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Surgery > Surgical Recall > Flashcards

Surgical Recall Flashcards

1
Q

Ballance’s sign

A

Constant dullness to percussion in the L flank/LUQ & resonance to percussion in the R flank - splenic rupture/hematoma

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2
Q

Beck’s triad

A

Cardiac tamponade:

1) JVD
2) Dec/muffled heart sounds
3) Dec BP/Pulsus paradoxus

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3
Q

Bergman’s triad

A

Fat embolism syndrome:

1) Mental status change
2) Petechiae (axilla/thorax)
3) Dyspnea

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4
Q

Blumer’s shelf

A

Metastatic disease to rectouterine (pouch of Douglas) or rectovesical pouch, creating a palpable sehlf on rectal exam

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5
Q

Boas’ sign

A

R subscapular pain from cholelithiasis

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6
Q

Borchardt’s triad

A

Gastric volvulous:

1) Emesis followed by retching
2) Epigastric distention
3) Failure to pass NGT

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7
Q

Carcinoid triad/syndrome

A

W/carcinoid syndrome:

1) Flushing
2) Diarrhea
3) R-sided HF (2ndary to chemicals released by tumor)
4) Bronchospasm

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8
Q

Charcot’s triad

A

W/cholangitis:

1) Fever/chills
2) Jaundice
3) RUQ pain

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9
Q

Courvoisier’s law

A

Enlarged nontender GB seen with obstruction of the CBD, common with pancreatic CA

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10
Q

Cushing’s triad

A

Inc ICP:

1) HTN
2) Bradycardia
3) Irregular respirations

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11
Q

Dance’s sign

A

Empty RLQ in children w/ileocecal intussusception

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12
Q

Fothergill’s sign

A

Intra-abd mass vs mass in abd wall: mass felt while tension in mm (sitting up) –> mass in abd wall

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13
Q

Fox’s sign

A

Ecchymosis of inguinal ligament w/ retroperitoneal bleeding

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14
Q

Hamman’s sign

A

Crunching sound on auscultation of heart - from emphysematous mediastinum (Boerhaave’s syndrome, pneumomediastinum)

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15
Q

Howship-Romberg sign

A

Pain along inner thigh - obturator hernia compressing nn

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16
Q

Kehr’s sign

A

L shoulder pain from splenic rupture (referred pain from diaphragmatic irritation)

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17
Q

Kelly’s sign

A

Visible peristalsis of ureter in response to squeezing or retraction - ID ureter during surg

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18
Q

Mittelschmerz

A

LQ pain d/t ovulation

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19
Q

Obturator sign

A

Pain w/int rot of leg, hip and knee flexed - pts with appendicitis/pelvic abscess

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20
Q

Pheochromocytoma

A

1) Palpitations
2) HA
3) Episodic diaphoresis

10% b/l, malig, children, extra-adrenal, multiple tumors

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21
Q

Reynold’s pentad

A

1) Fever
2) Jaundice
3) RUQ pain
4) Mental status change
5) Shock/sepsis

in suppurative cholangitis

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22
Q

Saint’s triad

A

1) Cholelithiasis
2) Hiatal hernia
3) Diverticular disease

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23
Q

Sister Mary Joseph’s sign/node

A

Met tumor to umbilical LNs

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24
Q

Virchow’s node

A

Met tumor to L supraclavicular node (d/t gastric CA)

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25
Q

Valentino’s sign

A

RLQ pain from perforated peptic ulcer d/t succus/pus draining into RLQ

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26
Q

Westermark’s sign

A

Dec pulm vascular markings CXR in a pt w/PE

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27
Q

Whipple’s triad

A

Insulinoma:

1) Hypoglycemia (<50)
2) CNS and vasomotor symp (Syncope, diaphoresis)
3) Relief of symp w/ glucose

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28
Q

Afferent loop syndrome

A

Obstruction of affarent loop of Billroth II gastrojejunostomy (greater curvature of the stomach connected to the first part of the jejunum in end-to-side anastomosis.)

