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Surgery > preop > Flashcards

preop Flashcards

1
Q

informed consent

A

transfer of info between physician and pt that allows the pt to make a knowledgeable decision about a particular tx

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2
Q

informed consent

A

transfer of info between physician and pt that allows the pt to make a knowledgeable decision about a particular tx

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3
Q

consent form

A

legal documentation of these discussions between the physician and the pt

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4
Q

surrogate decision maker

A

person empowered to make decisions for a patient who is not competent to do so

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5
Q

advance directive

A

a mentally capable pt/s instructions regarding his or her medical care if he or she becomes incapacitated and unable to make decisions

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6
Q

beta blockers

A

Abrupt discontinuation can increase risk of Ml;

With a sip of water a few hours before operation;

Parenteral agent until taking p.o.

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7
Q

atrial antiarrhythmics

A

With a sip of water a few hours before operation;

IV ß-blockers, diltiazem or digoxin until p.o. intake resumed

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8
Q

ventricular antiar

A

Monitor Mg, K, and Ca levels preoperatively;

With a sip of water a few hours before operation;

Parenteral amiodarone or procainamide

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9
Q

nitrates

A

Transdermal (paste, patch) may be poorly absorbed intraoperatively;

With a sip of water a few hours before operation;

Intravenous (most reliable) or transdermal until p.o. intake resumed

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10
Q

antihtn

A

Abrupt discontinuation of clonidine can cause rebound hypertension;

With a sip of water a few hours before operation;

Parenteral antihypertensives; if on clonidine, consider clonidine patch or alternative antihypertensive agents

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11
Q

insulin

A

5% dextrose solutions should be given intravenously intra- and postoperatively in patients receiving insulin;

Yi dose usual long-acting agent at the usual time preoperatively;

SSI until p.o. intake back to baseline

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12
Q

oral agents for DM

A

hold am of operation;

ssi until po intake back to baseline

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13
Q

metformin

A

Can produce lactic acidosis, particularly in the setting of renal dysfunction or with administration of IV radiographic contrast agents;

Hold for at least 1 day preoperatively;

Monitor renal function closely. Resume metformin when renal function normalizes, usually 2–3 days postoperatively. SSI until then.

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14
Q

aspirin, clopidogrel, ticlopidine

A

dc 7 days preop;

resume when diet resumed

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15
Q

warfarin

A

Hold until INR normalizes, usually 3–5 days. If anticoagulation critical, maintain anticoagulation with heparin;

Resume when diet resumed

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16
Q

heparin

A

Discontinue 4 hr preoperatively;

Resume 6–12 hr postoperatively, provided no increased risk of hemorrhage thought to exist

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17
Q

levothyroxine

A

held few days preop;

parenterally until diet resumed

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18
Q

estrogen

A

stop 4 wk prior to cases w high risk dvt

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19
Q

ample

A

allergies, medications, past medical hx, last meal, events preceding the emergency

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20
Q

baseline ekg

A

men >40 and women >50; symp cariovasc ds, htn, or dm

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21
Q

Dripps-American Surgical Association Classification: to quantify surgical risk

A
  1. healthy
  2. mild-mod systemic ds
  3. severe
  4. life threatening
  5. no expected to survive
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22
Q

cardiac risk index

A

high risk surgery, hx ischemic heart ds, hx chf, hx cerebrovasc ds, preop tx w insulin, preop serum cr >2

total up the number:

  1. 0risk
  2. 1 risk
  3. 2 risks
  4. more than 2 risks
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23
Q

METs class 1

A

Activity requiring >6 METs

Carrying 24 lb up eight steps

Carrying objects that weigh 80 lb

Performing outdoor work (shoveling snow, spading soil)

Participating in recreation (skiing, basketball, squash, handball, jogging/walking at 5 mph)

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24
Q

METs class 2

A

Activities requiring >4 but not >6 METs

Having sexual intercourse without stopping

Walking at 4 mph on level ground

Performing outdoor work (gardening, raking, weeding)

