Surgery Lectures Flashcards
What are the two different routes to surgery?
Emergency and Elective
What is the elective surgical pathway?
Pt sees GP. Referred to surgical outpatient appt. Decision for surgery. Pt seen at pre-operative assessment clinic. Pt sent surgery date. Pt arrives in Admission Suite 7.30am.
What does the pre-op assessment consist of?
Medical history. Medication history. Blood tests - eGFR, Hb. Weight - dosing. BP measured. BG/HbA1c measured. MRSA screen and eradication.
What problems are there WRT the surgical pathway?
Pre-op nurses often used Pts handwritten list of medication - No Medicines Reconciliation.
No Drs in admission suite to prescribe regular medicine.
Surgeons/ aneasthetists do not have time to do this.
No pharmacist in the admission suite.
Why do Pts fast before surgery?
Risk of aspiration of stomach contents when under general aneasthetic.
General rule - Most regular medication (except ________ and _____________) should be given on the day of surgery with small sips of water.
General rule - Most regular medication (except anticoagulants and oral hypoglycaemics) should be given on day of surgery with small sips of water
When should warfarin be stopped pre surgery?
5 days.
Pts INR should be _____ for surgery to proceed.
<1.5
If a pt taking warfarin needs emergency surgery what can be done?
Vit K given = reversal within 4 - 24 hours.
Beriplex = reversal with one hour.
What is beriplex?
Dried prothrombin complex containing variable amounts of some of the clotting factors.
The risk of VTE would be ____ in a patient with AF + CHADVASc = 0 - 2 w/ no prior history of stroke/TIA.
LOW - no LWMH pre surgery required.
The risk of VTE in someone with a history of a single VTE >12 months previously would be:
Low risk - no LWMH needed.
The risk of VTE in someone with AF and CHADSVASc = 3-4 would be
Moderate, start therapeutic dose of LWMH two days after stopping warfarin.
Also: active cancer, recurrent VTE, VTE in past 3-12 months.
The VTE risk in someone with AF CHADVASc score of 5-6:
High, LMWH as above or admit for unfractionated heparin infusion once INR less than 2 or 3.
The last dose of warfarin should be taken SIX days before surgery. LMWH should be started __ days after stopping warfarin.
We ____ give LMWH on the morning of surgery and unfractionated heparins should be ________ before surgery.
2 days after stopping warfarin.
Do not give LMWH on morning of surgery.
Stop unfractionated heparin 6 hours before surgery.
