Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

EMED Final > Role of the Surgical PA > Flashcards

Role of the Surgical PA Flashcards

(77 cards)

Start Studying
1
Q

Who are the different members of the surgical team?

A 
Surgeon
Anesthesia (Anesthesiologist, CRNA)
PA/First Assist
Residents/Med students
Nursing (Preop, Scrub Nurse, Circulator, Monitor, Recovery)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When assessing a patient’s hydration status preoperatively, who are we most concerned about?

A

Elderly and chemo patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Do you need to d/c ASA, NSAIDs, Plavix, and warfarin 3-5 days prior to surgery?

A

Possibly

Depends on the type of procedure (IR May WANT them on these)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What should the pre-op H&P include?

A

Age, overall health, and specific risk factors
Hydration status
Review meds and allergies
Review prior surgical and anesthesia history
SHx: TOB, EtOH, illicit drugs
Elective v. Emergency procedure
Document discussion of risks/benefits (ie blood loss)
ID potential problems early
ID need for specialty consult (ie Pulm, Cardio, Heme, Endocrine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is SCIP?

A

Surgical Care Improvement Project protocol

Adopted and enforced by The Joint Commission to improve patient care and prevent avoidable deaths

Adopted in response to 77% of deaths related to infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Classification system used by anesthesia providers to indicate overall preoperative health and predict operative risk

A

ASA classifications

On a scale of I-VI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe ASA I Patients

A

Healthy with no known comorbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe ASA II Patients

A

Patients with mild systemic disease (ie well controlled HTN, DM)

Smokers

BMI 30+

Pregnant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe ASA III Patients

A

Severe systemic disease (ESRD on dialysis, poorly controlled HTN/DM)

Substance abuse

Moderate CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe ASA IV Patients

A

Systemic disease that is a constant threat to life (ie recent MI, CVA, TIA, stents, severe CHF, active CAD, ESRD not on dialysis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe ASA V Patients

A

Moribund patient who is not expected to survive w/o the operation

Ruptured TAAA, ruptured AAA, massive trauma, ICH with MLS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe ASA VI Patients

A

Organ harvest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Scoring system for determining ease of intubation

A

Mallampati Score

Class I-IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name the Mallampati Score:

Complete visualization of the soft palate

A

Class I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name the Mallampati Score:

Complete visualization of the uvula

A

Class II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name the Mallampati Score:

Visualization of only the base of the uvula

A

Class III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name the Mallampati Score:

Soft palate is not visible at all

A

Class IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What pre-op studies would you order for an otherwise healthy patient?

A

CBC

Electrolytes (BUN/Cr if potential renal concerns)

No need for LFTs

PT/INR

U/A

Pregnancy test

CXR if >50 or Hx of CV/pulm disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Who gets an ECG prior to surgery?

A

Men >45

Women >55

Known Hx of cardiac dz

Hx of diuretic use

Hx of DM or HTN

Major surgical procedure planned

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the risk factors for pulmonary complications?

A

Smoking (including vaping) - 2-6x increased risk

COPD/Asthma

Thoracic and upper abdominal procedures

Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When should smokers ideally quit prior to surgery?

A

2 months (8 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What pre-op assessments do you want to do on patients at risk for pulmonary complications (smokers, COPD, obesity, etc)?

A

H&P

CXR

PFTs

ABGs

Pulmonary consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Patients with these things in their prior history are at higher risk of peri-operative MI

A 
HTN
MI***
CHF
Dysrhythmias
Valvular heart disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

