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SPC > Surgery Shelf - Emma Holiday Lecture > Flashcards

Surgery Shelf - Emma Holiday Lecture Flashcards

1
Q

Absolute contraindications to surgery

A

Diabetic Coma
DKA

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2
Q

Markers of poor nutritional status

A

Albumin < 3
Transferrin < 200
Weight loss < 20%

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3
Q

Indicators of severe liver failure

A

Bili > 2
PT > 16
Ammonia < 150
Encephalopathy

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4
Q

Length of time before surgery to stop smoking

A

8 weeks prior

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5
Q

Why to adjust goal SpO2 in post-op for a patient with COPD

A

CO2 retainer - need higher CO2/lower O2 to maintain respiratory drive

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6
Q

Cutoff to not do surgery in a patient with CHF

A

EF < 35%

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7
Q

If MI within 6 mos of elective surgery, what is the proper workup pre-op?

A

EKG –> stress test –> cardiac cath –> revasc (if needed)

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8
Q

Greatest risk factors for surgery

A

CHF
MI w/in 6 months
Arrhythmia
Age > 70
Emergent surgery
Aortic stenosis, poor medical condition, surg in chest/abd

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9
Q

Description of AS murmur

A

Late systolic
Crescendo-decrescendo
Radiation to carotids
Increases with squatting
Decreases with decreased preload

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10
Q

Medications to stop pre-operatively

A

Aspirin, NSAIDs, Vit E (2 wks)
Warfarin (5 d), goal INR < 1.5
1/2 morning dose of insulin

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11
Q

Pre-op optimization for CKD on dialysis

A

Dialyze 24 hours pre-op

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12
Q

Significance of BUN and Cr for surgery

A

Increased risk of post-op bleeding secondary to uremic platelet dysfunction

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13
Q

Coag panel findings of elevated BUN/Cr

A

Normal platelets but prolonged bleeding time (uremic platelet dysfunction)

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14
Q

Vent setting that provides a set tidal volume and rate, but give volume if patient breathes

A

Assist-control

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15
Q

Vent setting that provides pressure boost to patient-drive respiratory rate

A

Pressure support

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16
Q

Vent setting where patient must breathe on their own and vent provides a constant pressure

A

CPAP

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17
Q

Vent setting where pressure is given at the end of inspiratory cycle to keep alveoli open

A

PEEP

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18
Q

Diagnoses associated with use of PEEP

A

ARDS
CHF

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19
Q

Best test to evaluate effective respiratory management for patient on a vent

A

ABG

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20
Q

Intervention if PaO2 is lower for patient on vent

A

Increase FiO2

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21
Q

Intervention if PaO2 is high for patient on a vent

A

Decrease FiO2

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22
Q

Intervention if PaCO2 is low for patient on vent

A

Decrease respiratory rate
Decrease tidal volume

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23
Q

Intervention if PaCO2 is high for patient on a vent

A

Increase rate
Increase tidal volume

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24
Q

Which is a more efficient intervention to manage PaCO2 for a patient on a vent: rate control or tidal volume control?

A

Tidal volume

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25
Q

Condition if HCO3 is high and PCO2 is high

A

Respiratory acidosis

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26
Q

Condition if HCO3 is low and pCO2 is low

A

Metabolic acidosis

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27
Q

Next step if patient has metabolic acidosis

A

Check anion gap (Na - [Cl + HCO3])

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28
Q

Causes of anion gap metabolic acidosis

A

Methanol
Uremia
Dka
Paraldehyde
Iron, Isoniazid
Lactic acidosis
Ethylene glycol
Salicylate (aspirin)

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29
Q

Causes of non-anion gap metabolic acidosis

A

Diarrhea
Diuretics
Renal tubular Acidosis

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30
Q

Condition if HCO3 is low and pCO2 is low

A

Respiratory alkalosis

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31
Q

Condition if HCO3 is high and pCO2 is high

A

Metabolic alkalosis

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32
Q

Next step if patient has metabolic alkalosis

A

Check urine [Cl-]

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33
Q

Causes of metabolic alkalosis with urine [Cl-] < 20

A

Vomiting/NG
Antacids
Diuretics

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34
Q

Causes of metabolic alkalosis if urine [Cl-] > 20

A

Conn’s
Bartter Gittleman’s

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35
Q

Cause of hyponatremia (high level)

A

Too much water (not a sodium problem)

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36
Q

Next step if patient is hyponatremic

A

Plasma osmolality
Urine osmolality
Volume status

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37
Q

Causes of hypervolemic hyponatremia

A

CHF
Nephrotic syndrome
Cirrhosis
Diuretics
Vomiting + free water

38
Q

Causes of normovolemic hyponatremia

A

SIADH
Addison’s
Hypothyroidism

39
Q

Treatment for hypervolemic hyponatremia

A

Fluid restriction
Diuretics

40
Q

Treatment for hypovolemic hyponatremia

A

Normal saline

41
Q

Indications for use of hypertonic (3%) saline to treat hyponatremia

A

Symptomatic (e.g. seizures)
Na < 110 (severely hyponatremic)

42
Q

Feared complication if hyponatremia is corrected too quickly

A

Central Pontine Myelinolysis

43
Q

Cause of hypernatremia

A

Loss of water

44
Q

Treatment for hypernatremia

A

Replace with D5W or hypotonic saline

45
Q

Complication if overtreatment of hypernatremia

A

Cerebral edema

46
Q

Signs of hypocalcemia

A

Chvostek sign (When the facial nerve is tapped in front of the ear, the facial muscles on the same side of the face will contract sporadically)

