Post-operative medicine Flashcards
What is pulmonary artery occlusion pressure?
indirect measure of left atrial pressure, and thus filling pressure of the left heart.
What is a normal PAOP?
8-12mmHg
what does low PAOP mean?
<5
hypovolaemia
What does low PAOP with pulmonary oedema mean?
<5 ARDS
What does high PAOP mean?
> 18
overload
What does ASA I mean?
No organic physiological, biochemical or psychiatric disturbance. The surgical pathology is localised and has not invoked systemic disturbance
What does ASA II mean?
Mild or moderate systemic disruption caused either by the surgical disease process or though underlying pre-existing disease
What does ASA III mean?
Severe systemic disruption caused either by the surgical pathology or pre-existing disease
What does ASA IV mean?
Patient has severe systemic disease that is a constant threat to life
What does ASA V mean?
A patient who is moribund and will not survive without surgery
Which anaesthetic agent is associated with hepatotoxicity?
Halothane
How is TPN best administered?
Internal jugular vein via central venous catheter
for feeding < 14 days consider feeding via a peripheral venous catheter
for feeding > 30 days use a tunneled subclavian line
Which patients are at risk of malnutrition?
eaten nothing or little > 5 days, who are likely to eat little for a further 5 days
poor absorptive capacity
high nutrient losses
high metabolism
which patients are malnourished?
BMI < 18.5 kg/m2
unintentional weight loss of > 10% over 3-6/12
BMI < 20 kg/m2 and unintentional weight loss of > 5% over 3-6/12
ECG features in hyperkalaemia?
Peaking of T waves (occurs first)
Loss of P waves
Broad QRS complexes
Ventricullar fibrillation
What does TPN contain?
glucose, lipids and essential electrolytes, the exact composition is determined by the patients nutritional requirements.
Complications of TPN?
sepsis, re-feeding syndromes and hepatic dysfunction.
Pulmonary function tests in obstructive lung disease?
FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced (less than approx. 70%)
Pulmonary function tests in restrictive lung disease?
FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased (over approx. 70%)
Examples of obstructive lung disease?
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
Examples of restrictive lung disease?
Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis
Neuromuscular disorders
Which muscle relaxant is an agent that is degraded by hydrolysis and may produce histamine release?
atracurium
Negative side effects of etomidate?
adrenal suppression
Post operative vomiting is common
Complications of using dextran?
Dextran 40 and 70 have higher incidence of anaphylaxis than either gelatins or starches
What is typically used to monitor cardiac output?
Swan Genz catheter
Swan-Ganz catheter can measure several variables it can be used to calculate:
Stroke volume
Systemic vascular resistance
Pulmonary artery resistance
Oxygen delivery (and consumption)