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Flashcards in Surgery Deck (58)
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1

Which surgery patients may not need pre op assessment

Some local anaesthetic surgeries

2

Who carries out initial surgery assessment

Sp nurse or junior then secondary assessment by anaesthetist

3

Purpose of pre op assessment

Identify risks
Modify the risks
Give advice on fasting and medications for example
Make decisions on post op care

4

When does pre op occur

2-4 weeks

5

Pre op history taken

Find out what surgery
Find PMH in full
Had surgery or anaesthetics in past? Any problems or reactions
Systems review- mainly resp, cardiac, renal, endo
Medication on at the moment
Allergies
Social history- stop smoking
Family history of anaesthetic issues such as malignant hyperpyrexia, myasthenia gravis

6

What is malignant hyperpyrexia

Very feverish in response to some anaesthetics

7

What is ASA score

American society of anaesthesia score

8

How is ASA ranked

1 to 4
1 healthy
2 minor systemic disease
3 severe systemic disease
4 severe systemic disease with constant threat to life

9

What are categories of surgery

Minor
Intermediate
Major surgery
Major plus

10

What things are you going to look for in initial assessment examination

Obs
Airway
CV
Resp
Abdo

11

What do you do in an airway assessment

Check neck flexion and extension- can touch chin on chest and tilt head all the way back without pain or stiffness
Mouth opening- how far?
Mallampati
Jaw protrusion- can get back teeth in front of front ones

12

What is mallampati grading

Ask patient to open mouth and see what structures are visible

13

What special tests are needed depends on what

Category of surgery
Then what you pick up in your assessment

14

What special reactive tests must be carried out

If taking specific medication for something must check function of that test eg warfarin check PT
Ask if pregnant
SCD if Fx

15

What medications must be stopped pre surgery

Blood thinners depending on surgical bleeding risk
Diabetic meds depending on the surgical severity
Antihypertensives- ACEi must be stopped due to anaesthetic instability

16

What does when to stop medication depend on

The half life of the drug for example clopidgorel binds to plt for whole life so must wait for them to be replaced

17

How long do patients fast for

12 hours

18

What does it mean when you say acutely unwell surgery patient

Sudden onset
Deranged physiology
Unstable
Shock

19

Define shock

Life threatening condition where circulation fails to adequately supply tissue with oxygen to meet its demands

20

4 types of shock

Hypovolaemia
- hameorrhage
- dehydration
Distributive
- sepsis
Cardiogenic
- arrythmia
- pump failure
Obstructive
- tamponade
- pneumothorax

21

What is neurogenic shock

Neurological dysfunction of nerves supplying vasculature causing excess parasym supply

22

Where do you deal with patients acutely unwell

New patient in ED
Post op

23

Causes of patient becoming acutely unwell

Inflammation- any itis
Infection
Perforation- oesophagus, stomach, colon etc any organ
Trauma
Ischaemia- limb, colonic, small bowel
Obstruction- bowels or renal tract
Haemorrhage- GI, AAA, trauma

24

What will cause a stable post operative patient to become unwell

Either direct to surgery or indirect general

25

What are direct post operative causes of acutely unwell

Direct
- leakage of a resection of anastamosis
- cholecystectomy can lead to biliary tree stenosis, leak
- AAA repair- ischaemia or haemorrhage
Any bleeding

26

What are indirect post operative causes of acutely unwell

CVS- MI, arrythmia
Respiratory- atelectasis, PE
Renal- ARF
Endocrine- glucose derrangement

27

Managing acutely unwell patient

ACDEFG

28

What to do with airway managing acutely unwell patient

Look, listen and feel
Manoeuvres to open airway and give O2

29

What to do with breathing managing acutely unwell patient

Look listen and feel
Rate, expansion, percussion and breath sounds

30

What to do with circulation managing acutely unwell patient

Feel hands perfusing?
BP
HR
Cap refill