Ramahi Peri op, Electrolytes, Burns, Heme.

Question 1

Absolute Contraindications to Surgery (2)?

Answer 1

DKA, Diabetic Coma

Question 2

Nutritional Contraindications to Surgery (4)?

Answer 2

Weight loss >20%, no reaction to skin test anergy, Albumin <200.

Question 3

Liver Failure Contraindications to Surgery (4)?

Answer 3

Bilirubin >2, Ammonia >150, PT >16, Encephalopathy.`

Question 4

Lung Contraindications to Surgery?

Answer 4

Smoking. 8 weeks cessation required.

Question 5

Two most concerning cardiac Contraindications to Surgery?

Answer 5

CHF (distended JVP and EF <35%).
Recent MI (within 6 mo).

Question 6

When should Aspirin be discontinued before surgery?

Answer 6

2 weeks.

Question 7

When should Warfarin be discontinued before surgery?

Answer 7

5 days.

Question 8

If Chronic Kidney disorder, when should last dialyzation occur before surgery?

Answer 8

24 hours

Question 9

If diabetic, when should last insulin dose be given before surgery?

Answer 9

Day of, 1/2 morning dose.

Question 10

If a patient has a BUN>100, what is the surgical complication that can arise?

Answer 10

Post op bleeding from uremic platelet dysfunction. Prolonged bleeding time with normal platelets.

Question 11

How does an assist-control ventilator setting function?

Answer 11

Sets tidal volume and rate, vent gives the volume if patient initiates a breath.

Question 12

How does an pressure support ventilator setting function?

Answer 12

Patient sets rate but vent gives additional pressure (8-20mmHg)

Question 13

How does CPAP function?

Answer 13

Pressure given continually but patient breaths on their own.

Question 14

How does PEEP function? When is it often used?

Answer 14

Pressure given at the end of the cycle to keep alveoli open (5-20mmHg). ARDS or CHF patients.

Question 15

How is PaO2 adjusted on a ventilator?

Answer 15

Change FiO2

Question 16

How is PaCO2 adjusted on a ventilator? Less efficient method?

Answer 16

Change Tidal Volume. Change rate.

Question 17

If Acidotic, what metabolic state are you in with High HCO3 and High PaCO2?
What about Low HCO3 and Low PaCO2?

Answer 17

Respiratory Acidosis. Metabolic Acidosis.

Question 18

If Alkalotic, what metabolic state are you in with High HCO3 and High PaCO2?
What about Low HCO3 and Low PaCO2?
What additional electrolyte should you check if in Metabolic Alkalosis?

Answer 18

Metabolic Alkalosis. Respiratory Alkalosis. Chlorine.

Question 19

How do you calculate an anion gap? What’s a normal range?

Answer 19

Na-Cl-HCO3. 8-12.

Question 20

In Hyponatremia, what [Na] corresponds to symptoms?
What are the symptoms?
How are they treated?
Deadliest complication?

Answer 20

110.
Seizures.
Hypertonic Saline (3%)
Central Pontine Myolinolysis.

Question 21

In Hypernatremia, what is the deadliest complication?

Answer 21

Cerebral Edema.

Question 22

Signs of Hypocalcemia (4)?

Answer 22

Numbness, Chvostek sign (tap masseter, whole side of face twitches), Troussaeu sign (blood pressure cuff left on for a few minutes and hand and forearm start contracting), Long QT.

Question 23

Signs of Hypercalcemia (5)? Pathological causes?

Answer 23

Bones (break from osteitis fibrosa cystica), Groans (constipation, indigestion), Stones, Psychic Moans (fatigue, depression), Short QT.
Osteosarcoma or Hyperparathyroidism. .

Question 24

Signs of Hyperkalemia on EKG? How to correct?

Answer 24

Peaked T waves, long PR interval, widened QRS. IV Calcium Chloride (can also give Insulin, kayexalate, or dialysis as a last result).

Question 25

Signs of Hypokalemia on EKG? How to correct, and limitations to correction?

Answer 25

ST depression and U waves on EKG. Give K, max of 40mEq/hr.

Question 26

How to calculate maintenance fluids for a man who is peeing? How much of what fluid would you give him if he weighed 80kg?

Answer 26

Up to 10 kg -> 100 ml/kg/day
Next 10 kg -> 50 ml/kg/day
Above 20 kg -> 20/ml/kg/day

D 5 1/2 NS.
10(100) + 10(50) + 60(20) = 2700ml

Question 27

How to check Carbon Monoxide exposure? Treatment?

Answer 27

Check carboxyhemoglobin. 100% O2 (might require hyperbaric oxygen if very severe).

Question 28

Old patients who clot have?

Answer 28

Cancer.

Question 29

Patients with Edema, HTN, foamy pee, and who clot have?

Answer 29

Nephrotic Syndrome.

Question 30

Young patient with family history of clotting who clots has?

Answer 30

Factor 5 Leiden.

Question 31

A patient who has ATIII deficiency is in trouble because they can’t use what medication?

Answer 31

Heparin.

Question 32

Young female patient with multiple spontaneous abortions who clots has?

Answer 32

Lupus.

Question 33

A post op patient develops thrombocytopenia and clots has? How do you treat it?

Answer 33

Heparin induced thrombocytopenia (HIT). Leparudin or Agatroban (direct thrombin inhibitors).

Question 34

A patient with normal platelets but increased bleeding time and PTT has?

Answer 34

vWD

Question 35

A patient with DIC would have what lab abnormalities (7)?

Answer 35

Thrombocytopenia, low fibrinogen, high PT, PTT, and bleeding time, Ddimer, and schistocytes.

Question 36

Timeline of burn fluid resuscitation?

Answer 36

Give 1/2 of fluid during the first 8 hours, and the other 1/2 over the next 16 hours.

Question 37

What is the first step of treatment after an electrical burn?

Answer 37

EKG!

Question 38

What renal complication can arise after an electrical burn? Will urine dipstick be positive for blood? Will RBC be found in the urine?

Answer 38

Myoglobinuria and ATN. Yes. No.