Participating in recreation (roller-skating, dancing fox trot)

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25
Q

METs class 3

A

Activity requiring >1 but not >4 METs

Showering, dressing without stopping, stripping, and making bed

Walking at 2.5 mph on level ground

Performing outdoor work (cleaning windows)

Participating in recreation (golfing, bowling)

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26
Q

METs class 4

A

no activity requiring >1met; can’t carry out any activities

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27
Q

1 met represents an oxygen consumption of

A

3.5ml/kg/min

(avg for resting 70kg man)

hr of 100bpm=4mets

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28
Q

when should smokers stop smoking before a procedure

A

6w

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29
Q

procedure related risk factors for postop pulm compl

A

surgical site (thoracic, upper abd), duration (3-4hr), anesthesia technique (general, spinal, and epidural)

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30
Q

periop mc cause of AKI is secondary to

A

acute tubular necrosis

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31
Q

goal in periop manage of pts w CKD or AKI

A

maintenance of euvolemia and renal perfusion

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32
Q

serum potassium levels should be blank before surgery

A
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33
Q

someone on ACE and angiotensin 2 for CKD should stop them when

A

10hrs before general anesthesia to reduce risk of post induction hypotension

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34
Q

what are essential records for postop CKD pts

A

daily weights and I&Os

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35
Q

when should pt be dialyzed before surgery

A

within 24hr of surgery

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36
Q

periop management of pts w diabetes

A
  1. Insulin is available in several types and is typically classified by its length of action. Rapid-acting and short-acting insulin preparations are usually withheld when the patient stops oral intake usually at midnight the day before surgery. Intermediate-acting and long-acting insulin preparations are administered two-thirds the normal evening dose the night before surgery and half the normal morning dose the morning of surgery. Long-acting oral agents are stopped 48 to 72 hours before surgery, while short-acting agents can be withheld the night before or the day of surgery.
  2. The ideal method of providing insulin in the perioperative period is debatable. Any regimen should however (1) maintain adequate glycemic control to avoid hyperglycemia or hypoglycemia; (2) prevent metabolic disturbances; (3) be easy to understand and administer. The patient should receive a continuous infusion of 5% dextrose to provide 10 g glucose/hour. Fingerstick glucose levels are monitored intraoperatively and followed postoperatively at least every 6 hours. The goal is to maintain a glucose level of between 120 and 180 mg/dL. It is generally considered preferable to have the patient at the higher end of this range because of the adverse consequences of hypoglycemia. Sliding scale use of subcutaneous insulin has been the standard method of glucose control in surgical patients. Alternatively, intravenous insulin can be used with a continuous infusion of 1 to 3 units/hour of intravenous insulin being given. This approach is particularly helpful in the brittle diabetic. In the postoperative period, close attention should be paid not only to the patient’s blood sugar, but also to the patient’s carbohydrate intake.
  3. Diabetic ketoacidosis (DKA) can develop in patients with either type I or type II diabetes. DKA is deceptively easy to overlook because it can mimic postoperative ileus. It may present as nausea, vomiting, and abdominal distension, or in association with polyuria (which is commonly mistaken for mobilization of intraoperative fluids). For this reason, patients with type I diabetes (and many with type II diabetes) should have their urinary ketone level monitored by dipstick. This method is faster and much less costly than following serum ketone levels, and it gives a fairly accurate picture of developing ketoacidosis. A glucose level that is
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37
Q

consent form

A

legal documentation of these discussions between the physician and the pt

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38
Q

surrogate decision maker

A

person empowered to make decisions for a patient who is not competent to do so

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39
Q

advance directive

A

a mentally capable pt/s instructions regarding his or her medical care if he or she becomes incapacitated and unable to make decisions

How well did you know this?
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40
Q

beta blockers

A

Abrupt discontinuation can increase risk of Ml;

With a sip of water a few hours before operation;

Parenteral agent until taking p.o.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

atrial antiarrhythmics

A

With a sip of water a few hours before operation;

IV ß-blockers, diltiazem or digoxin until p.o. intake resumed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

ventricular antiar

A

Monitor Mg, K, and Ca levels preoperatively;

With a sip of water a few hours before operation;

Parenteral amiodarone or procainamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

nitrates

A

Transdermal (paste, patch) may be poorly absorbed intraoperatively;

With a sip of water a few hours before operation;

Intravenous (most reliable) or transdermal until p.o. intake resumed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

antihtn

A

Abrupt discontinuation of clonidine can cause rebound hypertension;

With a sip of water a few hours before operation;

Parenteral antihypertensives; if on clonidine, consider clonidine patch or alternative antihypertensive agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

A 28-year-old man is undergoing an operation for right inguinal hernia. The anesthesiologist notices that his end-tidal CO2 value rises abruptly, and the patient’s jaw is stiff. The patient’s temperature is 41 °C, his heart rate is 130 beats/minute, and his blood pressure (BP) is 130/75 mm Hg. Which of the following abnormalities would be expected if a sample of his blood were tested at this point in the operation?

A. Hyperkalemia

B. Hypocalcemia

C. Alkalosis

D. Anemia

E. Hypoalbuminemia (Lawrence 31-32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

A

Answer: A

This is a classic description of malignant hyperthermia. The typical electrolyte picture is that of rhabdomyolysis, with hyperkalemia, hypercalcemia, and acidosis. Malignant hyperthermia is not known to affect red cell mass or albumin levels. The patient should be given 100% oxygen, the operation should be stopped and the wound closed, and dantrolene should be administered. (Lawrence 32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

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46
Q

oral agents for DM

A

hold am of operation;

ssi until po intake back to baseline

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47
Q

metformin

A

Can produce lactic acidosis, particularly in the setting of renal dysfunction or with administration of IV radiographic contrast agents;

Hold for at least 1 day preoperatively;

Monitor renal function closely. Resume metformin when renal function normalizes, usually 2–3 days postoperatively. SSI until then.

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48
Q

aspirin, clopidogrel, ticlopidine

A

dc 7 days preop;

resume when diet resumed

How well did you know this?
1
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2
3
4
5
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49
Q

warfarin

A

Hold until INR normalizes, usually 3–5 days. If anticoagulation critical, maintain anticoagulation with heparin;

Resume when diet resumed

How well did you know this?
1
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2
3
4
5
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50
Q

heparin

A

Discontinue 4 hr preoperatively;

Resume 6–12 hr postoperatively, provided no increased risk of hemorrhage thought to exist

How well did you know this?
1
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2
3
4
5
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51
Q

levothyroxine

A

held few days preop;

parenterally until diet resumed

How well did you know this?
1
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2
3
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52
Q

estrogen

A

stop 4 wk prior to cases w high risk dvt

How well did you know this?
1
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2
3
4
5
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53
Q

ample

A

allergies, medications, past medical hx, last meal, events preceding the emergency

54
Q

baseline ekg

A

men >40 and women >50; symp cariovasc ds, htn, or dm

55
Q

Dripps-American Surgical Association Classification: to quantify surgical risk

A
  1. healthy
  2. mild-mod systemic ds
  3. severe
  4. life threatening
  5. no expected to survive
56
Q

cardiac risk index

A

high risk surgery, hx ischemic heart ds, hx chf, hx cerebrovasc ds, preop tx w insulin, preop serum cr >2

total up the number:

  1. 0risk
  2. 1 risk
  3. 2 risks
  4. more than 2 risks
57
Q

METs class 1

A

Activity requiring >6 METs

Carrying 24 lb up eight steps

Carrying objects that weigh 80 lb

Performing outdoor work (shoveling snow, spading soil)

Participating in recreation (skiing, basketball, squash, handball, jogging/walking at 5 mph)

58
Q

METs class 2

A

Activities requiring >4 but not >6 METs

Having sexual intercourse without stopping

Walking at 4 mph on level ground

Performing outdoor work (gardening, raking, weeding)

