Surgery Rotation 5 Flashcards
Absolute contraindication to surgery
DKA
Measures of poor nutrition
Albumin > 3
Transferrin > 200
Lost more than 20% of body weight
Most important factors for predicting mortality for surgery
- CHF - check EF
- MI within 6 months - check EKG
- Arrhythmias
- Old age
- Emergent surgery
- Aortic stenosis - listen for murmur (late systolic, crescendo-decrescendo)
Meds to stop before surgery
Aspirin, NSAIDs, Warfarin, metformin (lactic acidosis)
What do you do on a vent if patient’s paCO2 is low?
Patient is blowing off too much CO2
So want to decrease tidal volume (preferable) or rate
What is the formula for anion gap?
Na - (Cl + HCO3)
Normal = 8-12
Causes of hypervolemic hyponatremia
CHF, nephrotic syndrome, cirrhosis
Causes of hypovolemic hyponatremia
vomiting, diuretics
Causes of euvolemic hyponatremia
SAIDH, Addisons, hypothyroidism
When do you use hypertonic saline solution (3%)
Symptomatic hyponatremia (e.g. seizures) or extremely low Na level (< 110)
Why don’t you use hypertonic solution to always fix hyponatremia?
Central pontine myolinolysis
Treatment of hypernatremia
D5W or hypotonic solution
What is the concern when correcting hypernatremia
Cerebral edema
Treatment for hyperkalemia
Calcium gluconate (to stabilize cardiac membranes), insulin and glucose, albuterol (also shifts K+ into cells), last resort = dialysis
Boundaries of axilla for dissection
Superior boundary = axillary vein
Posterior = long thoracic nerve
Lateral = latissimus dorsi muscle
Medial = pec minor muscle
Common cause of hypercoagulable state in the elderly?
Cancer
Hypercoagulable state with edema, HTN, and foamy pee?
Nephrotic syndrome (will lose protein such as ATIII in the urine)
Most common inherited hypercoagualable disorder?
Factor V Leiden
Why is Antithrombin III deficiency important?
Heparin won’t work
Cause of young woman with multiple spontaneous abortions
Lupus anticoagulant
Cause of post op pt with thromocytopenia and increased clots
HIT - Heparin-induced thrombocytopenia
How do you treat HIT?
Synthetic heparin - Leparudin or agatroban
Cause of bleeding with isolated decreased platelets?
ITP
Cause of bleeding with normal platelets but increased bleeding time and PTT
vWD
Cause of bleeding with low platelets, increased PT, PTT, BT, low fibrinogen, high Ddimer, schistocytes
DIC
Formula for fluid resuscitation in adult burn victim
(Kg) x (% burn surface area) x (3-4)
Formula for fluid resuscitation in child burn victim
(Kg) x (% burn surface area) x (2-4)
Ddx of pt with oliguruia who is not in shock
Not enough fluid or acute renal failure
Hoe can you differentiate between lack of fluids and acute renal failure
Measure Na of urine - will be low in pt with low fluids because they are trying to reabsorb as much as possible. Will be high in pt with kidney dysfunction
Nerves susceptible to damage during axillary dissection
Long thoracic (serratus anterior)
Thoracodorsal (latissimus dorsi)
Medial pectoral
Lateral pectoral
What are the suspensory ligaments of the breast called
Cooper’s ligament
What is the tail of breast tissue that tapers into the axilla
Tail of Spence
What do you see on X-ray of paralytic ileus
Dilated gas-filled loops of bowel with no transition point
What are the W’s associated with post-op fever?
Wind - atelectasis Water - UTI Wound - infection Walking - DVT Wonder drug - drug fever
What is the diagnosis: persistent pneumothorax following chest tube placement in a patient who sustained chest blunt trauma. + pneumomediastinum and subcutaneous emphysema
Tracheobronchial rupture
What will you see on CT in colonic ischemia
Edema and air (pneumatosis) in the bowel wall
What will you see on colonoscopy of colonic ischemia?
Segments of cyanotic mucosa and hemorrhagic ulceration with sharp transition from affected to unaffected mucosa
Management of colonic ischemia
- IV fluids and bowel rest
- Antibiotics with enteric coverage
- Colonic resection only if necrosis develops
Pathology of penile fracture
Rupture of corpus cavernosum due to traumatic tear in tunica albuginea (which envelops the corpus cavernosum)
Management of penile fracture
Urological emergency = urgent operative care
If there is evidence of urethral injury (blood at meatus, hematuria, dysuria, urinary retention) - indication for retrograde urethrogram
Management of blunt abd trauma in hemodynamically unstable patients
FAST (US) exam
- If positive (intraperitoneal fluid) = urgent laparotomy
- If negative = stabilize if signs of extra-abd hemorrhage, or stabilize then CT if no signs of extra-abd hemorrhage
Management of blunt abd trauma in hemodynamically stable patients
Positive FAST exam = CT abd
Management of hemodynamically stable patient with penetrating abd trauma and signs of peritonitis (rebound/guarding)
Urgent exploratory laparotomy
