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Emergency Medicine and Surgical Care > Surgical Care > Flashcards

Surgical Care Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Causes for Post-op fever 6 W’s

A

Wind (atelectasis), Water (UTI), Wound (post-op infection), Walking (DVT/PE), Wonder (drug), What did we do?

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2
Q

Wind POD

A

1-3

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3
Q

Water POD

A

3

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4
Q

Wound POD

A

5

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5
Q

Walking POD

A

7

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6
Q

Wonder POD

A

anytime

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7
Q

Virchows Triad

A

Stasis, vessel damage, hypercoaguable state

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8
Q

When there’s a fever also consider

A

necrotizing infection (48hrs), malignant hyperthermia, anastomotic leak (POD3-5)

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9
Q

necrotizing infection TX

A

CBC resuscitation, Pen G, surgical debridement

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10
Q

Malignant hyperthermia TX

A

CBC, resuscitation, rapid cooling, IV dantrolene

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11
Q

Anastomotic leak TX

A

place a drain or return to OR

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12
Q

Four crucial assessments of Burns

A

Airway, evaluation of other injuries, estimation of burn size, diagnosis of CO and cyanide poisoning

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13
Q

First degree Burn

A

superficial- no blisters, blanching. 7 days to heal

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14
Q

second degree burn

A

partial thickness- blisters, pain. superficial- 14-21 days to heal. Deep- 3-8 wks to heal

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15
Q

third degree

A

full thickness, no pain, do not heal, need skin grafts. months to heal and leaves scar

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16
Q

Fourth degree

A

life threatening, may extend into tissue and fascia. Multiple surgeries needed.

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17
Q

Parkland Formula

A

LR 4cc x wt (kg) x %BSA= amount given in 24 hrs. half over the first 8 hrs the other half over 16 hrs.

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18
Q

Lactated ringers

A

maintain stable blood pH, contains less Na and Cl than NS

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19
Q

CO poisoning SX

A

HA, lightheadedness, dizziness, confusion, tachypnea, hypoxia

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20
Q

When to refer burns

A

partial thickness burns >10% TBSA, burns on face, hands, feet, genitalia, perineum, 3rd degree, electrical burns, chemical burns, inhalation injury, complicated comorbidity, circumferential burns, Peds, burns requiring special social, emotional or rehab

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21
Q

Net Stress response to surgery

A

1) water and sodium retention to maintain cardiovascular stability
2) increased catabolism to provide energy sources

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22
Q

Calorie need

A

30kcal/kg/day

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23
Q

protein need

A

1g/kg/day

24
Q

Harris-Benedict equation

A

Weight in KG + Height in cm - age in years

25
Q

phases of wound healing

A

1) hemostasis and inflammation 0-5
2) Proliferation 5 days-2 wks
3) Maturation 2 wks- several months

26
Q

Local Factors that affect wound healing

A

edema, infection, mechanical injury, Ischemia, Necrotic Tissue, Radiation effects, Hypoxia, Foreign body

27
Q

Systemic factors that affect wound healing

A

age, nutrition, obesity, trauma, metabolic disease, Immunosuppression connective tissue disease, smoking

28
Q

Necrotizing Fasciitis organisms

A

GAS, Staph aureus, Clostridium perfringens, Baceroides fragilis, Aeromonas hydrophila

29
Q

Allografts

A

transplant between same species

30
Q

Autografts

A

transplant in same individual

31
Q

Isografts

A

transplants between genetically identical individuals

32
Q

Xenografts

A

transplant between different species

33
Q

split transplant

A

graft divided between two patients

34
Q

“En bloc” transplant

A

both pediatric organs transplanted into a single adult

35
Q

Kidney transplant placement

A

extraperitoneal in the RLQ or LLQ in the iliac fossa

36
Q

Pancreas transplant placement

A

exocrine portion goes into the duodenum, endocrine remains outside

37
Q

Hyperacute rejection

A

occurs within minutes to hours due to something like mismatched blood

38
Q

Acute rejection

A

during the first 6 months

39
Q

Chronic rejection

A

years after transplant, most commonly antibody and cell-mediated

40
Q

Autologous transplant

A

patients own stem cells

41
Q

Allogenic

A

stem cells from a donor

42
Q

Is there adequate tissue perfusion?

A

ABI 0.9-1.2–> refer to vascular surgeon if not

43
Q

is there nonviable tissue?

A

debridement

44
Q

Is the wound infected?

A

cultures and antibiotics

45
Q

Is edema present?

A

check tissue perfusion and consider compression

46
Q

Is the wound bed conducive to healing?

A

if it’s too dry, wet it. If it’s too wet, dry it.

47
Q

is tissue growth optimized?

A

consider NPWT, hyperbaric oxygen, growth factors or skin grafts

48
Q

is offloading or pressure loading appropriate?

A

consider casting

49
Q

Grade 1 Wagner Classification

A

superficial Ulcer w/o subq involvement

50
Q

Grade 2 Wagner Classification

A

penetrates through the SubQ. May expose bone, tendon, ligament or joint capsule

51
Q

Grade 3 Wagner Classification

A

extensive ulceration with exposed bone

52
Q

Grade 4 Wagner Classification

A

gangrene of toes or foot

53
Q

Grade 5 Wagner Classification

A

gangrene of the whole foot

54
Q

ideal wound care product

A

maintain moisture, conformability, painless, odor control, nonallergenic and nonirritating, permeability to gas, nontraumatic removal, cost effective, convenient

55
Q

criteria for transfusion

A

acute hemorrhage

Hgb

56
Q

Fresh Whole Blood indications

A

Massive hemorrhage when more than 10 units of blood is required

Emergency Medicine and Surgical Care (9 decks)

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