Surgery PEARLS Flashcards
Stress induced hyperglycemia is primarily due to
Peripheral resistance to insulin
Basal caloric requirement in mild stress
25-30 kcal/kg/day
Basal caloric requirement in moderate stress
30 kcal/kg/day
Basal caloric requirement in severe stress
30-35 kcal/kg/day
Cancer + severe malnutrition
30 kcal/kg/day
Phase of surgical metabolism/injury with reduced REE
EBB phase
Primary source of energy during stress
Fat
Systemic proteolysis following injury is mediated primarily by
Glucocorticoids
% protein catabolised per day
1.5%
Dry, scaly dermatitis following prolonged parenteral treatment
Essential fatty acid (EFA) deficiency
MC fluid disorder in surgical patients
Extracellular, mainly GI
Source of HCO3 in plain LR
Lactate
Dextrose in D5-containing IVFs
50 g/L
What to request in patients with persistent hypocalcemia/hypokalemia
Serum magnesium
Most important treatment of metabolic acidosis
Volume resuscitation, NOT bicarbonate
Early acid-base picture of sepsis
Respiratory alkalosis
Criteria for SIRS
1) Temp 36C or less OR 38 or more 2) HR 90 or more 3) RR 20 or more 4) WBC 4000 or less OR 12000 or more or 10% or more bands
MC organism isolated in G- septicemia
E.coli
Adverse changes in G- septicemia is due to
Lipid A release
Earliest stage of hemostasis
Vascular constriction (> platelet plug > fibrin > fibrinolysis)
Average life span of platelets
7-10 days
Inherited disorder of platelet disorder due to lack of gpIIb/IIIa
Glanzmann thrombasthenia
Inherited disorder of platelet disorder due to lack of gpIb/IX/V
Bernard-Soulier syndrome
MC abnormality of homeostasis in surgical patients
Thrombocytopenia
Platelet level when there is spontaneous hemorrhage
Treatment of choice in patients with von Willebrand disease
Intermediate purity factor 8/DDAVP
Best method of identifying a potential bleeder
Complete history and PE
MC indication for blood transfusion in surgical patients
Volume replacement
Treatment for bleeding due to fibrinolysis
Aminocaproic acid aka tranexamic acid
Most important management for DIC
Treat underlying cause
Mechanism of DIC
Excessive plasminogen activator
Differentiates DIC from primary fibrinolysis
Protamine test (+) in DIC
Diffuse oozing of blood from SSI is most likely due to
Platelet deficiency
Most important management of immediate transfusion reaction
Stop the transfusion
Delayed transfusion reaction usually occurs within how many days post-transfusion
2-10 days
Differentiate delayed from immediate transfusion reaction
Delayed is d/t EXTRAVASCULAR hemolysis and no specific intervention is needed
Shock in a setting of adequate intravascular volume
Cardiogenic shock
Preferred test in the diagnosis of cardiac tamponade
Echocardiography
Immediate step after 2D echo-confirmed cardiac tamponade
Pericardiocentesis
Sign seen in echocardiography of patient with cardiac tamponade
Halo sign
Persistently elevated base deficit in a trauma patient is usually due to
Ongoing bleeding
Caloric content of 1L D5LR
180
MCC of death of all individuals aged 1-44
Trauma
Widened mediastinum
Aortic dissection
Gold standard for determining blunt descending torn aortic injury
CT scan
MC indication for intubation
Altered mental status
Preferred technique used in establishing a definitive airway
Orotracheal intubation
Main difference between tension pneumothorax and simple pneumothorax
Hypotension
Multiple sta wounds on right chest, awake, normotensive, tachypneic, tachycardic, absent breath sounds on right. Next best step.
CXR
3 contiguous ribs fractured on both right and left hemithorax
Flail chest
Lethargic, arousable, palpable femoral pulse. SBP is at least
70 mmHg
Cutoff blood volume in a massive hemothorax
1500mL
Blood volume that may cause cardiac tamponade
Less than 100 mL
Most reliable indicator of organ perfusion
UO
Adequate UO in adult
0.5cc/kg/hr
Adequate UO in child
1cc/kg/hr
Adequate UO in infant
2cc/kg/hr
Hypotensive, tachycardic, tachhypneic, anxious, confused. Class of shock
3
Estimated blood loss in a class 3 shock
At least 30%
Fracture of 3 ribs can result to approximately how much blood loss
300-600
Most important radiograph to obtain in the setting of a blunt trauma or motor vehicular accident
1) Cervical 2) Chest 3) Pelvic (SFA NOT included)
MC organ injured in blunt trauma
Spleen
Next best step in management of symptomatic neck injuries
CT angio of neck and chest
