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Surgery > Response to injury, fluid and hydration; Surgical Metabolism, Hemostasis, Wound Healing > Flashcards

Response to injury, fluid and hydration; Surgical Metabolism, Hemostasis, Wound Healing Flashcards

1
Q

What is the normal value for anion gap

A

10-12mmol/L or meq/L

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2
Q

What are the causes of high anion gap metabolic acidosis

A 
"MUDPILES"
Methanol
Uremia(renal failure)
Diabetic ketoacidosis
Propylene glycol, Paraldehyde
Infection, Iron, Isoniazid
Lactic acidosis
Ethylene glycol
 Salicylates
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3
Q

What are the causes of normal anion gap metabolic acidosis

A 
"HARD UP"
Hyperalimentation
Acetazolamide
(Carbonic anhydrase inhibitor)
Renal tubular acidosis
Diarrhea
Ureteroenteric fistula
Pancreaticoduodenal fistula
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4
Q

What method is use for maintenance Fluid requirements?

A

HOLLIDAY-SEGAR METHOD

in which first 10kg x100
next 11-20kg x 50
then each kg >20 x 20
(For elderly patients or
patients with cardiac disease,
this amount is
reduced to 15 mL/kg/d)
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5
Q

Difference between WHO criteria and Asian Criteria in BMI

A

Normal:
18.5-24.9(WHO)
<18.9-22.9(asian)

Obese:
>30(WHO)
>25(asian)

Obese type 2: >30 (asiam)

Obese type 3:>40(WHO

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6
Q

what formula is use to measure Ideal body weight

A

modified Broca’s Formula

Men: 110lbs(50kg) for first 5 feet then add 5 lbs(2.3kg) for each additionl inch

Women:100lbs (45kg) for first 5 feet then add 5 lbs(2.3kg) for each additionl inch

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7
Q

Normal value of serum albumin

A

3.5-5.2 mg/dl

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8
Q

absolute lymphocyte count formula and values

A

WBC x % of lymphocyte

Normal value: >2000

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9
Q

It represents the minimum

caloric requirements of the resting, unstressed patient.

A

Basal Energy Expenditure (BEE)

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10
Q

Calculation performed to determine Basal energy expenditure and its components

A

Harris Benedict Equation

W = actual weight in Kg
§ H = actual height in cm
§ A = age in years

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11
Q

What is the estimated protein maintenance requirements for nonstressed
patients

A

0.8-1 g/kg/day

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12
Q

In a patient with prolonged starvation what is the basal caloric requirement to be started

A

15 kcla/kg/day which is half of normal Basal Caloric requirement of 25-30kcal/ kg/day to prevent refeeding syndrome or insulin surge

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13
Q

What is the difference of chronic wound and non healing wound

A

chronic wound:4-6 weeks
non healing wound: >3mos

all non healing wounds are chronic but not all chronic wounds are non healing

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14
Q

most important cell in wound healing

A

macrophage

because it has a phagocytosis effect also a source for various cytokines and growth Factor

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15
Q

Procedure for Class I CLEAN

A 
• Breast surgery (MRM)
• Thyroid surgery
• Inguinal hernia
• Operative incisional wounds that follow nonpenetrating
(blunt) trauma
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16
Q

Procedure for Class II CLEAN CONTAMINATED

A 
Operations involving biliary tract, appendix, vagina,
and oropharynx (provided no evidence of infection
or major break in technique is encountered)
17
Q

Procedure for Class III CONTAMINATED

A

• Operations with major breaks in sterile technique
(e.g. open cardiac massage)
• Incisions in which acute, non-purulent
inflammation is encountered including necrotic
tissue without evidence

18
Q

Procedure for Class IV

DIRTY

A
  • Drainage of abscess
  • Debridement of soft tissue infection
  • Resection of infarcted bowel
19
Q

3 stages of wound healing and its relative cells abundant on that stage

A
  1. Inflammation (day 0-4)- Neutrophils and macrophages
  2. Proliferation(day 4-14) Macrophage, lymphocyte
  3. Maturation(day 8- 16)
20
Q

Normal value of platelet

A

150,000-400,000

Threshold to proceed surgery : at least 50,000

21
Q

Normal value of WBC

A

4,000-12,000

22
Q

Earliest sign of sepsis

A

Tachypnea of >22/min

23
Q

What are the parameters of qSOFA

A
  • RR >22/min (1point)
  • Altered mental status (or GCS <15) (1point)
  • SBP < 100mmHg (1point)
24
Q

What are the parameters of SOFA

A 
Respiration
Coagulation
CNS
Cardiovascular
Renal
Liver
25
Q

In sepsis the initial fluid of choice, amount and target MAP

A

30mL/Kg IV crystalloids in first 3 hours

• Target MAP = > 65mmHg

26
Q

First choice of vasopressor in sepsis

A

Norepinephrine

27
Q

Target glucose in patient with sepsis

A

<18O mg/dL

28
Q

Most often use prophylatic drug in surgery

A

Cefazolin

29
Q

Which class of wound does need Pre op prophylaxis?

A

Class 2-4 except cases of low risk laparoscopic biliary tract procedure

30
Q

Which class of wound doesn’t need Pre op prophylaxis?

A

Class 1 except class1D which is clean wound with device

31
Q

Preoperative glycemic control target level to prevent SSI

A

<200mg/dl with or without DM

Surgery (4 decks)

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