Ramahi Peri op, Electrolytes, Burns, Heme. Flashcards
Absolute Contraindications to Surgery (2)?
DKA, Diabetic Coma
Nutritional Contraindications to Surgery (4)?
Weight loss >20%, no reaction to skin test anergy, Albumin <200.
Liver Failure Contraindications to Surgery (4)?
Bilirubin >2, Ammonia >150, PT >16, Encephalopathy.`
Lung Contraindications to Surgery?
Smoking. 8 weeks cessation required.
Two most concerning cardiac Contraindications to Surgery?
CHF (distended JVP and EF <35%). Recent MI (within 6 mo).
When should Aspirin be discontinued before surgery?
2 weeks.
When should Warfarin be discontinued before surgery?
5 days.
If Chronic Kidney disorder, when should last dialyzation occur before surgery?
24 hours
If diabetic, when should last insulin dose be given before surgery?
Day of, 1/2 morning dose.
If a patient has a BUN>100, what is the surgical complication that can arise?
Post op bleeding from uremic platelet dysfunction. Prolonged bleeding time with normal platelets.
How does an assist-control ventilator setting function?
Sets tidal volume and rate, vent gives the volume if patient initiates a breath.
How does an pressure support ventilator setting function?
Patient sets rate but vent gives additional pressure (8-20mmHg)
How does CPAP function?
Pressure given continually but patient breaths on their own.
How does PEEP function? When is it often used?
Pressure given at the end of the cycle to keep alveoli open (5-20mmHg). ARDS or CHF patients.
How is PaO2 adjusted on a ventilator?
Change FiO2
How is PaCO2 adjusted on a ventilator? Less efficient method?
Change Tidal Volume. Change rate.
If Acidotic, what metabolic state are you in with High HCO3 and High PaCO2?
What about Low HCO3 and Low PaCO2?
Respiratory Acidosis. Metabolic Acidosis.
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?
Metabolic Alkalosis. Respiratory Alkalosis. Chlorine.
How do you calculate an anion gap? What’s a normal range?
Na-Cl-HCO3. 8-12.
In Hyponatremia, what [Na] corresponds to symptoms?
What are the symptoms?
How are they treated?
Deadliest complication?
110.
Seizures.
Hypertonic Saline (3%)
Central Pontine Myolinolysis.
In Hypernatremia, what is the deadliest complication?
Cerebral Edema.
Signs of Hypocalcemia (4)?
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.
Signs of Hypercalcemia (5)? Pathological causes?
Bones (break from osteitis fibrosa cystica), Groans (constipation, indigestion), Stones, Psychic Moans (fatigue, depression), Short QT.
Osteosarcoma or Hyperparathyroidism. .
Signs of Hyperkalemia on EKG? How to correct?
Peaked T waves, long PR interval, widened QRS. IV Calcium Chloride (can also give Insulin, kayexalate, or dialysis as a last result).
Signs of Hypokalemia on EKG? How to correct, and limitations to correction?
ST depression and U waves on EKG. Give K, max of 40mEq/hr.
How to calculate maintenance fluids for a man who is peeing? How much of what fluid would you give him if he weighed 80kg?
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
How to check Carbon Monoxide exposure? Treatment?
Check carboxyhemoglobin. 100% O2 (might require hyperbaric oxygen if very severe).
Old patients who clot have?
Cancer.
Patients with Edema, HTN, foamy pee, and who clot have?
Nephrotic Syndrome.
Young patient with family history of clotting who clots has?
Factor 5 Leiden.
A patient who has ATIII deficiency is in trouble because they can’t use what medication?
Heparin.
Young female patient with multiple spontaneous abortions who clots has?
Lupus.
A post op patient develops thrombocytopenia and clots has? How do you treat it?
Heparin induced thrombocytopenia (HIT). Leparudin or Agatroban (direct thrombin inhibitors).
A patient with normal platelets but increased bleeding time and PTT has?
vWD
A patient with DIC would have what lab abnormalities (7)?
Thrombocytopenia, low fibrinogen, high PT, PTT, and bleeding time, Ddimer, and schistocytes.
Timeline of burn fluid resuscitation?
Give 1/2 of fluid during the first 8 hours, and the other 1/2 over the next 16 hours.
What is the first step of treatment after an electrical burn?
EKG!
What renal complication can arise after an electrical burn? Will urine dipstick be positive for blood? Will RBC be found in the urine?
Myoglobinuria and ATN. Yes. No.