A patient who recently had an MI should postpone elective surgery until…

A

> 6 months post-MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What patient history items can clue you in to potential coagulation abnormalities?
Use of NSAIDs vs. anti-coagulants Hx of Abnormal bleeding (easy bruising, frequent epistaxis, increased bleeding w/ dental or surgical procedures) Chronic liver disease Chronic EtOH (+) FH of bleeding disorders If indicated, check PT, PTT, CBC w/ platelets Check with hematologist regarding special precautions
26
What do you need to add to your pre-op assessment for diabetic patients?
Average glucose levels (HbA1C) - elevations in glucose and A1C levels pre-op are associated with increased risk of post-op infections ECG Meds: • Hold any oral meds in the morning • Insulin regimens should be adjusted as needed due to above
27
What are the biggest post-op risks for DM patients?
Hypo or hyperglycemia | Infections
28
What special post-op care do you need for a patient with DM?
Follow BS q6h - maintain between 150-200 Cover BS with sliding scale, allowing for dosing of insulin based on BS levels • “If BS 201-250, give X units insulin” • Parameters to call physician (ie BS <70 or >450) May restart regular insulin and/or oral agents when patient has resumed eating
29
How do you prevent adrenal insufficiency in patients with metabolic risk factors?
Cover with additional steroids peri-operatively Pre-op: 100mg hydrocortisone Post-op: 100mg/day tapered over ~5 days
30
How do you adjust peri-operative care for patients with renal disease?
Need strict attention to fluids Watch electrolytes (esp K+) Adjust meds that are excreted by the kidneys
31
What is consent?
Outlines procedure and potential complications of the procedure Imperative that the patient is “consentalbe” • May require MPA for signature • In trauma, done regardless if question of survival
32
What does -otomy mean?
Incision into Ex: Thoracotomy, craniotomy, laparotomy
33
What does -ectomy mean?
Removal of Ex: Laryngectomy, cholecystectomy
34
What does -ostomy mean?
Creation of a new opening Ex: Tracheostomy, colostomy, gastrostomy
35
What does -plasty mean?
Surgical repair Ex: Palatoplasty, septoplasty
36
What does -pexy mean?
Fixation Ex: Orchiopexy
37
What does -rrhaphy mean?
Suturing Ex: Herniorrhaphy
38
What is the name for an incision into the thorax between two ribs?
Thoracotomy
39
What is the name for the oblique incision running form the epigastric area to the RLQ?
McBurney Not used so much anymore since a lot of the surgeries in this area are now done laparoscopically
40
Position most commonly used for general surgery (cholecystectomy, colon resection, hernia repair, etc)
Supine Don’t forget to put the patient’s seat belt on!
41
Patient position that increases exposure to pelvic organs Also used when placing central lines (to reduce risk of air embolus)
Trendelenburg
42
Patient position that enhances exposure to upper abdominal viscera (ie diaphragm, liver)
Reverse Trendelenburg
43
What types of surgeries are done with the patient in the sitting position?
Craniotomies (esp posterior fossa) Cervical spinal surgery
44
What patient position is used for urologic procedures, gynecological procedures, and rectal surgeries?
Lithotomy
45
What patient position is used for most spinal surgeries?
Prone position
46
What patient position is used for thoracotomies, nephrectomies, retroperitoneal approaches?
Lateral position
47
General surgery covers ______ to _______
Diaphragm to pelvis ``` Includes: Gastric dz Biliary dz Pancreatic dz Liver dz Bowel dz Breast dz Thyroid dz Trauma ```
48
Why do you have to pay close attention to ABGs with patients who have undergone laparoscopic procedures?
B/c CO2 is used to inflate the abdomen for visualization
49
Which gas is used for laparoscopy and why?
CO2 Better solubility in blood
50
Why do patients frequently get post-op shoulder pain with laparoscopic procedures?
Referred pain from CO2 on diaphragm and diaphragmatic stretch
51
Advantages of laparoscopy
``` Shorter hospitalization Less pain Less scarring Lower cost Decreased ileus ```
52
Tips for “driving” the camera in laparoscopy
Keep action centered Watch all trocars enter the peritoneal cavity Watch all instrument as they come through the trocars Keep camera oriented (ie up and down) FRED (fog reduction elimination device) for the lens, or use liver or peritoneum Don’t let camera lens come into contact with the bowel Watch the trocars being removed to check for bleeding
53
What can help maintain visibility with the camera during laparoscopic procedures?
FRED (fog reduction elimination device) Use liver or peritoneum to de-fog DON’T use the bowel
54
How often should wounds be checked post-op?
Every day
55
How often should vitals and I&Os be reviewed post-op?
I&O q4-6h POD1 If fever POD 3-5, r/o infection (CBC, UA, CXR)
56
Why do we want to encourage early ambulation post op?
To reduce risk of blood clots
57
Post-op fever immediately (within hours) is usually due to ...
Medications Blood products ***Malignant hyperthermia***
58
Acute post-op fevers (within the first week) are usually due to...
Nosocomial infections UTI Aspiration PNA
59
Subacute post-op fevers (1-4 weeks later) are usually due to ...
Surgical site infection Infection from central venous catheters Abx associated diarrhea (ie C. diff)
60
Delayed post-op fevers (>1 month later) are usually due to ...
Infection abscess - get a CT!
61
What you need to know about prepping a patient ...
Pressure points to avoid (esp with injury to extremities Prevent cross-contamination Prevent infection Check for allergies to preps Shave? ALWAYS prep above and below surgical site
62
What are the different types of pickups to be familiar with and what are they used for?
Adson - grasping skin or tissue/vessels Adson with teeth - for suturing/skin Debakey - for grasping tissue or vessels
63
What are the different types of retractors we should know and what are they used for?
Army Navy - smaller areas Deaver - for abdomen/thorax Weitlander - for carotid or other artery
64
Straight mayo scissors are used for...
Cutting sutures only
65
Curved mayo scissors are used for...
Dissection and cutting tissue
66
What are the different types of clamp?
``` Straight crile Curved crile Kelly Snap Mosquito ``` Used for holding tissue, holding suture, dissection, and occluding vessels
67
What size sutures are used on the abdominal muscle and fascia?
1.0-2.0
68
What size sutures are used on skin closure but not the face?
3.0-4.0
69
What size suture is used on the face?
5.0-6.0
70
What size suture is used for vessels (microsurgery) and anastamoses?
>7.0
71
When are absorbable sutures used?
On muscle Sub Q When removal would be traumatic
72
What types of suture are absorbable?
Vicryl and monocryl
73
Non-absorbable sutures are used on...
Fascia, Rectus muscle, Vessels, Skin
74
Examples of non-absorbable suture material
Prolene, Silk, Nylon
75
What type of suture are available as braided?
Silk and Vicryl
76
What are the pros/cons of braided sutures?
Pros: Good tensile strength Less apt to tear Cons: Risk of infection (unless coated)
77
What types of suture are non-braided?
Prolene, monocryl Reduces risk of infection, good tensile strength, can expand with tissue swelling but can also tear tissue

EMED Final (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions