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
