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My Surgery > Pre operative care > Flashcards

Pre operative care Flashcards

1
Q

Preoperative check list

A 
Know Hx and physical findings
Check consent
Check bloods - all pt having GA need a FBC, Uand E, BSL, LFT's, urine dipstick, B HCG
Order antibiotics and DVT prophylaxis
CVS check - BP, Pulse, ECG. 
Medications - stop relative meds
Resp check exam, RFT 
Renal insufficiency - beware of dehydration
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2
Q

Specific intervention prior to surgery

A

Right patient
Right site
Right operation
Sources of sepsis - oral, urine, chest
Cigarette smoking and alcohol - stop 6 wks before
Obesity - 2wk crash diet meal substitution

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3
Q

Topics to cover in post operative handover

A 
Problems
Observations chart
Test results and X-rays
Fluid balance chart
Medication chart
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4
Q

Topic covered in post operative Ward round

A 
End of the bed
Nurses report
Hx and physical
Orders
Patient questions death with
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5
Q

Ways to sort out post op problems

A

First 24 hr - anaesthetic, medical, surgical
1-7 days - Surgical, medical, anaesthetic
7 - 30 days - Medical, surgical, social/domestic

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6
Q

Cause of unresponsive post operative pt in the first 24 hrs

A

Inadequate reversal
Drug interaction
Opiate overdose

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7
Q

Cause of shock in post operative pt in the first 24 hrs

A

Bleeding - anaesthetic or surgical
MI
Rare sepsis clostridial/strep epidural

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8
Q

Cause of Hypoxic in post operative pt in the first 24 hrs

A

Airway obstruction
Collapsed lung
Pneumothorax

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9
Q

Cause of febrile in post operative pt in the first 24 hrs

A

May be normal, lung collapse

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10
Q

Cause of febrile in post operative pt in the 1-7 days

A 
Chest infection
UTI
Wound infection
IV site 
Leak
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11
Q

Cause of Febrile and unstable in post operative pt in the 1-7 days

A 
Chest infection
UTI
Wound infection
IV site 
Leak
Severe sepsis
Beware complex wound infection
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12
Q

Cause of vomiting/distention in post operative pt in the 1-7 days

A

Acute Gastric dilatation
Intestinal Obstruction
Ileus
Pseudo-obstruction- OGilvie’s syndrome

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13
Q

Cause of Leg swelling in post operative pt in the 7-30 days

A

CHF

DVT

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14
Q

Cause of Chest pain in post operative pt in the 7-30 days

A

Lung collapse
Pneumonia
PE
MI

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15
Q

Cause of sepsis in post operative pt in the 7-30 days

A 
Wound
Chest
blood stream
Prosthesis
Urine
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16
Q

Cause of dehydration and or malnutrition in post operative pt in the 7-30 days

A

Poor slide or food intake

Unable to deal with stoma

17
Q 
M38, post total colectomy for CUcolitis
• Steady post-op deterioration. Now 6 hours postop-shocked and hypoxic despite oxygen by mask not responsive to fluids. No blood in drain, abdomen flat. Subclavian CVP low
• Hb 8, sats 90 on oxygen, GCS 14
• What investigation is crucial?
• What are you going to do?
A

Ix - Chest Xray

18
Q

A 75 year old woman has had a sigmoid colectomy. She has been coughing post- operatively, and has a post op ileus.
• You are asked to see her because a large volume of clear, slightly blood stained fluid has been discharged from an opening in the skin wound.
• What should you do, and what do you expect to find? What management?

A

?

19
Q

An elderly, frail lady living alone, 3 weeks after laparoscopic cholecystectomy is admitted via A&E, with dehydration, creatinine of 180, confusion and faecal incontinence.
• What do you think is happening?
• What treatments are required?
• How may have this been prevented?

A

?

20
Q

F34/Routine admission for LapChole
• Recent mild pain/Dark urine
• Has stopped all meds including OCP • Insists on Keyhole surgery only
LFT’s/ lipase abnormal/ Pregnancy test?/ Urgent US-CBD stone
What are you going to do?
What do you think the surgeons options are?
Are there implications for consent?

A

?

21
Q

M78-admit for resection Ca sigmoid
• Decreasing exercise tolerance
• Bilateral leg swelling
• Continuous dribbling urine
• Physical exam- JVP/S3/Basal creps/Pitting odema. Bladder palpable
• Tests-Hb9/creatinine up/ ECG recent change/BSL 18
What are your options?

A

?

22
Q

A 58 year old executive, recently divorced, has an incompletely excised BCC on the tip of his nose. The margins were positive on the deep surface and on one edge, and was histologically a micronodular BCC. He presents for re-excision and graft or flap
• Describe the consent process that may be required, and what issues you may need to discuss with the patient.

A

Re operation on tip of nose leads to conmectic defect. (hole in nose

23
Q

Things to ask on Hx and Ex for a pre operative patient

A 
Why having the surgery
PSHx
PMHx/Meds
FmHx
Ask about Heart, diabetes, Resp, endocrine, DVT, PVD.
Allergies
Clots
Cancer
Prothetics/dentures
Fluid
Assess surgical fitness
- exercise tolerance - 2 flights
- Prev anaesthetics
- MSK disorder
- Chronic disease + Mx  to optimise
Snap
- 6wks Wt loss
- Nutrient 
- Stop smoking
- Physical activity
24
Q

Ix for pre operative patient

A 
FBC
UEC
LFTs
Albumin
Group and hold
ECG, RFT, B12
B HCG
Folate and B 12 if needed
ECG
Imaging if require
25
Q

Prophylaxis ABX of surgery

A

Cephazolin

Cephazolin and metronidazole

26
Q

Medications to stop prior to surgery

A

Warfarin 5 days prior and consider bridge
NOACS - 3 days no bridging
AntiPLT - Aspirin day off, Clopidogrel 7-10 days prior
Clexane - skip morning dose
Metformin - stop 24 hr prior (lactic acidosis)
Diuretic - Day before
NSAIDs - Stop the day before
Steroids - depends on disease. If it can’t be stopped then switch to hydrocortisone

27
Q

Antidotes for the following

  • Warfarin
  • Heparin
  • Dabigatran
A

Warfarin - Vit K FFP or prothrombin X
Heparin - protamine sulfate
Dabigatran - MAB

28
Q

Pre operative Anaesthetics check

A 
ASA 1-6
Malampatti 1-4
Dentures
Prev Hx anaesthics reaction
Neuromuscular disorders
Endocrine disorders
Liver/heart disorder
RA, Scodiosis and ankylosing Spondylitis
Different types of anaesthetics

My Surgery (8 decks)

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