Essentials Flashcards by M B

Prevents air from entering and fluid from siphoning back

Underwater seal drainage (i.e. Chest tube)

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Drains through a tube to a reservoir at a lower level

Gravity drainage (i.e. Foley)

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Drains large volumes of fluids (GI) and promotes closure of dead space.

Suction drainage (i.e. Jackson-Pratt drain)

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One lumen for suction, one for irrigation allows drainage of particulate matter, abscess debris or as continuous irrigation catheter

Sump drain (i.e. NG tube)

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Unsealed on both ends, used for contaminated cases

Penrose drain

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Used for pneumothorax, hemothorax

Chest tube

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Used for non functional GI tract > 1-2 days, decompresses, determines fluid loss

Sump tube/NG tube

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Used for large raw surfaces to be kept opposed i.e. mastectomies, skin flaps

Suction drainage

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What can isolate a drain from tissues

Foreign body reaction

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Used for feeding purposes between skin and stomach

Gastrostomy tube/PEG

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Used for compression of esophageal varices

Gastroesophageal balloon tamponade tube

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Tx for SBO
First time
Recurrent

First: laparotomy, lysis of adhesions
Recurrent: long intestinal tube

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Used for feeding from skin to jejunum

Jejunostomy tube

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Tx for colonic ileus (cecum d>12cm)

For colonic obstruction

Ileus: cecostomy tube
Obstruction: proximal diverting colostomy

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Tx for sigmoid volvulus

Or for colonic ileus

Rectal tube (transanally) under sigmoidoscopic visualization

Leave for several days or pressure necrosis

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Placed in int jugular, svc or femoral vein

Complication - bacteremia

Central venous catheter

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Placed in intrathoracic vein from antecubital vein

Peripherally inserted central catheter

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Prolonged venous access, provokes ingrowth of surrounding tissue

For chemotherapy, hemodialysis, hyperalimentation

Cuffed central venous catheter

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For long term dialysis or management of ascites in pt with malignancy

Peritoneal dialysis catheter

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How to stage Hodgkin’s disease

Staging laparotomy

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How to stage upper abdominal tumors

Laparoscopy

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Therapy for local tumor, lymph nodes

Surgery and radiation

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Therapy for metastatic tumor, system wide

Chemotherapy, immunotherapy

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Multimodal therapy for breast ca

Surgery and radiation for local control and staging

Chemotherapy for positive nodes

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Multimodal therapy for pancoast tumor

Preop radiation for spread into brachial plexus Surgical resection

Multimodal therapy for extremity sarcoma

``` Incisional biopsy for diagnosis Preop radiation Radical local resection Postop radiation Chemotherapy ```

Tx for low grade neoplasm | I.e. Basal cell, mixed tumor of parotid

Wide local resection

Tx for deeply invading neoplasms | I.e. Sarcoma

Radical local resection

Tx for tumors that met to regional lymph nodes | I.e. Colon cancer

Radical resection with en bloc excision of lymphatic drainage

Tx for locally extensive disease with low likelihood of metastatic spread I.e. Advanced rectal, cervical, bladder, uterine cancers

Super radical resection Removal of all local tissue and lymphatics

Tx for advanced ovarian cancer

Debulking resection Made more susceptible to chemo and radiation

General principles of postop management | 6 things

1. Daily examination, incl wound 2. Remove tubes asap 3. Early ambulation 4. Monitor fluid balance, electrolytes 5. Adequate but not excessive pain meds 6. Good nursing care

Causes of post op fever

``` Day 1-3: atelectasis, pneumonia, pulmonary problems Day 3-5: UTI Day 5-8: wound infection DVT, PE, thrombophlebitis Drug fever (esp abx) ```

Tx for atelectasis

Incentive spirometry, coughing, deep breathing and ambulation Collapse of lobes- NT suction, bronchoscopy to remove secretions No abx unless infection present

What causes wound infections before days 5-8

Streptococci, clostridium

Pattern of volume flux post op

Post op hypovolemia from third spacing | Day 4-5 hypervolemia

Tx for surgical infection

Drainage, debridement, antibiotics

Most common organism infecting prosthesis

Staphylococci

Timing of prophylactic abx

1-2 hrs preop to 6-24 hrs postop

Most common sites of intraabdominal abscess

1. Subphrenic 2. Subhepatic 3. Lateral gutters posteriorly 4. Pelvis 5. Periappendiceal, pericolonic 6. Multiple sites in 15%

Signs of abdominal abscess

Spiking fevers, pain, leukocytosis in 2nd week postop Can result in sepsis

Approach to drain pelvic abscess

Transrectally or through superior vagina

Approach to draining subphrenic abscess

Posteriorly through 12th rib

Most common organism in cellulitis

Streptococci

Tetanus prophylaxis after penetrating injury

If immune: booster if > 5 years If not immune: 3 doses, dose 1 and 6 months If not immune and dirty wound: tetanus Ig and 3 doses at separate site

Tx for suspected C. tetani infection

Prophylactic PCN in high doses

Hemorrhagic bullae, progressive toxicity, foul-smelling serous discharge, air in soft tissues

Necrotizing fasciitis

Organisms causing nec fasc

Microaerophilic streptococci Staphylococci Gram-neg aerobes and anaerobes

Upper GI surgery abx prophylaxis

Obstruction, blood, achlorhydria or malignancy Cephalosporins or fluoroquinolones

Biliary tract surgery abx prophylaxis

Elective chole - cephalosporin Common duct stones, cholangitis, empyema or gangrene of GB - cephalosporin or penicillin combination E. coli, S. faecalis, salmonella, c. perfringens

Colon and rectal surgery abx prophylaxis

Mechanical removal preop - mannitol, polyethylene glycol Oral abx 10-22 hrs preop - neomycin, erythromycin Emergencies - IV abx, no primary closure

Urologic surgery abx prophylaxis when

Given perioperatively

Vascular surgery abx prophylaxis

Perioperative cephalosporin For s. aureus, s. epidermidis Amoxicillin if pt undergoes later procedure with bacteremia (i.e. Dental extraction)

Complications of cardiac surgery

Sternal osteomyelitis and dehiscence Prosthetic valve endocarditis Same prophylaxis as vascular surgery

Prophylaxis for pulmonary resections

Abx against gram-pos cocci

Infection complication in orthopedic surgery

Slime-forming staphylococci

Abx tx for deep burns

Assure tetanus prophylaxis Penicillin G if group A strep infection (first 5 days) Topical abx on uninjured tissue

Tx for suppurative thrombophlebitis

Vein excision

Tx for bites

Penicillin

Esophageal atresia fistula

Tracheoesophageal

Anastomotic leak fistula

Colocutaneous fistula

Splenectomy fistula complication

Pancreaticocutaneous fistula

Crohn's disease fistulas

Enterovesical, ileosigmoid fistula

Sigmoid colon cancer fistula

Colovesical fistula

Pelvic irradiation (cervical ca) fistula

Enterovaginal fistula

Pancreatic fistula leak causes what

Metabolic acidosis