Pre And Perioperative Flashcards
unfrictioneted heparin overdose
Give protamine sulphate
DVT complication develops in
The following surgical patients are at increased risk of deep vein thrombosis:
Surgery greater than 90 minutes at any site or greater than 60 minutes if the procedure involves the lower limbs or pelvis
Acute admissions with inflammatory process involving the abdominal cavity
Expected significant reduction in mobility
Age over 60 years
Known malignancy
Thrombophilia
Previous thrombosis
BMI >30
Taking hormone replacement therapy or the contraceptive pill
Varicose veins with phlebitis
Dehydration diagnosis
Diagnosing dehydration can be complicated, laboratory features include:
Hypernatraemia
Rising haematocrit
.Metabolic acidosis
Rising lactate
Increased serum urea to creatinine ratio
Urinary sodium <20 mmol/litre
Urine osmolality approaching 1200mosmol/k
Postoperative optimi urine output is
0,5ml/kg/hr
Postoperative oliguria is
<30ml/hr for 4 consecutive hours
Bupivacaine and lidocaine dosage with and without adrenaline
Bupivcaine without is 2mg/kg and with is 3mg/kg
Lidocaine without is 3mg/kg ND with is 7mg/kg
Amaximum dose of lidocaine in adults is
200mg
Thus if according to weight the dosage is more than we will not increase it to more than 200
CABG is preferred in
The guidelines state that CABG is the preferred treatment in high-risk patients with severe ventricular dysfunction or diabetes mellitus.
which is the excellent conduit for coronary artery bypass
internal mammary artery is an excellent conduit for coronary artery bypass
Indications for CABG
Left main stem stenosis or equivalent (proximal LAD and proximal circumflex)
Triple vessel disease
Diffuse disease unsuitable for PCI
Incisions for CABG
Midline sternotomy or left sub mammary incision
What happens when both IMA are used for bypass
Use of both is associated with increased risk of sternal wound dehiscence
Perioperative risk for CABG is calculated by
Perioperative risk is quantified using the Parsonnet and Euroscores and unit outcomes are audited using this data.
Among all structure which arebehind sternum, which needs to be divided
The interclavicular ligament lies at the upper end of a median sternotomy and is routinely divided to provide access
fibrocartilage
risk factors for recurrent Venous thromboembolism
SIGN also state that the following are risk factors for recurrent VTE:
previous unprovoked VTE
male sex
obesity
thrombophilias
Which antipsychotics causes VTE
Olanzapine
Drugs causing VTE
Medication
combined oral contraceptive pill: 3rd generation more than 2nd generation
hormone replacement therapy
raloxifene and tamoxifen
antipsychotics (especially olanzapine) have recently been shown to be a risk factor
Swinging pyrexia in
Anastomotic leak
Central line sepsis
Groin lines and those for TPN have the highest risk of central lin sepiai
Most common site of aortic dissection
Ascending aorta
Stanford classification of Aortic dissection
Type A: Proximal to subclavian
Type B: Distal to subclavian
Rx of aortic dissection
Proximal (Type A) lesions are usually treated surgically, type B lesions are usually managed non operatively
a popular choice drug in managing complex peri anal Crohns
Infliximab