preop Flashcards Preview

Surgery > preop > Flashcards

Flashcards in preop Deck (131):
1

informed consent

transfer of info between physician and pt that allows the pt to make a knowledgeable decision about a particular tx

2

informed consent

transfer of info between physician and pt that allows the pt to make a knowledgeable decision about a particular tx

3

consent form

legal documentation of these discussions between the physician and the pt

4

surrogate decision maker

person empowered to make decisions for a patient who is not competent to do so

5

advance directive

a mentally capable pt/s instructions regarding his or her medical care if he or she becomes incapacitated and unable to make decisions

6

beta blockers

Abrupt discontinuation can increase risk of Ml;

With a sip of water a few hours before operation;

Parenteral agent until taking p.o.

7

atrial antiarrhythmics

With a sip of water a few hours before operation;

IV ß-blockers, diltiazem or digoxin until p.o. intake resumed

8

ventricular antiar

Monitor Mg, K, and Ca levels preoperatively;

With a sip of water a few hours before operation;

Parenteral amiodarone or procainamide

9

nitrates

Transdermal (paste, patch) may be poorly absorbed intraoperatively;

With a sip of water a few hours before operation;

Intravenous (most reliable) or transdermal until p.o. intake resumed

10

antihtn

Abrupt discontinuation of clonidine can cause rebound hypertension;

With a sip of water a few hours before operation;

Parenteral antihypertensives; if on clonidine, consider clonidine patch or alternative antihypertensive agents

11

insulin

5% dextrose solutions should be given intravenously intra- and postoperatively in patients receiving insulin;

Yi dose usual long-acting agent at the usual time preoperatively;

SSI until p.o. intake back to baseline

12

oral agents for DM

hold am of operation;

ssi until po intake back to baseline

13

metformin

Can produce lactic acidosis, particularly in the setting of renal dysfunction or with administration of IV radiographic contrast agents;

Hold for at least 1 day preoperatively;

Monitor renal function closely. Resume metformin when renal function normalizes, usually 2–3 days postoperatively. SSI until then.

14

aspirin, clopidogrel, ticlopidine

dc 7 days preop;

resume when diet resumed

15

warfarin

Hold until INR normalizes, usually 3–5 days. If anticoagulation critical, maintain anticoagulation with heparin;

Resume when diet resumed

16

heparin

Discontinue 4 hr preoperatively;

Resume 6–12 hr postoperatively, provided no increased risk of hemorrhage thought to exist

17

levothyroxine

held few days preop;

parenterally until diet resumed

18

estrogen

stop 4 wk prior to cases w high risk dvt

19

ample

allergies, medications, past medical hx, last meal, events preceding the emergency

20

baseline ekg

men >40 and women >50; symp cariovasc ds, htn, or dm

21

Dripps-American Surgical Association Classification: to quantify surgical risk

1. healthy
2. mild-mod systemic ds
3. severe
4. life threatening
5. no expected to survive

22

cardiac risk index

high risk surgery, hx ischemic heart ds, hx chf, hx cerebrovasc ds, preop tx w insulin, preop serum cr >2


total up the number:
1. 0risk
2. 1 risk
3. 2 risks
4. more than 2 risks

23

METs class 1

Activity requiring >6 METs

Carrying 24 lb up eight steps

Carrying objects that weigh 80 lb

Performing outdoor work (shoveling snow, spading soil)

Participating in recreation (skiing, basketball, squash, handball, jogging/walking at 5 mph)

24

METs class 2

Activities requiring >4 but not >6 METs

Having sexual intercourse without stopping

Walking at 4 mph on level ground

Performing outdoor work (gardening, raking, weeding)

Participating in recreation (roller-skating, dancing fox trot)

25

METs class 3

Activity requiring >1 but not >4 METs

Showering, dressing without stopping, stripping, and making bed

Walking at 2.5 mph on level ground

Performing outdoor work (cleaning windows)

Participating in recreation (golfing, bowling)

26

METs class 4

no activity requiring >1met; can't carry out any activities

27

1 met represents an oxygen consumption of

3.5ml/kg/min

(avg for resting 70kg man)

hr of 100bpm=4mets

28

when should smokers stop smoking before a procedure

6w

29

procedure related risk factors for postop pulm compl

surgical site (thoracic, upper abd), duration (3-4hr), anesthesia technique (general, spinal, and epidural)

