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EOR General Surgery > Preoperative / Postoperative (12%) > Flashcards

Preoperative / Postoperative (12%) Flashcards

1
Q

Major cardiac risk factors for surgery

A

Unstable coronary syndrome
Recent MI
Severe valvular disease
Ventricular arrhythmia

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2
Q

Intermediate cardiac risk factors for surgery

A

Asymptomatic MI
DM
Compensated CHF

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3
Q

Minor cardiac risk factors for surgery

A

History of stroke

Uncontrolled HTN

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4
Q

Goldman’s Criteria

A 
High risk surgery?
History of ischemic heart disease?
History of CHF?
History of CVD? (CVA/TIA)
Pre-op insulin treatment?
Serum creatinine > 2 mg/dL?
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5
Q

Based on Goldman’s, > 2 factors generally yield a > ____% risk of Major Adverse Coronary Events

A

5%

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6
Q

Laboratory testing for cardiac dz prior to surgery

A

Resting LV Fxn
Ambulatory EKG monitoring
Exercise stress test
Non-exercise stress testing

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7
Q

Patients with an ejection fraction of < ____% are at greatest risk for complication

A

35%

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8
Q

Beta blockers before surgery can decrease rate of ____, especially in those at intermediate and high risk

A

MI

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9
Q

Who gets pre-operative resting 12 lead EKG testing?

A

Asymptomatic women > 50 y/o or men > 45 y/o

Known cardiac history

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10
Q

Patient’s with a history of rheumatic heart disease require prophylactic antibiotics to prevent ___________

A

Endocarditis

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11
Q

Postoperative _________ complications are the most common form of postoperative morbidity experienced by pts undergoing abdominal procedures and thorarcotomy

A

Pulmonary

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12
Q

Risk factors for development of pulmonary complications from surgery

A 
Upper abdominal or cardiothoracic procedures
Prolonged anesthesia (> 4 hrs)
Age > 60 y/o
Tobacco abuse
COPD/CHF/OSA
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13
Q

All candidates for lung resection should have preoperative ______

A

LFTs

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14
Q

Hormones that increase in the operative period (5), and all of this causes hyperglycemia in the postoperative patient

A 
Catecholamines
Growth hormone
Glucagon
ACTH
Cortisol
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15
Q

Hormone release during surgery leads to decreased _________ _______ and decreased _________ ______, leading to more wound infections

A

Decreased wound healing

Decreased neutrophil function

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16
Q

General rule of diabetic patients going in for surgery:

A

Give 1/2 of the usual dose of injectable insulin the morning of surgery
Give 5 dextrose continuous infusion
Keep BG at 150-200

17
Q

General rule for adrenal insufficient patients going in for surgery:

A

Give IV drip of hydrocortisone at 10 mg/hr

18
Q

Factors that increase risk of infection of surgical wounds

A 
Malnutrition
Advanced age
Immunosuppressive drugs
Prolonged hospitalization
Recent abx
Obesity
19
Q

Necrotizing fasciitis is most commonly caused by:

A

Streptococci

20
Q

Treatment of necrotizing fasciitis

A

Debridement of tissues
ABX: ampicillin/sulbactam + clindamycin + ciprofloxacin
If suspicious of MRSA, give vanco

21
Q

Virchow’s Triad

A
  1. Stasis
  2. Vascular injury
  3. Hypercoagulability
22
Q

Diagnostic studies for DVT

A
  1. Duplex ultrasonography
  2. Doppler analysis
  3. Venography
  4. D-dimer - negative can eliminate
23
Q

Diagnostic modality if pulmonary emboli is suspected

A

VQ scan versus spiral CT

24
Q

Treatment of DVT

A

LMWH
Need heparin until INR is therapeutic for 48 hours
Followed by warfarin - 6 months if initial occurrence or lifelong tx

25
Q

Well’s Criteria

A

Used to determine likelihood of pulmonary embolism
Score of > 6 means highly likely
Score of < 2 makes diagnosis highly unlikely

26
Q

DVT prophylaxis in surgery

A

Heparin 5000 units subcutaneously started 2 hours before the operation and continued every 8-12 hours after surgery until fully ambulatory and discharged
May also give enoxaparin 40 mg qd

27
Q

Intracellular water is _____ total body water and extracellular is ______

A

2/3

1/3

28
Q

Interstitial water is _____% of extracellular water or ____% of body weight

A

75%

15%

29
Q

Intravascular water is ____% of extracellular water or _____% of body weight

A

25%

4-7%

30
Q

In the intracellular compartment, ____ is the dominant cation, followed by _____

A

K+

Mg+

31
Q

In the extracellular compartment, ___ is the dominant cation

A

Sodium

32
Q

During laparotomy, estimated evaporative fluid loss is _____ mL/kg/hr

A

10

33
Q

__________ with accompanying ______ _______ is the most frequent disorder in the preoperative patient

A

Dehydration

Salt loss

34
Q

Fluid administration in the postop patient can prevent ______ _______ and optimize ________ ______

A

Renal failure

Cardiac function

35
Q

Excess fluid may cause ______ and _______ and thus inhibit wound healing

A

CHF

Edema

36
Q

Want to keep urine output > ______ mL/hr

A

30

EOR General Surgery (10 decks)

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