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Total Surgical Care Flashcards

1
Q

Systemic Risk Factors for Infection

A 
DM
Corticosteroid use
Obesity
Age
Malnutrition
Second surgery
Co-morbidities
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2
Q

Local Risk Factors for Infection

A 
Foreign body
Electrocautery
Wound drains
Injection with epinephrine
Hair removal
Previous radiation
Prolonged operation
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3
Q

Most Commonly Given Antibiotic

A

Cefazolin (Ancef, Kefzol)

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4
Q

Antibiotics to Cover Gram-Negative & Anaerobic Pathogens

A

Cefotetan
Cefoxitin
Cefizoxime
+/- metronidazole (Flagyl)

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5
Q

Cardiac Complications & Diabetes

A

Men 2x the risk
Women 4x the risk
Hypotension from neuropathy

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6
Q

Gastroparesis & Diabetes

A

Aspiration risk

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7
Q

Infection & Diabetes

A

Reduced blood flow decreases healing

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8
Q

Risk Factors for Venous Thromboembolism Disease (VTE)

A 
Extent of surgery or trauma
Duration of hospital stay
Previous VTE
Immobility
Central line placement
Ortho procedures
Age
Obese patients
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9
Q

Appropriate Prevention of VTE in Very Low Risk Patients

A

Early & frequent ambulation

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10
Q

Appropriate Prevention of VTE in Low Risk Patients

A

Mechanical methods when contraindication to medicinal prophylaxis

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11
Q

Appropriate Prevention of VTE in Moderate Risk Patients

A

Pharmacologic

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12
Q

Appropriate Prevention of VTE in Very High Risk Patients

A

Combination

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13
Q

Medications Given for VTE Prophylaxis

A

Low molecular weight heparin
Low dose unfractionated heparin (UFH)
Warfarin
Aspirin

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14
Q

Mechanical Methods of VTE Prophylaxis

A

Intermittent pneumatic compression (IPC)
Graduated compression stockings (GCS)
Venous foot pump (VFP)

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15
Q

Define Surgical Site Infection

A

Infection related to an operation that occurs at or near the surgical incision within 30 days of the procedure or 90 days of an implant

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16
Q

Impact of Surgical Site Infections

A

Increase in mortality

Increase cost to patient & hospital

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17
Q

Risk Factors for Surgical Site Infections

A 
Surgical technique
Prolonged surgery time
Instrument sterilization
Pre-op preparation
Thermoregulation & glycemic control
Medical condition of the patient
Surgical environment
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18
Q

Surgical Environment Risk Factors

A

Personnel traffic
Excessive use of electrosurgical cautery units
Prosthesis or foreign body
Need for blood transfusion

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19
Q

Presentation of a Surgical Site Infection

A

Localized erythema
Induration
Warmth
Pain at incision site

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20
Q

Treatment of Surgical Site Infections

A

Prophylactic antibiotics
Infected wounds
Antibiotics: broad spectrum, culture & gram stain
Surgical technique

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21
Q

Surgical Technique Treatment of Surgical Site Infections

A 
Limit electrocautery
Closure of subQ tissue
Skin closure
Delayed closure & heal by secondary intention
Limit hypothermia
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22
Q

Define Hematoma & Seroma

A

Collection of blood or serum under the incision

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23
Q

Presentation of a Hematoma or Seroma

A 
Few days post-op
Pain
May have sebum like fluids
Fever
Erythematous
Edematous
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24
Q

