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Flashcards in Gen Surg Deck (189)
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1

numer one limiting factor prior to surgery is....

hx of cardiovascular disease

2

history of CV disease predisposing to surgery complications

- EF

3

if had a recent MI and surgery

must defer surgery for 6 months and stress the patient at that interval

4

patient has CHF and needs surgery for something else

give the drugs that decrease mortality:
ACE inhibitors, beta blockers, spironolactone

5

cardiovascular risk factor if male

male older than 45yo

6

patient with CV risk factors-- what needs to be done before surgery

- bp meds adjusted
- daily finger sticks monitored
- insulin regimen adjusted
- stress test with ECG
(possibly ECHO if murmur)

7

preop assessment if under 35yo and no hx of cardiac disease

EKG ONLY

8

preop assessment if hx of cardiac disease and ANY AGE

- EKG
- stress testing-- evaluate for ischemic coronary lesions
- ECHO for structural disease, and for ejection fraction

9

preop assessment PFT's necessary for...

known lung disease
smoking history

10

preop patient is a smoker-- what suggestions

quit smoking for 6-8weeks before surgery and use nicotine patch in meantime

11

preop assessment patient with renal disease

- give fluids before and during surgery
- if patient is on dialysis, dialyze pt 24hrs before surgery

12

ABC's: airway

- no facial trauma= orotracheal tubes
- facial trauma= cricothyroidotomy
- C-spine injury= orotracheal tube with flexible bronchoscopy

13

ABC's: breathing

O2 sats above 90%= ideal

14

ABC's: circulation

insert 2 large bore IV cannulas and being aggressive fluid resuscitation to prevent hypovolaemic shock

15

cool skin, shock

cardiogenic or hypovolaemic shock

16

cardiogenic vs. hypovolaemic shock

PCWP/LVEDP:
cardio: increased
hypo: decreased

17

warm skin, shock

neurogenic, anaphylactic, septic

18

CO change in neurogenic shock

decreased CO

19

CO change in anaphylactic and septic shock

increased CO

20

PCWP change anaphylactic vs. septic shock

anaphylactic: decreased
septic: no change

21

sepsis definition

2/4 and infection source

22

SIRS criteria

2/4
1. bp: less than 36, greater than 38
2. HR: greater than 90bpm
3. resp: tachypnea>20breaths/min, or O2 sats

23

severe sepsis

2/4 + infection source + organ dysfunction

24

septic shock definition

2/4 + infection source + organ dysfunction + HYPOtn

25

example of "infection source"

CXR: shows infiltrates= pneumonia

26

car accident and abdomen hurts, and end up with large ecchymosis on right flank, most likely diagnosis

HAEMORRHAGIC PANCREATITIS

27

complication 6-8 weeks after pancreatitis

pancreatic pseudocyst

28

differential for cullen sign

haemorrhagic pancreatitis
ruptured aortic aneurysm

29

grey turner sign

flank bruising--> RETROperitoneal haemorrhage

30

kehr sign

pain in L shoulder---> splenic rupture