General Surgery Flashcards
(29 cards)
Timing of suture removal for adults
Face: 4-5 days Scalp: 6-7 days Trunk, arm, leg: 7-10 days Joints, extensor surface: 8-14 days Joints, flexor surface: 8-10 days Dorsum of hand: 7-9 days Palm: 7-12 days Sole of foot: 7-12 days
Timing of suture removal for children
Face: 3-4 days Scalp: 5-6 days Trunk, arm, leg: 5-9 days days Joints, extensor surface: 7-12 days Joints, flexor surface: 6-8 days Dorsum of hand: 5-7 days Palm: 7-10 days Sole of foot: 7-10 days
Hemorrhage class II
750-1500mL blood loss
(15-30%)
HR>100
Orthostatic hypotension
Hemorrhage class III
1500-2000mL blood loss
(30-40%)
HR>120
Hypotension
First-line tx of ITP
Corticosteroids, longer courses
IVIG, 1g/kg one-time dose (may be repeated as necesary)
[table 4-2]
Febrile NHTR
MOA: preformed cytokines, host Ab to donor lymphocytes
Prev: use leukocyte-reduced blood, store plt <5days
Allergic transfusion reactions
MOA: soluble transfusion constituents
Prev: provide antihistamine prophylaxis
TACO
Transfusion-assoc’d circulatory overload MOA: large volume of blood transfused into an OLDER patient with CHF Prev: 1. Increase transfusion time 2. Adminsiter diuretics 3. Miinimize assoc’d fluids
TRALI
MOA: anti-HLA or anti HNA Ab in transfused blood attacks circulatory and pulmonary leukocytes
Prev: limit female donors
Guidelines for referral to a burn center [table 8-1]
Partial thickness burns greater than 10% TBSA
Burns involving the face, hands, feet, genitalia, perinium, or major joints
3rd degree burns in ANY age group
Electrical burns, including lightning injury
Chemical burns
Inhalational injury
Comoribidities
Concomitant trauma in which the burn is the greatest risk
Burned children
Px who will require special social, emotional, or rehabilitative intervention
BURNS: 4 crucial assessments in initial evaluation
- Airway
- Other injuries
- Burn size
- CO and cyanide poisoning
BURNS: preferred method for securing the airway
Orotracheal intubation
BURNS: When is two large-bore IV ideal?
When the burn is >40% TBSA
Burns and antibiotics
Patients with acute burn injuries should never receive prophylactic antibiotics. This intervention has been clearly demonstrated to promote development of fungal infections and resistant organisms and was abandoned in the mid-1980s
Acid that causes liquefactive necrosis
Hydrofluoric acid
- may also cause hypocalceia
- mgt: topical / IV calcium gluconate
Formic acid
Known to cause hemolysis and hemoglobinuria
BURNS: Dupuytren classification (1832), as per Schwartz, 2019
1st degree: superficial 2nd degree: partial-thickness (BLISTERS) 3rd degree: full-thickness (LEATHERY) 4th degree: affects underlying soft tissue 5th degree: muscle to bone 6th degree: charring bones
BURNS: Zones of tissue injury
“Jackson’s 3 zones”
Zone of coagulatiotn
Zone of stasis
Zone of hyperemia
Remarks on 2nd and 3rd degree
Superficial partial thickness: will heal with nonoperative mgt
Deep partial thickness and 3rd degree: will benefit from excision and skin grafting
BURNS: formulas in nutrition
Harris-Benedict equation -uses factors such as gender, age, height, weight -may be inaccurate in burns <40% TBSA Curreri formula -25kcal/kg/day + 40kcal/%TBSA/day
BURNS: fluid resuscitation
Parkland / Baster formula:
3-4mL LRS / kg / %TBSA
ABA formula:
2mL LRS / kg / % TBSA
CHOLEDOCHAL CYSTS: Type I mgt
Cholecystectomy + excision of extrahepatic biliary tree + R en Y HJ
CHOLEDOCHAL CYSTS: Type II mgt
Same as type I (Cholecystectomy + excision of extrahepatic biliary tree + R en Y HJ)
Or
Diverticulecctomy
CHOLEDOCHAL CYSTS: Type III mgt
Sphicterotomy
- if small: sphicterotomy
- if large: transduodenal excision
