REVIEW

Question 1

advantages of regional anesthesia?

Answer 1

• less blood loss in some surgeries
• decreased metabolic stress
• decreased infection rate

Question 2

regional and general have equal rates of?

Answer 2

• post-op cognitive dysfunction
• postop pulmonary infection
• cardiac complications
• lenght of hospital stay

Question 3

purpose of the surgical drain?

Answer 3

• withdrawal of fluids
• apposition of tissues to remove a potential space by suction

Question 4

a closed drainage system attached to a suction bulb (grenade)

Answer 4

JP (jackson-pratt drain)

Question 5

an open drainage system composed of a thin rubber hose

Answer 5

Penrose drain

Question 6

when do you use absorbable vs. non absorbable?

Answer 6

absorbable- deep
non-absorbable- surperficial

Question 7

braided vs monofilament

Answer 7

braided- easier to handle but could harbor infection
monofilament- more difficult to handle

Question 8

what should you do if you prescribe PCA?

Answer 8

• continuous pulse ox should be prescribed for patient monitoring
• remember narcan can be used to help distinguish mental status changes

Question 9

• s/sx: altered mental status, hypotension, tachycardia
• treatment: fluid resuscitation, broad spectrum antibiotics, +/- pressors

Answer 9

septic shock

Question 10

what organ is the most common source of infection in sepsis

Answer 10

lung

Question 11

criteria for qSOFA calculator

Answer 11

• AMS: GCS < 15
• respiratory rate > 22
• systolic BP < 100

Question 12

diagnosis and treatment for suspected sepsis?

Answer 12

diagnosis

• CXR
• lactate level
• urinalysis

Treatment

• Norepinephrine is the first line vasopressor used for septic shock

Question 13

• visibly dilated lower extremity veins (i.e telangiectsia, reticular veins, varicose veins)
• s/sx: aching, swelling, heaviness may be indicative of underlying venous insufficiency
• one risk factor for impaired wound healing and wound complications

Answer 13

Chronic venous disease

Question 14

when should antibiotics be used in surgery?

Answer 14

• timing of antibiotic adminsitration is critical to efficacy
• the first dose should always be given before the procedure, preferably within 30 minutes before incision

Question 15

what if often used to close most lacerations?

Answer 15

non-absorbable monofilament

Question 16

buried sutures often use

Answer 16

• absorbable monofilament
• absorbable braied

Question 17

what sutures are needed for a drain stitch on bowel?

Answer 17

non-absorbable braided

Question 18

Based on time frame, what could be the cause of fever post-op?

Answer 18

< 24hrs –> inflammatory mediators
24-48hrs–> UTI, pnemonia, IV (phlebitis)
72hrs–> wound infection, deep infection, DVT/PE, UTI, pneumonia, deep SSI, abscess, prosthetic infection, C-diff

Question 19

• localized swelling and incisional pain, erythema, fluctuance and scant drainage
• tx: empiric antibiotic and drainage of abscess if temps >38.5C and tachycardia
• if temps ,38.5 and no tacycardia: observation, dressing changes, +/- opening incision site

Answer 19

Abscess

Question 20

dx and tx of deep surgical site infections

Answer 20

• CT of MRI for diagnosis
• urgent surgical debridement & antibiotic therapy

Question 21

treatment of SSI

Answer 21

• if a SSI sets in the treatment often involves opening the wound, evacuating pus, and cleansing the wound/draining the abscess
• exam the wound for tunneling and pockets of abscess that must be drained. Document wound measurement and findings

Question 22

involves only the skin and subcutaneous tissue of incision

Answer 22

Superficial incisional SSI

Question 23

• Involves deep tissues, such as fascial and muscle layers

Answer 23

Deep incisional SSI