Surgical conditions Flashcards
What does SOCRATES stand for
Site Origin Character Radiation Associated symptoms Time Exacerbation or releiving Severity
What are the 3 types of pain someone can have?
Somatic
Visceral
Neuropathic
What is Somatic pain?
MSK or body surface
What is visceral pain?
Internal organs
What is neuropathic pain?
Spinal Cord and peripheral nerves
Where is the pancreas located?
Epigastric area
Where can pain radiate to if you have pancreas pain?
The back
What do you check if someone has Peritonitis?
Amylase
What kind of pain might someone have if they have toothache?
MSK pain
What kind of pain is post op pain likely?
Somatic +/- visceral
4 steps to manage pain?
- Oral/topical analgesic
- Local analgesia
- Regional analgesia (spinal/epidural)
- Patient controlled analgesia
What might you use for local analgesia around a wound?
Bupvicaine
What is the WHO pain ladder?
Step 1- mild pain- non-opiod +/- adjuvent analgesia
Step 2- mild-moderate pain- opiod for pain + non-opiod +/- adjuvent analgesia
Step 3- Severe pain- opiod for pain + non-opiod +/- adjuvent analgesia
What is a simple analgesia?
Paracetamol
What are examples for NSAIDS?
Aspirin, Ibuprofen, Biclofenac, Naproxen, Celocoxib
When should you be cautious with Biclofenac?
Cardiovascular disease
What is a mild opiate?
Codeine, co-codamol
What is a moderate opiate?
Tramadol
What is a strong opiate?
Morphine, Oxycodone, Pethadine
Why is Pethadine not recommended post operatively?
It is metabolised by the renal system
What are adjuvents to Analgesia?
Gabapentin, Carbamazipine, Amytriplyline
What are some side effects of opiates?
N & V
Constipation
Toxicity
Respiratory depression
NSAIDS cause various side effects, what are they?
Renal impairment Hepatic impairment Avoided in pregnancy Gi pathology- ulceration and GORD Asthma symptoms may be worsened Risk of Cv disease- MI
What are signs of Opiod toxicity?
Decreased consciousness Pin point pupils Seizures Muscles spasm Cyanosis
What should you do if someone is suffering from opiod toxicity?
ABCDE approach
Naloxone 0.4-2mg at intervals of 2-3 mins.
Electrolytes will be altered- explain what happens
Vomiting will depite the body of water and HCl- leading to hypochloremic alkalosis
What are the K levels of someone with hypochloremic alkalosis?
<3.5mmol/L
What is post op Pyrexia?
Fever
Post op pyrexia day 1-2 cause?
Atelectasis (fluid)
Post op pyrexia day 3-4 cause?
Pneumonia (after anasthetic in operation)
Post op pyrexia day 4-5 cause?
Anatomostic leak
Post op pyrexia day 7-8 cause?
Would infection
Post op pyrexia 8+ cause?
DVT
What is sepsis?
SIRS is when 2 or more of: temp is <36/>38 HR>90 RR>20 WCC<4 >12 BG >7.7mmol/L
What is sepsis shock?
Severe sepsis when BP is constantly low and failed response to fluid
What is the Sepsis 6??
- Oxygen
- Take blood tests
- IV antibiotics
- Fluid challenge
- Measure lactate
- Measure urine output
What is primary haemorrhage?
Continuous bleeding during surgery
What is secondary haemorrhage?
1-2 weeks post op due to infection
What is reactive bleeding?
Bleeding stable until high BP
What are the signs of a class 3 haemorrhage?
Blood loss: 1500-2000ml %: 30-40 Pulse >120 BP: Decreased RR: 30-40 Symptoms- confused Urine output- 5-15ml
What drug if someone had DVT?
Heparin