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29
Q

Blind loop syndrome

A

Bacterial overgrowth of intestine 2ndary to stasis

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30
Q

Budd-Chiari syndrome

A

Thrombosis of hepatic vein

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31
Q

Dumping syndrome

A

Delivery of large amount of hyperosmolar chyme into sm bowel after vagotomy and gastric drainage procedure (pyloroplasty, gasterojejunosotmy) –> autonomic instability, abd pain, and diarrhea

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32
Q

Fitz-Hugh-Curtis syndrome

A

Perihepatic gonorrhea infx

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33
Q

Gardner’s syndrome

A

GI polyps assoc w/ Sebaceous cyst, Osteomas, Desmoid tumors. High malig potential

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34
Q

HIT syndrome

A

Heparin Induced Thrombocytopenia
Type I - Non-immune, 1-4 days after heparin, mild thrombocytopenia, 6-14 day tx
Type II - Immune mediated against Platelet Factor-4, 5-10 days after heparin, severe thrombocytopenia, min 6 mo tx

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35
Q

Leriche’s syndrome

A

Iliac occlusive disease

1) Claudication of buttocks and thighs
2) Impotence
3) Atrophy of legs

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36
Q

Mendelson’s syndrome

A

Chemical pneumonitis after aspiration of gastric contents

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37
Q

Mirizzi’s syndrome

A

Extrinsic obstruction of CBD from gallstone in GB or cystic duct

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38
Q

Ogilvie’s syndrome

A

Massive nonobstructive colonic dilatation (no mechanical cause)

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39
Q

Peutz-Jeghers syndrome

A

Benign GI polyps and buccal pigmentation

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40
Q

Plummer-Vinson syndrome

A

1) Esophageal web
2) Fe-deficiency anemia
3) Dysphagia
4) Spoon shaped nails
5) Atrophic oral and tongue mucosa
- Inc affinity for SqCC, Older female

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41
Q

RED reaction syndrome

A

Skin erythema from rapid vancomycin infusion (AEs red man syndrome, anaphylaxis)

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42
Q

Refeeding syndrome

A

HypoK, hypoMg, hypoP

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43
Q

Osler-Weber-Rendu syndrome

A

GI tract telangiectasia/AV malformations (Port Wine stain)

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44
Q

SVC syndrome

A

Obstruction of the SVC, associated Horner’s (ptosis, miosis, anhydrosis)

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45
Q

Thoracic Outlet Syndrome

A

Compression of VAN between the clavicle and 1st rib

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46
Q

Tietze’s syndrone

A

Costrochondritis, aseptic

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47
Q

Toxic Shck syndrome

A

S aureus toxin –> fever, hypotension, organ failure, rash (desquamation esp palms and soles)

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48
Q

MC indication for sug in Crohn’s disease

A

SBO

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49
Q

MC Breast CA

A

Infiltrating ductal

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50
Q

MC vessel in bleeding duodenal ulcer

A

Gastroduodenal aa

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51
Q

MC bacteria in stool

A

B fragilis

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52
Q

MC site of GI carcinoids

A

Appendix

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53
Q

MC electrolyte deficiency causing ileus

A

HypoK

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54
Q

MC position of anal fissure

A

Posterior

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55
Q

MC type of colonic volvulus

A

Sigmoid volvulous

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56
Q

MC causes of post-op fevers

A 
Wind - POD 1-3 - Atelectasis/pneumo
Water - POD 3-5 - UTI
Walk - POD 4-8 - DVT/PE
Wound - POD 5-7 - SSI
Wonder drugs - anytime - meds
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57
Q

MC organ damaged in blunt abd truama

A

Liver

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58
Q

MC organ damaged in penetrating abd trauma

A

Sm bowel

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59
Q

MC benign liver tumor

A

Hemangioma

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60
Q

MC cause of ICU pneumonia

A

Gr (-) bacteria

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61
Q

1 L of O2 via nasal cannula raises FiO2 by…?

A

3%

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62
Q

Suture sizes

A

By diameter: higher the O, the smaller the diameter (2-O >5-O) (ie the number of Os (zeros) in front of the number, so 0.00 >vs> 0.00000)

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63
Q

Catgut

A
  • -Absorbable
  • -Monofilament
  • -Fibers from cow or sheep intestines.
  • Chromic gut - tx with chromium salts –> more collagen crosslinking, the suture is more resistant to breakdown
  • Plain - quicker dissolution
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64
Q

