Flashcards in Surgery Deck (14):
how do you tell an ETT is properly placed? (looking for an imaging ans)
needs to sit 3-4cm above the carina.
How to tell if muscle is dead?
Whether it bleeds or whether it contracts
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
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
what is the target BSL range for diabetic patients about to go into surgery. what do you do if it is too high?
If greater than 10, then give short acting insulin with fluids
some types of internal hernias?
• Hiatus hernia
• Congenital diaphragmatic hernias
• Traumatic diaphragmatic hernia
• Para-duodenal hernias
ADHESIONS FROM PREVIOUS ABDOMINAL SURGERY
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!!
where is a spigellian hernia?
semilunaris, below the arcuate line
what are some contributions to poor wound healing for an incisional hernia?
diabetes, immunosuppressive drugs like methotrexate and steroids, obesity
what can cause post operation confusion?
• Drug withdrawal- particularly alcohol!!
• Metabolic and electrolyte disturbance
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
why might we use ketamine instead of morphine for a patient post operation?
they might have OSA and so need to avoid opioid drugs
it is the process of returning a person to maximal physical, psychological, social and vocational functions