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Surgical Care > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Why is it optimal for a patient to have an empty stomach prior to surgery?

A

Decreases likelihood of aspiration pneumonia

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2
Q

Conditions that elevate intra abdominal pressure and therefore increase aspiration risk

A

Morbid obesity

Pregnancy

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3
Q

Conditions that delay gastric emptying and therefore increase aspiration risk

A

Gastroparesis
Pregnancy
Abdominal trauma

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4
Q

Minimum fasting period for clear liquids

A

2 hours

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5
Q

Minimum fasting period for breast milk

A

4 hours

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6
Q

Minimum fasting period for infant formula

A

4 hours for < 3 months

6 hours for > 3 months

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7
Q

Minimum fasting period for nonhuman milk

A

6 hours

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8
Q

Minimum fasting period for light meal

A

6 hours

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9
Q

Why does a patient need a preoperative bowel prep?

A

Decreases abdominal contamination in the event of bowel entry

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10
Q

Emergency surgery pre-op questions

A

AMPLE
Allergies
Medications - when did you most recently take them
Past medical and surgical history
Last meal
Events that immediately preceded this surgery

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11
Q

Total body water is distributed with about _____ existing intracellularly and _____ found in extracellular spaces

A

2/3 intracellular

1/3 extracellular

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12
Q

The extracellular portion of body water is _____ interstitial and _____ intravascular

A

3/4 interstitial

1/4 intravascular

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13
Q

Plasma volume is _____ or about _____% of TBW

A

1/12

8.3

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14
Q

Total kg (body weight) x _____ = total body water

A

0.6

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15
Q

Fluid maintenance requirement for first 0-10 kg of body weight

A

100 ml/kg/d

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16
Q

Fluid maintenance requirement for next 10 mg of body weight

A

50 ml/kg/d

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17
Q

Fluid maintenance requirement for all subsequent kg of body weight

A

20 ml/kg/d

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18
Q

Electrolyte requirements for maintenance of sodium

A

1-2 mEq/kg/d

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19
Q

Electrolyte requirements for maintenance of potassium

A

0.5-1 mEq/kg/d

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20
Q

Signs of fluid shifts out of intravascular space

A

Changes in vitals: blood pressure, heart rate, central venous pressure
Decreased urine output

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21
Q

Volume excess signs

A

Weight gain, pulmonary edema, peripheral edema, S3 gallop

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22
Q

When does third-spaced fluid tend to mobilize after surgery?

A

POD #3

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23
Q

Fever associated cytokines are _____, ______, ______, and ______

A

IL-1
IL-6
TNF-alpha
IFN-gamma

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24
Q

Differential diagnosis of a postop fever

A 
Wind (atelectasis, pneumonia)
Water (UTI)
Wound (wound infection, abscess)
Walking (DVT, PE)
Wonder drug or what did we do?
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25
Q

Most common onset of atelectasis or pneumonia

A

Atelectasis POD #1

Pneumonia POD #1-3

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26
Q

Most common onset of UTI

A

POD #3

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27
Q

Most common onset of wound infection or abscess

A

POD #5

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28
Q

Most common onset of DVT or PE

A

POD #7

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29
Q

Risk factors for post-op UTI

A

Female gender
Older age
Diabetes
Immobilization

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30
Q

Virchow’s Triad

A

Stasis
Vascular damage
Hypercoagulability

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31
Q

Treatment for malignant hyperthermia

A

Resuscitation, rapid cooling, IV dantrolene

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32
Q

New onset abdominal pain, abdominal distention, peritoneal signs post surgery

A

Anastomotic leak

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33
Q

Fever, tachycardia, hypotension post surgery with abdominal signs

A

Anastomotic leak

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34
Q

Raise threshold for CNS toxicity of local anesthetics

A

Benzodiazepines

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35
Q

ADRs of sedation, disorientation

A

Benzodiazepines

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36
Q

Tolerance observed in patients with chronic use of alcohol

A

Barbiturates

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37
Q

ADRs of cardiac and respiratory depression (monitoring important)

A

Barbiturates

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38
Q

Avoid in porphyria

A

Barbiturates

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39
Q

Potent ultra-short acting hypnotic without analgesic properties

A

Etomidate

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40
Q

Works on GABA receptors

A

Etomidate

Propofol

41
Q

Must follow with analgesic and muscle relaxant drugs

A

Etomidate

42
Q

ADRs of hypotension, cardiac dioxide retention, suppresses corticosteroid synthesis at adrenal cortex

A

Etomidate

43
Q

ADRs of respiratory depression, N/V, constipation

A

Opioids

44
Q

Associated with unconsciousness, analgesia, and amnesia; ER use with orthopedic indications and children

A

Ketamine

45
Q

Allows fractures to be reduced in a safe and effective method

A

Ketamine

46
Q

ADRS of hallucinations, bad dreams, increased muscle tone/rigidity

A

Ketamine

47
Q

Lipophilic, cannot see through this IV anesthetics

A

Propofol

48
Q

Used often in neuro ICU, it’s rapid onset in less than a minute and it’s lasting effects of < 15 minutes makes it widely used and hugely effected

A

Propofol

49
Q

ADRs of significant respiratory depression, hypotension, injection site pain

A

Propofol

50
Q

Agents include nitrous oxide, sevoflurane, isoflurane, desflurane

A

Inhaled anesthetics

51
Q

ADRs include N/V, malignant hyperthermia, caution in patients with renal/hepatic dysfunction

