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Surgery > Pre-op/Post-op > Flashcards

Pre-op/Post-op Flashcards

1
Q

Under what ejection fraction is surgery contraindicated

A

EF < 35%

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2
Q

What is single most predictive risk factor for preoperative heart complications

A

Jugular vein distension

Give ACEIs, beta-blockers, digitalis and diuretics before operating

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3
Q

What is the approach to pt with recent transmural or subendocardial MI

A

Non-emergent: delay surgery 6 months

Emergent: admit to SICU day before surgery

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4
Q

What causes increased pulmonary risk, how is it approached

A

Smoking

Cessation 8 weeks pre-op, intensive respiratory therapy

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5
Q

Hepatic risk factors for mortality

A

Increased bilirubin
Decreased albumin
Increased PT
ascites, encephalopathy

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6
Q

For how long must nutritional depletion be corrected before surgery

A

Ideally 7 days via the gut

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7
Q

What components of diabetic coma must be corrected before surgery

A

Rehydration
Return of urinary output
Acidosis
Hyperglycemia

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8
Q

Tx for malignant hyperthermia

A

IV dantrolene
100% O2
Correction of acidosis
Cooling blankets

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9
Q

Tx for intraoperative bacteremia (45 mins into surgery temp spikes to 104 with chills)

A

Blood cultures x 3

Empiric antibiotics

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10
Q

Post-op fever day 1 and tx

A

Atelectasis

Bronchoscopy

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11
Q

Post-op fever day 3 with infiltrates on CXR

A

Pneumonia

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12
Q

Post-op fever day 3 with negative CXR

A

UTI

order urine cultures and UA

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13
Q

Post-op fever day 5 and tx

A

Deep thrombophlebitis
Anticoagulate with heparin

Dx by deep leg and pelvic doppler

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14
Q

Post-op fever day 7 and tx

A

Wound infection
antibiotics if cellulitis, I&D if abscess

Dx best by ultrasound

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15
Q

Post-op fever day 10-15 and tx

A

Deep abscess
Percutaneous radiographically guided drainage

Dx by CT

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16
Q

Cause of peri- and post-operative MI and tx

A

Peri: hypotension
Most commonly 2-3 days postop

Tx includes angioplasty and stents

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17
Q

Acute shortness of breath post-op day 7

Tx?

A

Pulmonary embolism

Heparinization, IVC filter if recurrent or if anticoagulation is contraindicated

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18
Q

Tx for aspiration

A

Bronchoscopic lavage, bronchodilators and respiratory support

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19
Q

Tx of intraoperative tension pneumothorax

A

Decompression through diaphragm or anterior chest wall
Chest tube

Can occur while bagging pt with lung trauma

20
Q

Seen in patients with difficult post-op course

Precipitating event usually sepsis

A

ARDS

21
Q

Tx for ARDS

A

PEEP without excessive volume

Correct sepsis

22
Q

Post-op day 2-3 confusion, combativeness and hallucinations

Tx?

A

Delirium tremens

IV benzodiazepines

23
Q

Confusion, convulsions, coma, death in a pt who received D5W and had high levels of ADH
Tx?

A

Hyponatremia/water intoxication

Can give small amounts of hypertonic saline and osmotic diuretics but this is controversial

24
Q

Large unreplaced urinary losses
Rapid weight loss
Rising serum sodium in pt with confusion, lethargy, coma
Tx?

A

Hypernatremia

Tx is D5 with 1/2 or 1/3 NS

25
Q

Etiology of hypernatremia

A

Unrecognized surgical damage to posterior pituitary (iatrogenic diabetes insipidus)
Unrecognized osmotic diuresis

26
Q

Coma in a cirrhotic patient with bleeding esophageal varices who undergoes portocaval shunt

A

Ammonium intoxication

27
Q

Cause of zero urine output

A

Usually plugged or kinked catheter

28
Q

Cause of low urine output (< 0.5mL/kg/h)

A

Dehydration

Acute renal failure

29
Q

How do you differentiate causes of low urine output

A

Measure fractional excretion of sodium

>1 is renal failure

30
Q

Painless abdomen, mild distension

No bowel sounds, no passage of gas

A

Paralytic ileus

31
Q

Ileus after post-op day 5, 6, 7

CT shows transition point between dilated proximal bowel and distal collapsed bowel

A

Early mechanical bowel obstruction

Due to adhesions

32
Q

What is Ogilvie syndrome

A

Paralytic ileus of the colon

In sedentary elderly patients who have become further immobilized

33
Q

Dx and tx of Ogilvie syndrome

A

Massively dilated colon on Xray or endoscopy and rule out obstruction
tx with IV neostigmine or long rectal tube

34
Q

Salmon-colored fluid soaking dressings after post-op day 5 of open laparotomy

A

Wound dehiscence

35
Q

Tx of evisceration (complication of wound dehiscence)

A

Bed rest, cover bowel with large sterile saline-soaked dressings, emergency abdominal closure

36
Q

Tx for GI fistulas

A

Fluid and electrolyte replacement
Nutritional support
Protection of the abdominal wall while fistula heals naturally

37
Q

Etiology and tx of hypokalemia

A

Loss from GI and urinary fluids (slowly)
Correction of DKA (rapidly)

Potassium replacement 10 mEq/h

38
Q

Etiology and tx of hyperkalemia

A 
Renal failure (slowly)
Crushing injuries, acidosis (rapidly)

IV calcium, exchange resins, NG suction, insulin and glucose, eventual dialysis

39
Q

Etiology of metabolic acidosis

A

DKA, lactic acidosis, loss of buffers from GI, renal failure

40
Q

In what acidotic state is anion gap unchanged

A

Loss of buffers from GI tract

41
Q

Tx of metabolic acidosis

A

Correct underlying problem

Potassium replacement

42
Q

Tx for metabolic alkalosis

A

KCl 5-10 mEq/h

NH4Cl rarely needed

43
Q

Tx for respiratory alkalosis and acidosis

A

Improve ventilation in acidosis

Reduce ventilation in alkalosis

44
Q

How long should aspirin be withheld before surgery?

NSAIDs

A

Aspirin 7-10 days

NSAIDs 2 days

45
Q

Preop management of obese patient

A

ABG, PFTs with bronchodilators

Epidural anesthesia aggressive postoperative pulmonary care

46
Q

How does CABG affect preop cardiac risk

A

<5 years will decrease risk

At 10 years 50% are again occluded and no benefit is achieved

Surgery (17 decks)

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