Flashcards in Intro to Surgery Deck (32):
IL1, IL 6, TNF alpha and IFN gamma
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
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?
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
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
5 atelectasis risk factors
Painful abdominal or thoracic incision
respiratory muscle weakness
on x ray is a unilateral infiltrate in the CXR usually atelectasis or pneumonia
atelectasis is typically bilateral
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
___ is most common tx fr grossly infected wound
open it up, release the pus, allow tissue to heal from inside out and fill in
what are 4 possible causes of post op fevers that could kill my patient?
Necrotizing infection (can kill rapidly)
Anastomotic leak (GI)
Allergy rxn to abx or transfusion
how to treat necrotixing infection
resuscitation, Pen G, surgical debridement
malignant hyperthermia tx
resuscitation, rapid cooling, IV dantrolene (excitation - contraction decoupler)
anastomotic leak GI
place a drain or return to OR
allergic rxn to abx or transfusion treatment
stop the offending agent
what is DDX of post op fever after 5 days.. top 3?
UTI (indwelling foley)
PNA (vent, COPD)
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
PE: check wound/surg site, lung sounds, heart/abd/extremity exam, check IV sites, central line, foley, tubes
how long to empty:
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
t/f conditions that elevate intra-abdominal pressure like morbid obesity and pregnancy increase aspiration risk
true: obesity, preg etc
T/F delayed gastric emptying increases aspiration risk
true: gastroparesis, pregnancy, abdominal trauma
preop bowel prep lowers risk for what 3 things?
bowel rupture during surgery, post op N/V, abdominal contamination in event of bowel entry
bowel prep increases absorption rate of __ meds
preop anesthesia meds
plasma volume is what fraction and percentage of total body weter?
1/12 or 8%
total body water is about __
Extracellular volume is..
intracellular volume is about
interstitial volume is about
25% of TBW or 9 L
Total blood volume is equal to...
7% of body weight (kg)
how much does 1 L of water weigh?
what are maintenance levels of sodium and k ?
1-2 mEq/Kg/d for Na