30

periop mc cause of AKI is secondary to

acute tubular necrosis

31

goal in periop manage of pts w CKD or AKI

maintenance of euvolemia and renal perfusion

32

serum potassium levels should be blank before surgery

33

someone on ACE and angiotensin 2 for CKD should stop them when

10hrs before general anesthesia to reduce risk of post induction hypotension

34

what are essential records for postop CKD pts

daily weights and I&Os

35

when should pt be dialyzed before surgery

within 24hr of surgery

36

periop management of pts w diabetes

1. Insulin is available in several types and is typically classified by its length of action. Rapid-acting and short-acting insulin preparations are usually withheld when the patient stops oral intake usually at midnight the day before surgery. Intermediate-acting and long-acting insulin preparations are administered two-thirds the normal evening dose the night before surgery and half the normal morning dose the morning of surgery. Long-acting oral agents are stopped 48 to 72 hours before surgery, while short-acting agents can be withheld the night before or the day of surgery.

2. The ideal method of providing insulin in the perioperative period is debatable. Any regimen should however (1) maintain adequate glycemic control to avoid hyperglycemia or hypoglycemia; (2) prevent metabolic disturbances; (3) be easy to understand and administer. The patient should receive a continuous infusion of 5% dextrose to provide 10 g glucose/hour. Fingerstick glucose levels are monitored intraoperatively and followed postoperatively at least every 6 hours. The goal is to maintain a glucose level of between 120 and 180 mg/dL. It is generally considered preferable to have the patient at the higher end of this range because of the adverse consequences of hypoglycemia. Sliding scale use of subcutaneous insulin has been the standard method of glucose control in surgical patients. Alternatively, intravenous insulin can be used with a continuous infusion of 1 to 3 units/hour of intravenous insulin being given. This approach is particularly helpful in the brittle diabetic. In the postoperative period, close attention should be paid not only to the patient’s blood sugar, but also to the patient’s carbohydrate intake.

3. Diabetic ketoacidosis (DKA) can develop in patients with either type I or type II diabetes. DKA is deceptively easy to overlook because it can mimic postoperative ileus. It may present as nausea, vomiting, and abdominal distension, or in association with polyuria (which is commonly mistaken for mobilization of intraoperative fluids). For this reason, patients with type I diabetes (and many with type II diabetes) should have their urinary ketone level monitored by dipstick. This method is faster and much less costly than following serum ketone levels, and it gives a fairly accurate picture of developing ketoacidosis. A glucose level that is

37

consent form

legal documentation of these discussions between the physician and the pt

38

surrogate decision maker

person empowered to make decisions for a patient who is not competent to do so

39

advance directive

a mentally capable pt/s instructions regarding his or her medical care if he or she becomes incapacitated and unable to make decisions

40

beta blockers

Abrupt discontinuation can increase risk of Ml;

With a sip of water a few hours before operation;

Parenteral agent until taking p.o.

41

atrial antiarrhythmics

With a sip of water a few hours before operation;

IV ß-blockers, diltiazem or digoxin until p.o. intake resumed

42

ventricular antiar

Monitor Mg, K, and Ca levels preoperatively;

With a sip of water a few hours before operation;

Parenteral amiodarone or procainamide

43

nitrates

Transdermal (paste, patch) may be poorly absorbed intraoperatively;

With a sip of water a few hours before operation;

Intravenous (most reliable) or transdermal until p.o. intake resumed

44

antihtn

Abrupt discontinuation of clonidine can cause rebound hypertension;

With a sip of water a few hours before operation;

Parenteral antihypertensives; if on clonidine, consider clonidine patch or alternative antihypertensive agents

45

A 28-year-old man is undergoing an operation for right inguinal hernia. The anesthesiologist notices that his end-tidal CO2 value rises abruptly, and the patient’s jaw is stiff. The patient’s temperature is 41 °C, his heart rate is 130 beats/minute, and his blood pressure (BP) is 130/75 mm Hg. Which of the following abnormalities would be expected if a sample of his blood were tested at this point in the operation?

