SURGERY Flashcards
BLUNT TRAUMA PELVIS / FRACTURE 40 MPH SOB PE: PELVIC TENDERNESS ANTERIOR*
BLUNT TRAUMA TO CHEST R/O RIB FRACTURE CARDIAC CONTUSION, STERNAL FRACTURE.
BLUNT TRAUMA TO PELVIS R/O FRACTURE OR PERFORATED VISCUS.
AIRWAY BREATHING CIRCULATION DISABILITY EXPOSURE/ENVIRONMENT CONTROL
IDP:
X RAY CERVICAL SPINE C7 CXR SUPINE PELVIC X RAY CBC TYPE AND CROSSMATCH AND PLATELETS EKG SERUM LYTES AND AMYLASE BLOOD ALCOHOL LEVEL PULSE OXYMETER NASOGASTRIC TUBE AND FOLEY CATHETER UNLESS BLOOD IN URETHRAL MEATUS URETHRAL OPENING SEND URINALYSIS
ADMIT NPO OBSERVE CARDIAC MONITORING POSSIBLE TEE TO R/O PERIC EFFUSION EKG ARRYTHMIAS MCC CONTUSION CARDIAC UA HEAD CT SCN IF AMS ABD PELVIS CT SCANWITH ORAL AND IV CONTRAST
FU:
SERIAL CBC SERIAL ABD/MENTAL STATUS EXAM
SERIAL EXAMINATION
WBC+FEVER, PERITONEAL SIGNS OR HEMODYNAMIC INSTABILITY»_space; LAPAROTOMY
ORTHOPEDIC CONSULT
DO CT SCAN OR PERITONEAL LAVAGE TO ALL UNSTABLE BEFORE HEAD OR LIMB SURGERY BECAUSE DURING ANESTHESIA YOU CAN NOT
AIRWAY
GLASGOW<8 ET INTUBATION
CLEAR OROPHARYNX FOR SECRETIONS
JAW THRUST
REMOVE DENTURES OR LOOSE TEETH
INMEDIATE AIRWAY IS CRYCOTHYROIDOTOMY
DEFINITIVE IS TRACHEOTOMY BUT ELECTIVE
CRICOTHYROIDOTOMY IS CONTRAINDICATED IN LESS THAN 12 YEARS
DO NEEDLE CRICOTHYROIDOSTOMY AND PULSE O2 ALLOWS 20-40 MIN IN MID FACE FRACTURES THEN TRACHEOTOMY
RUQ PAIN*
+JAUNDICE FEVER : ECRP DECOMPRESS
+LOW BP AND AMS: ERCP DECOMPRESS
RESUCITATE: IVF + ABX
FOLLOWED BY LAP OR OPEN CHOLE ON SAME ADMISSION
DZ X
PANCREATITIS CHOLANGITIS PUD APPY ECTOPIC / OVARIAN CYST
IM:
CBC
RUQ US THICK WALL*
HIDA SCAN
ADMIT
FWU:
LYTES AMYLASE/LIPASE
FLAT AND UP RIGHT AXR
UA
U BHCG
FM:
NPO
IVF
ABX
48 HRS EVALUATION
RESOLUTION {?}
LAP CHOLE 6-8 WKS vs URGENT LAP OR OPEN CHOLE
ACUTE LIMB ISCHEMIA
POS MI -A.FIB* - WARF WITHDRAWAL
EMBOLUS
THROMBOTIC (LESS LIKELY)
GOUT
NO DOPPLER STUDIES IN TIME SENSITIVE CASES
ARTERIOGRAPHY IS IN TH OR
NO ARTERIOGRAPHY IN ALL NEW CASES AS ARE NO SCHEDULED FOR SURGERY
IWU:
EKG: A.FIB
CXR
FM:
HEPARIN
LEFT ARTERIOGRAM*
EMBOLECTOMY
FU: RE PERFUSION INJURY TIME SENSITIVE 6 HRS IRREVERSIBLE ISCHEMIA PULSE PE BUN CREA SERUM K P Ca UAc COMPARTIMENT SYNDROME FREE RADICALS MYOGLOBULINURIA AKI RHABDO
LOW OCCLUSION COLON*
DZ X
OGILVIE
