Set 1 Flashcards
Ogilvie Syndrome
paralytic ileus of colon; NOT after abd surgery but instead in elderly sedentarry pts that have surgery
large abd distention (tense but non-tender)
Tx: fluids & correct electrolytes then colonoscopy & place long rectal tube
Goldman’s Index
findings that predict cardiac trouble
JVD (worst finding; treat with ACEI or BB or diuretics), recent MI, premature ventricular contractions, arrhythmia, >70yo, emergency surgery, aortic stenosis, poor medical condition, & chest or abd surgery
Ejection Fraction that is risky
<35% (normal is 55%)
↑risk of peri-op MI (mortality of 55-90%)
Delirium Tremens
common in alcoholics that have surgery; occurs 2-3 days post-op
Sx: confusion, hallucinations, combative
Tx: IV benzos
Intraoperative tension pneumothroax
ribs get traumatized when exposed to positive pressure ventilation (previous blunt trauma causing broken ribs)
BP declines & CVP (central venous pressure) rises
Tx: decompression through diaphragm if abd surgery OR needle through anterior chest wall; insert chest tube later
Metabolic Alkalosis
too much bicarb or loss of gastric juices; pH >7.4, bicarb >25
Tx: abundant intake of KCl so that kidney can correct problem
Pulmonary Embolism
- Post-op day 7
- pleuritic chest pain w/ SOB; JVD
- Dx: CT angio (spiral CT w/ IV contrast)
- Tx: heparin
- prevent by preventing DVT
Post-Op Urinary Retention
common after lower abd, pelvic, peritoneal, or groin surgery; pt feels need to void but cannot
Tx: straight cath at 6h if no voiding; indwelling cath at 2nd conseecutive catheterization
Causes of Disorientation/ Coma in Post-Op patient
- hypoxia- suspect this 1st; may be secondary to sepsis
- Adult Respiratory Distress Syndrome (ARDS)- b/l pulmonary infiltrates & hypoxia w/o CHF; Tx: positive end-expiratory pressure (PEEP)
- Delirium Tremens (alcoholics; 2-3 days post-op)
- Hyponatremia (confusion, convulsions, coma)
- Hypernatremia (confusion, lethargy, coma) caused by large unreplaced water loss (eg: DI)
Hypokalemia
develops slowly from loss in GI tract or urine; develops rapidly in DKA
Tx: K+ replacement administered at a rate no more than 10 mEq/h
Metabolic Acidosis
excess acids, loss of buffers, or renal failure; pH <7.4 & bicarb <25
anion gap (>20)
Tx: treat the cause; bicarb will treat all but can cause rebound alkalosis if that is not the problem; be prepared to replace K+
Why NPO before surgery
reduce risk of aspiration
Ammonium Intoxication
causes coma in cirrhotic pt w/ bleeding esophageal varices w/ portocaval shunt
Hepatic Risk
- classified using Child class
- Class A = 10% mortality
- Class B = 30% mortality
- Class C = 80% mortality
- Predictors- encephalopathy, ascites, serum albumin (normal: 3.5-5 g/dL), prothrombin time (INR), & bilirubin
Nutritional Risk
- Severe Nutritional Depletion = loss of 20% of body weight over a few months, serum albumin <3, anergy to skin Ag, or serum transferrrrin <200 mg/dL
- 4-5 days of pre-op nutritional support makes a difference (7-10 days preferred)
Wound Dehiscence
5th day post-op after open laparotomy; wound intact but pink salmon colored fluid soaking through dressing (peritoneal fluid)
Tx: tape, wrap, & move w/ care until re-operation to prevent evisceration or ventral hernia
Hyperkalemia
occurs slowly in renal failure; occurss rapidly in crushing injuries/ dead tissue/ acidosis
Tx: 50% dextrose & insulin to push K+ into cells or IV calcium to neutralize effects on cell membrane; Ultimately hemodialysis
Malignant Hyperthermia
- develops soon after onset of anesthesia; temp >104
- metabolic acidosis and hypercalcemia
- Tx: IV dantrolene & 100% O2
Fistulas of GI tract
- concerns for spesis
- Concerns when draining freely: fluid/ electrolyte loss, nutritional depletion, erosion/ digestion of body wall
- Nature will heal them if there is no foreign body, epithelization, tumor, infection, IBD, or distal obstruction (FETID) (steroids also prevent healing)
Paralytic Ileus
expected in 1st few days after abd surgery; no bowel sounds, no passage of gas, no pain
Prolonged by hypokalemia
Hyponatremia
Rapidly developing causes CNS Sx & requires careful use of hypertonic saline (3% or 5%)
if developed slowly (SIADH) then no CNS effects; Tx: water restriction
Pulmonary Risk for Surgery
smoking is most common cause
problem is compromised ventilation (NOT compromised oxygenation)
STOP smoking 8wks before surgery & resp therapy
Risk with recent MI
operative mortality: 40% if within 3mo; 6% after 6mo
Bacteremia
- fever of 104+ w/in 30-45 min of invasive procedures
- Dx/ Tx: cultures x3; start emperic Abx
Hypernatremia
pt has lost water; every 3 mEq/L above 140 is 1L of water lost
Correct volume changes fast but sodium levels slowly (D5½NS) if chronic
If acute then there will be CNS Sx & you can correct w/ more dilute fluid (D5W or D5 1/3NS)
Post-Op Fever
- Atelectasis (Wind)- day 1; Tx: bronchoscopy
- Pneumonia- day 3 if atelectasis is not resolved; Tx: sputum culture & Abx
- UTI- (water) fever starts day 3; Tx: Abx
- DVT- (walking); day 5; doppler & heparin
- Wound Infection- (wound); day 7; PE: erythema, warmth, tenderness; sonogram to distinguish cellulitis from abscess if uncertain; Tx: Abx or open and drain