Vicryl

A
  • -Absorbable
  • -Braided/multifilamentous
  • -Copolymer of lactide and glycoside
  • ~10% strength after 4 wks
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65
Q

PDS (polydioanone)

A
  • -Absorbable
  • -Monofilament
  • -Polymer of polydioxanone
  • -complete absorption 6 mo
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66
Q

Silk

A
  • -Non-absorbable

- -Braided/multifilamentous

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67
Q

Prolene

A
  • -Non-absorbable

- Vascular anastomosis, hernias, abd fascial closure

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68
Q

Wound closure - Primary intention

A

Wound edges are approximated in a clean manner

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69
Q

Wound closure - Secondary intention

A

Wound remains open to heal via granulation, contraction, and epithelization - for dirty wounds, abscess

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70
Q

Wound closure - Tertiary intention

A

Wound remains open for a time and then closed, allows for debridement and wound care to reduce bacterial infx –>delayed primary closure

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71
Q

Taper point needle

A

Round body needle - spreads without cutting - suturing soft tissue (GI tract, mm, nn, peritoneum, fascia)

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72
Q

Conventional cutting needle

A

Triangle body needle - sharp edges - suturing skin

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73
Q

Vertical mattress use

A

For difficult to approximate skin edges - eversion of tissue

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74
Q

Retention suture

A

Large suture (#2) - full thickness through entire abd wall (except peritoneum) - used buttress and abd wound at risk for dehiscence

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75
Q

Time to remove sutures

A 
Face - 3-5 d
Extremities - 10 d
Joints - 10-14 d
Back - 14 d
Abd - 7 d
76
Q

Femoral structures

A

Lateral to medial: Nerve, Artery, Vein, Lymphatics

77
Q

Very high drainage from NGT

A

NGT may be in duodenum and picking up 3L/hr fluid

78
Q

Bowel prep

A

Colon cathartic (Golytely), oral abx (neomycin, erythromycin), and IV abx before incision

79
Q

Pringle maneuver

A

Occlusion of the porta hepatis through hepatoduodenal ligament: Hepatic aa, Portal vv, and CBD
-Temporary control of liver blood flow when parenchyma is actively bleeding

80
Q

Hartmann’s procedure

A

1) Proximal colostomy

2) Distal stapled-off colon or rectum that is left in peritoneal cavity

81
Q

What reverses the deleterious effects of steroids on wound healing?

A

Vit A

82
Q

Wound dehiscence

A

Opening of the fascial closure –> OR for immediate fascial reclosure

83
Q

Dakin solution

A

Dilute sodium hypochlorite (bleach) used in contaminated wounds

84
Q

Gerota’s fascia

A

Fascia surrounding the kidney

85
Q

Collateral circulations in portal HTN

A

1) Esophgeal varices
2) Hemorrhoids (inf hemorrhoidal vv to internal iliac vv)
3) Umbilical vv (caput medusa)
4) Retroperitoneal vv (via lumbar tributaries)

86
Q

Retroperitoneal GI tract structures

A

Most of duodenum, ascending colon, descending colon, pancreas

87
Q

What is the Gubernaculum?

A

Embryologic structure - adheres the testes to the scrotal sac

88
Q

Rotter’s LNs

A

LNs between the pectoralis minor and major mm

89
Q

Hesselbach’s triange

A

Bordered by:

1) Inguinal ligament
2) Epigastric vessels
3) Lateral border of the rectus sheath

90
Q

Calot’s triangle

A

Bordered by:

1) Cystic duct
2) Common hepatic duct
3) Cystic aa
* * Calot’s node is LN in th triangle

91
Q

Gastrinoma triangle

A

> 80% of gastrinomas located within borders of:

1) Junction of the 2nd/3rd protions of the duodenum
2) Cystic duct
3) Pancreatic neck

92
Q

White lines of Toldt

A

Lateral peritoneal reflections of the ascending and descending colon

93
Q

Submucosa of the GI tract

A

Strongest layer of small bowel

*SEROSA not present in esophagus, middle, and distal rectum

94
Q

Vein of Mayo

A

vv overlies the pylorus

95
Q

Layers of abd wall

A

1) Skin, fat
2) Scarpa’s fascia
3) Ext oblique
4) Int oblique
5) Transversus abdominis
6) Transversalis fascia
7) Preperitoneal fat
8) Peritoneum

