Pre-op and Post-op care Flashcards
2 CV contraindications for surgery
besides those, what is the 1 other thing that’s signficiant in Goldman index for assessing operative risk?
EF <35% (increased JVD)
MI within 6 months
arrhythmia
what is the single worst finding predicting high cardiac risk? how to treat this if you rlly must operate? (4 meds)
JVP distention
tx: ACEI’s, BB, Digoxin, diuretics
if person has smoking or COPD, how do you assess their operative risk?
how do you decrease that risk?
start with FEV1. if abnormal -> blood gases.
need to stop smoking 8 weeks prior to surgery + intensive respiratory therapy
the 2 clinical findings and 3 lab values used to predict hepatic risk of operative mortality
what is % mortality if any one of these are positive?
- ascites
- encephalopathy
- bilirubin
- albumin
- PT/INR
40% mortality rate if any ONE is abnormal
% operative mortality if MI within 3 months?
at 6 months?
40% at 3 months
6% at 6 mo
malnutrition is defined as any one of the following: loss of body weight >20% within few months, serum albumin < 3, anergy to skin antigens, or serum transferrin <200 mg/dL. what is tx for this?
oral nutrition if possible (IV if not) 5-10 days. the longer the better.
if pt has decreased albumin, what can you measure to determine if it’s nutritional problem vs liver problem?
prealbumin & CRP (other proteins in your body, albumin is a precursor).
if these are low, it’s nutritional problem (overall not enough protein)
if they are normal but albumin is low, it’s a liver problem (liver’s just not making enough albumin but you have enough protein overall in your body)
so pt doesnt have any cardiac pulmonary hepatic or nutritional risk factors. WHATS THE OTHER THING YOU NEED TO CHECK THOUGH
blood glucose and blood gases.
anyone with increased blood glucose or in DKA can’t get surgery.
malignant hyperthermia can develop after giving _______ or succinylcholine. what is tx? what do you have to watch out for?
IV dantrolene, 100% O2, cooling blankets, correction of acidosis. watch for development of myoglobinuria (f/u with UA)
what complication if pt gets fever 30-45 mins (or even a few hours) after surgery?
tx?
bacteremia. you may have punctured bowel, or possibly gas gangrene in surgical wound
tx: get blood culture + start empiric abx
pt has fever Post op day 5. what do you look for? what study? tx?
ultrasound legs/doppler studies of deep leg and pelvic veins. concern for DVT (if pt also in respiratory distress look at lungs for PE days 5-7)
tx: heparin bridge to warfarin
post op day numbers for wind wind water walking wound wound?
1 wind (atelectasis) 3 wind (pneumonia) 3 water (UTI) 5 walking (DVT/PE) 7 wound (wound infection) 10-15 wound (deep abscess)
specific abx for catheter related UTI (CAUTI)
cepftriaxone
take out catheters asap except when?
if they were there before the surgery
prophylactic abx for hospital acquired pneumonia? (2)
vancomycin
pip/tazo
what study to distinguish if abscess is present or not or if it’s just a wound infection? (post op day 7) tx?
ultrasound. tx is abx if just infection. need to drain too if abscess present (erythematous and BOGGY, plus ultrasound confirm)
note this is different from suspecting deep abscess. (post op fever day 10-15) in which CT would dx. pt probs needs to go back to surgery to drain it. or percutaneous drainage.
what drugs are NOAC? (involved in heparin bridge to warfarin)
apixiban, rivaroxaban, apixiban
what will you see on EKG when pt is having MI? (in this context, perioperative. within first 2-3 post op days)
what is most reliable dx test? tx?
ST depression
T wave flattening
dx by troponin levels
perioperatively canNOT use clot busters (tPA). must use angioplasty or stent + supportive tx
dx and tx of PE
dx: CT angio (spiral CT with IV contrast)
tx: anticoag = heparinization. also need to add vena cava filter if PE recurs or if heparin/anticoag is contraindicated
prophylaxis for DVT and PE (3)
- scheduled heparin or other anticoagulation
- sequential compression devices
- WALKING
intraoperatively, pt all of a sudden becomes more difficult to bag. BP declines. CVP rises.
what is next step? whats going on?
intraop tension pneumothorax (pt will have had recent lung trauma and/or broken ribs)
tx: decompression through diaphragm if abdomen is open. otherwise needle through chest wall. put in chest tube later.
post op patient suddenly gets confused and disoriented. what is your #1 and #2 diff dx and thus what tests?
1. hypoxia. check blood gases and give respiratory support
post op day 2-3 gets delirious, hallucinations, combative. what’s going on? (their blood gases and white count are normal) what is treatment?
delirium tremens. alcohol withdrawal.
tx: benzodiazepines. or IV alcohol (5% alcohol in 5% dextrose) or just oral alcohol
giving IVF D5W to a postop or trauma patient. suddenly they get confusion, convulsions. maybe even fall into a coma. next step?
check electrolytes, may have hyponatremia bc you didn’t have Na in the IVF. give some hypertonic saline, +/-osmotic diuretics
