Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > intro to surgery > Flashcards

intro to surgery Flashcards

1
Q

Elective Surgery:

A

non-emergent which is scheduled at least 24 hours in advance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Emergent Surgery:

A

Surgery for a condition which is immediately life-threatening. performed within a few hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Preparations that greatly improve outcome of surgery (elective vs. emergent)

A
  • appropriate pre-op meds
  • cardiac optimization
  • pulm optimization
  • empty stomach
  • bowel prep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why is it optimal for a patient to have an empty stomach prior to surgery?

  1. Decreases likelihood of gastric rupture
  2. Decreases likelihood of aspiration pneumonia
  3. Decreases postoperative nausea and vomiting
  4. Increases absorption rate of preoperative anesthesia medications
A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how long does emptying the stomach take?

A
  • clear liquids = 2 hr
  • breast milk = 4 hr
  • infant formula= 4 (<3 mo), 6(>3 mo)
  • nonhuman milk= 6
  • light meal = 6 hour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

conditions that increase aspiration risk (elevate intra-abdominal pressure)

A

morbid obesity
prego
gastroparesis, abdominal trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

why would a pt need a pre-op bowel prep?

A

-decrease abdominal contamination in event of bowle entry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

pre-op questions (AMPLE)

A
  • allergies
  • meds
  • pmh
  • last meal
  • events prior
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

describe the distribution of water in the human body:

A

total body water is distributed with about 2/3 intracellular (25 L) and 1/3 is extra cellular (12 L)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

extra cellular water distribution:

A 
interstitial= 25% (9 L)
Plasma= 8% (3 L)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

calculating blood volume=

A

TBV= 7% x Body Weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how many L = 1 kg

A

1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

why are surgical pos prone to disruptions of fluid and electrolytes?

A
  • cant eat or drink for a while
  • anesthesia causes increased pulmonary insensible loss
  • postop fever increases insensible loss
  • thrid spacing
  • sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

during and after surgery pt needs:

A
  • maintenance volume fluid replacement
  • maintenance electrolyte replacement
  • replacement for ongoing losses in excess of maintenance
  • replacement of pre-exisiting volume deficits
  • replacement of pre-existing electrolyte deficits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

maintenance requirements:

A
  • 0-10 kg = 100ml per kg/day
  • 10-20 kg= 50 ml/kg/d
  • all kg after that= 20 ml/kg/d
  • divide by 24 for ml/hr
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

best way to monitor fluid status

A

Despite all of the aforementioned, best way to monitor fluid status is to measure urine output you will measure it/follow it ALL THE TIME in an inpatient setting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Na maintenance=

A

1-2 mEq/kg/d

18
Q

K maintenance=

A

.5-1 mEq/kg/d

-always infusion, never as bolus

19
Q

how fluid is lost:

A 
*NG tube (gastric contents = H+, K+ and Cl- loss)
Evaporation via open incision
Operative bleeding 
Third space losses 
Drains 
Fistulae 
Burns
20
Q

how to recognize acute volume deficit:

A 
Changes in vital signs
Blood pressure
Heart rate
CVP (central venous pressure)
Decreased urine output
Why a postop foley is so helpful
Tissue changes often are not obvious when there’s an acute volume loss!
21
Q

how to tell volume excess:

A 
Over hydration can happen
Signs of volume excess:
weight gain
pulmonary edema
peripheral edema
S3 gallop

Third spacing Third-spacingoccurs when too much fluid moves from the intravascularspace(blood vessels) into the interstitial or “third”space, area between cells.
Third spaced fluids eventually will re-enter the intravascular space (mobilize)
Typically, third space mobilization happens around POD3.
Can get a very large urine output when mobilization begins

22
Q

time frame for fluid replacement:

A

Try to correct abnormalities over 24 hours– don’t go too fast.
For seriously ill patients and patients with tenuous lungs or cardiac status, calculate over shorter period and reassess more frequently (even q hour in some)
For large fluid deficits - correct over a longer period of time

23
Q

when does 3rd spacing fluid tend to mobilize after surgery?

A

POD3

24
Q

fevers after surgery:

A

Fever <38.5ºC (101.3 Fahrenheit) is common after surgery
It’s usually due to the inflammatory stimulus of surgery and resolves spontaneously
Fever = response to cytokine release
Fever-associated cytokines are released by tissue trauma and do not necessarily signal infection

25
Q

fever associated cytokines:

A

IL-1, IL-6, TNF-alpha, IFN-gamma

26
Q

What is the “mechanical” cause of the shaking chills that come before– or with– a fever? What are these called?

