Surgery Workbook Flashcards
How is the water in 5% dextrose v normal saline distributed throughout the body?
dextrose - into total body water
normal saline - into extracellular water
What factors can increase fluid losses?
high urine output
D+V
stoma output
sweating
burns
haemorrhage
What should you do before prescribing IV fluids to any patient?
- check notes to understand clinical setting
- look at recent bloods
- inspect patients fluid charts and BP charts
- decide if pt is high risk (renal compromise/HF)
- are they in balance or deficit or surplus?
Why does urea increase relative to creatinine during dehydration?
decreased perfusion of kidneys = decreased excretion of urea
Consequences of starvation prior to surgery?
decreased wound healing
inc infection and skin breakdown
Why does surgery place additional demands on nutritional status of the body?
creates a catabolic state
Average daily calorie requirements for adult patients?
M = 2900
F = 2200
Complications of parenteral feeding?
thrombosis
infection
liver failure
micronutrient deficiencies
Commonest cause of preventable death in surgical patients?
P.E
Where do surgical patients often develop DVTs?
soleal and gastrocnemius venous sinuses
What pre-op, intra-op and post-op factors increase risk of DVT ?
Pre:
poor hydration, obesity, malignancy, prothrombotic drugs e.g. COCP
Intra-op:
longer procedure, under GA
Post:
prolonged immobility
How long must have elapsed since insertion of epidural before administering LMWH? Why?
4 hours
risk of epidural haematoma which can cause spinal cord compression
Which surgical pts should receive Dalteparin for up to 35 days post surgery?
Hip fracture and THR
Malignancy
target range of intra-op blood glucose?
below what value = ‘rescue tx’?
6-12
<4
Why is there risk of aspiration at induction of anaesthesia? Why is it so dangerous?
loss of LOS tone and protective laryngeal reflexes due to paralysis
can causes asphyxiation and aspiration pneumonia
Half life of IV insulin?
5 mins
How many calories does a litre of 5% dextrose contain?
700
What normally happens to serum ACTH after a major trauma such as surgery? Benefit?
It increases
prevent adrenal crisis because surgery increases demand on cortisol as your body is under physiological stress
Why is Addisonian crisis often difficult to detect operatively and operatively?
mimics other surgical complications
How long before surgery should EPO be given to increase Hb?
6 weeks
What 3 requirements must be met for consent to be legally valid?
given voluntarily
patient has capacity to consent
patient understands nature of tx
How should you present a CXR?
- Give the type of radiograph and projection
- Give the patients name
- Give the date the X-ray was taken
- Briefly assess the film quality to ensure it is adequate
- Run through the ABC of chest radiology
- Give a short Summary at the end.
What are you looking for in a CXR?
Airway - trachea, bronchi
Breathing - lung expansion, lung outlines, lung fields
Circulation - cardiac size, great vessels, mediastinum
Dem bones - ribs and shoulder girdle
Everything else - air under diaphragm, surgical emphysema, foreign bodies
What are you looking for in an abdo XR?
Air in the wrong place - pneumoperitoneum, air in biliary tree, Rigler’s sign
Bowel - dilated bowel, volvulus, hernias, thickened walls
Calcification - calcified gallstones, pancreatic calcification, AAA, foetus
Disability - fractures and solid organ enlargement
Everything else - evidence of surgery, lung bases, foreign bodies
