surgical complications Flashcards
what drugs might give you a morbilliform rash and arthralgias 3 days later if Mono was treated with it.
ampicillin, amoxicillin azithromycin (3As)
how long can perichondritis and chondritis last after a wedge excision of the ear.
2 months
For a cartilage post op ear infection what two Fluoroquinolones could be chosen for treatment?
Cipro ciprofloxacin
levofloxacin
What is this condition called
Erosive pustular dermatosis of the scalp
How is erosive pustular dematosis of the scalp treated.
High potency topical steroids.
Dapsone and calcineurin inhibitors as well as a second line treatment
what is the main cardiac complication of Bupivacaine
Bradycardia
If someone is having an arrythmic reaction to Bupivacaine what can be given to correct it.
lipid emulsion
Bupivacaine is highly lipid soluble
increasing Lipid solubility of an anesthetic does what
Increases the potency
(penetrates the nerve better)
what are the four branches of the facial artery
angular
lateral nasal
superior labial
inferior labial
Should tension vectors be horozontial or perpendicular to a free margin
Perpendicular
What is this condition
levamisole cut cocaine toxicity
It is an anti helminthic for pets
If prophylactic antibiotic is needed what is most commonly used
2 grams Cephalexin 30-60mins prior to keratinized skin surgery.
what is the antibiotic prophylaxis for mucosal surfaces that meet criteria
2 grams amoxicillin 30-60min prior to the procedure
What are the four stages of hematoma formation
First stage- early development - if not removed later phases occur <48 hours
Second Stage- Gelatinous day2-3
Third stage - Organization hard and rubbery- difficult to get out day 3-5
4th stage- Liquifaction 7-10 days
What is Frey’s Syndrome
Gustatory sweating due to auriculotemporal nerve damage.
What four classes of drugs can potentiate side effects of epinephrine?
Beta Blockers
MAO inhibitors
Tricyclic antidepressants
Phenothiazines
circumoral numbness is associated with what complication during surgery?
lidocaine toxcity
What is the dtug of choice if you can’t give cephalexin 2gms 30-60mins prior to surgery due to a PCN and possible cross rxn
Clindamycin 600mg one hr prior to surgery.
which has a higher rate of infections secondary intention healing or first intention healing
Secondary intention healing
What is the risk for infection primary intention vs secondary intention
3.2 % vs 6.8%
what is the rate of infection face vs leg
2.5% vs 10.5%
What are three things to know about intralesional injection of clindamycin to prevent post op infections
Lower systemic absorption than oral
No increase in antibiotic resistance
decreased GI effects
what areas of the body have a higher rate of surgical infections
nose lips ears
lower leg and feet
groin
what is the most common cultured bacteria in surgical wound infections
Staphlococcus aureus
Name three anticoagulants that have more post op bleeding than coumadin aspirin and plavix
Apixaban - Eliquis bid
Rivaroxaban - Xarelto qd factor Xa inhibitor
Dabigabtran - Pradaxa bid thombin inhibitor
what is the treatment for overdose of apixaban and Rivaroxaban
Eliquis & Xerelto
Factor Xa Andexxa
what is the treatment for overdose of dabigatran
Pradaxa
Idarucizumab (Praxbind)
what vascular problem causes the quickest flap necrosis
venous congestion can occur in less than 4 hours
order edema-capillary slowing- thrombosus arteries and veins- ischemia- necrosis
how to tell veinous congestion from arterial insufficiency
11 blade prick will not bleed in arterial insuffieceny and will ooze dark purple blood in venous congestion
Venous congestion will be cyanotic or purple flap
Arterial insufficeny will be pale
what is trigeminal trophic syndrome and how is it treated.
anesthetic ucler on upper lip or more commonly ala with nasal tip sparing
Multiple treatments exist
anti depressants
bolsters
Steroids
flap
anticonvulants gabapentin and pregbalin
what foods do laxtex cross react allergically
Bananas
Avocado
chestnut
Kiwi and Passion Fruit
What is a serious risk for surgery on the nasal sidewall
the opthalmologic veins drain into the cavernous sinus.
Septic thrombosis can occur with meingitis and brain abcesses
What is the maxium dose of Lidocaine with epi for tumescent anesthesia?
55mg/Kg
LAST (Local and Systemic Toxcisity) can occur in over 60 minutes in what % of patient that get it.
25%
40% at 10 minutes
What are early symptoms of LAST from lidocaine.
perioral numbness
paraesthesias
tinnitus
tremor
all signs of CNS stimulation followed by CNS inhibition then cardiac stimulation followed by inhibition
antibiotic prohylaxis is reccomended for high risk surgical site infection in all cases
what are the high risks 6
lower extremity
Groin
Wedge excisions lip or ear
Flaps on the nose
Grafting
Extensive inflamatory disease.
