Surgery p415-425 Flashcards
what is the minimum ejection fraction for non-cardiovascular surgery?
35%
what meds can you give to CHF pts to reduce mortality before surgery?
ACE inhibitors, beta blockers, and spirinolactone
what is the indication for EKG being the only pre-op test?
under the age of 35 and no hx of cardiac dz
name the 3 pre-op tests for a pt with a hx of cardiac dz
- EKG
- stress test for ischemic coronary lesions
- echo for structural dz to assess ejection fraction
best way to maintain an airway with no facial trauma?
orotracheal tubes
best way to maintain an airway with facial trauma?
cricothyroidotomy
what is the indication for flexible bronchoscopy in Trauma/ABC assessment algorithm?
cervical spine injury
for breathing you should keep the O2 sat above
90%
Name 4 SIRS criteria
- temp < 36 or > 38
- HR more than 90
- RR > 20 or pCO2 < 32 mmHg
- WBC < 4,000 or > 12,000
among the 4 SIRS criteria, how many do you need to fulfill SIRS?
2
define sepsis
2 SIRS criteria + source of infection
define severe sepsis
2 SIRS criteria + source of infection + organ dysfunction
define septic shock
severe sepsis + hypotension
among 4 types of shock (hypovolemic, cardiogenic, neurogenic, septic), which two parameters are the best one to use to identify cardiogenic
high CVP, high PCWP
pt with shock comes in and you feel warm/flushed, what is your next step to identify the type of shock?
are there changes in cardiac output? if it’s elevated then septic shock, if not neurogenic
warm/flushed shock pt comes in and cardiac output is increased, what is your next step?
measure PCWP, if low it’s anaphylatic, if no change then septic
pt comes with pale/cool skin the next step?
measure PCWP, if high then it’s cardiogenic, if low it’s hypovolemic
a trauma pt comes in with bruising around the umbilicus, what are the causes and what is it called?
cullen sign, hemorrhagic pancreatitis, ruptured abdominal aortic aneurysm
a trauma pt comes with bruising in the flank. what is the name of the sign and what causes it?
grey turner sign, retroperitoneal hemorrhage
what are the two signs and symptoms from splenic rupture?
- kehr sign: pain in the Lt. shoulder
2. balance sign: dull percussion on the Lt. and shifting dullness on the Rt.
the best test to evaluate free air under the diaphragm?
upright chest x-ray
a trauma pt comes in and you see a free air under the diagphragm, what is the most likely dx?
perforation of the bowel
the best test to diagnose intraabdominal bleeding for a trauma pt?
FAST scan
a trauma pt comes in with a possible retroperitoneal bleed or splenic rupture, but the FAST scan was negative, what do you want to do?
CT scan
abdominal trauma pt comes in bp is 100/80, how would you manage?
serial abdominal exams, IV fluids
abdominal trauma pt comes in and bp is 80/50, what is your next step
exploratory laparotomy
how is the treatment diff btw tension vs plain pneumothorax
for tension, you need immediate needle decompression followed by chest tube placement, plan pneumothorax, just chest tube placement
a trauma pt comes in with absent breath sounds and dull to percussion. chest x-ray shows blunting of costophrenic angle, what is your next step?
(hemothorax) chest tube drainage and possible thoracotomy
what is the etiology of hemothorax?
blood in the pleural space
what is the etiology of pneumothorax?
air in the plueral space
3 signs of pericardial tamponade?
- JVD
- hypotension
- muffled heart sounds
a trauma pt comes in with chest pain and the EKG shows electrical alternans, what is the dx?
pericardial tamponade
how would you diff btw tension pneumothorax vs. atelectacis on chest x-ray?
TP pushes the trachea away from the involved lung, whereas atelectasis pulls the trachea toward the involved lung
a trauma pt comes in with blood at the urethral meatus, what is the best next step?
retrograde urethrogram
80 y/o old male with significant hx of CAD, a fib comes in with pain in abdomen after meals, no fever, no peritoneal sign, what is the best next step?
angiography
what are the 2 most common watershed areas for infarction?
splenic, hepatic flexures
what are the 2 most common symptoms of ischemic bowel dz?
abdominal pain after eating, bloody diarrhea
best initial test for ischemic bowel dz?
CT abdomen
most accurate test for ischemic bowel dz?
angiography
tx for ischemic bowel dz?
IV normal saline followed by surgical intervention to remove necrotic bowel
acute mesenteric ischemia is the acute occlusion of mesenteric arteries, most commonly which artery?
superior mesenteric artery
number one risk factor for acute mesenteric ischemia?
a fib
best initial test for mesenteric ischemia?
abdominal x-ray
the most accurate test for mesenteric ischemia?
angiography
the most appropriate therapy for mesenteric ischemia?
emergent laparotomy with resection of necrotic bowel
a pt comes with Rt. upper q pain, give 4 diff dx
- cholecystitis
- biliary colic
- cholangitis
- perforated duodenal ulcer
2 diff dx for Lt. upper quadrant?
- splenic rupture
2. IBS - splenic flexure syndrome
3 diff dx for midepigastrium?
- pancreatitis
- aortic dissection
- peptic ulcer dz
Rt. lower q abdominal pain, 4 diff dx?
- appendicitis
- ovarian torsion
- ectopic preg
- cecal diverticulitis
Lt. lower q abdominal pain, 4 diff dx?
- sigmoid volvulus
- sigmoid diverticulitis
- ovarian tosrion
- ectopic preg
a 65 y/o male with significant hx of CAD comes in with pain in Lt. chest, haw, and Lt. arm, dx?
MI
70 y/o female with significant weight loss in 3 months comes in with back pain as a referred pain, what organ is responsible for this pain?
pancreas
60 y/o male with recent jaundice comes in with pain in Rt. shoulder/scapular, what organ is responsible for this pain?
gall bladder
