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Surgery - Year 3 > Surgery - Peri-Operative > Flashcards

Surgery - Peri-Operative Flashcards

1
Q

What is the split of Extra and Intracellular water within the body?

A

33:66 - 14L : 28L

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2
Q

What are the components of the extracellular compartment?

A

Intravascular and interstitial

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3
Q

What is the blood’s normal plasma osmolality?

A

290mOsmol/Kg

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4
Q

How much solute does a 1% solution have in 1L?

A

1% solution has 1g per 100ml

Therefore, 10g

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5
Q

Where does 5% Dextrose go with regards to the cellular compartments?

A

Dextrose is immediately absorbed, meaning the fluid will disperse evenly between all compartments.

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6
Q

Where will 0.9% Saline go with regards to the cellular compartments?

A

Will remain in the extracellular comparment

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7
Q

What is the usual regime for maintenance fluids?

A

1 salty, 2 sweet
1L Saline over 8 hours + 20mmol K+
1L Dextrose over 8 hours + 20mmol K+
1L Dextrose over 8 hours + 20mmol K+

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8
Q

Describe the regime of giving resus fluids

A

500ml IV Saline bolus, then give 250ml again until 2L if no improvement

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9
Q

List 8 signs of a patient’s hydration/fluid balance status

A 
Mucous membranes
Skin turgor
Blood pressure
Capillary refill time
Oedema
Ascites
Urine output
Na level
Respiratory rate (raised in pulmonary oedema)
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10
Q

Define Third Spacing

A

Movement of fluid from the intravascular compartment to the interstitial compartment (non-functional area between cells)

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11
Q

How does vomiting affect acid-base balance?

A

In vomiting there is loss of Cl- and H+ ions (hydrochloric acid from stomach). This leads to metabolic alkalosis. To make up for this, the kidneys reabsorb H+ at the cost of K+, leading to hypokalaemia.

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12
Q

What are the side-effects of pain?

A
  • Reduced wound healing rate
  • Urinary retention
  • Chronic pain from increased neuro-plasticity of tissues
  • Increased protein breakdown and clotting
  • Depression
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13
Q

Name 2 strong opioids

A

Morphine, Oxycodone, Fentanyl

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14
Q

Name 2 weak opioids

A

Codeine, Tramadol

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15
Q

What would you do on day of surgery for a Type 1 Diabetic?

A

Give Potassium Chloride + Glucose + NaCl, titrated to their electrolytes
Give VRII + NaCl with the target range of 6-10mmol/L

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16
Q

When would you give “rescue treatment” and what would it be?

A

4mmol/L glucose

IV glucose 20%

17
Q

When should subcutaneous insulin be restarted?

A

When oral intake can be achieved without nausea/vomiting

18
Q

What tablet-controlled drugs would you stop before surgery and why?

A

Sulfonylureas eg. gliclazide - hypo risk

Metformin - AKI risk

19
Q

When does Warfarin need to be stopped before surgery? And DOACs?

A

Warfarin - 5 days

DOACs - 24 - 96 hours before surgery

20
Q

What is given to steroid dependent patients?

A

IV Hydrocortisone 4 times per day

21
Q

Name the Sepsis red flags

A
  • Confusion
  • Systolic <90 or drop >40 from normal
  • HR > 130
  • RR > 25
  • spO2 <92% or need Oxygen to maintain this
  • Non-blanching rash
  • <0.5ml/kg/hour urine over last 18 hours
  • Lactate >2mmol/L
  • Recent chemo
22
Q

What antibodies are present in the blood of someone with:
A blood
AB blood
O blood?

A 
A = B antibodies
AB = no antibodies
O = AB antibodies
23
Q

What is the universal donor?

What is the universal acceptor?

A

O-

AB+

24
Q

What are the indications for O- blood?

A

Phenotype specific blood required, non-crossmatch blood required, neonatal ICU, transplant patients

25
Q

Blood transfusion indications?

A
  • Symptomatic anaemia
  • Acute sickle cell crisis
  • Acute blood loss of more than 30% in last 4 hours
26
Q

Name 6 complications of blood transfusions

A

AKI, acute haemolytic reaction, transfusion-associated circulatory overload and acute lung injury, anaphylaxis, GvH disease, infection, iron overload

27
Q

What can be done to prevent blood loss?

A

Use a “cell saver” machine and give tranexamic acid

28
Q

What is the name of the pre-aspiration pneumonia syndrome?

A

Chemical pneumonitis

29
Q

What hormone response is seen post-surgery?

A

Cortisol up
Aldosterone up
Adrenaline up
ADH up

30
Q

What does the hormone change after surgery lead to?

A 
Hyperglycaemia
Hypertension
Oliguria
Lipolysis/Proteolysis
Sodium retention
31
Q

How do graduated compression stockings work?

A

Increased pressure at base of ankle, reducing as it goes up. Forces blood towards heart and occludes vessels, increasing pressure.

Surgery - Year 3 (6 decks)

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