REVIEW Flashcards
advantages of regional anesthesia?
- less blood loss in some surgeries
- decreased metabolic stress
- decreased infection rate
regional and general have equal rates of?
- post-op cognitive dysfunction
- postop pulmonary infection
- cardiac complications
- lenght of hospital stay
purpose of the surgical drain?
- withdrawal of fluids
- apposition of tissues to remove a potential space by suction
a closed drainage system attached to a suction bulb (grenade)
JP (jackson-pratt drain)
an open drainage system composed of a thin rubber hose
Penrose drain
when do you use absorbable vs. non absorbable?
absorbable- deep
non-absorbable- surperficial
braided vs monofilament
braided- easier to handle but could harbor infection
monofilament- more difficult to handle
what should you do if you prescribe PCA?
- continuous pulse ox should be prescribed for patient monitoring
- remember narcan can be used to help distinguish mental status changes
- s/sx: altered mental status, hypotension, tachycardia
- treatment: fluid resuscitation, broad spectrum antibiotics, +/- pressors
septic shock
what organ is the most common source of infection in sepsis
lung
criteria for qSOFA calculator
- AMS: GCS < 15
- respiratory rate > 22
- systolic BP < 100
diagnosis and treatment for suspected sepsis?
diagnosis
- CXR
- lactate level
- urinalysis
Treatment
- Norepinephrine is the first line vasopressor used for septic shock
- 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
Chronic venous disease
when should antibiotics be used in surgery?
- timing of antibiotic adminsitration is critical to efficacy
- the first dose should always be given before the procedure, preferably within 30 minutes before incision
what if often used to close most lacerations?
non-absorbable monofilament
buried sutures often use
- absorbable monofilament
- absorbable braied
what sutures are needed for a drain stitch on bowel?
non-absorbable braided
Based on time frame, what could be the cause of fever post-op?
< 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
- 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
Abscess
dx and tx of deep surgical site infections
- CT of MRI for diagnosis
- urgent surgical debridement & antibiotic therapy
treatment of SSI
- 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
involves only the skin and subcutaneous tissue of incision
Superficial incisional SSI
- Involves deep tissues, such as fascial and muscle layers
Deep incisional SSI
