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Surgery > Total Surgical Care > Flashcards

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
Q

Prevention of Hematoma’s and Seroma’s

A

Closure of dead space
Meticulous hemostasis
Placement of drains (controversial)

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26
Q

Risk Factors for Fascial Dehiscence

A

Age
Males
COPD
Ascites

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27
Q

Define Fascial Dehiscence

A

Abdominal wall tension overcoming tissue or suture strength

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28
Q

Main Cause of Fascial Dehiscence

A

Failure of the sutures to remain anchored, knot failure, large stitch intervals

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29
Q

Presentation of Fascial Dehiscence

A

Profuse serosanguinous drainage

Popping sensation with abdominal bulge

30
Q

Treatment of Fascial Dehiscence

A

Closure in the operating room

31
Q

Prevention of Fascial Dehiscence

A

Continuous mass closure or interrupted

Internal or external retention sutures

32
Q

Wound Healing via Primary Intention

A

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
Q

Wound Healing via Secondary Intention

A

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
Q

Pulmonary Complications

A

Hypoventilation
Pneumonia
Atelectasis
1/2 peri-op mortality

35
Q

Categories of Pulmonary Complications

A

Atelectasis
Infection
Prolonged mechanical ventilation & respiratory failure
Exacerbation of underlying chronic lung disease
Bronchospasm

36
Q

Risk Factors for Pulmonary Complications

A 
50+
Chronic lung disease
Asthma
Smoking: 20+ pack year history
General health status: CHF, URI
37
Q

Procedure-Related Risk Factors for Pulmonary Complications

A

Surgical site: abdominal & thoracic
Duration: 3+ hours
Type of anesthesia
Type of neuromuscular blockade

38
Q

When should you obtain PFT’s on a patient pre-operatively?

A

Lung resection
COPD
Asthma
Unexplainable dyspnea or exercise intolerance

39
Q

When should a chest x-ray be performed pre-operatively?

A

Known CVD

50+ years with a high risk surgical procedure

40
Q

Strategies to Reduce COPD Complications Post-Operatively

A

Bronchodilators + antibiotics + systemic steroids
Inhaled ipratropium or tiotropium QD
Beta-agonists (as needed)

41
Q

Strategies to Reduce Asthma Complications Post-Operatively

A

Beta-agonists

Peri-operative systemic steroids

42
Q

URI & Surgery

A

Delay elective surgery

43
Q

Patient Education for Reduce Pulmonary Complications

A

Coughing
Incentive spirometry
Deep breathing

44
Q

Intra-Operative Strategies to Prevent Pulmonary Complications

A

Spinal or epidural if possible
Neuromuscular blockade intermediate agents
Short procedures in high risk patients

45
Q

Post-Operative Strategies to Prevent Pulmonary Complications

A

Deep breathing exercises
Incentive spirometry
Adequate pain control

46
Q

5 Reasons for Post-Op Fever

A 
Wind
Water
Walking
Wound
Wonder drugs
47
Q

Wind Issues for Post-Op Fever

A

Pneumonia

PE

48
Q

Water Issue for Post-Op Fever

A

Indwelling catheter

49
Q

Walking Issues for Post-Op Fever

A

DVT

PE

50
Q

Wound Issues for Post-Op Fever

A

Surgical site infections

51
Q

Wonder Drug Issues for Post-Op Fever

A

Infections from lines

Drug induced

52
Q

Treatment of Post-Op Fever

A

Remove unnecessary treatments (meds or catheters)
Suppress fever with Tylenol
Antibiotics per judgement or culture results

53
Q

Define Malignant Hyperthermia

A

Uncommon but life-threatening reaction to some anesthetic agents

54
Q

Unsafe Medications for Patients with Risk of Malignant Hyperthermia

A 
Depolarizing muscle relaxants (Anectine)
Halothane
Isoflurane
Enflurane
Desflurane
Sevoflurane
Succinylcholine
55
Q

Medications that are Safe for Patients with Malignant Hyperthermia

A 
Barbiturates
Benzodiazepines
Droperidol
Ketamine
Local anesthetics
Nitrous oxide
Non-depolarizing muscle relaxants
Opioids
Propofol
56
Q

Clinical Manifestations of Malignant Hyperthermia

A 
Hypercarbia
Skeletal muscle rigidity
Tachycardia
Tachypnea
High temp
HTN
Cardiac dysrhythmias
Acidosis
Hypoxemia
Hyperkalemia
Myoglobinuria
57
Q

Pathophysiology of Malignant Hyperthermia

A

Genetic predisposition
Increased intracellular calcium
Continuous muscle contraction

58
Q

Treatment of Malignant Hyperthermia

A 
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
Q

Surgical Care Improvement Project National Goal

A

Reduce preventable surgical morbidity & mortality

60
Q

Complications That are Preventable

A

Infection
Cardiovascular
VTE

61
Q

Infection Prevention in SCIP

A

Antibiotics 1 hour prior to incision
Glucose control in cardiac surgery patients
Proper hair removal
Normothermia

62
Q

Prevention of Cardiac Events with SCIP

A

Maintain patient on a beta-blocker

63
Q

Risk Factors for VTE

A 
Hospitalization or nursing home
Active malignant neoplasm
Trauma
CHF
CV catheter
Neurologic disease with paresis
Superficial vein thrombosis
Varicose veins/stripping
64
Q

SCIP 1-2-3 Antibiotics

A

1: one hour prior to incision
2: appropriate selection of antibiotic
3: discontinue within 24 hours after anesthesia end time

65
Q

SCIP 4- Blood Glucose

A
66
Q

SCIP 6- Hair Removal

A

Clippers in OR

67
Q

SCIP 9- Foley D/C

A

Discontinue by post-op day 2

68
Q

SCIP-CARDIAC-2: Beta Blocker

A

Continue on home regiment pre-op

Continue on post-op day 1 or 2

69
Q

SCIP-VTE-2: Timing of VTE Prophylaxis

A

24 hours prior to surgery OR

Within 24 hours after anesthesia end time

70
Q

SCIP-10 Normothermia

A

96.8+ within 15 minutes of anesthesia end time or warmer

Surgery (20 decks)

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