Trousseau sign (involuntary contraction of the muscles in the hand and wrist when BP cuff applied)

Prolonged QT interval

47
Q

Signs of Hypercalcemia

A

Bones
Stones
Groans
Psychiatric overtones
Shortened QT interval

48
Q

Signs of hypokalemia

A

Paralysis
Ileus
ST depression
U waves

49
Q

Treatment of hypokalemia

50
Q

Max rate of hypokalemia correction

51
Q

Signs of hyperkalemia

A

Peaked T waves
Prolonged PR and QRS
Sine waves

52
Q

Treatment for hyperkalemia

A

Calcium gluconate (1st!)
Insulin + glucose
Kayexalate
Albuterol and sodium bicarb
Dialysis last resort

53
Q

Maintenance IVF

A

D5 1/2 NS + 20KCl

54
Q

Calculation of maintenance IVF

A

0-10 kg: 100 mL/kg/day
10-20 kg: 50 mL/kg/day
>20 kg: 20 mL/kg/day

55
Q

Why are enteral feeds superior to parenteral feeds?

A

Keep gut mucosa in tact and prevent bacterial translocation

56
Q

Indications for TPN

A

Inability to absorb nutrients due to physical (-ectomy) or functional (mucosal damage) loss

57
Q

Risks of TPN

A

Acalculus cholecystitis
Hyperglycemia
Liver dysfunction
Zinc deficiency
Electrolyte abnormalities

58
Q

Layers damaged in first degree burn

59
Q

Layers damaged in 2nd degree burns

A

Epidermis
Dermis (partial)

60
Q

Layers damaged in 3rd degree burn

A

Epidermis
Dermis (full)

61
Q

Description of 1st degree burn

A

Red, painful, dry, and with no blisters

62
Q

Description of 2nd degree burn

A

Red, blistered, and may be swollen and painful

63
Q

Description of 3rd degree burn

A

White or charred
No sensation in the area since the nerve endings are destroyed

64
Q

Treatment consideration if circumferential burns

A

Escharotomy

65
Q

Treatment consideration if patient with singed nose hairs, wheezing, and soot in the mouth/nose

A

Intubation

66
Q

Best next step if patient with confusion, headache, and cherry red skin

A

Check carboxyhemoglobin (COHb)

67
Q

Treatment if elevated COHb

A

100% O2
Hyperbaric O2 if severely elevated

68
Q

Concern if unexplained/new clotting in elderly patient

69
Q

Concern if edema, hypertension, and foamy pee in patient with clotting disorder

A

Nephrotic syndrome

70
Q

Concern if young person with a family history of clotting

A

Factor V Leiden

71
Q

Special consideration for patients with ATIII deficiency

A

Heparin will not work as an anticoagulant

72
Q

Concern if young woman with multiple spontaneous abortions

A

Lupus anticoagulant

73
Q

Concern if post-op patient with thrombocytopenia and and paradoxical clotting

74
Q

Treatment for HIT

A

Leparudin
Argatroban

75
Q

Concern if isolated decrease in platelets

76
Q

Concern if normal platelets but increased bleeding time and PTT

A

von Willebrand Disease

77
Q

Concern if low platelets, increased PT/PTT/BT, low fibrinogen, high D-dmer, and schistocytes

78
Q

Causes of DIC

A

Gram (-) sepsis
Carcinomatosis
OB stuff

79
Q

Rules of 9s (Adult)

A

Head - 9% BSA
Chest/Abdomen - 18% BSA
Back - 18% BSA
Arm - 9% BSA
Leg - 18% BSA

80
Q

Rule of 9s (Pediatric)

A

Head - 18% BSA
Front - 18% BSA
Back - 18% BSA
Arm - 9% BSA
Leg - 18% BSA

81
Q

Parkland formula for burn resuscitation (over 24 hrs)

A

Adults - Kg x % BSA x 3-4
Pediatrics - Kg x % BSA x 2-4

82
Q

Order of operations for burn fluid resuscitation

A
  1. Calculate BSA affected
  2. Calculate Parkland formula
  3. Give 1/2 of fluids of first 8 hrs, remainder of next 16 hrs
83
Q

Topical, PO, or IV antibiotics for burn patients?

A

Topical
Others breed Abx resistance

84
Q

Topical abx that doesn’t penetrate burn eschar and can cause leukopenia

A

Silver sulfadiazine

85
Q

Topical abx that penetrates eschar but is terribly painful

86
Q

Topical abx that doesn’t penetrate eschar and causes hypoK and hypoNa

A

Silver nitrate

87
Q

Best next step if chemical burn

A

Irrigate burn for >30 min prior to ER

88
Q

Best next step if electrical burn/electrocution

89
Q

Best next step if abnormal EKG or loss of consciousness following electrical burn/electrocution

A

Telemetry for 48 hrs

90
Q

Concern if urine dipstick positive for blood but no RBCs on microscopy following electrical burn/electrocution

A

Rhabdomyolysis causing myoglobinuria, ATN

91
Q

Next step if myoglobinuria following electrical burn/electrocution

92
Q

Concern if extremity is extremely tender, number, white, cold with faint doppler signals

A

Compartment syndrome

SPC (2 decks)

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