Firms: General Flashcards
What is important to ask about alongside past surgical hx?
Anaesthetic hx
?issues, ?well intra and post op, ?PONV
How do you prep someone for surgery as an F1?
- NBM + Fluids
- Drugs: Allergies, Bleeding Risk, VTE, Abx
- Airway Difficulty
The pre-op drug regime
To stop - OCP/HRT, hypoglycaemics, clopidogrel, warfarin
To alter - S/C insulin + long term steroids
To start - LMWH, TED stockings, abx
What is involved in the pre-op examination?
General - identify any underlying undx pathology
Airway - predict difficulty of intubation
What is included in the airway examination?
Any obv facial abnormalities e.g. retrognathia
Degree of mouth opening, dentition and loose teeth, Mallampati classification
Neck ROM and distance b/w thyroid cartilage and chin <6.5cm difficult intubation
Outline the ASA classification
I - normal healthy pt
II - mild systemic disease: current smoker, preg, BMI 30-40
III - severe systemic disease: BMI >40
IV - above + constant threat to life
V - moribund + won’t survive w/o op
What does the ASA grade correlate with?
Risk of post op comps and absolute mortality
What is the surg safety checklist before induction of anaesthesia? (3)
Pt confirmed identity, site, procedure + given consent
The site is marked, anaesth machine + meds checked, pt has pulse ox on
Any allergies recorded, risk of blood loss, assessed difficulty of airway
What is the surg safety checklist before skin incision? (5)
Staff introductions, confirm pt name site procedure, abx prophylaxis, anticipated critical events, essential imaging displayed
What are the causes of a post op fever?
The 5W’s: wind, water, wound, walking, wonder drugs ie pneumonia, UTI, infection at incision organ blood, PE/DVT, drugs/transfusion
RFs for PONV
Patient: female, younger, non-smoker, prev ep, motion sickness
Surgical: prolonged, abdo lap, intracranial, middle ear, squint, gynae, poor pain control after
Anaesthetic: prolonged, intraop bleed, inhalational agents, overuse of bag and mask ventilation, spinal, opioids
Alternative causes of PONV
Infection, GI (ileus or obstrc), metabolic (hyperCa, uraemia, DKA), meds, raised ICP, anxiety
Mx of PONV
Prophylactic - antiemetics, dex at induction, anaesthetic measures
Conservative - adequate fluids, adequate analgesia, ensure no obstrc
Pharmaceutical - multimodal therapy
Antiemetics if impaired gastric emptying
Metoclopramide or Domperidone
Antiemetic if suspected obstrc
Hyoscine
Antiemetic if metabolic
Metoclopramide
Antiemetics if opioid induced
Ondansetron or Cyclizine