Treatment of Hematoma or Seroma

A

Percutaneous drains

Wound exploration: pack & heal by secondary intention

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25
Prevention of Hematoma's and Seroma's
Closure of dead space Meticulous hemostasis Placement of drains (controversial)
26
Risk Factors for Fascial Dehiscence
Age Males COPD Ascites
27
Define Fascial Dehiscence
Abdominal wall tension overcoming tissue or suture strength
28
Main Cause of Fascial Dehiscence
Failure of the sutures to remain anchored, knot failure, large stitch intervals
29
Presentation of Fascial Dehiscence
Profuse serosanguinous drainage | Popping sensation with abdominal bulge
30
Treatment of Fascial Dehiscence
Closure in the operating room
31
Prevention of Fascial Dehiscence
Continuous mass closure or interrupted | Internal or external retention sutures
32
Wound Healing via Primary Intention
Wound closed with stitches or staples Covered with a sterile dressing Drain small amount of fluid Keep protected from getting wet for 2-10 days Monitor for erythema, swelling, warmth, & drainage
33
Wound Healing via Secondary Intention
Epidermis & dermis not closed Usually due to contamination, infected wound, or peritonitis Pack daily with saline moistened gauze/sponge & covered with a sterile dressing
34
Pulmonary Complications
Hypoventilation Pneumonia Atelectasis 1/2 peri-op mortality
35
Categories of Pulmonary Complications
Atelectasis Infection Prolonged mechanical ventilation & respiratory failure Exacerbation of underlying chronic lung disease Bronchospasm
36
Risk Factors for Pulmonary Complications
``` 50+ Chronic lung disease Asthma Smoking: 20+ pack year history General health status: CHF, URI ```
37
Procedure-Related Risk Factors for Pulmonary Complications
Surgical site: abdominal & thoracic Duration: 3+ hours Type of anesthesia Type of neuromuscular blockade
38
When should you obtain PFT's on a patient pre-operatively?
Lung resection COPD Asthma Unexplainable dyspnea or exercise intolerance
39
When should a chest x-ray be performed pre-operatively?
Known CVD | 50+ years with a high risk surgical procedure
40
Strategies to Reduce COPD Complications Post-Operatively
Bronchodilators + antibiotics + systemic steroids Inhaled ipratropium or tiotropium QD Beta-agonists (as needed)
41
Strategies to Reduce Asthma Complications Post-Operatively
Beta-agonists | Peri-operative systemic steroids
42
URI & Surgery
Delay elective surgery
43
Patient Education for Reduce Pulmonary Complications
Coughing Incentive spirometry Deep breathing
44
Intra-Operative Strategies to Prevent Pulmonary Complications
Spinal or epidural if possible Neuromuscular blockade intermediate agents Short procedures in high risk patients
45
Post-Operative Strategies to Prevent Pulmonary Complications
Deep breathing exercises Incentive spirometry Adequate pain control
46
5 Reasons for Post-Op Fever
``` Wind Water Walking Wound Wonder drugs ```
47
Wind Issues for Post-Op Fever
Pneumonia | PE
48
Water Issue for Post-Op Fever
Indwelling catheter
49
Walking Issues for Post-Op Fever
DVT | PE
50
Wound Issues for Post-Op Fever
Surgical site infections
51
Wonder Drug Issues for Post-Op Fever
Infections from lines | Drug induced
52
Treatment of Post-Op Fever
Remove unnecessary treatments (meds or catheters) Suppress fever with Tylenol Antibiotics per judgement or culture results
53
Define Malignant Hyperthermia
Uncommon but life-threatening reaction to some anesthetic agents
54
Unsafe Medications for Patients with Risk of Malignant Hyperthermia
``` Depolarizing muscle relaxants (Anectine) Halothane Isoflurane Enflurane Desflurane Sevoflurane Succinylcholine ```
55
Medications that are Safe for Patients with Malignant Hyperthermia
``` Barbiturates Benzodiazepines Droperidol Ketamine Local anesthetics Nitrous oxide Non-depolarizing muscle relaxants Opioids Propofol ```
56
Clinical Manifestations of Malignant Hyperthermia
``` Hypercarbia Skeletal muscle rigidity Tachycardia Tachypnea High temp HTN Cardiac dysrhythmias Acidosis Hypoxemia Hyperkalemia Myoglobinuria ```
57
Pathophysiology of Malignant Hyperthermia
Genetic predisposition Increased intracellular calcium Continuous muscle contraction
58
Treatment of Malignant Hyperthermia
``` Call for help Stop triggering agents Hyperventilate Finish/abort procedure Administer Dantroline Cool patient Monitor & treat acidosis Promote urine output Treat hyperkalemia Treat dysrhythmias with procainamide & CaCl Monitor creatinine kinase, urine myoglobin, & coagulation for 24-48 hours ```
59
Surgical Care Improvement Project National Goal
Reduce preventable surgical morbidity & mortality
60
Complications That are Preventable
Infection Cardiovascular VTE
61
Infection Prevention in SCIP
Antibiotics 1 hour prior to incision Glucose control in cardiac surgery patients Proper hair removal Normothermia
62
Prevention of Cardiac Events with SCIP
Maintain patient on a beta-blocker
63
Risk Factors for VTE
``` Hospitalization or nursing home Active malignant neoplasm Trauma CHF CV catheter Neurologic disease with paresis Superficial vein thrombosis Varicose veins/stripping ```
64
SCIP 1-2-3 Antibiotics
1: one hour prior to incision 2: appropriate selection of antibiotic 3: discontinue within 24 hours after anesthesia end time
65
SCIP 4- Blood Glucose
66
SCIP 6- Hair Removal
Clippers in OR
67
SCIP 9- Foley D/C
Discontinue by post-op day 2
68
SCIP-CARDIAC-2: Beta Blocker
Continue on home regiment pre-op | Continue on post-op day 1 or 2
69
SCIP-VTE-2: Timing of VTE Prophylaxis
24 hours prior to surgery OR | Within 24 hours after anesthesia end time
70
SCIP-10 Normothermia
96.8+ within 15 minutes of anesthesia end time or warmer

Surgery (20 decks)

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