Participating in recreation (roller-skating, dancing fox trot)

59
Q

METs class 3

A

Activity requiring >1 but not >4 METs

Showering, dressing without stopping, stripping, and making bed

Walking at 2.5 mph on level ground

Performing outdoor work (cleaning windows)

Participating in recreation (golfing, bowling)

60
Q

METs class 4

A

no activity requiring >1met; can’t carry out any activities

61
Q

1 met represents an oxygen consumption of

A

3.5ml/kg/min

(avg for resting 70kg man)

hr of 100bpm=4mets

62
Q

when should smokers stop smoking before a procedure

A

6w

63
Q

procedure related risk factors for postop pulm compl

A

surgical site (thoracic, upper abd), duration (3-4hr), anesthesia technique (general, spinal, and epidural)

64
Q

periop mc cause of AKI is secondary to

A

acute tubular necrosis

65
Q

goal in periop manage of pts w CKD or AKI

A

maintenance of euvolemia and renal perfusion

66
Q

serum potassium levels should be blank before surgery

A
67
Q

someone on ACE and angiotensin 2 for CKD should stop them when

A

10hrs before general anesthesia to reduce risk of post induction hypotension

68
Q

what are essential records for postop CKD pts

A

daily weights and I&Os

69
Q

what anesthetic is used for pt in renal failure

A

cisatracurium

70
Q

when should pt be dialyzed before surgery

A

within 24hr of surgery

71
Q

periop management of pts w diabetes

A
  1. Insulin is available in several types and is typically classified by its length of action. Rapid-acting and short-acting insulin preparations are usually withheld when the patient stops oral intake usually at midnight the day before surgery. Intermediate-acting and long-acting insulin preparations are administered two-thirds the normal evening dose the night before surgery and half the normal morning dose the morning of surgery. Long-acting oral agents are stopped 48 to 72 hours before surgery, while short-acting agents can be withheld the night before or the day of surgery.
  2. The ideal method of providing insulin in the perioperative period is debatable. Any regimen should however (1) maintain adequate glycemic control to avoid hyperglycemia or hypoglycemia; (2) prevent metabolic disturbances; (3) be easy to understand and administer. The patient should receive a continuous infusion of 5% dextrose to provide 10 g glucose/hour. Fingerstick glucose levels are monitored intraoperatively and followed postoperatively at least every 6 hours. The goal is to maintain a glucose level of between 120 and 180 mg/dL. It is generally considered preferable to have the patient at the higher end of this range because of the adverse consequences of hypoglycemia. Sliding scale use of subcutaneous insulin has been the standard method of glucose control in surgical patients. Alternatively, intravenous insulin can be used with a continuous infusion of 1 to 3 units/hour of intravenous insulin being given. This approach is particularly helpful in the brittle diabetic. In the postoperative period, close attention should be paid not only to the patient’s blood sugar, but also to the patient’s carbohydrate intake.
  3. Diabetic ketoacidosis (DKA) can develop in patients with either type I or type II diabetes. DKA is deceptively easy to overlook because it can mimic postoperative ileus. It may present as nausea, vomiting, and abdominal distension, or in association with polyuria (which is commonly mistaken for mobilization of intraoperative fluids). For this reason, patients with type I diabetes (and many with type II diabetes) should have their urinary ketone level monitored by dipstick. This method is faster and much less costly than following serum ketone levels, and it gives a fairly accurate picture of developing ketoacidosis. A glucose level that is
72
Q

postop malignant hyperthermia

A

disruption of intracellular calcium metabolism= build up

73
Q

s/sx of postop malignant hyperthermia

A

violent and sustained muscle contraction and rigidity, heat production, and acidosis; (tachycardia, cyanosis, muscle rigidity)**;+/- muscle necrosis and rhabdo

74
Q

first sign of postop malignant hyperthermia

A

abrupt rise in end tidal carbon dioxide

75
Q

tx postop malignant hyperthermia

A

dantrolene (muscle relaxant that blocks calcium release) in rapid IV push in doses of 1mg/kg (max dose of 10mg/kg)

