Surgical Care Flashcards
Causes for Post-op fever 6 W’s
Wind (atelectasis), Water (UTI), Wound (post-op infection), Walking (DVT/PE), Wonder (drug), What did we do?
Wind POD
1-3
Water POD
3
Wound POD
5
Walking POD
7
Wonder POD
anytime
Virchows Triad
Stasis, vessel damage, hypercoaguable state
When there’s a fever also consider
necrotizing infection (48hrs), malignant hyperthermia, anastomotic leak (POD3-5)
necrotizing infection TX
CBC resuscitation, Pen G, surgical debridement
Malignant hyperthermia TX
CBC, resuscitation, rapid cooling, IV dantrolene
Anastomotic leak TX
place a drain or return to OR
Four crucial assessments of Burns
Airway, evaluation of other injuries, estimation of burn size, diagnosis of CO and cyanide poisoning
First degree Burn
superficial- no blisters, blanching. 7 days to heal
second degree burn
partial thickness- blisters, pain. superficial- 14-21 days to heal. Deep- 3-8 wks to heal
third degree
full thickness, no pain, do not heal, need skin grafts. months to heal and leaves scar
Fourth degree
life threatening, may extend into tissue and fascia. Multiple surgeries needed.
Parkland Formula
LR 4cc x wt (kg) x %BSA= amount given in 24 hrs. half over the first 8 hrs the other half over 16 hrs.
Lactated ringers
maintain stable blood pH, contains less Na and Cl than NS
CO poisoning SX
HA, lightheadedness, dizziness, confusion, tachypnea, hypoxia
When to refer burns
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
Net Stress response to surgery
1) water and sodium retention to maintain cardiovascular stability
2) increased catabolism to provide energy sources
Calorie need
30kcal/kg/day
protein need
1g/kg/day
Harris-Benedict equation
Weight in KG + Height in cm - age in years
phases of wound healing
1) hemostasis and inflammation 0-5
2) Proliferation 5 days-2 wks
3) Maturation 2 wks- several months
Local Factors that affect wound healing
edema, infection, mechanical injury, Ischemia, Necrotic Tissue, Radiation effects, Hypoxia, Foreign body
Systemic factors that affect wound healing
age, nutrition, obesity, trauma, metabolic disease, Immunosuppression connective tissue disease, smoking
Necrotizing Fasciitis organisms
GAS, Staph aureus, Clostridium perfringens, Baceroides fragilis, Aeromonas hydrophila
Allografts
transplant between same species
Autografts
transplant in same individual
Isografts
transplants between genetically identical individuals
Xenografts
transplant between different species
split transplant
graft divided between two patients
“En bloc” transplant
both pediatric organs transplanted into a single adult
Kidney transplant placement
extraperitoneal in the RLQ or LLQ in the iliac fossa
Pancreas transplant placement
exocrine portion goes into the duodenum, endocrine remains outside
Hyperacute rejection
occurs within minutes to hours due to something like mismatched blood
Acute rejection
during the first 6 months
Chronic rejection
years after transplant, most commonly antibody and cell-mediated
Autologous transplant
patients own stem cells
Allogenic
stem cells from a donor
Is there adequate tissue perfusion?
ABI 0.9-1.2–> refer to vascular surgeon if not
is there nonviable tissue?
debridement
Is the wound infected?
cultures and antibiotics
Is edema present?
check tissue perfusion and consider compression
Is the wound bed conducive to healing?
if it’s too dry, wet it. If it’s too wet, dry it.
is tissue growth optimized?
consider NPWT, hyperbaric oxygen, growth factors or skin grafts
is offloading or pressure loading appropriate?
consider casting
Grade 1 Wagner Classification
superficial Ulcer w/o subq involvement
Grade 2 Wagner Classification
penetrates through the SubQ. May expose bone, tendon, ligament or joint capsule
Grade 3 Wagner Classification
extensive ulceration with exposed bone
Grade 4 Wagner Classification
gangrene of toes or foot
Grade 5 Wagner Classification
gangrene of the whole foot
ideal wound care product
maintain moisture, conformability, painless, odor control, nonallergenic and nonirritating, permeability to gas, nontraumatic removal, cost effective, convenient
criteria for transfusion
acute hemorrhage
Hgb
Fresh Whole Blood indications
Massive hemorrhage when more than 10 units of blood is required
