PAs in Surgery Flashcards by Anthony Carli

ASA Classifications range from __ to ___ to predict…

1-6 (from normal to organ donor)

predict operative risk

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The Mallampati score ranges from class ___ to ____ and describes…

class 1 to 4

soft palate visualization

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Pre-op labs… (7)

CBC
Lytes
PT/INR
Preg

+/- UA, BUN/Cr, CXR (> 50 yo)

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the below patient should have a pre-operative ____

Men > 45, women > 55
cardiac dz
diuretic use
hx DM, HTN
major surgical procedure

ECG

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cigarette smoking should be ceased _____ before surgery

2 mo

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Pulm risk assessment labs/studies… (3)

CXR, PFTs, ABGs

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The cardiac risk factor score totals ____ points. > ____ warrants concern

53 points

> 10 concerning

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elevated _____ is a/w increased post-op infx

glucose & A1c

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Post op DM attempts to maintain sugar between…

150-200

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at what frequency should blood sugar be monitored post-op in DM?

q6hrs

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Pre and post-op steroid regimen for adrenal insufficiency…

pre-op: 100mg hydrocotisone

post-op 100mg QD tapered over 5 days

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MC patient position

used for many general surgery procedures

supine

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which position?

increased exposure to pelvic organs

used to place central lines

trendelenburg

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which position?

enhances exposure to abdominal viscera

reverse trendelenburg

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which position?

used for spinal surg

prone

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which position?

used for thoracotomy, nephrectomy, retroperitoneal approach

lateral

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General surgery covers from ____ to _____

diaphragm to pelvis

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what causes referred post-op shoulder pain after laparooscopy?

diaphragm stretch and CO2

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The below procedures usually use what approach?

cholecystectomy
appendectomy
inguinal hernia repair
ventral hernia repair
nissen fundoplication

laparoscopy

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The camera during laparoscopy shouldn’t come in contact with…

the bowel

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8 procedures surgical PAs commonly perform

art lines and IVs
central lines
drain removal
foleys
NG tubes
bedside CT
I &amp; D

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how often should wounds be checked post-op?

daily

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I&Os should be checked with what frequency post-op day 1?

q 4-6 hours

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if fever post-op day 3-5, what must be r/o?

infx

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the below would cause a ____ post-op fever... meds blood products malignant hyperthermia

immediate (hours)

the below would cause a ____ post-op fever... nosocomial infx UTI apiration pneumonia

acute (1st weeks)

the below would cause a ____ post-op fever... SSI central line infx abx diarrhea

subacute (1-4 weeks)

the below would cause a ____ post-op fever... infection/abscess

delayed ( > 1 mo)

workup for fever 48 hours post-op or temps > 102... (4)

CBC UA Cx blood, urine, sputum CXR

4 common causes of post-op fever w/in 0-48 hours

atelectasis infx (GAS) leakage of bowel anastomosis aspiration pneumonia

tx of post-op aspiration pneumonia

pulm toilet | abx

tx of post-op wound infx

open wound | abx

tx of post-op atelectasis (4)

spirometry, cough, deep breathing, ambulation

The below usually occur as a fever after post-op day ___ ``` UTI wound infx catheter infx abscess DVT ```

day 3

Wound dressings on clean surgical wounds should be left in place for how long?

48hours

_______ wounds are packed open to promote hemostasis and drainage. wet/moist dressings should be changed _____

contaminated wounds changed 8-12 hours

MC agent of post-op wound infx

group A strep

3 common pathogens of post-op wound infx

staph, strep, G-

post-op drains help prevent...

seroma/hematoma

post-op patient p/w: sudden drainage of pink, serosanguineous salmon colored peritoneal fluid

fascial wound dehiscence

fascial wound dehiscence occurs between days __ and __ post-op

5-8

optimum time for parenteral prophylactic abx?

30-60 min prior to incision

what abx are commonly used for prophylaxis during most operations?

1st/2nd gen cephalosporins

MC cause of fever in first 48 hours after surgery?

atelectasis

post-op patient presents with: ``` abd. pain fever leukocytosis tachycardia ill appearing ```

intra-abdominal infx

workup for suspected intra-abdominal infx

CXR (free air, pleural effusion) CT abd US

Patient presents with: ``` fever chills tachy leukocytosis hypotension ```

bacteremia

evaluation of bacteremia...

blood cx x 2 catheter cx inspection of IV sites

to prevent bacteremia, IV lines should be changed...

q 3 days

5 types of debridement...

``` sharp mechanical autolytic enzymatic biologic ```

What type of debridement? Uses body’s own enzymes to liquefy necrotic debris and maintain moist wound environment

autolytic

can autolytic debridement be used for infected wounds?

enzymatic debridement is best used on...

eschar/necrotic tissue

enzymatic debridement requires a ____dressing

second

What is a strategy of mechanical debridement?

wet to dry dressing

2 painful types of debridement

mechanical, sharp

this is best used for debridement of large wounds that are infected with necrotic tissue

sharp surgical debridement

______ has the below characteristics: ``` – Enhances granulation – Clears heavy exudate and infectious material – Increases perfusion to the wound bed – Stretching initiates cell proliferation ```

negative pressure wound therapy

_______ is contraindicated in presence of: ``` – Necrotic tissue – Untreated Osteomyelitis – Fistula to body cavity – Malignancy in wound – Exposed artery or vein ```

negative pressure wound therapy

lab studies for wound infx...

CBC, ESR

PAs in Surgery Flashcards

(60 cards)