Surgery Pre-op/Post-op Flashcards
How to determine acid/base disorder?
- Look at pH
- Look at CO2
- Look at bicarb
When to refer ABI to vascular?
> 1.4 - sclerotic
< 0.8 - arterial disease
< 0.4 - severe arterial disease
Who should receive a pre-op EKG?
Patients 40 and older
Patients should stop smoking ___ prior to surgery
8 weeks
Which patients need antibiotic prophylaxis for endocarditis?
Prosthetic valve
Prior endocarditis
Cyanotic congenital heart disease
Heart transplant
What procedures need endocarditis prophylaxis?
Dental and respiratory procedures
6 predictors for poor cardiac surgical outcomes
IHD
CHF
CVD
High risk operation
Pre-op treatment with insulin
Pre-op Cr over 2
What patients should receive a stress test prior to surgery?
Unstable angina
Recent MI
Arrhythmias
Severe valvular disease
DVT prophylaxis
Heparin or LMWH in hospital
DOACs or warfarin outpatient
EKG changes in electrolyte disorders
-Hyperkalemia: peaked T waves
-Hypokalemia: U waves
-Hypocalcemia: long QT
-Hypercalcemia: short QT
-Hypermagnesemia: tall T waves
-Hypomagnesemia: wide QRS and prolonged PR
MCC of renal failure
Hyperphosphatemia
Characteristics of various fluids
NS: MC
LR: most similar to body composition, used for diabetics who are NPO prior to surgery
Hypotonic NS: used in hypernatremia or DKA
Calculation of maintenance fluids
4:2:1 rule
4 x 10 for the first 10 kg
2 x 10 for the second 10 kg
1 x remaining kg
K supplementation with fluids
Don’t give in the first 24 hours post-op
20 meq K for each 1L
Indications for catheter placement
Anticipating long procedure
Urologic or pelvic surgery
Need to monitor fluid balance
Best method of peri-op glucose control
IV insulin
Surgical site infection increases with the BG over ___
140
Two determinants of risk in pulmonary operations
Operative site
Presence of lung disease
Pre-op treatment of COPD
Smoking cessation
Antibiotics
Bronchodilators
Pre-op treatment of asthma
Should receive a step-up in their asthma treatment (may include a short course of steroids)
Qualifications for elective surgery of asthma patients
Peak flow > 80%
Pre-op for asthma patients who require intubation
Administer rapid-acting beta agonist or nebulizer 30 minutes before intubation
5 W’s of post-op fever
Wind: atelectasis (24-48h hours)
Water: UTI (3-5 days)
Wound: wound infection (5-7 days)
Walking: DVT (7-10 days)
Wonder drugs: drug fever (anytime post-op)
MC nosocomial infections
UTIs
MC organism of post-op wound infections
Staph
Treatment of post-op wound infection
Removal of sutures
Pack open wound
Antibiotics
Pre-op ___ can significantly decrease the incidence of surgical site infections
High flow oxygen
Meds to stop the day before surgery
Statins
Diuretics
Antidepressants
Insulins
Diabetic meds
Meds to stop 5-7 days before surgery
Anticoags
NSAIDs
Vitamin E
Herbals
Meds that can be taken the day of surgery
Cardio drugs
Synthroid
OCPs
Anticonvulsants
GERD meds
Asthma meds
INR needs to be ___ before elective surgery
Below 1.5
Getting labs prior to surgery
If patient is healthy, any labs in the past 4 months will work
Pre-op for adrenal insufficiency
Admit 1-2 days prior for fluids, Na replacement, and cortisol therapy
Cortisol injections throughout treatment
Best indicator for pulmonary complications
PFT
MCC of perioperative death
MI
Examples of pre-treatment agents
Fentanyl
Examples of induction agents
Propofol
Ketamine
Examples of paralysis agents
Succinylcholine
Steps of induction
Oxygen
Pre-treatment
Induction
Intubate
Paralysis
Possible adverse reaction of succinylcholine
Malignant hyperthermia
S/S of malignant hyperthermia
Unexplained tachycardia
Increased end-tidal CO2
Increased body temperature
Masseter rigidity
Treatment of malignant hyperthermia
Dantrolene
MAC (monitored anesthesia care)
Without intubation
Propofol, Fentanyl, Versed
Spinal anesthesia
L3-L4
Enter subarachnoid space and inject into CSF
In LLD or sitting and bending forward
Epidural anesthesia
Any point in the vertebral column
Into the epidural space
How long does pulmonary function remain diminished post-op?
12-14 hours, returns to baseline after 7 days
MC pulmonary risk post-op
Atelectasis
Treatment of post-op atelectasis
Breathing exercises
Chest percussion
Bronchodilators
How to minimize risk of atelectasis post-op?
Incentive spirometry and early mobilization
Rules for blood transfusion
Hgb < 7
Hgb < 8 in patients with comorbidities
Mallampati score
1: complete visualization of soft palate
2: complete visualization of uvula
3: visualization of only base of uvula
4: soft palate is not visible at all
Eating rules pre-op
NPO after midnight before the surgery
Rules for timeline after PCI before elective surgery
Angioplasty alone: 2-4 weeks
Metal-stents: 4-6 weeks
Drug eluting stent: 1 year
How long should sutures stay in?
Face: 3-5 days
Abdomen: 8-10 days
Extremeties: 10-14 days
Treatment of post-op hematoma
Small will resorb on its own
Evacuation
Common sites of seromas
Axilla
Breast
Inguinal
Treatment of post-op seromas
Needle aspiration and compression dressings
Antibiotics used for surgical site infections
Ancef
Rocephin
Cefoxitin
Post-op follow-up
Typically 2 weeks
2-4 weeks for PCP