96
Q

Jejunum vs ileum

A

Jejunum - long vasa rectae, large plicae circularis (valvulae conniventes), thicker wall
Ileum - shorter vasa rectae, smaller plicae circulares, thinner wall

97
Q

Lg vs Sm bowel

A

Lg - has taeniae coli, haustra, and appendices epiploicae (fat appendages)
Sm - smooth

98
Q

Should pt take anti-hypertensive med on day of surgery?

A

Yes - Esp clonidine because it has a rebound HTN effect

99
Q

Billroth I

A

Antrectomy with gradtoDUODenostomy (pylorus and gastric antrum is removed and duodenum is attached to the remaining gastric pouch)

100
Q

Billroth II

A

Antrectomy with gastroJEJUnostomy (greater curvature attached to the jejunum, the duodenum is a limb no longer attached to the stomach)

101
Q

Bassini Herniorrhaphy

A

Inguinal hernia repair:

Approximating transversus abdominis aponeurosis and conjoint tendon to Poupart’s (inguinal) ligament

102
Q

McVay Herniorrhaphy

A

Inguinal hernia repair:
Approximating transversus abdominis aponeurosis and conjoint tendon to Cooper’s ligament (superior pubic bone periosteum)

103
Q

Lichtenstein Herniorrhaphy

A

Inguinal hernia repair:

Tension free - uses mesh (or synthetic graft)

104
Q

Shouldice Herniorrhaphy

A

Inguinal hernia repair:
Imbrication of the transversalis fascia, transversus abdominis aponeurosis, and conjoint tendone and approximation of the transversus abdominis aponeurosis and the conjoint tendon to the inguinal ligament

105
Q

Plug and Patch Herniorrhaphy

A

Prosthetic plug pushes hernia sac in and is then covered with prosthetic path to repair hernia

106
Q

AbdominoPerineal Resection (APR)

A

Removal of rectum and sigmoid colon through abdominal and perineal incisions (pt w/colostomy)
For low rectal cancers <8cm from anal verge

107
Q

Low Anterior Resection (LAR)

A

Resection of low rectal tumors through anterior abd incision

108
Q

Kocher Maneuver

A

Dissection of the duodenum from the R sided peritoneal attachment –> allows for mobilization and visualization of the back of the duodenum and pancreas

109
Q

Puestow Procedure

A

Side-to-side anastomosis of the pancreas and jejunum

110
Q

Stamm gastrostomy

A

Gastrostomy placed by open surgical incision and tacked to the abdominal wall

111
Q

Highly selective vagotomy

A

Transection of vagal fibers to the body of the stomach. Fibers to the pylorus remain intact (no need for pyloroplasty or other drainage since pylorus continues to function)

112
Q

Heineke-Mikulicz pyloroplasty

A

Longitudinal incision through all layers of the pylorus, however, closure in a transverse direction to make pylorus non-functional.

113
Q

Whipple Procedure

A

Pancreaticoduodenectomy”

  • Removal of the head of the pancreas and duodenum
  • Cholecystectomy
  • Choledochojejunostomy
  • Truncal Vagotomy
  • Pancreaticojejunostomy (Anastomosis of distal pancreas remnant to the jejunum)
  • Gastrojejunostomy (Anastomosis of the stomach to jejunum)
114
Q

L Vagus nn

A

Positioned anteriorly - the esophagus rotates during development

115
Q

Foregut
Midgut
Hindgut

A

Foregut - mouth to ampulla of Vater
Midgut - ampulla of vater to distal 1/3 of transverse colon
Hindgut - distal 1/3 of transverse colon to anus

116
Q

Cantle’s line

A

Line drawn from the IVC to just the L of the GB fossa –> Separates the R and L lobes of the liver

117
Q

Anterior Spinal Syndrome (Beck’s syndrome)

