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Core conditions Olivia MD > Surgery > Flashcards

Flashcards in Surgery Deck (14):
1

how do you tell an ETT is properly placed? (looking for an imaging ans)

needs to sit 3-4cm above the carina.

2

How to tell if muscle is dead?

Whether it bleeds or whether it contracts

3

what do you do if the HbA1c of a patient about to undergo elective surgery comes back 9% or greater?

you defer the elective surgery and refer to endocrinologist

4

why might glucose levels need to be monitored acutely for diabetic individuals going for surgery?

hyperglycaemia can delay wound healing and predispose wound infection

hyperglycaemia can cause a diuresis leading to dehydration

5

what is the target BSL range for diabetic patients about to go into surgery. what do you do if it is too high?

6.1-10

If greater than 10, then give short acting insulin with fluids

6

some types of internal hernias?

• Hiatus hernia
• Congenital diaphragmatic hernias
• Traumatic diaphragmatic hernia
• Para-duodenal hernias
ADHESIONS FROM PREVIOUS ABDOMINAL SURGERY

7

tell me about femoral hernias

• Found in elderly women
• Very rare. More rare than inguinal hernias
• Enclosed within the femoral sheath which is quite tight so ALWAYS leads to incarceration and strangulation!!

8

where is a spigellian hernia?

semilunaris, below the arcuate line

9

what are some contributions to poor wound healing for an incisional hernia?

diabetes, immunosuppressive drugs like methotrexate and steroids, obesity

10

what can cause post operation confusion?

• Sepsis
• Hypoxia
• Drug withdrawal- particularly alcohol!!
• Metabolic and electrolyte disturbance
Medications (opiates/sedatives)

11

what drugs usually go into PCA

morphine or fentanyl

decision of which drug depends on anaesthetist and the half life. Fentanyl is much quicker acting, with a shorter lifespan. It requires frequent dosing as compared to morphine. So may not be appropriate for a very invasive surgery

12

why might we use ketamine instead of morphine for a patient post operation?

they might have OSA and so need to avoid opioid drugs

13

define rehabilitation

it is the process of returning a person to maximal physical, psychological, social and vocational functions

14

what are the things we need to look out for in a diabetic patient preparing for surgery?

- HbA1c level
-Type of medications they are taking
-Complications of diabetes
e.g.
autoneuropathy--> haemodynamic instability
CVD- risk of silent MI
peripheral neuropathy--> record existing neurological deficit in the case of regional anaesthesia