Summary of Essentials - Ch. 38-40 (Post-Op)

Question 1

Cause of surgical bleeds?

Answer 1

Inadequate hemostasis

Question 2

Risk factors for coagulopathy?

Answer 2

Copious IV fluids or transfusions, hypothermia, metabolic acidosis, liver or kidney disease, DIC, family history of bleeding, anticoagulant medications

Question 3

Work-up of post-operative bleeding?

Answer 3

Clinical history (most important)
INR; PTT
Liver/kidney dysfunction

Question 4

Warfarin is monitored with ___. Heparin is monitored with ___.

Answer 4

INR; PTT

Question 5

Rx uremic coagulopathy?

Answer 5

Desmopressin (acutely)

Hemodialysis (more definitively)

Question 6

Rx hepatic coagulopathy?

Answer 6

FFP

Question 7

Reverse heparin?

Answer 7

Protamine

Question 8

Reverse warfarin?

Answer 8

FFP

Question 9

Rx TRALI?

Answer 9

IV fluids, vasopressors, respiratory support

Question 10

Earliest sign of AKI?

Answer 10

Oliguria

Question 11

Define oliguria

Answer 11

<0.5 mL/kg/hr for 2 consecutive hours

Question 12

Define anuria

Answer 12

<50 mL-100 mL/day

Question 13

Define contrast-induced AKI?

Answer 13

Increase in serum Cr of 0.5 mg/dL within 48-72 hours

Question 14

Work-up of post-operative decreased urine output?

Answer 14

BUN and creatinine (best initial test)

May get UA, urine sodium, FENA, urine osms
U/S to assess for obstructive pathology

Question 15

Management of decreased urine output?

Answer 15

Flush Foley, stop nephrotoxic drugs, fluid challenge

Question 16

Indications for urgent/emergent dialysis?

Answer 16

Acidosis
Electrolyte imbalance (hyperkalemia)
Intoxication (ethylene glycol)
Overload
Uremia

Question 17

Presentation - sudden onset of dyspnea, pleuritic chest pain, and/or tachycardia

Answer 17

PE

Question 18

Wells Criteria for PE?

Answer 18

+3 clinical signs and symptoms of DVT
+3 if PE #1 diagnosis or equally likely
+1.5 if HR >100
+1.5 if immobilization at least 3 days or surgery in the previous 4 weeks
+1.5 if hx PE or DVT
+1 if hemoptysis
+1 if malignancy w/treatment within 6 months or palliatve

Question 19

Diagnose PE?

Answer 19

If high suspicion - start heparin immediately + CT angio
If CT angio non-diagnostic -> V/Q scanning
D-dimer, BNP, troponin labs
Echo to assess for R heart strain
EKG will show sinus tachycardia most commonly

Question 20

Manage PE?

Answer 20

IV heparin or subQ LMWH

Question 21

Manage submassive PE?

Answer 21

Consider tPA

Question 22

Manage massive PE?

Answer 22

tPA vs. pulmonary embolectomy

Question 23

When is an IVC filter indicated?

Answer 23

Only if there is a contraindication to anticoagluation?

Question 24

Rx VTE with malignancy?

Answer 24

LMWH

Question 25

Rx VTE in pregnancy?

Answer 25

NOT warfarin

Question 26

Rx VTE with HIT?

Answer 26

Direct thrombin inhibitors