A. Hyperkalemia

B. Hypocalcemia

C. Alkalosis

D. Anemia

E. Hypoalbuminemia (Lawrence 31-32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

Answer: A

This is a classic description of malignant hyperthermia. The typical electrolyte picture is that of rhabdomyolysis, with hyperkalemia, hypercalcemia, and acidosis. Malignant hyperthermia is not known to affect red cell mass or albumin levels. The patient should be given 100% oxygen, the operation should be stopped and the wound closed, and dantrolene should be administered. (Lawrence 32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

46

oral agents for DM

hold am of operation;

ssi until po intake back to baseline

47

metformin

Can produce lactic acidosis, particularly in the setting of renal dysfunction or with administration of IV radiographic contrast agents;

Hold for at least 1 day preoperatively;

Monitor renal function closely. Resume metformin when renal function normalizes, usually 2–3 days postoperatively. SSI until then.

48

aspirin, clopidogrel, ticlopidine

dc 7 days preop;

resume when diet resumed

49

warfarin

Hold until INR normalizes, usually 3–5 days. If anticoagulation critical, maintain anticoagulation with heparin;

Resume when diet resumed

50

heparin

Discontinue 4 hr preoperatively;

Resume 6–12 hr postoperatively, provided no increased risk of hemorrhage thought to exist

51

levothyroxine

held few days preop;

parenterally until diet resumed

52

estrogen

stop 4 wk prior to cases w high risk dvt

53

ample

allergies, medications, past medical hx, last meal, events preceding the emergency

54

baseline ekg

men >40 and women >50; symp cariovasc ds, htn, or dm

55

Dripps-American Surgical Association Classification: to quantify surgical risk

1. healthy
2. mild-mod systemic ds
3. severe
4. life threatening
5. no expected to survive

56

cardiac risk index

high risk surgery, hx ischemic heart ds, hx chf, hx cerebrovasc ds, preop tx w insulin, preop serum cr >2


total up the number:
1. 0risk
2. 1 risk
3. 2 risks
4. more than 2 risks

57

METs class 1

Activity requiring >6 METs

Carrying 24 lb up eight steps

Carrying objects that weigh 80 lb

Performing outdoor work (shoveling snow, spading soil)

Participating in recreation (skiing, basketball, squash, handball, jogging/walking at 5 mph)

58

METs class 2

Activities requiring >4 but not >6 METs

Having sexual intercourse without stopping

Walking at 4 mph on level ground

Performing outdoor work (gardening, raking, weeding)

Participating in recreation (roller-skating, dancing fox trot)

59

METs class 3

Activity requiring >1 but not >4 METs

Showering, dressing without stopping, stripping, and making bed

Walking at 2.5 mph on level ground

Performing outdoor work (cleaning windows)

Participating in recreation (golfing, bowling)

60

METs class 4

no activity requiring >1met; can't carry out any activities

61

1 met represents an oxygen consumption of

3.5ml/kg/min

(avg for resting 70kg man)

hr of 100bpm=4mets

62

when should smokers stop smoking before a procedure

6w

63

procedure related risk factors for postop pulm compl

surgical site (thoracic, upper abd), duration (3-4hr), anesthesia technique (general, spinal, and epidural)

64

periop mc cause of AKI is secondary to

acute tubular necrosis

65

goal in periop manage of pts w CKD or AKI

maintenance of euvolemia and renal perfusion

66

serum potassium levels should be blank before surgery

67

someone on ACE and angiotensin 2 for CKD should stop them when

10hrs before general anesthesia to reduce risk of post induction hypotension

68

what are essential records for postop CKD pts

daily weights and I&Os

69

what anesthetic is used for pt in renal failure

cisatracurium

70

when should pt be dialyzed before surgery

within 24hr of surgery

71

periop management of pts w diabetes

1. Insulin is available in several types and is typically classified by its length of action. Rapid-acting and short-acting insulin preparations are usually withheld when the patient stops oral intake usually at midnight the day before surgery. Intermediate-acting and long-acting insulin preparations are administered two-thirds the normal evening dose the night before surgery and half the normal morning dose the morning of surgery. Long-acting oral agents are stopped 48 to 72 hours before surgery, while short-acting agents can be withheld the night before or the day of surgery.

