Principles of Surgical Care Flashcards
(46 cards)
Definition of shock
Inadequate peripheral tissue perfusion resulting from lack of oxygen and nutrient supply to the cells
4 stages of shock
- initial
- compensatory
- progressive
- refractory
Types of shock
- hypovolaemic
- cardiogenic
- distributive (Septic, anaphylactic, neurogenic)
- obstructive (cardiac tamponade, PE)
Definition of severe sepsis
Acute organ dysfunction secondary to infection
Definition of septic shock
Severe sepsis and hyptension not reversed with fluid resus
Diagnosis of septic shock
Both criteria met:
- evidence of infection
- refractory hypotension
Plus 2 or more:
- tachypnoea
- HR >90
- WCC <4000 or >12000
- T <36 or >38
Pathophysiology of septic shock
- usually endotoxin-producing gram negative bacilli
- Free LPS bind to CD14 on monos, macs and neuts
- cytokine release causes systemic vasodilatation and decreases cardiac contractility
Treatment of septic shock (OVERS)
- oxygen admin and airway support
- volume resus
- early AB admin
- rapid source ID and control
- support of major organ dysfunction
Layers of the skin
- epidermis
- dermis
- subcutaneous fat
What is secondary healing?
- edges of full thickness wound are not approximated
- granulation tissue
- contraction
4 phases of wound healing
- haemostasis
- thromboxane and prostaglandin release
- inflammation
- proliferation
- remodelling
Criteria for diagnosis of surgical site infection
- purulent drainage from surgical incision
- organism isoalted from culture of fluid/tissue
- at least one of:
pain/tenderness, localised swelling, redness, heat - systemic findings
- an abscess or other infection of deep layers of the incision/cavity
Surgical wound classification
Class 1 = clean Class 2 = clean-contam Class 3 = contam Class 4 = dirty-infected Class 5 = unclassified
Definition of an acute wound
Healed in 3 weeks and remodelled in 1 year
Definition of chronic wound
Persists beyond 3 months
Characteristics of the ideal dressing
- removes exudates and toxins
- maintains high humidity
- debrides necrotic tissue
- allows for gaseous exchange
- anti-bacterial
- hypoallergenic
- free from particulate matter
- no trauma with removal
- reasonably priced and easily available
Risk factors for pressure sores
- immobilization
- PVD
- CCF
- advanced age
- malnutrition
- cachexia
- obesity
Variables that influence surgical recovery
- patient factors
- precipitating factors
- surgical strategy
- type of anaesthesia
Common surgical respiratory complications
- atelectasis
- pneumonia
Less common surgical respiratory complications
- aspiration
- ARDS
- pneumothorax
- pleural effusion
- PE
When does periop MI usually happen?
3 days post op
Risk factors for periop MI
Patient factors
- AS
- recent MI
- arrythmia
- heart failure
Op factors
- vascular surgery
- surgery >3 hours
Risk factors for surgical haemorrhage
- coagulopathy
- massive transfusion
Cardiovascular complications in surgery
- periop MI
- haemorrhage
- DVT