A

Rigors not just chills, they are “shaking chills” can be quite violent

Due to rapid, alternating muscle contractions which generate heat; body’s response to increased “set” temperature.

27
Q

post-op fever causes by days:

A
  1. wind- Atelectasis
  2. water- UTI
  3. wound- surgical site infection
  4. walking- dvt
  5. wonder- drugs
28
Q

In general, early fever is not infectious with one critical exception:

A

Necrotizing fasciitis or soft tissue infection

29
Q

Atelectasis:

A

A partial collapse of the alveoli, often due to hypo-inflation.

This partial collapse causes a decrease in lung compliance, making it tougher to re-inflate the lung.

Atelectasis occurs in the most dependent parts of the lung in 90% of patients who are anesthetized.

30
Q

why hypo-inflation after surgery?

A

Lungs may not have been inflated completely during endotracheal anesthesia
After surgery, patients may have trouble taking a deep inflating breath (pain, sedation)
Pulmonary disease like COPD can contribute

31
Q

risk factors for atelectasis?

A 
Painful abdominal or thoracic incision
– decreases pulmonary excursion
Smoking
Pulmonary Disease (asthma, CF)
Obesity
Respiratory muscle weakness
32
Q

atelectasis tx?

A

incentive spirometry

33
Q

differentiating atelectasis and pneumonia?

A

Hint: Atelectasis will usually be bilateral! A unilateral infiltrate is most likely pneumonia

This can be hard to differentiate from atelectasis.
Look for sputum production, elevated WBC, and temp curve that progresses upward.
In at-risk individuals, check CBC with Diff and CXR, and consider antibiotics earlier than in non-risk individuals.

34
Q

when do drugs tend to cause post-op fevers?

A

anytime!

35
Q

why UTI’s post op?

A

Catheter use during surgery
Delays in bladder emptying due to anesthesia
Bladder manipulation during surgery

Risk is increased by:
Female gender
Older age
Diabetes
Immobilization
36
Q

what about surgery increases risk of DVT?

A
  • immobility

- vascular damage

37
Q

virchows triad:

A
  • stasis
  • vessel damage
  • hyper-coaguability
38
Q

fever things that could kill the pt:

A

Necrotizing infection (can kill rapidly)
Clostridium perfringens, Group A β-hemolytic streptococcus
Tx: 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
Other: Allergic rxn (to abx) or transfusion
Look for hypotension, rash
Tx: Stop the offending agent

39
Q

fever things that could kill the pt:

A

Necrotizing infection (can kill rapidly)
Clostridium perfringens, Group A β-hemolytic streptococcus
Tx: 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
Other: Allergic rxn (to abx) or transfusion
Look for hypotension, rash
Tx: Stop the offending agent

Pulmonary embolism (can present with fever)
MI (unusual but can also present with fever)
Other things:
ventilator-associated pneumonia
aspiration pneumonia
nosocomial infection
EtOH withdrawal (day 3)

40
Q

delayed fever (5 days post-op):

A 
#1: Wound infection (40%)
#2: UTI (29%) especially if indwelling Foley
#3: Pneumonia (12%) if on vent or COPD
Also think of: 
C. difficile colitis
line sepsis &amp; bacteremia
intra-abdominal abscess
Rarer: 
Sinusitis
Meningitis
Acalculous cholecystitis
Weeks out: 
Endocarditis
Infected prostheses
41
Q

initial assessment of fever post-op:

A

If called for fever, get to the bedside, get the nurse/flowsheet and CBC with vitals
Obtain a history. If the situation is worrisome, jump to the AMPLE format
Type of surgery, meds or blood given, other symptoms (rash, cough, dyspnea, chest pain, dysuria, leg swelling, painful IV site, abd pain)
Physical:
#1 check the wound or surgical site
#2 lung sounds, heart/abd/extremity exam
#3 check IV sites, central line, Foley, tubes

42
Q

fever take home points:

A

Know the five Ws as a rough guide for most common causes & timing
Learn to think of what can kill the patient
Also think:“what did we do to cause this?” (iatrogenic)
Targeted H&P / labs / imaging to rule out the killers, then confirm most likely cause
Should have a working diagnosis before labs and imaging
Know the dx & treatment of necrotizing fasciitis (future lecture)

Surgery (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions