Surgical Management Flashcards
What are physiologic states that can cause an increase in insensible losses?
- fever
- open abdomen / chest (ex: exlap)
- burn injury
- hyperventilating
Which patients do not need additional steroids for stress dosing prior to surgery?
Patients taking <5 mg/day of prednisone for any duration or < 3 weeks of any doses.
Take their home dose of steroids on day of surgery only.
Which patients need additional stress dose steroids in addition to their home dose prior to moderate-major surgery?
Patients taking > 20mg/day of prednisone for 3 or more weeks
Patients with a Cushingoid appearance.
Patients who have intermediate risk (5-20mg/day for 3 or more weeks) for HPAA suppression should undergo evaluation of HPAA suppression preoperatively with
Cortisol levels and corticotropin (ACTH) stimulation testing.
What kind of closure does an FTSG donor site need to mitigate donor site morbidity?
Primary closure.
Management for a patient with a stab wound without anterior fascia violation
Discharge home
Histamine releasing medications should be avoided in patients with history of vancomycin infusion reaction such as
Opioids, muscle relaxants, abx (ciprofloxacin and rifampin).
Use fetanyl and/or tramadol for pain.
Management for hyperkalemia
IV calcium gluconate
- Calcium chloride in cases of circulatory arrest or cardiac arrest (increase cardiac output and preserves vascular tone).
When is calcium contraindicated in cases of hyperkalemia?
Digitalis toxicity
What is a biomarker useful in early diagnosis of sepsis in patients with burn injuries?
Procalcitonin.
Steps for sleeve gastrectomy:
- Devascularization of the greater curvature of the stomach.
- Using a bougie or endoscope to size the gastric sleeve.
- Transection of the stomach starting at a location 2-6 cm proximal to the pylorus.
- Specimen extraction.
When should patients on anticoagulation stop their medication prior to surgery? (Apixaban, Rivaroxaban, Dabigatran with normal renal function)
24 hours before low-risk surgeries, 48 hours before high risk surgeries.
Patients taking Dabigatran with decreased renal function should stop dabigatran 48 hours before low-risk procedures and 96 hours before high risk procedures.
Management of a patient who develops salmon color leakage from midline abdominal wound 2-3 weeks after surgery without herniation of bowel
Delayed repair of hernia 3-6 months later
Modified Blair incision is the most common incision used when performing a
Parotidectomy.
What maneuver exposes the entire abdominal aorta from the diaphragmatic hiatus to the celiac axis, SMA, IMA, and proximal L renal artery?
Mattox maneuver (medial visceral rotation)
- Divide left crus of diaphragm to access the distal thoracic aorta.
What maneuver exposes the retrohepatic IVC?
Cattell-Brassch (right medial visceral rotation)
What maneuver is used to mobilize the duodenum for better access to the pancreas and retroperitoneal structures over the great vessels?
Kocher maneuver
Management for postpolypectomy electrocoagulation syndrome
Bowel rest, IV hydration, broad-spectrum abx
What are the 2 common techniques for fasciotomy?
- One lateral incision from the head of the fibula to the ankle.
- Two vertical incisions. Lateral incision decompress the anterior and lateral compartment. Medial incision decompress the 2 posterior compartments.
Which bariatric surgery offers the most excess weight loss?
Duodenal switch with biliopancreatic diversion (BPD)
- Combines elements of a sleeve gastrectomy and bypass with a common channel.
Absolute contraindications to STNB in breast surgery
- Inflammatory breast cancer
- Palpable LN (clinically positive)
- Prior axillary surgery
- Chemo / radiation therapy in the past
- Multifocal breast cancers
Management of incidentally found Meckel diverticulum in adults vs. children intraoperatively
Adults: No resection > 50 yo unless oncologic concerns
Children: Resect
When follicular cells of undetermined significant are found on FNA, what is the next step in management?
Surgical resection
- lobectomy first for pathology
- completion thyroidectomy if cancer is found
Most common complication of PEG tube placement
Superficial infection at insertion site
Management of symptomatic infected pancreatic necrosis that does not respond to percutaneous catheter drainage
- Endoscopic transluminal necrosectomy
- Percutaneous transperitoneal minimally invasive necrosectomy (anterior collection)
- Video-assisted retroperitoneal debridement (posterior collections)
What is clamped in a Pringle?
Hepatoduodenal ligament: CBD, portal vein, proper hepatic artery
Management of difficult foley in a patient with BPH
Use coude cath that is larger in size
Management of a difficult foley in pts with obstruction d/t strictures
Use smaller size catheter
What albumin level is recommended by the SCIP for surgery?
3.5 mg/dL
Management for duodenal obstructions
Gastrojejunostomy
What is the FEV1 required for patients considered for pneumonectomy?
> 80% of predicted or > 2 L without dyspnea or other lung disease
What is the difference between closed (Ferguson) hemorrhoidectomy versus open (Milligan-Morgan) hemorrhoidectomy?
Closed hemorrhoidectomies have faster wound healing rates than open.
Percentage of decrease in PTH after excision of localized parathyroid gland to confirm the pathologic gland has been removed
50%
What are the minimum FEV1 values to allow for resection?
Pneumopnectomy - > 2.0 L
Lobectomy - > 1.5 L
Wedge resection > 0.8 L
What is the recommended reversal agent for a patient on Warfarin who needs rapid reversal for emergent surgery?
Prothrombin complex concentrate (PCC)
Therapies for low cardiac output syndrome after CABG
- SBP < 90
- Cardiac index < 2.2 L/min/m2
High dose inotropic
Intra-aortic balloon pump
Nasal septal bulge that is bluish in color after facial injury
Septal hematoma
- incision and drainage at base of septum
- plastic splint and anterior nasal packing
- antibiotic prophylaxis