76
Q

A 52-year-old man is in the clinic to discuss treatment of a newly diagnosed pancreatic cancer. He has no significant past medical history. He takes no medications. There is no evidence of metastatic disease, and the tumor is small and appears to be resectable by pancreaticoduodenectomy (Whipple procedure). Optimal treatment would also include adjuvant radiation therapy and chemotherapy. Informed consent for this patient is best defined as

A. a form that can be used as a legal defense should a complication occur during the treatment of the patient’s problem.

B. a process in which the physician and patient discuss the risks and benefits of different approaches to the patient’s problem.

C. a process in which every possible complication of treatment is enumerated.

D. a theoretical construct with little practical utility.

E. a philosophical principle that applies to surgical procedures but not medication administration. (Lawrence 31)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

A

Answer: B

Informed consent is a process in which the physician and patient discuss the risks and benefits of different approaches to the patient’s problem. This includes discussion of the most likely outcomes of treatment (including the decision to observe rather than operate). Informed consent permeates most of the discussions physicians have with their patients, although the discussions may not be labeled as such. It applies to medication choices as much as to surgical decision making, although a separate consent form is generally not obtained each time a new medication is prescribed. (Lawrence 32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

77
Q

A 60-year-old woman is being evaluated for surgery to repair an abdominal aortic aneurysm under general anesthesia. She smoked a pack of cigarettes daily for 35 years, but quit 5 years ago when she had a myocardial infarction (Ml) complicated by congestive heart failure. She still has occasional orthopnea. She also has hypercholesterolemia and hypertension. Which one of the following factors suggests the greatest risk for a cardiac complication following her surgery?

A. History of cigarette smoking

B. Congestive heart failure with orthopnea

C. General anesthesia

D. Hypertension

E. Hypercholesterolemia (Lawrence 31)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

A

Answer: B

General anesthesia does not itself increase risk of cardiac complications. The factors that do increase such risk include ischemic heart disease, congestive heart failure, chronic kidney disease, cerebrovascular disease, or high-risk operations such as major vascular surgery. (Lawrence 32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

78
Q

A 45-year-old man with a 25-year history of hepatitis C and cirrhosis is found to have a small hepatocellular carcinoma of the right lobe of the liver. In order to assess his risk for surgical therapy, an estimate of liver dysfunction given by the model for end stage liver disease (MELD) score is needed. Which one of the following laboratory studies is needed to calculate a MELD score for this patient?

A. Alkaline phosphatase

B. Serum creatinine

C. Serum ammonia

D. Serum albumin

E. Serum gamma glutamyl transpeptidase (γGT) (Lawrence 31)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

A

Answer: B

The MELD score formula is (0.957 × ln(Serum Creatinine) + 0.378 × ln(Serum Bilirubin) +1.120 × In(INR) + 0.643) × 10 (if hemodialysis, value for creatinine is automatically set to 4). Albumin is a component of the Childs-Pugh classification, but not the MELD score. Alkaline phosphatase is useful in determining biliary tract obstruction. Gamma GT is very sensitive for hepatobiliary disease and is best used to determine if an isolated elevation of alkaline phosphatase is due to liver rather than bone disease. (Lawrence 32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

79
Q

Which of the following patients is at the lowest risk for postoperative deep vein thrombosis?

A. An 18-year-old male with femur and lumbar fractures

B. A 55-year-old morbidly obese female undergoing total knee replacement

C. A 62-year-old man undergoing prostatectomy for cancer

D. A 45-year-old woman undergoing hysterectomy and bilateral salpingo-oophorectomy and debulking for ovarian carcinoma

E. A 38-year-old woman undergoing carpal tunnel release (Lawrence 31)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

A

Answer: E

Patients who are immobile, who have congestive heart failure or malignancy, who undergo pelvic or joint replacement operations, or who have vertebral, pelvic, or long bone fractures are at highest risk. Carpal tunnel release does not confer increased risk of deep vein thrombosis. (Lawrence 32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

80
Q

A 28-year-old man is undergoing an operation for right inguinal hernia. The anesthesiologist notices that his end-tidal CO2 value rises abruptly, and the patient’s jaw is stiff. The patient’s temperature is 41 °C, his heart rate is 130 beats/minute, and his blood pressure (BP) is 130/75 mm Hg. Which of the following abnormalities would be expected if a sample of his blood were tested at this point in the operation?