A

Inhaled anesthetics

52
Q

Includes lidocaine, bupivacaine, prilocaine, dibucaine

A

Amino amides

53
Q

Use for bupivacaine

A

Used in epidurals

54
Q

Use for dibucaine

A

Suppository use for pain relief from hemorrhoids

55
Q

Includes benzocaine, cocaine, procaine, and tetracaine

A

Amino esters

56
Q

Concentration, max dose, onset, and duration of lidocaine

A

1-2%
4.5-5 mg/kg
< 2 min
0.5-1 hour

57
Q

Concentration, max dose, onset, and duration of lidocaine with epinephrine

A

1-2%
7 mg/kg
< 2 min
4-6 hours

58
Q

Concentration, max dose, onset, and duration of bupivacaine

A

0.25%
2.5 mg/kg
5 min
2-4 hours

59
Q

Concentration, max dose, onset, and duration of bupivacaine with epinephrine

A

0.25%
max 225 mg
5 min
3-7 hours

60
Q

Concentration, max dose, onset, and duration of procaine

A

0.25-0.5%
350-600mg
2-5 min
0.25-1 hour

61
Q

Primary site of action is spinal nerve roots

A

Epidural anesthesia

62
Q

ADRs of spinal anesthesia

A

Hematoma, headache, infection

63
Q

Risk factors that affect pain control in perioperative settings

A

Preoperative pain (higher baseline), anxiety, genetics, female gender, opioid tolerance

64
Q

Alpha2-receptor agonist in areas of brain

A

Dexmedetomidine

65
Q

Used in ICU setting for sedation and in anesthesia for brief procedures

A

Dexmedetomidine

66
Q

ADRs: monitor HR, blood pressure, sedative effects

A

Dexmedetomidine

67
Q

Risk factors for PONV

A 
Female gender
Motion sickness/previous PONV
Non-smoking status
Post-operative use of opioids
Use of inhaled anesthetics
68
Q

Recommended anxiolytic for PONV reduction

A

Benzodiazepines

69
Q

Pharmacologic Treatment options for PONV

A 
Serotonin antagonists (ondansetron, granisetron)
Neurokinin inhibitors (aprepitant)
Steroids (dexamethasone)
Butyrophenones (Droperidol)
Benzodiazepines
70
Q

ADRs of HA, diarrhea, constipation, arrhythmia

A

Serotonin Antagonists

Ondansetron, Granisetron

71
Q

ADRs of HA, diarrhea, weakness, dizziness

A

Neurokinin inhibitors

Aprepitant

72
Q

ADRs of dizziness, mood change, nervousness

A

Steroids

Dexamethasone

73
Q

ADRs of sedation, confusion, dry mouth, urinary retention

A

Antihistamines

74
Q

ADRs of prolonged QT interval (black box warning), hypotension, tachycardia, extrapyramidal symptoms

A

Butyrophenones

Droperidol

75
Q

Four crucial assessment for burn evaluations

A
  1. airway management
  2. evaluation of other injuries
  3. estimation of burn size (burn depth and %TSA)
  4. diagnosis of CO and cyanide poisoning
76
Q

Parkland formula for burns

A

LR 4cc x kg x %BSA

Half over the first 8 hours, half over the next 16 hours

77
Q

Potential complications of electrical burns

A

Cardiac arrhythmias
Compartment syndrome
Rhabdomyolysis

78
Q

Treatment for smoke inhalation

A

Fluids and supportive care
Oxygen
Possible intubation
Bronchodilators (albuterol)

79
Q

Signs/symptoms of carbon monoxide poisoning

A

Headache, lightheadedness, dizziness, confusion, tachypnea, hypoxia

80
Q

ASA Risk of normal, healthy patient

A

0.1%

81
Q

ASA Risk of mild systemic disease

A

0.2%

82
Q

ASA Risk of severe systemic disease

A

1.8%

83
Q

ASA Risk of severe systemic disease that is a constant threat to life

A

7.8%

84
Q

ASA Risk of moribund patient, not expected to survive without an operation

A

9.4%

85
Q

Risk factors for post op pneumonia

A 
Upper abdominal or cardiothoracic procedures
Prolonged anesthesia (> 4 hrs)
Age > 60
Tobacco abuse (> 20 p/y)
COPD/HF/OSA/Pre-op sepsis
Hypoalbuminemia
Impaired cognition
86
Q

___% mortality if hemodialysis is required

A

50

87
Q

How many calories does a surgical patient need?

A

30 kcal per kg per day

88
Q

Protein and nonprotein calories for wound healing

A

1 gram protein/kg/day

150 nonprotein calories per 6.25 gm of protein

89
Q

Phase of wound healing that begins immediately and lasts for the first few days

A

Hemostasis and inflammation

90
Q

Phase of wound healing that starts after the first few days and lasts for several weeks

A

Proliferation

91
Q

Phase of wound healing that begins after 2-3 weeks and lasts several months

A

Maturation

92
Q

Phase of wound healing with platelet activation and release of cytokines. Initial cells are platelets quickly followed by neutrophils and macrophages

A

Inflammatory Phase

93
Q

Fibroblasts are the principal cell involved. These cells are activated by the many cytokines released by WBCs. Initially type III collagen is laid down and over time this is replaced by type I collagen. Endothelial cells, leading to new blood vessels (granulation tissue). New skin is formed.

A

Proliferation Phase

94
Q

During this phase, there is maturation of the wound collagen with collagen breakdown. Scar remodeling continues for up to 12 months

A

Maturation Phase

95
Q

A wound will eventually reach about ____% of its original strength

A

80

96
Q

Superficial infections make up ___% of all surgical site infections, while deep infections make up ___%

A

75%

25%

97
Q

Causes of necrotizing fasciitis

A

Group A strep, staph aureus, clostridium perfringens, bacteroides fragilis and aeromonas hydrophila

98
Q

Administered pre-anesthesia reduces PONV for up to 48 hours after surgery

A

Neurokinin Inhibitors

Aprepitant

Surgical Care (2 decks)

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