Terms Flashcards
Carcinoid Syndrome
Symptoms / mnemonic
B FDR
Bronchospasm
Flushing
Diarrhea
Right sided heart failure
HITT syndrome
Heparin-Induced Thrombocytopenic Thrombosis
What causes Red Man Syndrome
Vancomycin
Trousseau’s syndrome
Syndrome of DVT associated with carcinoma
What electrolyte deficiency causes ileus
Hypokalemia
MCC of transfusion related death
Error in typing
Two types of pickups
DeBakey
Adson
Which pickups has teeth?
Adson
Difference between Mayo and Iris scissors
Iris: smaller and sharper point
Mayo: thicker and more dull point
What does a Kelly clamp look like?
Longer, thin, curved tip
What does a Babcock clamp look like?
Small, triangular tip
Which clamp is best for fascia / “heavy” tissue?
Kocher
What does an Allis clamp look like?
Has teeth at the end of its longer neck
Name of most common suction tip
Yankaur
The “sweetheart” retractor with the heart shaped end is aka what?
Harrington
What are the 5 types of retractors?
Deaver
Harrington aka Sweetheart
Army-Navy
Richardson / RICH
malleable
What are the 2 types of catgut sutures?
Chromic and Plain
Difference between chromic gut and plain gut?
Chromic gut is more resistant to breakdown by the body
due to being treated with chromium salts
What type of sutures are braided?
Vicryl
Silk PDS
Are Vicryl sutures absorbable?
Yes
How much of a Vicryl suture’s strength is retained at 2 and 4 weeks?
2 weeks = 60%
4 weeks = 8%
Are PDS sutures absorbable?
Yes
Are catgut sutures absorbable?
No
How long for complete absorption of PDS sutures?
6 months
What are the non absorbable sutures?
Silk
Nylon
Prolene
Catguts
What suture is the “fishing line” suture
Nylon
What is healing by tertiary intention?
Wound left open for a time, closed later
Aka Delayed primary
What is a retention suture?
Large suture (i.e. #2) that is full thickness thru entire abdominal wall except for the peritoneum
Used to buttress an abdominal would at risk for dehiscence and evisceration
How many days until abdominal sutures should be removed?
7 days
What patient population should sutures be left in longer?
On steroids
Where is a Pfannenstiel incision?
Low transverse abdominal
Rectus abdominus is retracted laterally
When does third spacing tend to resolve?
POD 3
Classic signs of third spacing
Tachycardia
Decreased urine output
Classic acid-base finding with significant vomiting / NG?
Hypokalemic and hypochloremic metabolic alkalosis
Maintenance IV fluids equation
4 mL/kg for first 10kg
2 mL/kg for next 10kg
1mL/kg for every kg left
Most common adult maintenance IVF
D5 1/2 NS with 20 mEq KCl/L
Minimum urine output for adults on maintenance IVF
30 mL/hour
or 0.5cc/kg/hr
Normal K+ range and critical high
3.5 to 5
Critical >6.5
Acronym for treatment of acute symptomatic kyperkalemia
CB DIAL K
Calcium Bicarb
Dialysis
Insulin or dextrose
Albuterol
Lasix
Kayexalate
Which do you replace first? Mg or K+
MAG
Major consequence of lowering hypernatremia too fast?
Seizures from cerebral edema
Major consequence of raising hyponatremia too fast?
Central pontine myelinolysis
Symptoms of hypercalcemia
Stones, bones, groans, psychiatric overtones
One unit RBCs raises Hematocrit by how much?
~3 to 4%
What electrolyte is most likely to fall with the infusion of stored blood?
Ionized Ca2+
What should platelet count be pre op?
> 50,000
When should prophylactic platelet transfusion be given?
<10,000
What type of fluid is infused with PRBCs?
NS only
What should you do for hemolytic infusions reaction?
- STOP the transfusion
- Give fluids
- Give Lasix
- Give Bicarb
- Pressors PRN
What is in Zosyn?
Piperacillin and Tazobactam
What is in Unasyn?
Ampicillin and Sulbactam
3rd gen cephalosporin with strong anti-pseudomonal activity
Ceftazidime
Preop stress dose for steroids
100mg hydrocortisone IV q 8 hours with a taper
What reverses heparin?
Protamine in 1:100 ratio
Med to help with promethazine-induced dystonia?
Benadryl
Inpatient, should cipro be given IV or PO to a pt with regular diet?
PO — cheaper, easier, good bioavailability
MOST COMMON CAUSE POST OP FEVER DURING POD DAYS 1 AND 2
ATELECTASIS
What pt population should you be careful giving supplemental O2 to?
COPD
Can reduce respiratory drive
Virchow’s triad
Stasis
Endothelial injury
Hypercoagulable state
CXR finding for PE?
Westermark sign
Wedge-shaped area of decreased vasculature resulting in hyperlucency
Oliguria parameters
50 to 400 cc daily urine output
Anuria parameters
<50cc urine output daily
You get paged your post op pt is hypotensive suddenly. WYD
Examine for possible causes (PE, bleeding, pneumothorax, tamponade, meds, sepsis)
Look for hypoxia, heart sounds/bowl sounds
Do: fluid bolus, order CXR, EKG, O2, CBC/CMP/ABGs/T&C as needed
Common causes of post op HTN
Pain, anxiety, hypercapnea/hypoxia, urinary retention
5 types of shock
- Hypovolemic
- Septic
- Cardiogenic
- Neurogenic
- Anaphylactic
What are the 2 best indicators of tissue perfusion?
Urine output
Mental status
EARLY signs of hypovolemic shock
Orthostatic hypotension
Diaphoresis and anxiety
Decreased pulse pressure from increased diastolic BP
Why the decreased pulse pressure with early hypovolemic shock?
Vasoconstriction results in elevated diastolic BP which lowers the PP
Most common vital sign change in early hypovolemic shock
Tachycardia
What constitutes septic shock?
Documented bacterial infection + hypotension
What is SIRS
Systemic Inflammatory Response Syndrome
Fever, tachycardia, tachypnea, leukocytosis
On what POD can you scan for a peritoneal abscess and why?
POD #7
Earlier and the abscess will look like normal post op fluid collection
POD #1, has fever and wound infection. What Organism?
Strep
Or clostridium
5 Classic Ws of post op fevers
- Wind - atelectasis
- Water - UTI
- Wound - infection
- Walking - DVT/PE/thrombophlebitis
- Wonder drugs - drug fever
5 Ws and the timeframe they present with fevers
- Wind - POD #1-2
- Water - POD #3+
- Wound - POD #5 (can be anytime really)
- Walking - POD #7-10
- Wonder drugs - any time
What to order for post op fever workup
Physical exam
CXR, CBC, UA, Cultures
Post op fever causes <24 hours post op
Atelectasis, strep or clostridium infection, cytokines release, anastomotic leak