A

MC form of spinal cord infarction from blood flow interruption in the aa of Adamkiewicz (a branch of the aorta). Ant 2/3 and medulla oblongata effected, causing loss of motor below the level and loss of pain/temp sensation

118
Q

Layers of the artery

A

Outside to inside:

1) Adventitia
2) Media
3) Intima

119
Q

Body fluid composition

A

Total fluids = 60% Total Body Weight (TBW)

  • -Intracellular = 40% TBW (66% of body fluid)
  • -Extracellular = 20% TBW (Interstitial and intravascular - 33% of body fluid)

-Blood is 7% TBW (0.07 x body weight = volume in L)

120
Q

Paradoxical alkalotic aciduria

A

Seen in severe hypokalemic, hypovolemic, hypocholermic metabolic alkalosis with paradoxic metabolic alkalosis of serum and acidic urine. H lost in urine in exchange for Na in attempt to restore volume, H exchanged preferentially instead of K because K is low.

121
Q

Maintenance fluid

A

100/50/20 for 24 hours or 4/2/1 for hrly rate

Adult - D5 1/2 NS + 20 mEq KCl

Peds - Ds 1/4 NS +20 mEq KCl

122
Q

Why is dextrose added to maintenance fluid (D5 IVF?)

A

Inhibits mm breakdown

123
Q

Min urine output for adult

A

30 mL/hr or 0.5 cc/kg/hr

124
Q

1 oz = ? mL

A

30 mL

125
Q

Bolus fluids

A

Isotonic fluids (NS or LR) 1L given over 1 hour

126
Q

Possible consequence of hyperglycemia in hypovolemic patient?

A

Osmotic diuresis

127
Q

Portion of 1L NS remaining in intravascular space after laparotomy?

A

in 5 hours, ~200 cc (20%)

Post lap: give LR or DSLR for 24-36 hours then maintenance fluids

128
Q

When is a pt’s fluid mobalized after lap?

A

POD3 - mobalization of fluid back into IV space

129
Q

What IVF is used to replace duodenal or pancreatic fluid loss?

A

LR (bicarb loss)

130
Q

Normal range for Potassium (K)?

A

3.5-5 mEq

131
Q

Surgical causes of hyperkalemia?

A
  • Iatrogenic overdose
  • Blood transfusion
  • Renal Failure
  • Diuretics
  • Acidosis
  • Tissue destruction (injury/hemolysis)
132
Q

Signs & symptoms of hyperkalemia?

A
  • Decreased DTRs or areflexia
  • Weakness
  • Parenthesia or paralysis
  • Resp failure
133
Q

EKG findings of hyperkalemia?

A
  • Peaked T waves
  • Depressed ST segment
  • Prolonged PR
  • Wide QRS
  • Bradycardia
  • V-fib
134
Q

What is a critical Potassium (K) level (critical hyperkalemia)?

A

K>6.5

135
Q

Treatment for critical hyperkalemia?

A
  • IV Ca (Cardioprotective - stabilizes cardiac membranes) - monitor EKG
  • Sodium Bicarbonate IV (Alkalosis drives K intracellularly)
  • Glucose + insulin
  • Albuterol
  • Kayexalate (Na polystyrene sulfonate) and furosemide (dec K uptake via GI and GU tracks)
  • Dialysis

CB DIAL K - Calcium, Bicarb, Dialysis, Insulin/dextrose, Albuterol, Lasix, Kayexalate

136
Q

Treatment for hyperkalemia (non-critical)?

A
  • Furosemide

- Kayexalate (Na polystyrene sulfonate)

137
Q

Pseudohyperkalemia

A

Hyperkalemia from falsely elevated K in sample from hemolysis

138
Q

What acid-base change lowers serum K?

A

Alkalosis

139
Q

What are the surgical causes of hypokalemia?

A
  • Diuretics
  • Antibiotics
  • Steroids
  • Alkalosis
  • Diarrhea
  • Intestinal fistulae
  • NG aspitation
  • Vomiting
  • Insulin
  • Insufficient supplementation
  • Amphotericin B
140
Q

Signs & symptoms of hypokalemia?

A
  • Tetany
  • Ileus
  • Weakness
  • N/V
  • Parasthesias
141
Q

EKG findings of hypokalemia?

