Surgery Flashcards
indications for arterial catheritization
need for continuous blood pressure monitoring (shock states, hypertensive crisis, surgery in high risk pts, ppl getting inotropic agents or vasoactive, controlled hypotensive anastesia, procedures that can lead to rapid changes in cardiac fund)
need for frequent arterial blood sampling
relative contraindications to arterial cath
local infxn
bleeding problems
presence of vascular prosthesis
anticoagulant thearpy
most common site for arterial cath
radial artery
complicatino that can arise from using brachial artery
median artery contracture (volkman contracture)
indications for central venous cath
access for fluid therapy access for drug infusion parenteral nutrition cvp monitoring aspirate air embolism placement of cardiac pacemaker/ ivc filter hemodialysis access
normal cvp
4-7 mmH2O
(0-3- needs more fluid)
8-20- high; more fluid then heart can handle
what does cvp do
give info about relationship between fluid status and right ventricular function
useful w/ hypotensive pts
can detect arrithmias
great way to determine amount of needed fluids and blood products
CVP
indications for cvp
acute blood loss where you’re giving a lot of fluids
in cases of shock in post op
in old ppl who have limited cardiac reserve undergoing surgery
in pts w/ anuria due to possible kidney shutdown
respiratory monitoring indications
deciding if to use mechanical ventilation
assessment response to therapy
optimize ventilator mngmt
decision to wean of ventilator
things that affect BUN
increased in gi bleed, tpn, trauma, sepsis, steroid use
decreased in starvation and liver disease
intracranial pressure monitoring
normal cerebral perfusion pressure >70mmHg
glascow coma scale
how many days before surgery are pts required to have a workup
30 days
indication for cbc (H&H)
> 65 years old w/ major surgery
surgery w/ major blood loss expected
indication for serum creatinine
> 50 w/ intermediate or high risk surgery
younger w/ anticipated hypotension or use of nephrotoxic drugs
electrolytes
if on diuretics, arb, acei, or known renal disease
pt/ptt/platelets indications
pts on anticoagulants
neurosurgery
what is recommended in all women of reproductive age
pregnancy test
ekg
routinely recommended in pts > 50
required in pts w:
ischemic heart disease, chf, arrhythmia
peripheral artery disease or cerebrovascular disease
diabetes or renal insufficiency
cxr
recomneded in pt > 50 undergoing AAA or upper abdomina/thorac surgery
sleep study
for pts who have persistent sxs and NOT adherent w/ tx, and have had changes in weight
tx w/ cpap before surgery
scip program for preventing surgical infxn
meticulous sterile tech perioperative abx (depends on surgery) glucose control <200 normothermia room temp supplemental o2 therapy surveillance and infxn control programs
effects of Anesthesia
peripheral vasodilatoin leading to hypotension
reduced myocardial contractility
so much find out ejection fraction prior to surgery
what can the decrease in tidal volume caused by spinal epidural cause
atelectasis, so we do incentive spirometry and deep breathing exercises
tool to assess functional status before surgery
duke criteria
The ability to perform greater than 4 metabolic equivalents has been associated with a lower cardiovascular risk
lee index
risk factors for major cardiac complications
one point each for: High-risk surgery History of ischemic heart disease History of congestive heart failure History of stroke or transient ischemic attack Insulin-dependent diabetes mellitus Serum Cr > 2mg/dL
0 points, 0.4% complication rate
1 point, 1% complication rate
2 points, 7% complication rate
> or = to 3 points, 11% complication rate
when to perform an echo
if hear a murmur
what type of heart murmur is at greatest risk for complications
aortic stenosis
what level of htn is associated w/ higher compl
> 180/110
3 pt specific factors associated w/ increased risk of post operative pulmonary complications
chronic lung disease
tobacco use
morbidly obese
when to quit smoking before cabg
at least 8 weeks before
2 most common serious side effects of neuro
acute delirium and stroke
what meds have been associated w/ delirium
anticholinergics
meperidine
benzodiazepines
when to do steroid replacement
when on 7.5 mg prednisone for 3 weeks or 20 mg for 1 week
if evidence of adrenal insufficiency then give pts 100 mg of hydrocortisone every 8 hours beginning the morning of surgery and contenting for 48-72 hours; do not need to taper
meds to discontinue before surgery
acei, diuretics, metfomrin, hypoglycemics
herbal supplements 2 weeks before surgery
pts whose risk of bleeding exceeds thrombosis:
asa 7-10 days
nsaids 3-5 days
plavix 2 weeks
if taking warfarin where should inr be
<1.5
what med should all pts w/ cardiovascular risk factors take
beta blocker
