General, CV, Thoracic, Trauma, Ortho Flashcards
(133 cards)
1
Q
9 primary components of general surgeons
A
alimentary tract
abdomen
breast/skin/soft tissue
head/neck
vascular system
endocrine system
surgical oncology
trauma
critical care (ER/ICU/trauma/burn unit)
2
Q
appendicitis
A
inflammation of appendix
3
Q
appendicitis treatments
A
- abx (30% chance of recurrence)
- Lap appendectomy
4
Q
lap appy setup
A
single incision (umbillicus)
or
3 port technique
5
Q
mesoappendix
A
blood supply to appendix
6
Q
stapler during a lap appy indicates
A
close to end
prep zofran and toradol
7
Q
lap appy induction drugs
A
lido
propfol
sux/roc
fentanyl
8
Q
lap appy fluids
A
balance crystalloid solution
9
Q
lap appy lines
A
18ga IV
10
Q
lap appy positioning
A
supine
trendelenburg w/right side up
11
Q
lap appy can cause
A
pneumoperitoneum
decr venous return
decr CO
incr SVR (reflex brady)
12
Q
lap appy pts are considered
A
full stomach
RSI induction
13
Q
if pt has a perforated appendix w/active infection you should
A
withhold decadron
14
Q
if pt has perforated appendix and its bloody you should
A
withold toradol
15
Q
a perforated appendix is often painful you should consider
A
long-acting narcotic (dilaudid)
16
Q
lap chole
A
removal of gal bladder
17
Q
causes of cholecystitis
A
gb inflammation
unknown inflammation
18
Q
what signals a lap chole is almost done
A
cautery
19
Q
what are the drs looking for in lap chole
A
systic duct
20
Q
what signlas a lap chole is 1/2 done
A
clips
21
Q
how many trochars are used in lap chole
A
3-4
22
Q
positioning for lap chole
A
supine
reverse tburg
23
Q
what does pneumoperitoneum cause
A
decr venous return
decr CO
incr SVR
reflex brady
24
Q
lap chole positioning may cause _____
A
decr BP
25
hernia
sac formed by tissue protruding through weak spot in peritoneum
26
types of hernia repairs
total extraperitoneal (TEP)
transabdominal preperitoneal (TAPP)
open hernia repair
27
which surgeries require pneumoperitoneum?
lap appy
lap chole
hernia repair
Ex lap
28
which surgeries require RSI?
lap appy
hernia
Ex lap
29
hernia positioning
supine
steep tburg
30
hernia positioning may cause
incr BP
31
Ex Lap indications
bowel obstruction
bowel trauma
perforated bowel
abdominal mass
32
Ex lap lines
2x 18ga IV
art line
central line (maybe)
33
Ex lap positioning
supine
34
Ex lap pts are more likely to be
hemodynamically unstable
35
2 types of interventional cardiology procedures
coronary revascularization
electrophysiology
36
cardiac catheterization indication
eval of cardiac lesions
symptomatic ischemic heart disease from atherosclerosis
37
Cath lab procedures are done under ______ anesthesia
MAC
38
cath lab positioning
supine
39
electrophysiology indications
pts who have electrical activity that disrupts natural propogation
- wolf parkinson white
- afib
40
what condition has accessory electrical pathway that leads to SVT
wolf parkinson white
41
electrophysiology ablation methods
radiofrequency: heat
cryoablation: cold
42
what does ablation cause
scar tissue
43
electrophysiology lines
18ga IV
art line
44
what cant you use during mx in electrophys cases?
No muscle relaxant
45
what will you use during mx in electrophys?
> 1.2MAC volatile agent
phenylephrine drip
46
electrophys positioning
supine
47
CABG indications
pt with significant symptomatic coronary artery diseaseC
48
CABG procedure
grafts vessels from aorta to region distal to the blocking
49
what should you do when they use a saw during the CABG
bring the lungs down
50
what vessels are they most likely using during a CABG
saphenous vein
left internal mamary artery
51
when do you need an aortic valve replacement?
aortic stenosis
aortic insufficiency
thransaortic valve replacement (TAVR)
mitral stenosis
mitral regurge
52
what is a catheter into the groin used for
TAVR
53
what lines do you need for a CABG
18 ga IV
art line
central line
PAC
54
when should you place the art line for a CABG
before induction
55
what additional monitors are you using in a CABG?
art line
cvp
pap
tee
56
what additional drugs should you consider using during mx of a CABG
norepi drip
epi drip
inotrope
heparin
57
when would you use heparin in a CABG
if you are going on pump
58
what inotrope is commonly used during a CABG
milrinone
59
what drug do you give at the end of pump CABG case?
protamine
60
bronchoscopy
pulmonologist uses a flexible bronchoscope to eval pulmonary pathology
61
what pathology types are investigated w/bronchoscopy
bronchomalacia
infectious pathology
CG
62
bronchioalveolar lavage indications
lung pathology that needs to be cleared
- excess mucus
- infectious agents
63
bronchoscopy positioning
supine
64
what additional drug could you give during a bronchoscopy?
lidocaine to spray on cords/carina to suppress cough reflex
65
Video Assisted Thoracoscopy (VATS)
procedure to visualize the contents of the thoracic cavity
66
blebectomy
removal of air-filled spaces in visceral pleura
67
lobectomy
removal of entire lung lobe
68
VATS tube
DLT
or bronchial blocker
69
VATS lines
16 or 18ga IV
art line
70
VATS positioning
lateral w/surgical side up[
71
how long does it take for closure in ortho cases?
