Patient safety Flashcards
(20 cards)
The donabedian model of measuring quality identifies these as main ttypes of improvemments
Change to structure
Change to process
Change to outcome
The most common delayed complication following carotid endarterctomy
Myocardial infacrtion
- Other complications
- central or regional neurologic deficits
- immediate return to the OR
- bleeding with an expanding neck hematoma
- emergent airway intubation
- AV fistula
- Psuedoaneuryms
- infection
- intraoperative hypotension
- 1% lidocaine
- central or regional neurologic deficits
The most important appropriate treatment for a seroma after a soft tissue biopsy?
Multiple attemps of aspiration with application of pressure dressings
- Lymph node biopsy complications
- Bleeding - direct pressure
- infection - appear 5- 10 days postop. may require opening of the wound to drain the infection
- seromas
- Measures to prevent direct complications
- proper surgical hemostasis
- proper skin preparation
- single preoperative dose of antibiotic to cover skin flora for 30-60 minutes before incsision
Prophylaxis using low dose unfractionated heparin reduces the incidence of fatal pulmonary embolism by?
50%
- DVT occurs ~25 % while PE ~7% of all major surgical procedures withouth prophylaxis
- Both low dose unfractionated heparin and low moleculaer weight heparin have similar efficacy
Best test to predict successful extubation of a patient?
Tobin Index
- The use of a weaning protocol for patients on mechanical ventilator greater han 48 reduces the incidence of VAP
- Tobin index = RR/Tidal volume
- also called the rapid shalow breathing
- less than 105 = 70% chance of success
- greater than 105 = 80% chance of failing
- negative predictor
The root cause of the majority of wrong site surgeries result from____
Communication errors
Shown to decrease the time of postoperative ileus
Erythromycin
- Commonly used to stimulate functions are metcolopramide and erythromycin
- metoclopramide = gastroparesis (stomach and duodenum)
- erythromycin = motilin agonist (throughout the stomach and bowel)
- Alvimopan - mu opiod receptor antagonist
- neostigmine - refractory pan ileus aptients (Ogilvie syndrome)
In order to reduce the overall risk of stress gastritis in ICU patients mechanically ventilated for >48 hours, their gastric pH level should be kept greater then_________
4
- Proton pump inhibitors, H2 receptor antagonists, and intragastric anatacid anatcid instillation.
- For patients who are not mechanically ventilated or who do not have a hisotry of gastritis
- no prophylaxis
- carries a higher risk of pneumonia
- no prophylaxis
The treatment of choice for a biloma after a laparoscopic surgery
Biliary stent
- bile leak due unrecognized injury to the ducts may pressent after cholecystectomy
- abdominal pain
- hyperbilirubinemia
- Diagnosis
- CT scan
- ERCP
- radionuclide scan
- treatment
- retrograde biliary stent
- external drainage
The most frequent nosocomial infection
Urinary tracat infection
- uncomplicated
- treated with outpatient antibiotic
- Complicated
- hospitalized patient with indwelling catheter
- less than 100 000 CFU/ml
- remove catheter first then repeat culture
- more than 100 000 CFU/ml
- appropriate antibiotics
- change or removed as soon as possible
- can lead to urosepsis and septic shock
The first step in treating a 70 kg patient with a platelet count of 12 000 due to heparin induced thromocytopenia is
Transfusion of 12 units of platelets
- Thrombocytopenia may require platelet transfusion for a count <20,000 mL when invasive procedures are performed
- 1 unit of platelet = 5000 to 7500/ml in adults
- heparin induced thrombocytopenia I and II
- II can be serious because of the diffuse thrombogenic nature of the disorder
- Precautions to avoid this
- saline solution flushes instead of heparin solutions
- limiting the use of heaprin coated catheters
- Treatment
- anticoagulation with synthetic agents such as argatroban
VAP in ventilated ICU patients reaches a 70% probability at ________-
30 days
- Pneumonia is the most common infection in vemtialted patients
- 2nd most common nosocomial infection
- VAP 15to 40% with a probability rate of 5% per day up to 70% at day 30
- the 30 day moratlity rate is 40%
The only thing that shown to decrease wound infections in surgical patients wih contaminated wounds?
Saline irrigation of the peritoneum and wound
Tracheostomy may decrease the incidence of VAP, overall length of ventilator time, and the number of ICU patient days performed
Before the 10th day of ventilator support
Dominant cytokine in the pathogenesis of SIRS
IL-6, IL-1, and TNF-a
- Inclusion criteria for SIRS
- Temp: >38 or <36
- HR: >90 bpm
- RR >20/min or PaCO2 <32 mmHg
- WBC <4000 or >12000 or >10% immature forms
- Two criteria not requred for the diagnosis of SIRS
- Lowered blood pressure
- blood culture positive for infection
- Mortality rates
- 2 SIRS 5 %
- 3 SIRS 10%
- 4 SIRS 25-20%
The most common cause of postrenal failure
Clogged urinary catheter
- considered when low urine or anuria occurs
- Other less common cause
- unintentional ligation or trasection of ureters during difficult surgical dissection
- large retroperitoneal hematoma (ruptured aortic aneurysm)
Laryngoscopic findings after a superior laryngeal nerve injury include
asymmetrical glottic opening
- Superior laryngeal nerve injury is less debilitating
- common symptoms is loss of projection of the voice
- Management
- clinical observation
True regarding wound infection
- NO prospective, randomized, double-blind , controlled stuies exist that demostrate antibiotics used beyond 24 hours in the preoperative period
- Irrigation of the operative field and surgical wound with saline solution is beneficial
- Irrigation with an antibiotic based solution has not been shown to be beneficial
- Antibacterial-impregnated polyvinyl placed over the operative wound area for the duration of the surgical procedure is not beneficial
Most common cause of empyema in the postoperative patient
Pneumonia
- empyema or infection of the pleural space
- most debilitting infections
- other etiologies
- retained hemothorax
- systemic sepsis
- esophageal perforation
- infections with a predilection for the lung
The primary cause of hyperbilirubinemia in the surgical patient
Cholestasis
- Other causes
- reabsorption of blood (hematoma from trauma)
- decreased bile excretion (sepsis)
- increased unconjugated bilirubin due to hemolysis, hyperthyroidism
- impaired excretion due to congenital abnormalities or acquired disease
- missed or iatrogenic injuries