VOLVULUS
DIVERTICULITIS
CANCER
FUNCTIONAL- OGILVIE CORRECT LYTES TRY UNDERLYING PATH COLONOSCOPY DECOMPRESSION NEOSTIGMINE RESECTION LAST RESORT
DUKES B MUSCULAR ST II C STAGE III LAD D M1 STAGES III-IV CHEMO ADJUVANT
IWU:
CBC
LYTES
FLAT AND UPRIGHT AXR*
WATER SOLUBLE BARIUM? MASS DESCENDING
SIGMOIDOSCOPY
COLONOSCOPY
RESUSCITATE
IVF
RIGHT EXTENDED COLECTOMY ILEO COLONIC PRIMARY ANASTOMOSIS
OR PROXIMAL DIVERTING LOOP AND SECOND TIME RESECTION
FU CRC:
CEA / LFT EVERY 3 MOS/ FIRST YR
COLONOSCOPY AND CXR / YR
PET SCAN AND CT SCAN IF CEA LEVELS RAISES
ACUTE DIVERTICULITIS
IM:
ABD CT SCAN* FAT RING
IV ABX
IVF
BOWEL REST
BETTER{?}
NO:
HARTMANN
REVERT 6-8 WK HARTMAN PROCEDURE
SI: COLONOSCOPY* 4 WK LATER POSITIVE 4 CANCER RESECTION IN 6 WKS NO MUCOSAL LESION: SIGMOID RESECTION ELECTIVE
ABD. PAIN CONSTIPATION VOMITING
INCOMPLTE SBO
DZ X
FUNCTIONAL ILEUS: NON SURGICAL MEANS DECOMPRESS IVF HYDARTE, NPO AND K+ LYTE ISSUE CHOLECYSTITIS PANCREATITIS HERNIA INCARCERATED ADHESION'S GASTRIC OUTLET OBSTRUCTION
IWU:
CBC
LYTES
AMYLASE / LIPASE
FLAT AND UP RIGHT AXR SERIES*
FM:
NPO
IVF + LYTES
NGT
KUB LATERAL VIEW*
GAS RECTUM?
INCOMPLETE 72 HRS EXPECTANT MGMT»_space; RESUSCITATE »_space; 75 % SELF LIMITED
COMPLETE: RESUSCITATE »_space; LAPAROTOMY
IRREGULAR HEART BEAT AND SEVER ABD. PAIN
ACUTE EMBOLUS MSA PERF. VISCUS PANCREATITIS MESENTHERIC ISCHEMIA APPENDICITIS PANCREATITIS DIVERTICULITIS
PH: MI PAD ETC
CHRONIC MSA VARIANT: MESENTERIC ANGINA
TREAT ELECTIVELY BY PASS IT
ABD. VENOUS THROMBOSIS
THROMBOLFILIAS
TEST FOR:
C S PROTEIN DEF FACTOR V LEYDEN MUTATION,
ANTITHROMBINA III DEFICIENCY
IWU: CBC LYTES AMYLASE AXR FLAT - UP RIGHT ACUTE SERIES CXR ABD CT SCAN
FM:
EMERGENT MESENTHERIC ANGIOGRAPHY*
IV HEPARIN
IMMEDIATE EMBOLECTOMY AND / OR RESECTION
FU:
SECOND LOOK
LONG TERM ANTICOAGULANT IF ARRHYTHMIA
SUDDEN ONSET OF PAIN IN THE GROIN REGION
LIE TRANSVERSE ABSENT CREMASTERIC REFLEX*
TIME SENSITIVE DO NOT DOOPLER !!!
JUST EXPLORE ACUTE SCROTUM*
DZ X
SPERMATIC CORD TORSION INCARCERATED HERNIA TUMOR HEMORRHAGE EPIDIDIMITIS ORCHITIS
IWU:
CBC UA AXR IMMEDIATE SURGICAL DETORSION SURGERY PEDIATRIC CONSULT*
PREOP NPO…
COAG INR
BLOOD TYPE & CROSS
FM:
BILATERAL EXPLORATION VIA RAPHE MEDIO
BILATERAL ORCHIDOPEXIA
HE IS BEEN STABBED!
LOCAL WOUND EXPLORATION OF THE STAB W/ LIDOCAINE WOUND TRACT
FASCIA OPEN: EXPLORE
FASCIA INTACT: W & W
GENERAL RULES
HEMODYNAMIC INSTABILITY OR PERITONITIS OR EVISCERATION EXPLORE ALWAYS
CT SCAN OR PERITONEAL LAVAGE
RBC > 10,000 X FIELD
BLUNT
STABLE DO CT SCAN LAVAGE
UNSTABLE DO FAST
EXPLORE
IWU:
CBC TYPE & CROSS IVA FOLEY CXR AXR
FM:
LOCAL EXPLORATION OF THE STAB WOUND TRACT
CT SCAN OF THE ABDOMEN AND THE PELVIS
FM:
IMMEDIATE OPERATIVE EXPLORATION
ANTIBIOTICS
COLONIC VOLVULUS
MASS
OGILVIE
SBO HERNIA
MESENTHERIC ISCHEMIA
IWU:
CBC
UA
LYTES
AXR FLAT UPRIGHT OMEGA SIGN* FM: ADMITTED NPO IVA SURGERY CONSULT RECTAL TUBE DECOMPRESS TX:
RSMCOPY TO 18 CM BIRD’S BEAK
WATER SOLUBLE ENEMA: IDEM
RECTAL TUBE THROUGH THE SIGMOIDOSCOPE TO THE TWIST*
FU:
ELECTIVE SIGMOID RESECTION O SAME ADMISSION
IF PERITONEAL SIGNS: EMERGENT HARTMAN PROCEDURE.
BOERHAVE
DZ X
ASPIRATION PNEUMONITIS
SPONTANEPOUS PNEUMOTHORAX
ESPHAGEAL SPASM
MYOCARDIAL ISCHEMIA
IWU:
CBC LYTES EKG CXR* 4 EFFUSION L DISTAL RIGHT ABOVE AZYGOS FLAT UPRIGHT ABD. RX
FWU:
UPPER GI W/ WATER SOLUBLE* BARIUM IF NEEDED
CT SCAN: AIR FLUID LEVEL MEDIASTINUM
FM: IVA NSS INMEDIATE OPERATIVE REPAIR - DIVERSION IV ABX DRAIN PLEURAL SPACE - LEFT DISTAL THIRD MMF
TIME SENSITIVE CASE
DIABETIC FOOT ULCER
POSSIBLE FORIENG BODY
JOINT SPACE INFECTION
DZ X ULCERS
PAD/DM/VENOUS
TIP-TOES/PLANTAR/MEDIAL MALLEOLAR
IWU:
CBC ESR* LYTES X RAY FOOT PERIOSTIAL CHANGE* = OMYELITIS MRI
FM: DEBRIDEMENT DRAINAGE AND CULTURE AMPUTATION OF THE GREAT TOE IV ABX GLUCOSE/INSULIN CONTROL
PULSATILE ABD MASS*
AAA
CLASSICAL
> 5 OR SYMPTOMATIC = ELECTIVE REPAIR
<5 = ABD US* e/ 6 MOS
RUPTURED= REPAIR
IWU:
CBC LYES EKG CXR AXR
FWU:
CT SCAN W/ IV CONTRAST ABD PELVIS*
FM:
CARDIOPULMONARY ASSESSMENT
ELECTIVE AORTIC ANEURYSM REPAIR
36 YO BLOOD* COMING UP FROM MY NIPPLE
DZ X
PAPILLOMA
ECTASIA
CARCINOMA
TRAUMA
IM:
DUCTOGRAM*
MMX
EXCISION OF THE DUCT 10 % ARE MALIGNANT
EXCISION BX* BENIGN INTRADUCTAL PAPILLOMA
FU:
NO FURTHER MGMT NEEDED
SELF BREAST AND YEARLY MMX
