TBL sessions

Question 1

Classification for Hemorrhagic shock

Answer 1

Class I: <750 cc loss, HR <100, BP N, RR 20, Cap refill N, Urine output 30 cc/hr, give crystalloid IVF.

Class II: 750 - 1000 cc loss, HR >100, BP N, RR 30, cap refill increased, UO decreased (<20 cc/hr). Give crystalloid IVF.

Class III: 1.5 - 2L loss, HR >120, BP decreased, RR 35, cap refill increased, UO 10 cc/hr. Give crystalloid + blood products.

Class IV: >2L loss, HR >140, BP reduced, RR >45, cap refill increased, No UO. Give crystalloid + blood products.

Question 2

Most common causes of post-op fever by timeline:

Answer 2

Immediate post-op (hours after Sx): most likely inflammatory response to trauma from surgery. Other potentials include reaction to blood products, malignant hyperthermia.

Wind (pulmonary), POD1, 2: most common is atelectasis, potentially PNA.
Water (urine), POD3-5: UTI.
Wound, POD5-8: if earlier than this, think strep or clostridium.
Walk (clot), POD8+: thrombosis, DVT or PE.
Wonder drugs, POD1+: any drug. Alt intra-abdominal abscess.

Question 3

Classification of surgical site cleanliness

Answer 3

Clean wound: incision under sterile conditions, non-traumatic, no entrance of hollow organ. Infection rate <2%.

Clean-contaminated: incision under sterile conditions but enter a hollow viscus. No evidence of active infection, minimal contamination. E.g. routnine cholecystectomy. 3-4% infxn rate.

Contaminated: Incision under sterile conditions but major contamination of wound during procedure. E.g. spillage of stool into abdomen. 7-10% infection rate. May require secondary closure.

Dirty/infected: Established infection present before wound is made in skin. E.g. appendiceal abscess, perforated viscus. 30-40% infection rate. Secondary closure required.