Surgery Pre-op/Post-op Flashcards by Makenzie Cook

How to determine acid/base disorder?

Look at pH
Look at CO2
Look at bicarb

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When to refer ABI to vascular?

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

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Who should receive a pre-op EKG?

Patients 40 and older

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Patients should stop smoking ___ prior to surgery

8 weeks

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Which patients need antibiotic prophylaxis for endocarditis?

Prosthetic valve
Prior endocarditis
Cyanotic congenital heart disease
Heart transplant

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What procedures need endocarditis prophylaxis?

Dental and respiratory procedures

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6 predictors for poor cardiac surgical outcomes

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

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What patients should receive a stress test prior to surgery?

Unstable angina
Recent MI
Arrhythmias
Severe valvular disease

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DVT prophylaxis

Heparin or LMWH in hospital
DOACs or warfarin outpatient

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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

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MCC of renal failure

Hyperphosphatemia

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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

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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

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K supplementation with fluids

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

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Indications for catheter placement

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

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Best method of peri-op glucose control

IV insulin

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Surgical site infection increases with the BG over ___

140

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Two determinants of risk in pulmonary operations

Operative site
Presence of lung disease

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Pre-op treatment of COPD

Smoking cessation
Antibiotics
Bronchodilators

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Pre-op treatment of asthma

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

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Qualifications for elective surgery of asthma patients

Peak flow > 80%

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Pre-op for asthma patients who require intubation

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

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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)

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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

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