2. The ideal method of providing insulin in the perioperative period is debatable. Any regimen should however (1) maintain adequate glycemic control to avoid hyperglycemia or hypoglycemia; (2) prevent metabolic disturbances; (3) be easy to understand and administer. The patient should receive a continuous infusion of 5% dextrose to provide 10 g glucose/hour. Fingerstick glucose levels are monitored intraoperatively and followed postoperatively at least every 6 hours. The goal is to maintain a glucose level of between 120 and 180 mg/dL. It is generally considered preferable to have the patient at the higher end of this range because of the adverse consequences of hypoglycemia. Sliding scale use of subcutaneous insulin has been the standard method of glucose control in surgical patients. Alternatively, intravenous insulin can be used with a continuous infusion of 1 to 3 units/hour of intravenous insulin being given. This approach is particularly helpful in the brittle diabetic. In the postoperative period, close attention should be paid not only to the patient’s blood sugar, but also to the patient’s carbohydrate intake.

3. Diabetic ketoacidosis (DKA) can develop in patients with either type I or type II diabetes. DKA is deceptively easy to overlook because it can mimic postoperative ileus. It may present as nausea, vomiting, and abdominal distension, or in association with polyuria (which is commonly mistaken for mobilization of intraoperative fluids). For this reason, patients with type I diabetes (and many with type II diabetes) should have their urinary ketone level monitored by dipstick. This method is faster and much less costly than following serum ketone levels, and it gives a fairly accurate picture of developing ketoacidosis. A glucose level that is

72

postop malignant hyperthermia

disruption of intracellular calcium metabolism= build up

73

s/sx of postop malignant hyperthermia

violent and sustained muscle contraction and rigidity, heat production, and acidosis; (tachycardia, cyanosis, muscle rigidity)**;+/- muscle necrosis and rhabdo

74

first sign of postop malignant hyperthermia

abrupt rise in end tidal carbon dioxide

75

tx postop malignant hyperthermia

dantrolene (muscle relaxant that blocks calcium release) in rapid IV push in doses of 1mg/kg (max dose of 10mg/kg)

76

A 52-year-old man is in the clinic to discuss treatment of a newly diagnosed pancreatic cancer. He has no significant past medical history. He takes no medications. There is no evidence of metastatic disease, and the tumor is small and appears to be resectable by pancreaticoduodenectomy (Whipple procedure). Optimal treatment would also include adjuvant radiation therapy and chemotherapy. Informed consent for this patient is best defined as

A. a form that can be used as a legal defense should a complication occur during the treatment of the patient’s problem.

B. a process in which the physician and patient discuss the risks and benefits of different approaches to the patient’s problem.

C. a process in which every possible complication of treatment is enumerated.

D. a theoretical construct with little practical utility.

E. a philosophical principle that applies to surgical procedures but not medication administration. (Lawrence 31)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

Answer: B

Informed consent is a process in which the physician and patient discuss the risks and benefits of different approaches to the patient’s problem. This includes discussion of the most likely outcomes of treatment (including the decision to observe rather than operate). Informed consent permeates most of the discussions physicians have with their patients, although the discussions may not be labeled as such. It applies to medication choices as much as to surgical decision making, although a separate consent form is generally not obtained each time a new medication is prescribed. (Lawrence 32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

77

A 60-year-old woman is being evaluated for surgery to repair an abdominal aortic aneurysm under general anesthesia. She smoked a pack of cigarettes daily for 35 years, but quit 5 years ago when she had a myocardial infarction (Ml) complicated by congestive heart failure. She still has occasional orthopnea. She also has hypercholesterolemia and hypertension. Which one of the following factors suggests the greatest risk for a cardiac complication following her surgery?

A. History of cigarette smoking

B. Congestive heart failure with orthopnea

C. General anesthesia

D. Hypertension

E. Hypercholesterolemia (Lawrence 31)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

Answer: B

General anesthesia does not itself increase risk of cardiac complications. The factors that do increase such risk include ischemic heart disease, congestive heart failure, chronic kidney disease, cerebrovascular disease, or high-risk operations such as major vascular surgery. (Lawrence 32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

78

A 45-year-old man with a 25-year history of hepatitis C and cirrhosis is found to have a small hepatocellular carcinoma of the right lobe of the liver. In order to assess his risk for surgical therapy, an estimate of liver dysfunction given by the model for end stage liver disease (MELD) score is needed. Which one of the following laboratory studies is needed to calculate a MELD score for this patient?

