Surgery General Principles Flashcards
What kind of surgeries are prophylactic abx needed for?
Contaminated and dirty
Which immunisation requires ‘Z’ technique?
B12
proctoscopy indications
investigate anorectal conditions where DRE not good enough
internal haemorrhoids/anorectal masses
can collect samples eg in HIV
Colonoscopy indications
gold standard for bowel cancer screening preop before anorectal surgery surveillance radiation removal of rectal foreign bodies Biopsy haematochezia which needs haemostasis
Tube thoracostomy indications
pleural effusion
pneumothorax
haemothorax
empyema
Insertion site of chest drain
Need analgesia + @ least 2L O2
4-5th ic space in anterior axillary line
LA in wrong place
call for help stop injection secure airway IV access inralipid
Management of surgical drain
keep sterile suction if needed secure measure output monitor changes in fluid use this to help fluid calculations
risk factors for delayed wound healing
malnutrition poor gylcaemic control poor renal function long surgery co-morbidities medications
What does water follow?
SALT!!
SIGNS OF FLUID DEPLETION
dry mucous membranes delayed cap refill cool skin tachycardia bp drop postural hypotension
signs of fluid overload
crackles lung bases bilateral oedma elevated JVP hypertension third heart sound
biochemical signs of dehydration
specific gravity >1020
osmolality >500
urea >250 in urine
3 phases of septic shock
- peripheral vasodilatation
- endothelial damage –> capillary permeability
- depression of myocardial contractility
can lead to DIC
neurogenic shock causes
epidural analgesia
spinal cord injury
left atrial wedge pressure
tells you cause of cardiogenic shock
Causes of DIC - STOP MAKING NEW THROMBI
sepsis trauma obsteric complications pancreatitis malignancy nephrotic syndrome transfusion
how often should cannulae be changed?
every 72 hours ( 3 days)
disinfectant
destroys organisms
anti-septic
slows growth
cellulitis/erysipleas
penicillin, IV if severe
staph scalded skin syndrome
systemic flucloxacillin
necrotising fascitis
IV benpen + clindamycin/metronidazole
culture debrided tissue
gram stain exudate
amputation if v bad
post op pyrexia exam
look at wound + cannula sites chest exam (collapse, infection, infarction, subphrenic abcess) DVT rectal exam (abcess) urine dip/culture c diff stool culture consider drug sensitivity
