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Surgery - DONE > GENERAL PRINCIPLES > Flashcards

GENERAL PRINCIPLES Flashcards

1
Q

What are the components of a pre op assessment?

A
  • Are they fit for surgery
  • Haemostatic competence (are they going to bleed?)
  • Coagulation screen: APTT, PT
  • Group and save
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2
Q

What can cause a prolonged PT?

A
  • Warfarin
  • Vitamin K deficiency
  • Liver disease
  • Factor VII deficiency

-

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3
Q

What causes a prolonged APTT?

A
  • Factor VIII deficiency (haem A)
  • Factor IX deficiency (haem B)
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4
Q

What causes both a prolonged APTT and PT?

A
  • DIC
  • Massive transfusion
  • Liver disease
  • DOAC
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5
Q

What is the difference between primary, reactive and secondary bleeding?

A

Primary = Bleeding in intra-operative period

Reactive = Within 24 hours of op

Secondary = 7-10 days post op due to erosion of vessel from spreading infection

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6
Q

What are the clinical features of haemorrhagic shock?

A
  • Tachycardia
  • Dizziness
  • Agitation
  • Raised resp rate
  • Hypotension is a late sign
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7
Q

What is the management of haemorrhagic shock?

A
  • A to E
  • IV access (18G cannula)
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8
Q

What steps of managment in haemorrhagic shock are there?

A

Read op notes - looking for sites of bleeding

Apply pressure to bleeding site

Urgent senior surgical review

Urgent blood tranfusion

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9
Q

What are the two types of delerium?

A
  • Hypoactive (most common) - lethagy and reduced motor activity
  • Hyperactive (most recognised) - agitation and increased motor activity
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10
Q

What are some risk factors for delerium?

A

> 65 years old

Co-morbidities

Underlying dementia

Renal impairment

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11
Q

What are some common causes for dementia?

A
  • Hypoxia (post-op)
  • Infection (UTI / LRTI)
  • Drug withdrawal (alcohol)
  • Dehydration/pain
  • Contipation/urinary retention
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12
Q

How to assess a patient with delerium?

A
  • Collateral history
  • Onset and course of confusion
  • Previous episodes
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13
Q

What scoring systems are there for delerium?

A
  • Abbreviated mental test
  • Mini mental state examination
  • Confusional assessment method
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14
Q

Name some questions in the abbreviated mental test?

A

Age

Time (to nearest hour)

DOB

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15
Q

What is included in a confusion screen?

A

Bloods - FBC, U&Es, Calcium, TFTs, glucose

Blood cultures

Urinalysis/CXR

CT head

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16
Q

How should patients with delerium be managed?

A

Abx for infection, nasal oxygen if hypoxic, laxatives for constipation

  • Nursed in quiet area with regular routine
  • Oral haloperidol
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17
Q

What are some risk factors for post-op vomiting and nausea?

A
  • Female
  • Younger age
  • Motion sickness
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18
Q

What areas in brainstem control vomiting?

A

Vomiting centre in the medulla oblongata

Chemoreceptor trigger zone (located outside BBB in 4th ventricle)

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19
Q

What are the neurotransmitters in each area of vomiting process?

A

CTZ: Dopamine (peripheral) and 5HT3 receptors

Vomiting centre: Histamine and 5HT3 receptors

(The CTZ acts on the vomiting centre)

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20
Q

What are the conservate treatments of PONV?

A
  • Fluid hydration
  • Analgesia
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21
Q

What should patients with PONV and impaired gastric emptying be given as an anti-emetic?

A
  • Metoclopramide or domperidone (prokinetic, dopamine antagonists)
22
Q

Other than pro-kinetics, what else can patients with PONV and bowel obstruction be given?

A

Hyoscine (anti-muscarinic) to help reduce secretions

23
Q

What should patients with PONV and metabolic/biochemical imbalance e.g. uraemia be given?

A

Metoclopramide

24
Q

What should patients with opiod-induced N&V be given?

A

Ondansetron (5HT3 receptor antagonist)

OR

Cyclizine (H1 Histamine receptor antagonist)

25
What are the steps in the WHO analgesic ladder?
- Simple analgesics (paracetamol/NSAIDs) - Weak opiates (codeine or tramadol) - Stronger optiates (morphine)
26
What can be used for neuropathic pain?
Amitriptyline / gabapentin
27
Name some NSAIDs, how do they work?
**Ibuprofen/diclofenac** - inhibit synthesis of prostaglandins - reducing potential inflammation
28
What are some side effects of NSAIDs?
I-GRAB **Interactions** e.g. with warfarin **Gastric** **ulceration** (consider PPI) **Renal** inpairment (use sparingly here) **Asthma** sensitivity **Bleeding** risk (due to effect on platelets)
29
Name some strong opiates, how do they work?
**Morphine, oxycodone, fentanyl** Activate opiod receptors
30
What are some side effects of opiates? How is this managed?
Constipation / nausea (laxatives and anti-emetics given concurrently) Sedation, confusion, respiratory distress
31
Why should strong and weak opiates not be prescribed together?
**Competitively inhibit** the same receptor
32
What is patient controlled analgesia? Name a pro and a con
Iv pumps which provide bolus of analgesia when button pressed **Pro** - Tailored analgesia, risk of overdose negligible **Con** - Cumbersome, not suitable for learning difficulties
33
What can cause post op fever?
Pneumonia, UTI, Surgical site infection, infected IV lines
34
How to source the infection in post op sepsis?
- Urine dip and culture - Chest X-ray - Surgical wound swabs - LP - Stool culture
35
What are the seven C's for pyrexia in a surgical patient?
**Chest** (infection) **Cut** (wound infection) **Catheter** (UTI) **Collections** (abdomen, pelvic etc.) **Calves** (DVT) **Cannula** (infection, if applicable) **Central line** (infection, if applicable)
36
What does the term VTE encompass?
DVT and PE
37
What are the 3 points in Virchow's triad?
- **Abnormal blood flow** (recent immobility) - **Abnormal blood components** (smoking, sepsis, malinancy) - **Abnormal vessel wall** (atheroma)
38
What are the risk factors for VTE?
- **Age** - **Previous VTE** - **Smoking** - **Pregnancy** - Recent **surgery**
39
How does a DVT present?
Unilateral leg pain and swelling Pyrexia Pitting oedema
40
What is the wells criteria?
Score greater than 1 indicates DVT
41
What is the treatment for a DVT?
DOAC e.g. **apixaban, rivaroxaban** (factor Xa inhibitors) and **dabigatran** (direct thrombin inhibitor)
42
How does a PE present?
Sudden onset SOB Pleuritic chest pain Cough Haemoptysis
43
What Well's score indicates a PE?
Greater than 4
44
What are the 2 types of thromboprophylaxis?
**Mechanical:** Antiembolic stockings, intermittent penumatic conpression **Pharmacological:** LMWH (unless poor renal function the UFH)
45
What are some common organisms in HAP\>
E. Coli S. Aureus (MRSA) S. Pneumoniae
46
How would a **GI anastomotic leak** present?
**Abdo pain** and **fever**
47
How would an anastomotic leak be investigated?
CT scan with contrast
48
How is an anastomic leak treated?
NBM + broad spectum abx + surgery
49
What are some factors in the VTE risk assessment?
Cancer? Age \>60? Dehydration? Obesity? Personal history of VTE?
50
What form part of the pre-op surgical checklist?
**Confirmed identity**? **Site marked**? **Consented**? **Allergies**? **Risk of blood loss \>500ml**? **All team members introduced**?

Surgery - DONE (9 decks)

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