40-80mmol K, 1.5-2.5L of fluid
What is the tacklers triad for boerhaaves syndrome?
vomiting, thoracic pain, surgical emphysema
What is used to reverse intravenous heparin?
protamine sulphate
What is used to reverse warfarin?
octaplex/ prothrombin complex concentrate
What local anaesthetic is used for a biers block?
prilocaine
What does LMWH work on?
Factor 10a (Xa)
What is the best technique to destroy TB spore?
autoclaving
What material is used for a t-tube post CBD exploration?
latex on passive drainage
What is the cause of peptic and duodenal ulcers in H-Pylori?
increased acid production - leads to peptic/ duo ulcers
What is a litchenstein mesh repair?
Hernia open repair - mesh sutured to posterior wall of inguinal canal
What is the best way to defunction following an emergency rectal cancer operation?
loop colostomy - so CT and staging can take place
What features will show on endoscopy with h-pylori?
NONE
What is the best way to defunction a low anterior resection?
Loop ileostomy
What day post op is most likely to have a burst abdomen?
6
What is the best closure for a diabetic ray amputation?
vacum assisted closure system
What is a non suction surgical drain called?
Wallace Robson drain
