Surgery Flashcards
alcohol, NSAIDs, chemotherapeutic agents, and a/b all cause ?
increased bleeding tendencies… also herbal meds
most important preoperative evaluations
history and physical
preoperative creatinine levels in all patients ?
over 40 years old
bypass grafting for peripheral vascular disease, abdominal aortic aneurysm repair, or coronary artery bypass grafting all need ?
blood glucose obtained
coagulation factors may be abnormal in severe ? or ? dysfunction
hepatic, biliary
EKG recommended in all older than ?
40 years old
silent MI more common in ? 2
elderly, diabetics
CXR indicated in all w/ heart or pulmonary dz; all patients older than ?
60 y.o.
spirometry for pts evaluated for ? surgery or history of smoking or dyspnea
thoracic or abdominal
Virchow’s triad? (DVT)
stasis, intimal damage, hypercoagulability
DVT prophylaxis ?
unfractionated heparin 5,000 units sQ q 8 or 12 hours until patient fully ambulatory or enoxaprin (LMWH) 40mg sQ 12 hrs before or soon after surgery up to 14 days after
? associated with lower incidence of DVT in hip surgery; blocks activated factor X
fondaparinux, 2.5mg sQ starting 6h post-op
preferred DVT prophylaxis for trauma pts or those w/ abdominal/pelvic cancer
enoxaprin (LMWH)
? are not recommended in DVT prophy and can actually promote a tourniquet effect
non fitted thromboembolic stockings
? devices are beneficial in all pt populations for DVT trophy from on way to OR until fully ambulatory
sequential compression devices
prophy of clots only from lower extremities, for CI to other prophy or undergoing CNS procedures
Greenfield filter insertion
prophy DVT not associated with sig decreases in incidence of DVT but associated with heart failure, renal failure and difficulty in cross-matching blood
dextran
malnourished pt- lost more than ? and no adequate nutritional intake for more than 7 days
10% body weight
occurrence of bacterial translocation from gut linked with depletion of ?
amino acid glutamine
w/ severe malnutrition ? or ? may develop
marasmus, kwashiorkor
basal energy expenditure calculated using ?
Harris-Benedict equation
pts who are elderly, have marasmus, kwashiorkor, anorexia nervosa, or undergoing chemotherapy at risk for development of?
refeeding syndrome
abnormal glucose and lipid metabolism, thiamine deficiency, hypophosphatemia, hypomagnesemia, and hypokalemia
refeeding syndrome
? probs include air embolus, sepsis, pneumothorax, hemothorax, hydrothorax, and cardiac rupture
catheter-related problems
leading cause of death between ages 1 and 44
unintentional and violence related injuries
leading cause of accidental deaths in US
motor vehicle accidents
permissive hypotension prevents the ? and further exsanguination
dislodgment of ‘fresh clot’
MC indication for intubation?
AMS
? intubation requires the patient be awake
nasotracheal
cricothyroidotomy only by experienced operators and not under ? bc of risk of developing ?
12 yo, subglottic stenosis
paradoxical breathing
flail chest
open chest wounds- never be completely occluded with dressing because this may confer the wound into a ?
tension pneumothorax
each liter of ringer’s lactate solution contains ?
4 mEq of potassium
high riding prostate in association with blood in urinary meatus may imply ?
pelvic fracture
trauma eval not complete until ?
finger or tube inserted in every orifice
cribiform plate injury suspected- avoid ? and use ?
nasogastric tube, orogastric tube
? largely replaced diagnostic peritoneal lavage as diagnostic test of choice for intra-abdominal injury
FAST- focused assessment with sonography for trauma
? indicated if a patient exhibits any signs of shock, peritoneal irritation, or evisceration
immediate laparotomy
FAST reveals free intraperitoneal air or fluid- ? is indicated
laparotomy
Glascow Coma score
- intubate at ?
- normal?
- mild head injury?
- moderate?
- severe?
less than or equal to 8 15 13-15 9-12 less than 9
rhinorrhea, otorrhea, raccoon eyes, battle’s sign
basilar skull fracture
ecchymosis of lids?
raccoon eyes
ecchymosis behind the ear?
battle’s sign
epidural hematoma
- usually injury to ?
- herniation triad ?
- Dx w/ CT, require ?
middle meningeal artery
fixed/dilated pupils, coma, decerebrate posturing
emergent craniotomy
subdural hematoma
- usually injury to ?
- chronic more common in ?
bridging veins
elderly, alcoholics
burns
- first degree?
- second degree?
- third degree?
- fourth degree?
- only epidermis
- superficial partial thickness extends into papillary dermis; deep superficial extend into reticular dermis
- full thickness (epidermis and dermis)
- skin and sQ, further involves fascia, muscle, bone, or other structures
most common type of burns
scald burns
characteristics
first degree- absence of ?
second degree- ? walled, fluid filled blisters, pain?
third degree- appearance ?, dry skin without presence of ?
fourth degree- significant charring, exposure of muscle, fascia, tendons and pigs, extensive damage to nerves results in?
- blisters
- thin-walled, painful
- white, leathery, or charred, no sensation
- loss of sensation
fifth degree burns- for coding purposes, result in ?
amputation or loss of body part
findings on skin do not correlate with extent of burns when caused by ?
electrical energy
if chemical burn, don’t use ? but use
water (may cause further burn damage), powder
burns caused by white phosphorus may require neutralization with ? and ? to address concomitant hypocalcemia
copper sulfate, calcium gluconate
hydrofluoric acid burns- ? for at least 30 min with concomitant application of ? to affected area
copious lavage, calcium gluconate gel
parkland formula? (for burns)
percentage of burn area x weight (kg) x 4ml/hr
foley catheter & burns
- maintained urine output in adult
- child
0.5 mL/kg/hr in adult
1 mL/kg/hr
MC used topical burn ointment
sulfadiazine (silvadene)
deep dermal burns/full-thickness burns best covered by ?
autograph
severe burns - gastric or duodenal ulcerations aka?
curling ulcers
most common complication of burns?
infections
chrnoic healing burn wounds- transformation into SCC aka?
Marjolin ulcer
five Ws in determining cause of post-op fever
Wind- atelectasis (MC) (24-48h post-op) Water- UTI (48-72h) Wound- infection (MC fever after 72h) Wondering drugs/Whopper Walking- thrombophlebitis (after 72h)
thrombophlebitis in post-op fever can be associated with ? (MC), indwelling central lines, or DVT
IV catheters
post-op fever… whopper = ?
post-op abscess
shifting of mediastinum TOWARD affected side, loss of lung volume on affected side
atelectasis (tension PTX opposite)
MC nosocomially acquired infection
UTIs
hypertrophic tissue usually regresses without intervention; keloid?
usually requires intervention
pts w/ ? are at greatest risk of developing decubitus ulcers
spinal cord injury
standard in differentiating between colonization and true infection in ulcers?
deep tissue biopsy/deep tissue cultures
char. by rapidly progressing erythema, tissue crepitus, marked tissue tenderness, high temperatures, tachycardia, hypotension, and AMS
necrotizing fasciitis
triad of necrotizing fasciitis?
- elevated WBC (15 mg/mL)
- hyponatremia (<135 mmol/L)
mainstay of therapy in necrotizing fasciitis
surgical debridement
? of anterior chest wall may be seen post-op as a normal variant
subQ emphysema
MC method of repair for inguinal surgery
TAPP- TransAbdominal PrePeritoneal Herniorrhaphy
MC complication of open appendectomy
wound infection
MC complication of laparascopic appendectomy
intra-abdominal abscess
