Chapter 28: Surgical Prophylaxis Flashcards
What medications provide protection from postoperative GI bleeding?
H2 blockers, PPI (proton-pump inhibitor)
What measures provide protection from postoperative atelectasis/pneumonia?
Incentive spirometry, coughing, smoking cessation, ambulation
What treatments provide protection from postoperative DVT?
- Low–molecular-weight heparin (LMWH)
- subcutaneous low-dose unfractionated heparin
- sequential compression device (SCD) for lower extremities
- early ambulation
What measures provide protection from wound infection?
- Shower the night before surgery with chlorhexidine scrub
- Never use a razor for hair removal (electric shavers only)
- Ensure adequate skin prep in O.R.
- Do not close the skin in a contaminated case
- Ensure preoperative antibiotics in the bloodstream before incision
Why not use a razor to remove hair?
Micro cuts are a nidus for bacteria and subsequent wound infection
How long should “prophylactic antibiotics” be given?
<24 hours
What measures prevent ventilator-associated pneumonia (VAP)?
- Head of bed >30 degree
- handwashing
- patient oral hygiene
- avoidance of gastric overdistention
What treatment provides protection from Wernicke’s encephalopathy?
Rally pack (a.k.a. “banana bag” because the fluid is yellow with the vitamins in it); pack includes thiamine, folate, and magnesium
To avoid Wernicke’s encephalopathy in alcoholics, when do you give the glucose?
AFTER thiamine administration!
What is Wernicke’s encephalopathy?
- Condition resulting from thiamine deficiency in patients with alcoholism,
- causing a triad of symptoms; think “COA”:
- Confusion
- Ophthalmoplegia
- Ataxia
What treatment decreases the risk of perioperative adrenal crisis ina patient on chronic steroids?
“Stress-dose” steroids: 100 mg hydrocortisone administered preoperatively, continued postoperatively q8 hours, and then tapered off
