Surgical-Pre & Post OR care Flashcards

1
Q

when do you redose abx after preoperative dose that is required with in 1 hr of incision time?

A

For complex and prolonged procedures

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2
Q

When do you use broad-spectrum abx for preop dosing

A

only when cases where anaerobic organisms are anticipated such as during colon resection

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3
Q

Best way to assess need for coronary angiogram before surgery on pt with PVD?

A

Persantine thallium stress test followed by echo (If no PVD, exercise stress testing)

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4
Q

Tx for HIT

A
  • Stop Heparin

- Start nonheparin anticoagulant (direct thrombin inhibitors= Lepirudin & argatroban)

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5
Q

Warfarin tx should not be started until plt count is above?

A

100,000/mm3

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6
Q

Bleeding at the site of surgery early postoperative period is mostly due to

A

Error in surgical control of blood vessels in the operative field

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7
Q

elevated aPTT, normal PT & abnormal bleeding time. Dx? Tx?

A

Von Willenbrand disease; DDAVP

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8
Q

Define SIRS

A

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

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9
Q

Define Sepsis

A

SIRS + documented infection

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10
Q

Define severe sepsis

A

Sepsis+ organ dysfunction or hypo perfusion (lactic acidosis, oliguria, or AMS)

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11
Q

Define Septic shock

A

Sepsis + organ dysfunction + hypotension (SBP <90 or > 90 with vasopressors)

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12
Q

what is massive blood transfusion ? And when to you give FFP and Put?

A
  • 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
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13
Q

Heparin reversal for heparinized pt with life threatening hemorrhage is

A

protamine sulfate 1mg for each 100 unit of heparin

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14
Q

the 3 indications for inferior vena cava (IVC) filter placement are

A
  1. failure or complication of anticoagulation
  2. a known free-floating venous clot
  3. prior history of PE
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15
Q

factors that predispose to fistula formation and may prevent closure of surgical incision are

A

FRIENDS

foreign body; radiation, inflammation, epithelialization of the tract, neoplasm, distal obstruction and steroids.

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16
Q

a complication of referring syndrome, which occurs in malnourished patients who are administered with IV glucose

A

Hypophosphatemia

17
Q

when is FFP used for patient with liver cirrhosis who is having surgery?

A

should be administered on call on the OR, to ensure that the transfusion is complete prior to the incision

18
Q

The most common nosocomial infection is

A

UTI

19
Q

Tx for server hemophilia A

A

DDAVP (desmopression) in combination with an inhibitor of fibrinolysis (aminocaproic acid/AMICAR)
if if m ild hemophilia only DDAVP

20
Q

Most appropriate tx prior to surgery to minimize risk of bleeding from taking NSAID use?

A

Stop 3-4 days prior to surgery

21
Q

Bile, fluids found in duodenum, jejunum and ileum have an electrolyte content similar to

A

LR

22
Q

Saliva, gastric juice, and right colon fluid have what kind of electrolytes?

A

High K

Low Na

23
Q

pancreatic secretion are high in

A

bicarbonate

24
Q

Alopecia, poor wound healing, night blindness or photophobia, anosmia, neuritis and skin rashes

A

Zinc deficiency - can result from diarrhea

25
Q

Seleninum deficiency is characterized by

A

cardiomyopathy

26
Q

Molybdenum deficiency is characterized by

A

encephalopathy due to toxic accumulation of sulfur-containing amino acids

27
Q

Chromium definitely can occur in patients that are on_____ and characterized

A

long-term TPN and characterized by difficult-to-contorl hyperglycemia and peripheral neuropathy & encephalopathy

28
Q

encephalopathy and peripheral neuropathy , cardiac symptoms and cardiac failure, deficient in

A

Thiamine

29
Q

when do you use 0.45% normal saline?

A

postoperative fluid maintenance in the hemodynamically stable patient

30
Q

Colloids (albumin, hetastarch) in resuscitation of pt in hemorrhagic shock to replace blood volume is in what ratio?

A

1:1

31
Q

NS or LR (Crystalloids) are used to replace volume of blood lost in a ration of

A

3:1

32
Q

Early sepsis is a physiologically hyper dynamic hypermetabolic state representing a surge of ___, ______ & ________

A

Catecholamines, cortisol and other stress-related hormones

33
Q

what are the physical earliest manifestations of sepsis?

A
  • Changes in mental status
  • Tachypnea that leads to respiratory alkalosis
  • flushed skin (vasodilation)
34
Q

Cardiovascular response to early sepsis is characterized by

A
  • increased CO
  • Decreased SVR
  • Decreased peripheral utilization of oxygen (decreased arteriovenous oxygen difference)
35
Q

Tx for hemolytic transfusion reaction (3 steps)

A
  • Stop transfusion
  • Fluids resustitaiton
  • Mannitor (osmotic diuretics)
36
Q

During starvation metabolic rate is decreased by

A

decreased by 10%

37
Q

Trauma, stress, sepsis, burns and surgery causes metabolic rate to

A

increases