A. Hyperkalemia

B. Hypocalcemia

C. Alkalosis

D. Anemia

E. Hypoalbuminemia (Lawrence 31-32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

A

Answer: A

This is a classic description of malignant hyperthermia. The typical electrolyte picture is that of rhabdomyolysis, with hyperkalemia, hypercalcemia, and acidosis. Malignant hyperthermia is not known to affect red cell mass or albumin levels. The patient should be given 100% oxygen, the operation should be stopped and the wound closed, and dantrolene should be administered. (Lawrence 32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

81
Q

when should preop PT/PTT/INR be ordered

A

hx bleeding disorders, PT: myeloproliferative ds, splenomegaly, PTT: anticoag meds

82
Q

when should preop electrolytes be ordered

A

hx renal insuff, chf, diuretics, meds that may influence elec

83
Q

when should preop renal function tests be ordered

A

age 50, hx htn/cardiac ds/meds alt renal funct

84
Q

when should preop glucose tests be ordered

A

hx diabetes, obesity

85
Q

when should preop ekg be ordered

A

cardiac hx, >40yo

86
Q

when should preop car be ordered

A

pulm hx, age >50

87
Q

when should consults be done

A

prior to surgery

88
Q

ASA classification

A

1 (normal healthy pt), 2 (pt mild systemic ds), 3 (severe systemic ds), 4 (severe systemic constant threat to life), 5 (not expected to survive without surgery), 6 (declared brain dead; harvest organs)

89
Q

global risk assessment predicts clinical outcome for

A

surgery and anesthesia

90
Q

what is ASA based on

A

severity of pt co morbidities

91
Q

complications of anesthesia

A

corneal abrasions/dental injury, spinal/epidural hematoma, vascular catheter injury, positioning injury, infection, awareness, local anesthetic toxicity, aspiration

92
Q

pulmonary complications

A

atelectasis, pulmonary infx, prolonged mechanical ventilation, respiratory failure, chronic lung ds exacerbation, bronchospasm

93
Q

pt related risk factors for pulmonary complications

A

age, ASA class, smoking (modifiable, quit 1m before), obesity, impaired sensorium, functionally dependent, chronic lung ds, sleep apnea, chf

94
Q

why is smoking a pulmonary complication risk

A

damages the cilia in trachea and bronchioles so prevents clearance of fluids which accumulate during anesthesia, putting pts at risk for atelectasis and pneumonia; causes vasoconstriction in heart and periphery which inc chances of MI and problems w wound healing

95
Q

which surgical site is highest risk for pulmonary complication

A

open aortic surgery*

thoracic, upper abd, neurosurgery, head/neck, vascular

96
Q

Goldman cardiac risk index

A

High risk surgery, hx of ischemic heart ds (hx mi, hx pos stress test,angina,using NTG, pathological q), hx chf, hx cerebrovasc ds, dm tx w insulin, serum Cr >2

0=1
1=2
2=3
>3=4

97
Q

1met

A

3.5mL O2 uptake/kg per min

98
Q

Mets as cardiovascular risk

A

13= good survival prognosis

99
Q

Grading of mets w completing activity without stopping

A

1= sit upright
2=eat,dress,use toilet, make bed
3= walk around the house, take a shower
4=1 flight of stairs, 2blocks, golf, bowl
5=2 flights, walk on flat, sex
6=scrub floors, lift furniture, weight lift
7=good sex (break the bed neighbors call the cops)
8=shovel snow
9= swing dance
10= singles tennis, basketball, soccer
>12= competitive sports

