Preoperative and postoperative care Flashcards
Ischemic heart disease, congestive heart failure, cerebrovascular disease, a high-risk operation, preoperative treatment with insulin, and preoperative serum creatinine greater than 2.0 mg/dL is a predictive of complication?
surgical cardiac complication
what is the percentage of postoperative MI in a patient with prior hx of MI?
5 to 10%
What type of testing is indicated in non cardiac operations in patients with active cardiac conditions such as unstable angina, recent MI, or severe vascular dz?
Noninvasive stress testing
What should you do before non cardiac operations in pts with: L main coronary artery stenosis, stable angina with three-vessel coronary dz, L anterior descending coronary artery stenosis?
Coronary revascularization
Why may it be dangerous to give a patient with chronic COPD supplemental oxygen?
This patient uses relative hypoxia for respiratory drive, and supplemental O2 may remove this drive!
Optimally, when should patients who smoke stop smoking before scheduled surgery?
at least 8 weeks before surgery
What type of respiratory conditions are absolute contraindications for elective surgery?
Acute lower respiratory tract infections.
What type of testing should patients get with a history of DM prior to surgery?
blood glucose testing
The risk of a surgical site infection increases with the degree of hyperglycemia, with levels greater than what mg/dL being the sole predictor of surgical site infection
140mg/dL
What is the best medicine for perioperative glucose control and why?
IV insulin d/t rapid onset of action, short half-life, immediate availability
Is the preferred range for post op glycemic control?
Normal: 90-100 mg/dL
Moderate: 120 - 200 mg/dL
What is in Virchow’s triad?
Stasis, hyper coagulable states, trauma
What is the first-line imaging test for suspected DVTs?
venous duplex ultrasound
What is the gold standard dx for a DVT?
Venography
How do you treat DVTs?
IV Heparin and switch to warfarin
Women older then 35 and smoke cigarettes are at increased risk for what and what should they avoid?
Increased risk of a venous thrombosis and should avoid oral contraceptive pills. Progestin-only methods are ok.
If bridging for patients on warfarin, when should the last dose be given?
day 6
what day do you begin bridging with a different anti coag with patients taking warfarin?
different anti coag like enoxaparin or dalteparin begins 3 days pre op
Patients who smoke should stop smoking at least how long before scheduled surgery?
8 weeks
what percent of the population have alcohol or drug dependence?
5-10%
What is the most common cause of fever in the first 48 hours post?
Atelectasis
Is the most common cause of a post-op infection in the 48-72 hour time window
UTI
When do surgical site wound infections arise?
classically, days 5-7
What is the most common bacteria to cause a post op wound infection?
Staph. aureus
What bacteria will cause a post op infection that has a bone-brown weeping tender wound?
Clostridium
