Pre Peri and Postop Care Flashcards

1
Q

Prophylactic Abx:

  • when are these administered?
  • MC abx given
  • which Abx are good for gram negative anaerobic pathogens?
A

When: administered 60 min before incision

MC abx is Cefazolin (Ancef)

Gram negative, anaerobic: cefotetan, cefoxitin, ceftizoxime
*Each of these with or w/o metronidazole.

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2
Q

What is the MC preventable cause of death peri-post operatively?

What is the Caprini score used for?

A

Pulmonary embolism.

Caprini used in assessment of Thromboembolic dz, based upon scoring it places you in either very low, low, moderate, or high risk.

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3
Q
how do we prevent thromboembolic events in: 
-very low
-low risk 
-moderate 
-high 
-very high 
patients?
A

Very Low: early and frequent ambulation

Low: mechanical methods (teds, compression stockings, foot pumps)

Moderate & high: pharmacological

Very high: pharmacological and mechanical

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4
Q

Which medications are commonly used in thromboembolic dz prophylaxis?

T/F, IVC filter can be used in thromboembolic dz prophylaxis?

A

LMW heparin preferred in high risk pts

Low dose UFH

Warfarin

Aspirin

True. Only used with absolute CI to anticoagulation or failure to adequate anticoagulation.

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5
Q

Definition of Surgical site infection.

Risk factors of surgical site infection?

Presentation of surgical site infection?

A

SSI: an infection related to an operation that occurs at or near the surgical incision within 30days of the procedure or within 90 if an implant is used.

RIsk factors:

  • surgical technique
  • prolonged surgery time
  • instrument sterilization
  • preop prep
  • thermoregulation/glycemic control
  • Medical condition of pt
  • surgical environment (traffic, cautery, prosthesis, blood transfusion)

Presentation:

  • localized erythema
  • induration
  • warmth
  • pain
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6
Q

Surgical site infection Tx

A

Tx: prophylactic abx

  • debride infected wounds & give abx
  • Abx usually - clindamycin, vancomycin, ampicillin
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7
Q

Wound complications: Hematoma/Seroma

  • what is this?
  • consequences
  • presentation
  • tx
  • prevention
A

What: collection of blood or serum under the incision

Consequences: wound separation and infection

Presentation:
-pain and swelling a few days after surgery

Tx:

  • percutaneous drains
  • wound exploration (packed and healed by secondary intention)

Prevention:

  • closure of dead space
  • meticulous hemostasis
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8
Q
Wound Complications: 
Fascial Dehiscence 
-what is this? 
-complication 
-risk factors 
-cause 
-presentation 
-tx 
-prevention
A

What: abdominal wall tension overcoming tissue or suture strength THIS IS AN EMERGENCY

Complication: incisional hernia

Risk factors:

  • age
  • males
  • COPD (coughing)
  • ascities

Cause:
failure to remain anchored, knot failure, or large stitch intervals.

Presentation:

  • profuse serosanguinous drainage
  • popping sensation with abd buldge

Tx: closure in the OR.

Prevention: internal or external retention sutures.

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9
Q

What is primary intention wound healing?

Secondary intention?

A

Primary Intention: wound closed with stitches or staples and covering it with sterile dressing.

Secondary intention: epidermis and dermis not closed. Packed daily to every other day w/ saline moistened gause and covered with a sterile dressing.

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10
Q

Pulmonary complications of surgery?

A
  • Hypoventilation
  • Pneumonia (infection)
  • Atelectasis
  • Prolonged mechanical ventilation & resp failure
  • Exacerbation of underlying chronic lung dz
  • Bronchospasm
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11
Q

Who is high risk for pulmonary complications after surgery?

Procedure-related risk factors associated with Pulmonary complications?

A
  • Greater than 50YO
  • COPD
  • Asthma
  • Smoking greater than 20 pack year hx
  • general health status:
  • -CHF increases risk
  • -URI- best to postpone elective surgery until resolved.

Risk facotrs:

  • surgical site: abdominal and thoracic
  • duration of surgery: greater than 3-4hrs
  • Type of anesthesia: general
  • Type of neuromuscular blockade: using long acting agent
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12
Q

Post-op Fever:

  • considered fever at what temp?
  • cause
  • -what are the 5Ws?
  • -how many days post op can you expect each of the Ws?
A

Fever greater than 38C in the 1st few days after major surgery

Cause: most are caused by inflammatory stimulus of surgery and resolves spontaneously

5W:

  • wind (d1-2) (pna, aspiration)
  • water (d3-5) (urinary tract, indwelling catheter)
  • walking (d4-6) (venous thrombosis, PE)
  • wound (d5-7) (site infections)
  • wonder drugs (d7+) (drug fever, infection related to IV lines)
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13
Q

What are some medications that cause fever?

A

Antimicrobials: PCN, Cephalosporins, FQ…all of them.

CV meds:

  • Thiazide
  • Lasix
  • Hydralazine

Anticonvulsants:
-Phenytoin

Other:

  • UFH
  • salicylates
  • NSAIDS
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14
Q

Treatment of post-op fever?

A

Remove unnecessary tx including medications and catheters

Suppress fever with tylenol

Abx per clinical judgement

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15
Q

Malignant Hyperthermia:

  • what is this?
  • cause
  • signs of hypermetabolism
A

What: an uncommon and sometimes life-threatening rxn to some anesthetic agents

Cause:

  • deploarizing muscle relaxants (Anectine)
  • gases in anesthetic machine (halothane, isoflurane, enflurane, desflurane, sevoflurane)

Signs:

  • hypercarbia (most sensitive indicator of potential MH in the OR)
  • skeletal muscle rigidity (most specific sign)
  • tachycardia
  • tachypnea
  • high temperature (usually late sign)
  • hypertension
  • cardiac dysrrhthmias
  • acidosis
  • hypoxemia
  • hyperkalemia
  • myoglobinuria
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16
Q

Malignant HTN:

  • pathophys
  • what is the most dangerous triggering agent?
  • tx
A

Pathophys:

  • genetic predisposition
  • increased intracellular calcium
  • continuous muscle contraction

Succinylcholine is the most dangerous.

Tx:

  1. call for help
  2. Stop triggering agents
  3. hyperventilate pt with 100% O2
  4. Finish or abort procedure
  5. Administer dantrolene (muscle relaxer)
  6. Cool patient
  7. Monitor and treat acidosis
  8. Promote urine output (lasix, mannitol)
  9. Treat hyperkalemia (Insulin + D50W)
  10. Treat dysrhythmias with procainamide and calcium chloride
  11. Monitor creatinine kinase, urine myoglobin, and coagulation for 24-48hrs
17
Q

Surgical Care Improvement Project (SCIP)::

-goal

A

goal: reduce preventable surgical morbidity and mortality

18
Q

What are the SCIP measures:

  • 1
  • 2
  • 3
  • 4
  • 6
  • CARD-2
  • VTE-2
  • 9
  • 10
A

1: pre-op abx given within 1hr before incision
2: must recieve SCIP recommended prophylactic abx (ancef or possibly vanco if gut)
3: d/c abx within 24hrs of anesthesia end time
4: Controlled 6am postoperative serum glucose (Cardiac only)
6: appropriate hair removal (Clipping)

CARD 2: perioperative beta blocker therapy for pre B blocker Rx

VTE2: VTE prophylaxis within 24hrs prior to or after anesthesia end time.

9: remove urinary catheter by postop day 2
10: temperature greater than 96.8 (36C) 15 minutes after anesthesia end time.