A
  • Flattening T waves
  • U waves (appears after T wave)
  • ST segment depression
  • PACs and PVcs
  • A-fib
142
Q

Rapid treatment for hypokalemia?

A

IV KCl (max amount given 10 mEq/hr via peripheral IV and 20 mEq/hr via central line)

143
Q

Maximum amounts of KCl that can be given for hypokalemia?

A

10 mEq/hr - peripheral IV

20 mEq/hr - Central line

144
Q

What electrolyte condition exacerbates digitalis toxicity?

A

Hypokalemia

145
Q

What other electrolyte deficiency can cause hypokalemia?

A

Hypo-Magnasemia

–Low Mg inhibits K reabsorption from the renal tubules

146
Q

What electrolyte needs replacement before replacing K?

A

Magnesium

147
Q

Normal range for Sodium (Na)?

A

135-145 mEq/L

148
Q

Surgical causes of hypernatremia?

A
  • Inadequate hydration
  • Diabetes Insipidus
  • Diuresis
  • Diarrhea/Vomiting
  • Diaphoresis
  • Tachypnea
  • Iatrogenic (TPN)
149
Q

Signs & symptoms of hypernatremia?

A
  • Seizures
  • Confusion
  • Stupor
  • Pulm or peripheral edema
  • Tremors
  • Resp paralysis
150
Q

Treatment of hypernatremia?

A

Slowly (<12 mEq/L change per day)

  • D5W
  • 1/4 NS
  • 1/2 NS
151
Q

Complication of correcting hypernatremia too quickly

A

Seizures -likely from cerebral edema

152
Q

Surgical causes of hyponatremia

A

Hypovolemic:

  • -Excess diuretics
  • -Hypoaldosteronism
  • -Vomiting/NG suctioning
  • -Burns
  • -Pancreatitis
  • -Diaphoresis

Euvolemic

  • -SIADH
  • -CNS abnormalities
  • -Drugs

Hypervolemic

  • -Renal failure
  • -CHF
  • -Liver failure (cirrhosis)
  • -Iatrogenic fluid overload (dilutional)
153
Q

Signs & symptoms of hyponatremia?

A
  • Seizures/coma
  • N/V
  • Ileus
  • Lethargy
  • Confusion
  • Weakness
154
Q

Treatment for hyponatremia?

A

Slowly (<12 mEq/L change per day)
Hypovolemic
–IV NS, correct underlying cause

Euvolemic

  • -Fluid restriction
  • -SIADH - furosemide and NS acutely

Hypervolemic
–Dilutional - Fluid restriction and diuretics

155
Q

Complication of correcting hyponatremia too quickly?

A

Central pontine myelinolysis

  • -Confusion
  • -Spastic quadriplegia
  • -Horizontal gaze paralysis
156
Q

Signs of central pontine myelinolysis?

A

From quick correction of hyponatremia

  • -Confusion
  • -Spastic quadriplegia
  • -Horizontal gaze paralysis
157
Q

Pseudohyponatremia

A

Dilutional from fluid overload from hyperglycemia, hyperlipidemia, or hyperproteinemia

158
Q

Causes of hypercalcemia

A
  • Ca supplementation IV
  • Hyperparathyroidism (Primary and Tertiary), hyperthyroidism
  • Immobility/Iatrogenic (thiazide diuretics)
  • Mets/Milk alkali syndrome
  • Paget’s disease (bone breakdown)
  • Addison’s/Acromegaly
  • Neoplasm (colon, lung, breast, prostate, MM)
  • Zollinger-Ellison syndrome (MEN I)
  • Excessive Vit D or A
  • Sarcoid
159
Q

Signs and symptoms of hypercalcemia

A

Stones, bones, abdominal groans, psychiatric overtones

  • Polydipsia
  • Polyuria
  • Constipation
160
Q

ECG findings of hypercalcemia

A

Short QT interval

Prolonged PR interval

161
Q

Acute treatment of hypercalcemic crisis

A
  • Vol expansion w/NS
  • Diuresis with furosemide (not thazide)
  • Streoids
  • Calcitonin
  • Bisphosphonates (pamidronate)
  • Mithramycin
  • Dialysis (last resort)
162
Q