45 mins
72
polymethylmethacrylate
bone cement
73
polymethylmethacrylate results in
intramedullary hypertension >500mmHg
74
bone cement implantation syndrome effects
vasodilation
decr SVR
platelet aggregation-embolism
decr CO
incr PVR
hypoxia
75
how to treat bone cement implantation syndome
incr FiO2 to 100%
give vasoactive agent (incr BP)
76
pneumatic tourniquet
used to provide a bloodless field
77
torniquet is inflated to
100mmHg above systolic pressure
78
torniquet on
incr central volume
hypertension
tachycardia
79
tourniquet off
decr central volume
decr venous return
decr central BP
incr etCO2
incr HR
decr temp
80
tourniquet max inflation time
2 hrs
81
risk after tourniquet deflation
thromboembolisms
82
when does tourniquet pain occur
after 1 hour
83
best method to relieve tourniquet pain
let tourniquet down
84
when does fat embolism syndrome occur
within 72 hrs of long bone or pelvic fracture
85
fat embolism syndrome
fat cells liberated by bone fracture enter the medullary vessels
86
fat embolism syndrome symptoms
ARDs (dyspnea/hypoxia)
agitation and confusion
coagulation abnormalities (petechiae)
87
petechiae
non-blanching pinpoint rash
88
knee athroscopy indication
meniscus damage
joint pathology
ACL damage
89
autograft
use pts own tissue
90
allograph
use donor tissue
91
knee arthroscopy anesthetic choices
1. GA w/LMA/ETT and adductor block
2. MAC w/spinal/epidural
92
what is the benefit of an adductor canal block
early ambulation
93
total knee indication
osteoarthritis
94
total knee anesthesia
GA (LMA) and regional (adductor block)
95
total hip indications
osteoarthritis
avascular necrosis
rheumatoid arthritis
96
which sx has the highest risk of BCIS
total hip
(4x more than knee)
97
total hip anesthesia
GA
or
GA w/neuraxial block
98
are tourniquets used for hips
no
99
long bone fracture indications
trauma
bone cyst
100
2 methods of long bone fixation
intramedullary rod/nail
plate fixation
101
long bone fixation will use a tourniquet for
distal femur
tibia
102
special consideration for long bone fracture
move pt to bed prior to wakeup
103
trauma primary assessment
Airway
Breathing
Circulation
Disability
Exam/Exposure
104
trauma secondary assessment
Signs/symptoms
Allergies
Meds
Past medical hx
Pictures (CXR/CT/US)
Last oral intake
Lab values
Events
105
trauma pts are always considered
full stomach
106
FAST scan
ultrasound for internal bleeding
107
common locations to FAST scan
pericardium
RUQ
LUQ
Suprapubic area
Right anterior thoracic
Left anterior thoracic
108
TBI eval
glascow coma scale
AVPU scale
109
AVPU scale
Awake
Verbal (responds to verbal)
Pain (responds to pain)
Unresponsive (to stimulus)
110
cushings reflex
hypertension
bradycardia
incr ICP
111
common TBI symptoms
cushings reflex
seizures
amnesia
vomiting
112
Glascow coma scale: eye reponse
No opening: 1
open spontaneously: 4
113
GCS: motor response
no motor response: 1
obeys commands: 6
114
GCS: verbal reponse
no verbal response: 1
oriented: 5
115
postures common in brain injury
decorticate
decerebrate
116
decorticate
fists tucked to chest supine
117
decerebrate
fists by side rotated outward
118
what can be used to rule out cervical injury
neuro
radiology
119
what is possible with spine injury
neurogenic shock
120
what should you note when placing tourniquet
time
121
what should you do with ortho long bone fracture
splint immediately
122
how much EBL for each long bone fracture
1-3 units of EBL
123
how much EBL for pelvic fracture
several liters
124
retroperitoneal bleeding can be caused by
pelvic fracture
125
flail chest
caused by multiple larger rib fractures
126
what should you do with a flail chest pt
place ETT for PPV
127
what conditions can be associated with rib fractures
hemothorax
pneumothorax
128
hemo/pneumothorax diagnosis
CT
CXR
ausculation
tracheal deviation
distended jugular veins
129
hemo/pneumothorax treatment
chest tube
14ga needle decompression
130
cause of diaphragmatic rupture
intense acute abdominal pressure
- bowel content can push through diapragm
131
effects of diaphragmatic rupture
decr FRC
extrinsic cardiac compression
hypoxiqa
132
abdominal compartment syndrom
incr abdominal pressure
decr venous return
decr perfusion
133
