Surgical-Pre & Post OR care Flashcards
when do you redose abx after preoperative dose that is required with in 1 hr of incision time?
For complex and prolonged procedures
When do you use broad-spectrum abx for preop dosing
only when cases where anaerobic organisms are anticipated such as during colon resection
Best way to assess need for coronary angiogram before surgery on pt with PVD?
Persantine thallium stress test followed by echo (If no PVD, exercise stress testing)
Tx for HIT
- Stop Heparin
- Start nonheparin anticoagulant (direct thrombin inhibitors= Lepirudin & argatroban)
Warfarin tx should not be started until plt count is above?
100,000/mm3
Bleeding at the site of surgery early postoperative period is mostly due to
Error in surgical control of blood vessels in the operative field
elevated aPTT, normal PT & abnormal bleeding time. Dx? Tx?
Von Willenbrand disease; DDAVP
Define SIRS
2 or more of; Temp >38 (100) or <36 (97), HR >90, RR>20 or PaCO2 <32, WBC >12000 or <4000 or >10% immature neutrophils
Define Sepsis
SIRS + documented infection
Define severe sepsis
Sepsis+ organ dysfunction or hypo perfusion (lactic acidosis, oliguria, or AMS)
Define Septic shock
Sepsis + organ dysfunction + hypotension (SBP <90 or > 90 with vasopressors)
what is massive blood transfusion ? And when to you give FFP and Put?
- single transfusion greater than 10 units of PRBCs transfused over a period of 24hrs.
PRBC:FFP; 1:1 ratio, no longer need to wait for lab to give FFP and plt.
Only 2 L of crystalloid infusion
Heparin reversal for heparinized pt with life threatening hemorrhage is
protamine sulfate 1mg for each 100 unit of heparin
the 3 indications for inferior vena cava (IVC) filter placement are
- failure or complication of anticoagulation
- a known free-floating venous clot
- prior history of PE
factors that predispose to fistula formation and may prevent closure of surgical incision are
FRIENDS
foreign body; radiation, inflammation, epithelialization of the tract, neoplasm, distal obstruction and steroids.
a complication of referring syndrome, which occurs in malnourished patients who are administered with IV glucose
Hypophosphatemia
when is FFP used for patient with liver cirrhosis who is having surgery?
should be administered on call on the OR, to ensure that the transfusion is complete prior to the incision
The most common nosocomial infection is
UTI
Tx for server hemophilia A
DDAVP (desmopression) in combination with an inhibitor of fibrinolysis (aminocaproic acid/AMICAR)
if if m ild hemophilia only DDAVP
Most appropriate tx prior to surgery to minimize risk of bleeding from taking NSAID use?
Stop 3-4 days prior to surgery
Bile, fluids found in duodenum, jejunum and ileum have an electrolyte content similar to
LR
Saliva, gastric juice, and right colon fluid have what kind of electrolytes?
High K
Low Na
pancreatic secretion are high in
bicarbonate
Alopecia, poor wound healing, night blindness or photophobia, anosmia, neuritis and skin rashes
Zinc deficiency - can result from diarrhea