Ca levels as relating to hypoalbuminemia

A

measured albumin x 0.8 + measured CA level = Corrected Ca level

163
Q

Surgical causes of hypocalcemia

A
  • Short bowel syndrome
  • Intestinal bypass
  • Vit D deficiency
  • Sepsis
  • Acute pancreatitis
  • Osteoblastic met
  • Aminoglycosides
  • Diuretics
  • Renal faliure
  • HypoMg
  • Rhabdomyolysis
164
Q

Signs & symptoms of hypocalcemia

A
  • Chvostek’s -facial mm spasm with tappinc of facial nn
  • Trousseau’s - carpal spasm after occluding blood flow in forearm or tapping on wrist
  • Perioral parasthesia (early)
  • Increased DTRs (late)
  • Confusion
  • Abdominal cramps
  • Laryngospasms/stridor
  • Seizures
  • Tatany
  • Psych abnormalities (paranoia, depression, hallucinations)
165
Q

ECG findings of hypocalcemia

A

-Prolonged QT and ST interval

166
Q

Treatments for hypocalcemia

A

-Acute - Calcium gluconayte IV

Chronic - Calcium PO + Vit D

167
Q

Complication of infused Ca if IV infiltrates - for tx of hypocalcemia

A

Tissue necrosis

–(Never administer peripherally and Ca GLUCONATE is less toxic than Ca CHLORIDE)

168
Q

Best measure of Ca levels

A

Ionized Ca

169
Q

Normal range of Magnesium (Mg)

A

1.5-2.5 mEq/L

170
Q

Surgical causes of hypermagnesemia

A
  • TPN
  • Renal failure
  • IV over supplementation
171
Q

Signs & symptoms of hypermagnesemia

A
  • Res failure
  • CNS depression
  • Dec DTRs
172
Q

Treatment of hypermagnesemia

A
  • Ca gluconate IV
  • Insulin + glucose
  • Dialysis
  • Furosemide
173
Q

Surgical causes of hypomagnesemia

A
  • TPN
  • Hypocalcemia
  • Gastric suctioning
  • Aminoglycosides
  • Renal failure
  • Diarrhea/Vomiting
174
Q

Signs & smptoms of hypomagnesemia

A
  • Inc DTRs
  • Tetany
  • Asterixis
  • Tremor
  • Chvostek’s sign
  • Ventricular ectopy
  • Vertigo
  • Tachycardia/dysrhythmias
175
Q

Treatment of hypomagnesemia

A

Acute - MgSO4 IV

Chronic - Mg oxide PO (AE - diarrhea)

176
Q

Surgical causes of hyperglycemia

A
  • DM (poor control)
  • Infection
  • Stress
  • TPN
  • Drugs
  • Error (lab or drawing over IV site)
  • Somatostatinoma
  • Glucagonoma
177
Q

Weiss protocol

A

Sliding Scale Insulin

178
Q

Goal glucose level in ICU

A

80-110 mg/dL

179
Q

Surgical causes of hypoglycemia

A
  • Excess insulin
  • Dec caloric intake
  • Insulinoma
  • Drugs
  • Liver failure
  • Adrenal insufficiency
  • Gastrojejunostomy
180
Q

Signs & symptoms of hypoglycemia

A
  • Sympathetic response - diaphoresis, tachycardia, palpitation
  • Confusion
  • Coma/Neuro deficits
  • HA
  • Diplopia
  • Seizures
181
Q

Normal range of Phosphorous (P)

A

2.5-4.5 mg/dL

182
Q

Signs & symptoms of hypophosphatemia

A
  • Cardiomyopathy
  • Rhabdomyolysis
  • Hemolysis
  • Poor pressor response
  • Neurologic dysfunction (ataxia)
  • Weakness
183
Q

Complication of severe hypophosphatemia

A

Respiratory failure

184
Q

Causes of hypophosphatemia

A

GI losses, inadequate supplementation, medications, sepsis, ETOH abuse, renal loss

185
Q

Critical value of hypophasphatemia

A

<1 mg/dL

186
Q

Tx of hypophosphatemia

A

Sodium phosphate supplement or potassium phosphate IV

Surgery (1 decks)

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