Pre/Peri/Post Op Care

Question 1

Selection of antibiotics

Answer 1

Most commonly given drug:
Cefazolin (Ancef, Kefzol)
Gram-neg and anaerobic pathogens:
Cefotetan
Cefoxitin
Ceftizoxime
Each with or without metronidazole (Flagyl)

Question 2

Thromboembolic disease medications

Answer 2

LMW heparins preferred in high risk patients
Low dose Unfractionated heparin (UFH)- alternative for renal failure
Warfarin: Alternative to LMW/UFH
Aspirin

Question 3

Primary Intention Wound Healing

Answer 3

Wound closed with stitches or staples
Covered w/ sterile dressing
May drain a small amount of blood or serosangueness fluid
Generally kept protected from getting wet with a plastic cover for 2-10 days depending on wound site, if allowed to get wet—shower only, no bathtub or hot tub
Monitor for erythema, swelling, warmth and drainage

Question 4

Secondary Intention Wound Healing

Answer 4

Epidermas and dermas not closed, sometimes other layers not closed allowed to granulate in
Usually if there has been contamination, an infected wound, peritonitis
Has to be packed daily to every other day w/ saline moistened gauze or sponges and covered w/ a sterile dressing

Question 5

Post-op fever 6 W’s

Answer 5

Wind: day 1-2
Water: day 2-3
Wound: day 3-5
Walking: day 5-7
W abscess: day 7-10
Wonder drugs: anytime other etiologies 				have been ruled out

Question 6

Malignant Hyperthermia

Answer 6

An uncommon and sometimes life-threatening reaction to some anesthetic agents. 
Unsafe drugs:
Depolarizing muscle relaxants (Anectine) 
Potent inhalational agents:
Halothane
Isoflurane
Enflurane
Desflurane
Sevoflurane

Question 7

Malignant Hyperthermia Clinical Manifestations

Answer 7

Signs of hypermetabolism
Hypercarbia (the most sensitive indicator of potential MH in the OR)
Skeletal muscle rigidity (the most specific sign)
Tachycardia
Tachypnea
High temperature (usually a late sign of MH)
Hypertension
Cardiac dysrhythmias
Acidosis
Hypoxemia
Hyperkalemia

Question 8

Malignant Hyperthermia Treatment

Answer 8

Dantrolene
Succinylcholine (probably the most dangerous "triggering agent") should be avoided in caring for this patient.

Question 9

Surgical infection prevention

Answer 9

Antibiotics:
Administration within one hour before incision
Use of antimicrobial recommended in guideline
Discontinuation within 24 hours of surgery end
Glucose control in cardiac surgery patients
Proper hair removal
Normothermia in surgery patients

Question 10

Perioperative cardiac events

Answer 10

Perioperative beta blockers in patients who are on beta blockers prior to admission