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Surgery EOR > Surgery Pre-op/Post-op > Flashcards

Surgery Pre-op/Post-op Flashcards

1
Q

How to determine acid/base disorder?

A
  1. Look at pH
  2. Look at CO2
  3. Look at bicarb
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2
Q

When to refer ABI to vascular?

A

> 1.4 - sclerotic
< 0.8 - arterial disease
< 0.4 - severe arterial disease

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3
Q

Who should receive a pre-op EKG?

A

Patients 40 and older

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4
Q

Patients should stop smoking ___ prior to surgery

A

8 weeks

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5
Q

Which patients need antibiotic prophylaxis for endocarditis?

A

Prosthetic valve
Prior endocarditis
Cyanotic congenital heart disease
Heart transplant

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6
Q

What procedures need endocarditis prophylaxis?

A

Dental and respiratory procedures

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7
Q

6 predictors for poor cardiac surgical outcomes

A

IHD
CHF
CVD
High risk operation
Pre-op treatment with insulin
Pre-op Cr over 2

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8
Q

What patients should receive a stress test prior to surgery?

A

Unstable angina
Recent MI
Arrhythmias
Severe valvular disease

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9
Q

DVT prophylaxis

A

Heparin or LMWH in hospital
DOACs or warfarin outpatient

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10
Q

EKG changes in electrolyte disorders

A

-Hyperkalemia: peaked T waves
-Hypokalemia: U waves
-Hypocalcemia: long QT
-Hypercalcemia: short QT
-Hypermagnesemia: tall T waves
-Hypomagnesemia: wide QRS and prolonged PR

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11
Q

MCC of renal failure

A

Hyperphosphatemia

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12
Q

Characteristics of various fluids

A

NS: MC
LR: most similar to body composition, used for diabetics who are NPO prior to surgery
Hypotonic NS: used in hypernatremia or DKA

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13
Q

Calculation of maintenance fluids

A

4:2:1 rule
4 x 10 for the first 10 kg
2 x 10 for the second 10 kg
1 x remaining kg

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14
Q

K supplementation with fluids

A

Don’t give in the first 24 hours post-op
20 meq K for each 1L

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15
Q

Indications for catheter placement

A

Anticipating long procedure
Urologic or pelvic surgery
Need to monitor fluid balance

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16
Q

Best method of peri-op glucose control

A

IV insulin

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17
Q

Surgical site infection increases with the BG over ___

A

140

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18
Q

Two determinants of risk in pulmonary operations

A

Operative site
Presence of lung disease

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19
Q

Pre-op treatment of COPD

A

Smoking cessation
Antibiotics
Bronchodilators

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20
Q

Pre-op treatment of asthma

A

Should receive a step-up in their asthma treatment (may include a short course of steroids)

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21
Q

Qualifications for elective surgery of asthma patients

A

Peak flow > 80%

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22
Q

Pre-op for asthma patients who require intubation

A

Administer rapid-acting beta agonist or nebulizer 30 minutes before intubation

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23
Q

5 W’s of post-op fever

A

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)

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24
Q

MC nosocomial infections

A

UTIs

25
Q

MC organism of post-op wound infections

A

Staph

26
Q

Treatment of post-op wound infection

A

Removal of sutures
Pack open wound
Antibiotics

27
Q

Pre-op ___ can significantly decrease the incidence of surgical site infections

A

High flow oxygen

28
Q

Meds to stop the day before surgery

A

Statins
Diuretics
Antidepressants
Insulins
Diabetic meds

29
Q

Meds to stop 5-7 days before surgery

A

Anticoags
NSAIDs
Vitamin E
Herbals

30
Q

Meds that can be taken the day of surgery

A

Cardio drugs
Synthroid
OCPs
Anticonvulsants
GERD meds
Asthma meds

31
Q

INR needs to be ___ before elective surgery

A

Below 1.5

32
Q

Getting labs prior to surgery

A

If patient is healthy, any labs in the past 4 months will work

33
Q

Pre-op for adrenal insufficiency

A

Admit 1-2 days prior for fluids, Na replacement, and cortisol therapy
Cortisol injections throughout treatment

34
Q

Best indicator for pulmonary complications

A

PFT

35
Q

MCC of perioperative death

A

MI

36
Q

Examples of pre-treatment agents

A

Fentanyl

37
Q

Examples of induction agents

A

Propofol
Ketamine

38
Q

Examples of paralysis agents

A

Succinylcholine

39
Q

Steps of induction

A

Oxygen
Pre-treatment
Induction
Intubate
Paralysis

40
Q

Possible adverse reaction of succinylcholine

A

Malignant hyperthermia

41
Q

S/S of malignant hyperthermia

A

Unexplained tachycardia
Increased end-tidal CO2
Increased body temperature
Masseter rigidity

42
Q

Treatment of malignant hyperthermia

A

Dantrolene

43
Q

MAC (monitored anesthesia care)

A

Without intubation
Propofol, Fentanyl, Versed

44
Q

Spinal anesthesia

A

L3-L4
Enter subarachnoid space and inject into CSF
In LLD or sitting and bending forward

45
Q

Epidural anesthesia

A

Any point in the vertebral column
Into the epidural space

46
Q

How long does pulmonary function remain diminished post-op?

A

12-14 hours, returns to baseline after 7 days

47
Q

MC pulmonary risk post-op

A

Atelectasis

48
Q

Treatment of post-op atelectasis

A

Breathing exercises
Chest percussion
Bronchodilators

49
Q

How to minimize risk of atelectasis post-op?

A

Incentive spirometry and early mobilization

50
Q

Rules for blood transfusion

A

Hgb < 7
Hgb < 8 in patients with comorbidities

51
Q

Mallampati score

A

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

52
Q

Eating rules pre-op

A

NPO after midnight before the surgery

53
Q

Rules for timeline after PCI before elective surgery

A

Angioplasty alone: 2-4 weeks
Metal-stents: 4-6 weeks
Drug eluting stent: 1 year

54
Q

How long should sutures stay in?

A

Face: 3-5 days
Abdomen: 8-10 days
Extremeties: 10-14 days

55
Q

Treatment of post-op hematoma

A

Small will resorb on its own
Evacuation

56
Q

Common sites of seromas

A

Axilla
Breast
Inguinal

57
Q

Treatment of post-op seromas

A

Needle aspiration and compression dressings

58
Q

Antibiotics used for surgical site infections

A

Ancef
Rocephin
Cefoxitin

59
Q

Post-op follow-up

A

Typically 2 weeks
2-4 weeks for PCP

Surgery EOR (12 decks)

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