A. Alkaline phosphatase

B. Serum creatinine

C. Serum ammonia

D. Serum albumin

E. Serum gamma glutamyl transpeptidase (γGT) (Lawrence 31)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

Answer: B

The MELD score formula is (0.957 × ln(Serum Creatinine) + 0.378 × ln(Serum Bilirubin) +1.120 × In(INR) + 0.643) × 10 (if hemodialysis, value for creatinine is automatically set to 4). Albumin is a component of the Childs-Pugh classification, but not the MELD score. Alkaline phosphatase is useful in determining biliary tract obstruction. Gamma GT is very sensitive for hepatobiliary disease and is best used to determine if an isolated elevation of alkaline phosphatase is due to liver rather than bone disease. (Lawrence 32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

79

Which of the following patients is at the lowest risk for postoperative deep vein thrombosis?

A. An 18-year-old male with femur and lumbar fractures

B. A 55-year-old morbidly obese female undergoing total knee replacement

C. A 62-year-old man undergoing prostatectomy for cancer

D. A 45-year-old woman undergoing hysterectomy and bilateral salpingo-oophorectomy and debulking for ovarian carcinoma

E. A 38-year-old woman undergoing carpal tunnel release (Lawrence 31)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

Answer: E

Patients who are immobile, who have congestive heart failure or malignancy, who undergo pelvic or joint replacement operations, or who have vertebral, pelvic, or long bone fractures are at highest risk. Carpal tunnel release does not confer increased risk of deep vein thrombosis. (Lawrence 32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

80

A 28-year-old man is undergoing an operation for right inguinal hernia. The anesthesiologist notices that his end-tidal CO2 value rises abruptly, and the patient’s jaw is stiff. The patient’s temperature is 41 °C, his heart rate is 130 beats/minute, and his blood pressure (BP) is 130/75 mm Hg. Which of the following abnormalities would be expected if a sample of his blood were tested at this point in the operation?

A. Hyperkalemia

B. Hypocalcemia

C. Alkalosis

D. Anemia

E. Hypoalbuminemia (Lawrence 31-32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

Answer: A

This is a classic description of malignant hyperthermia. The typical electrolyte picture is that of rhabdomyolysis, with hyperkalemia, hypercalcemia, and acidosis. Malignant hyperthermia is not known to affect red cell mass or albumin levels. The patient should be given 100% oxygen, the operation should be stopped and the wound closed, and dantrolene should be administered. (Lawrence 32)

Lawrence. Essentials of General Surgery, 5th Edition. Lippincott Williams & Wilkins, 09/2012. VitalBook file.

81

when should preop PT/PTT/INR be ordered

hx bleeding disorders, PT: myeloproliferative ds, splenomegaly, PTT: anticoag meds

82

when should preop electrolytes be ordered

hx renal insuff, chf, diuretics, meds that may influence elec

83

when should preop renal function tests be ordered

age 50, hx htn/cardiac ds/meds alt renal funct

84

when should preop glucose tests be ordered

hx diabetes, obesity

85

when should preop ekg be ordered

cardiac hx, >40yo

86

when should preop car be ordered

pulm hx, age >50

87

when should consults be done

prior to surgery

88

ASA classification

1 (normal healthy pt), 2 (pt mild systemic ds), 3 (severe systemic ds), 4 (severe systemic constant threat to life), 5 (not expected to survive without surgery), 6 (declared brain dead; harvest organs)

89

global risk assessment predicts clinical outcome for

surgery and anesthesia

90

what is ASA based on

severity of pt co morbidities

91

complications of anesthesia

corneal abrasions/dental injury, spinal/epidural hematoma, vascular catheter injury, positioning injury, infection, awareness, local anesthetic toxicity, aspiration

92

pulmonary complications

atelectasis, pulmonary infx, prolonged mechanical ventilation, respiratory failure, chronic lung ds exacerbation, bronchospasm

93

pt related risk factors for pulmonary complications

age, ASA class, smoking (modifiable, quit 1m before), obesity, impaired sensorium, functionally dependent, chronic lung ds, sleep apnea, chf

94

why is smoking a pulmonary complication risk

damages the cilia in trachea and bronchioles so prevents clearance of fluids which accumulate during anesthesia, putting pts at risk for atelectasis and pneumonia; causes vasoconstriction in heart and periphery which inc chances of MI and problems w wound healing

95

which surgical site is highest risk for pulmonary complication

open aortic surgery*

(thoracic, upper abd, neurosurgery, head/neck, vascular)

