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Surgery Lab I > Lecture 6: evaluation of the pre-op patient > Flashcards

Lecture 6: evaluation of the pre-op patient Flashcards

1
Q

what is criteria for excellent prognosis

A
  1. Potential for complications is minimal
  2. High probability patient returns to normal after sx
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2
Q

what is criteria for good prognosis

A
  1. Some potential for complications
  2. High probability good outcome
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3
Q

what is criteria for fair prognosis

A
  1. Severe complications possible, but uncommon
  2. Recovery may be prolonged
  3. Patient may not return to normal pre-sx function
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4
Q

what is criteria for poor prognosis

A
  1. Underlying dz or surgery associated with many or severe complications
  2. Expect prolonged recovery
  3. Patient unlikely to return to pre-sx function
  4. Likelihood of death during or after procedure is high
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5
Q

what is criteria for guarded prognosis

A

outcome is unknown or uncertain

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6
Q

what is ASA status of I and what are some sx examples

A

healthy, no obvious dz
Ex: elective OVH, neuter

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7
Q

what is ASA status of II and some examples of sx

A

Healthy with localized or mild systemic disease
Ex: soft palate, patellar luxation

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8
Q

what is ASA status of III and some examples of sx

A

severe systemic disease
Ex: anemia, pneumonia

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9
Q

what is ASA status of IV and some examples of sx

A

severe systemic disease that can be life threatening
Ex: heart failure, renal failure, GDV

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10
Q

what is ASA status of V and what are some examples of sx

A

moribund, patient not expected to survive more than a few hours with or without sx

Ex: severe trauma, endotoxemia, shock

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11
Q

what lab tests will we be running prior to sx

A
  1. PCV
  2. TS
  3. Glucose
  4. Azo
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12
Q

what is PCV

A

estimate of RBC mass

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13
Q

what is TS

A

estimate of total protein- albumin, globulins via refractometry

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14
Q

what is normal PCV and TS for dogs

A

PCV: 35-55%
TS: 5.4-7.4 g/dl

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15
Q

what is normal PCV and TS for cats

A

PCV: 29-48%
TS: 6.6-8.4g/dl

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16
Q

what could it mean if PCV increased and TS normal

A

dehydration, splenic contraction, polycythemia,

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17
Q

what does it mean with increased PCV and TS

A

dehydration

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18
Q

what does it mean with increase PCV and decreased TS

A

Severe dehydration with protein loss

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19
Q

what is could it mean with normal or increased PCV with decrease TS

A

hemorrhage with splenic contraction, protein loss, decrease protein production (liver)

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20
Q

what could it mean with normal PCV and increased TS

A

anemia with dehydration, normal hydration, hyperproteinemia or hypoglobinemia

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21
Q

what does it mean with decreased PCV and normal TS

A

chronic RBC destruction, loss, reduced RBC production, anemia of chronic disease, bone marrow disorders

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22
Q

what does it mean with decreased PCV and Increased TS

A

anemia of chronic disease, lymphoproliferative disease

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23
Q

what is normal blood volume for dog and cat

A

dog: 90ml/kg
Cat: 70ml/kg

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24
Q

Why should you never bolus a maintenance fluid

A

potassium too high, will give potassium bolus

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25
what scenarios do you want to give fresh whole blood, what is general dose and shock dose
anemia, hemorrhage, coagulopathies, shock General dose: 10-22ml/kg Shock dose: 22ml/kg/h
26
what scenarios do you give stored whole blood or packed RBCs
anemia, hemorrhage
27
what is formula for blood needed
BW (kg) X (desired PCV - recipient PCV)/ donor PCV X 90 (dogs) or X 70 (cats)
28
what does Azo measure
BUN
29
what could an increased azo mean
1. Pre-renal- dehydration, shock 2. Renal failure 3. Post renal- obstruction 4. Extra renal- recent meal, GI ulcer/bleed
30
what could decreased azo mean
1. End stage liver dz 2. Liver shunt 3. Low protein diet 4. Increased loss via PU/PD
31
parenteral feeding delivered via __ or __
jugular catheter or central line
32
what is included in parenteral feeding
glucose, amino acids, electrolytes, fats
33
what are the three check in points for sx
1. Prior to ax 2. Prior to incision 3. Prior to recovery
34
define therapeutic abx
given to tx specific infection
35
define prophylactic abx
given before surgery to prevent infection
36
define nosocomial infection
healthcare associated infection, acquired during process of receiving care
37
Give examples when prophylactic antibiotics recommended
1. Dirty or contaminated procedures- open fracture 2. Clean- contaminated procedures- GIT or oral sx 3. Implants, previous implants 4. Pacemaker 5. Clean procedures >90 minutes
38
what are some common pathogens associated with sx, typically from patient
1. Staphylococcus pseudointermedius 2. Staphylococcus aureus 3. Enterobacteriae 4. Enterococcus 5. Pseudomonas
39
what bacterial spp is a specific concern due to high risk of resistance
staph spp
40
Skin and reconstructive sx: what bacteria and what abx
bacteria: staphylococcus Abx: cefazolin
41
Head and neck surgery: what bacteria and abx
bacteria: staphylococcus, streptococcus, anaerobes Abx: clindamycin or cefazolin
42
ortho elective procedures/closed fractures: what bacteria and abx
bacteria: staphylococcus Abx: cefazolin
43
thoracic surgery: what bacteria and abx
bacteria: staphylococcus Abx: cefazolin
44
abdominal sx what bacteria and abx
bacteria: staphylococcus Abx: cefazolin
45
upper GI sx: what bacteria and abx
bacteria: gram + cocci, gram - enteric bacilli Abx: cefazolin
46
hepatobillary sx: what bacteria and what abx
bacteria: clostridium gram - bacilli, anaerobes Abx: cefoxitin
47
lower GI sx: what bacteria and what abx
bacteria: enterococci, gram negative bacilli anaerobes Abx: cefoxitin
48
urogenital sx: what bacteria and what abx
bacteria: E. Coli, streptococcus, staphylococcus, anaerobes Abx: ampicillin or cefazolin
49
when should abx be given before sx
30-60 minutes before incision
50
when should you redose antibiotics
every 2 half lives
51
what is half life for cefazolin
47 minutes
52
what is half life for ampicillin
48 minutes
53
what is half life for clindamycin
124-195 minutes
54
what is half life for cefoxitin
40-60 minutes
55
t or f: post-op antibiotics are effective
false- no proof
56
when should you d/c prophylactic abx given for surgery
within 24hrs
57
what 4 things does infection depends on
1. # and virulence of pathogen 2. Host defense 3. Tissue damage 4. Dead space
58
how do you reduce risk of SSI
1. Minimize dead space, necrotic tissue, and contamination 2. Copious lavage 3. Aseptic technique 4. Appropriate timing of prophylactic abx
59
what are some signs of SSI
pain, swelling, redness, heat, discharge
60
how do you dx SSI
culture, cytology
61
what abx class is commonly given for skin SSI
cephalosorins
62
what bacteria should you target for GI SSI
gram - rods

Surgery Lab I (11 decks)

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