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Flashcards in Intro to Surgery Deck (32):
1

Fever cytokines:

IL1, IL 6, TNF alpha and IFN gamma

2

what are cervidil, prostin, and prepidil? Why can they cause a fever?

cervical softening agents prior to attempting to induce labor

patients given these drugs can have a fever.. WHy? they are 100% PGE2

3

What are the 6 W of Post op fever?

Wind on day 1? - atelectasis
Water on day 3? UTI, anastomotic leeak
Wound on day 5? surgical site infxn, abcess
Walking day 7? DVT / PE
Wonder more than 9 days.. drugs?
Final W.. What else or what did we do?

4

def atelectasis

a partial collapse of alveoli often due to hypoinflation

Post surg tends to be posterior alveoli from laying down for a long period

Or if sitting up a lot tends to be lower lobes

5

3 reasons why hypoinflation can occur during surg

lungs may not fully inflated due to endotracheal anesthesia

Post op pain/ sedation limit pt from taking in full breath

Pulmonary disease COPD etc

6

5 atelectasis risk factors

Painful abdominal or thoracic incision
smoking
pulmonary disease
obesity
respiratory muscle weakness

7

prevention atelectasis?

incentive spirometry

8

on x ray is a unilateral infiltrate in the CXR usually atelectasis or pneumonia

pneumonia
atelectasis is typically bilateral

9

when do you consider prophylactic abx for cath pts?

if they will have indwelling foley for more than 2 days.. consider daily abx for UTI prvt

10

___ is most common tx fr grossly infected wound

open it up, release the pus, allow tissue to heal from inside out and fill in

11

virchows triad

hypercoagulable state
stasis
endothelial injury

12

what are 4 possible causes of post op fevers that could kill my patient?

Necrotizing infection (can kill rapidly)
Malignant hypothermia
Anastomotic leak (GI)
Allergy rxn to abx or transfusion

13

how to treat necrotixing infection

resuscitation, Pen G, surgical debridement

14

malignant hyperthermia tx

resuscitation, rapid cooling, IV dantrolene (excitation - contraction decoupler)

15

anastomotic leak GI

place a drain or return to OR

16

allergic rxn to abx or transfusion treatment

stop the offending agent

17

what is DDX of post op fever after 5 days.. top 3?

wund infection
UTI (indwelling foley)
PNA (vent, COPD)

18

if you are called on your hospital floor for a fever what do you do?

Go to bedside
Get nurse and flowsheet with CBC and vitals
AMPLE hx
PE: check wound/surg site, lung sounds, heart/abd/extremity exam, check IV sites, central line, foley, tubes

19

how long to empty:
clear liquids
breast milk
infant formula
nonhuman milk
light meal

clear liq. 2 h
breast milk 4 h
formula 4 h if under 3 mo, 6 h if over 3 mo
nonhuman milk 6 h
light meal 6h

20

t/f conditions that elevate intra-abdominal pressure like morbid obesity and pregnancy increase aspiration risk

true: obesity, preg etc

21

T/F delayed gastric emptying increases aspiration risk

true: gastroparesis, pregnancy, abdominal trauma

22

preop bowel prep lowers risk for what 3 things?

bowel rupture during surgery, post op N/V, abdominal contamination in event of bowel entry

23

bowel prep increases absorption rate of __ meds

preop anesthesia meds

24

plasma volume is what fraction and percentage of total body weter?

1/12 or 8%

25

total body water is about __

37 L

26

Extracellular volume is..

12L

27

intracellular volume is about

25L

28

interstitial volume is about

25% of TBW or 9 L

29

Total blood volume is equal to...

7% of body weight (kg)

30

how much does 1 L of water weigh?

1 kg

31

what are maintenance levels of sodium and k ?

1-2 mEq/Kg/d for Na
K 0.5-1mEq/kg/d

32

signs of volume excess 4

peripheral edema, weight gain, s3 gallop, pulmonary edema