96

Goldman cardiac risk index

High risk surgery, hx of ischemic heart ds (hx mi, hx pos stress test,angina,using NTG, pathological q), hx chf, hx cerebrovasc ds, dm tx w insulin, serum Cr >2




0=1
1=2
2=3
>3=4

97

1met

3.5mL O2 uptake/kg per min

98

Mets as cardiovascular risk

13= good survival prognosis

99

Grading of mets w completing activity without stopping

1= sit upright
2=eat,dress,use toilet, make bed
3= walk around the house, take a shower
4=1 flight of stairs, 2blocks, golf, bowl
5=2 flights, walk on flat, sex
6=scrub floors, lift furniture, weight lift
7=good sex (break the bed neighbors call the cops)
8=shovel snow
9= swing dance
10= singles tennis, basketball, soccer
>12= competitive sports

100

Edmonton frailty scale

Cognition:clock drawing (0=no errors 1=minor spacing 2=other errors)

Meds:5 or more or forgot to take (0=no 1=yes)

General health status:#admissions (0=0 1=1/2 2=>2

Functional independence:require help (0=0/1 1=2-4 2=5-8)

Social support: 0=always 1=sometimes 2= never

Functional performance:get up and go (0=0-10sec 1=11-20sec 2=>20sec or needs assist)

101

when should aspirin be stopped prior to surgery

7 days; irreversible platelet effect

102

when to stop warfarin prior to surgery

5 days

103

when to stop heparin IV/SC prior to surgery

6hr

104

when to stop LMWH prior to surgery

12-24hr

105

when to stop dabigatran before surgery

3-4d

106

when to stop rivaroxaban before surgery

2-3d

107

when to stop apixaban before surgery

1-2d

108

CHADS2

chf, htn, age 75, dm, previous stroke or transient ischemic attack

109

manage of DM day of surgery

blood glucose morning of, oral meds withheld, 1/2 dose insulin morning of

110

risk of surgery for hypothyroid

subject to hypotension, shock, hypothermia during surgery, may have hypoventilation post op

111

risk of surgery for hyperthyroid

thyrotoxicosis (thyroid storm); can give propylthiouracil (PTU)

112

tx of adrenal insuff before surgery

stress dose steroids for procedure (usually 100mg IV prior and 50-100mg every 6hr during surgery); then taper over several days after surgery

113

general anesthesia

pt in controlled coma w anesthetic, muscle relaxant, and analgesic medications

114

mc cause of anesthetic morbidity and mortality is

failure to secure the airway;

second mc is nerve damage from malpositioning during surgery

115

spinal anesthesia

good for lower ext; less stress on cardiac system and few pulmonary complications; but unable to redose if procedure goes long; headache, hypotension

116

epidural anesthesia

extradural injection of anesthetic; similar to spinal but can leave catheter in and redose; mc used in child birth and for long term pain relief

117

regional anesthesia

nerve block (axillary, scalene, femoral, ankle block); low risk complications; takes 30-40min to set up; time limited, no cardiopulm problems

118

local anesthesia

safe, small area affected;may be combined w conscious sedation for patient comfort

lidocaine (45-60m)
bupivacaine (3-5hr)

119

normal hemoglobin and hematocrit

hemoglobin (12-14)
hematocrit (40-50%)

120

one unit of blood is how much and will raise hgb and hct by how much

about 300-350mL; raise hgb by 1g/dl; hct by 3%

121

type and screen

pt's blood is typed and screened for antibodies; doesn't assign unit but takes more time to process prior to transfusion

122

type and cross

pt's blood is matched to specific donor unit; quick but assigns unit so if don't use need to discard

123

universal donor blood type

o neg

124

platelet levels

normal (100,000);

125

a normal pack of platelets contains for many donor units

5-6; 1 pack will raise platelet count 10,000

126

fresh frozen plasma

clotting factors/albumin/fibrinogen;

used in coagulopathies when there is active bleeding

127

cryoprecipitate

replaces fibrinogen; von willebrand factor

128

autologous donation

pt donates own blood to be given back during or after surgery, blood production, esp for pt w cancer

129

blood conservation surgery

techniques for rapid surgery also stimulates blood production

130

cell saver

suction machine connected to vacuum, then spins and washes blood to be re transfused

131

re transufusion drains

suction drains preserve sterility and allow re transfusion of drainage