Surgical Care Flashcards
Define SCIP
surgical care improvement project
Measures:
- infection
- cardiac
- VTE
- global (death/readmit)
- vascular
- respiratory (HOB elevation, ventilation)
Define SCIP Inf-1
prophylactic abx received within one hour prior to surgical incision (except vanco & FQs d/t longer infusion time)
Define SCIP Inf-2
prophylactic abx selection for surgical patients (almost always ancef, check current list for appropriate prescribing)
Define SCIP Inf-3
prophylactic abx d/c within 24 hrs s/p surgery end time (48 hrs if vascular surgery)
- may need re-dosing througout procedure if it is long
Define SCIP Inf-4
cardiac surgery patients with controlled 6am post-op glucose
Define SCIP Inf-6
Surgery pts with appropriate hair removal (clipping not shaving)
Define SCIP Inf-7
Colorectal surgery pts with immediate post-op normothermia (greater than or equal to 96.8)
Define SCIP Card-2
surgery pts on a beta blocker therapy prior to arrival who received a beta blocker during the perioperative period
- helps regulate heart rate variation & decreases mortality
Define SCIP VTE-1
surgery patients with recommended VTE prophylaxis ordered
Define SCIP VTE-2
surgery patients who received appropriate VTE prophylaxis within 24 hrs prior to surgery to 24 hours after surgery
Define SCIP Inf-9
urinary catheter removed on POD 1 or POD 2 with day of surgery being day zero
List the goals of surgical anesthesia
Establish a reversible state of: analgesia, amnesia, and akinesia
Describe general anesthesia
- intubation
- close monitoring with end tidal CO2, pulse, ox
Describe monitored anesthesia care
- spectrum
- may have intraoperative recall
- need appropriate local anesthetic
- patient able to move
Describe neuraxial anesthesia
spinal/epidural
List the common complications of anesthesia
- PONV
- upper airway problems/hypoxia
- HoTN
- dysrhythmia
- AMS
- urinary retention
- cardiac events
List the steps of a surgical time-out
- purpose to reduce wrong site surgery
- team participation & surgeon led
- stop activity
STEPS
- verify pt, DOB, allergies
- verify procedure
- verify needed equipment/implants available
- specimens
- discuss expected complications
- fire risk
List the components of a post-op note
- pre & post op diagnoses
- procedure
- surgeon/assistant
- anesthesia
- estimated blood loss
- drains
- specimen removed
- complications
- findings
- condition to recovery
List the 6 W’s of post-op fever
- waves: MI (POD#0)
- wind: pneumonia (POD#1-2), encourage sitting up & IS use
- water: UTI, pneumonia (after POD#3)
- wound: SSI (after POD#4-5)
- walk: PE/DVT (POD#7-10)
- wonder drugs: review meds
