basic surgical concerns Flashcards
What findings suggest a high risk of surgical complications?
age >70, FEV1/FVC 45, pulmonary edema, MI in past 30 days, poorly controlled arrhythmias, severe valvular disease, poor LVEF, Crt
When is the risk of post-op MI greatest?
within the first 48 hrs after surgery
How long before surgery should pts stop smoking?
ideally 8 wks
When is a pre-op CXR useful?
age >50, hx of pulm disease, anticipated surgical time >3 hrs
What medication can be given to protect the kidneys in pts with renal insufficiency who are expected to receive intraoperative contrast?
acetylcysteine
When can you restart LMWH after the removal of an epidural catheter? Why the delay?
at least 2 hrs afterward to prevent formation of an epidural hematoma
When can you restart LMWH in a patient who had a recent thromboembolism and surgery?
restart 12 hrs post-operatively
When do different post-op fevers arise?
PNA: days 3-5; often have a productive cough and findings on CXR
UTI: days 3-5
Would infection or catheter infection: days 5-8 post op
DVT, PE, meds, transfusion rxns can all cause fevers at any time
What are the different types of wounds (ie clean, dirty, etc)?
clean: incision through disinfected skin w/o GI or resp entry: 1% infection rate
clean-contaminated: incision through disinfected skin with GI or resp entryl 2-8% infection rate
contaminated: contact of wound with GI or GU contents, traumatic woulds. 6-15% infection rate
dirty: established infection in tissue before surgery
What is secondary intention wound approximation?
wound left open and allowed to wheal through epithelialization; higher risk of infection
How do you care for closed vs open wounds post-op?
closed wounds need dressings for an additional 48 hrs after closure
open wounds require debridement and special dressings