100
Q

Edmonton frailty scale

A

Cognition:clock drawing (0=no errors 1=minor spacing 2=other errors)

Meds:5 or more or forgot to take (0=no 1=yes)

General health status:#admissions (0=0 1=1/2 2=>2

Functional independence:require help (0=0/1 1=2-4 2=5-8)

Social support: 0=always 1=sometimes 2= never

Functional performance:get up and go (0=0-10sec 1=11-20sec 2=>20sec or needs assist)

101
Q

when should aspirin be stopped prior to surgery

A

7 days; irreversible platelet effect

102
Q

when to stop warfarin prior to surgery

A

5 days

103
Q

when to stop heparin IV/SC prior to surgery

A

6hr

104
Q

when to stop LMWH prior to surgery

A

12-24hr

105
Q

when to stop dabigatran before surgery

A

3-4d

106
Q

when to stop rivaroxaban before surgery

A

2-3d

107
Q

when to stop apixaban before surgery

A

1-2d

108
Q

CHADS2

A

chf, htn, age 75, dm, previous stroke or transient ischemic attack

109
Q

manage of DM day of surgery

A

blood glucose morning of, oral meds withheld, 1/2 dose insulin morning of

110
Q

risk of surgery for hypothyroid

A

subject to hypotension, shock, hypothermia during surgery, may have hypoventilation post op

111
Q

risk of surgery for hyperthyroid

A

thyrotoxicosis (thyroid storm); can give propylthiouracil (PTU)

112
Q

tx of adrenal insuff before surgery

A

stress dose steroids for procedure (usually 100mg IV prior and 50-100mg every 6hr during surgery); then taper over several days after surgery

113
Q

general anesthesia

A

pt in controlled coma w anesthetic, muscle relaxant, and analgesic medications

114
Q

mc cause of anesthetic morbidity and mortality is

A

failure to secure the airway;

second mc is nerve damage from malpositioning during surgery

115
Q

spinal anesthesia

A

good for lower ext; less stress on cardiac system and few pulmonary complications; but unable to redose if procedure goes long; headache, hypotension

116
Q

epidural anesthesia

A

extradural injection of anesthetic; similar to spinal but can leave catheter in and redose; mc used in child birth and for long term pain relief

117
Q

regional anesthesia

A

nerve block (axillary, scalene, femoral, ankle block); low risk complications; takes 30-40min to set up; time limited, no cardiopulm problems

118
Q

local anesthesia

A

safe, small area affected;may be combined w conscious sedation for patient comfort

lidocaine (45-60m)
bupivacaine (3-5hr)

119
Q

normal hemoglobin and hematocrit

A

hemoglobin (12-14)

hematocrit (40-50%)

120
Q

one unit of blood is how much and will raise hgb and hct by how much

A

about 300-350mL; raise hgb by 1g/dl; hct by 3%

121
Q

type and screen

A

pt’s blood is typed and screened for antibodies; doesn’t assign unit but takes more time to process prior to transfusion

122
Q

type and cross

A

pt’s blood is matched to specific donor unit; quick but assigns unit so if don’t use need to discard

123
Q

universal donor blood type

A

o neg

124
Q

platelet levels

A

normal (100,000);

125
Q

a normal pack of platelets contains for many donor units

A

5-6; 1 pack will raise platelet count 10,000

126
Q

fresh frozen plasma

A

clotting factors/albumin/fibrinogen;

used in coagulopathies when there is active bleeding

127
Q

cryoprecipitate

A

replaces fibrinogen; von willebrand factor

128
Q

autologous donation

A

pt donates own blood to be given back during or after surgery, blood production, esp for pt w cancer

129
Q

blood conservation surgery

A

techniques for rapid surgery also stimulates blood production

130
Q

cell saver

A

suction machine connected to vacuum, then spins and washes blood to be re transfused

131
Q

re transufusion drains

A

suction drains preserve sterility and allow re transfusion of drainage

Surgery (21 decks)

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