Surgery Didactic Cards Flashcards
(283 cards)
1
Q
Time off of cigarettes’ before surgery
A
8 weeks
2
Q
Family history question to ask before surgery
A
Malignant hyperthermia fam hx
if yes - put first in the day to avoid cross contamination
3
Q
PE to always perform presurgery
A
Airway, Heart, Lungs, Abdomen w/ rectal exam
4
Q
Preoperative testing
A
Screen for asymptomatic disease that may effect result or understanding extent of existing contraindication
5
Q
Diagnostics to consider before surgery
A
Labs -CBC, CMP, PT/INR, HcG
Imaging - U/S, CT, MRI
ECG
Echo
6
Q
When to get a preoperative EKG
Five reasons
A
Known arrhythmia, PVD, Cerebrovascular disease, structural heart disease, high risk surgery
7
Q
When to get a CXR before surgery
A
50+ patient with cardiopulmonary disease undergoing AAA or upper abdominal/thoracic sx
8
Q
How old can previous labs be to use for preoperative assessment
A
4 months if not at risk
9
Q
bHcG for before surgery
A
Premenopausal women - 15-60
10
Q
MET Scale
A
1 MET - Basic ADLs - eating
4 MET - Good prognosis walk up incline or flight of stairs
5-10 METS - Heavy housework
10+ METS - Sports
11
Q
Greatest risk with weight loss for surgery
A
Loss of weight over 10%
12
Q
9 things to assess before surgery
A
Physiologic age - METS
Nutrition
BMI
Immune competence
Wound healing
Hemostasis
Thromboembolism
PFT
Cardiovascular
13
Q
STOP-bang questionairre
A
Assess for risk of sleep apnea
3-4 is intermediate risk
14
Q
ARISCAT
A
Estimates risk of postoperative pulmonary complications
26-44 is intermediate
15
Q
Potential pulmonary complications from surgery
A
Atelectasis
Hypoxia
Pneumonia
Respiratory failure
PE
16
Q
NSQIP stratification
A
Calculator to assess risk of complication from surgery
17
Q
Workup for low risk, good functional capacity pts
A
No workup needed
18
Q
Workup for low cardiac risk patients (ie. hx of afib)
A
EKG
19
Q
Workup for intermediate cardiac risk surgical patients
A
ECG and pertinent labs
20
Q
Workup for high cardiac risk surgical patients
A
EKG, ECHO, Cardiac consult
3+ Intermediate predictors
21
Q
Workup for very high cardiac risk patients
A
1+ Major predictors
Cardiac consult and postpone sx if not emergent
22
Q
Eight Intermediate cardiac risk predictors for surgical patients
A
CAD
Stable angina
Remote MI (more than 6 months)
Compensated CHF
Renal insufficiency
DM
CVD
Obesity
23
Q
5 Major predictors of cardiac risk
A
Recent MI
Unstable angina
Recent PCI
Active CHF
V. Tach or AV block
24
Q
PreAnesthesia assesment
A
For low risk surgeries and patients
Assess airway and comorbidities
ASA I-VI
25
ASA I
Healthy non-smoking, non-alcoholic patient
26
ASA II
Patient with mild systemic disease
30-40BMI
27
ASA III
Patient with severe systemic disease
28
ASA IV
Patient with severe systemic disease that is a constant threat to life
29
ASA V
A moribund patient who is not expected to survive w/o operation
30
ASA VI
A declared brain dead patient whose organs are being harvested
31
Anesthesia airway assessment
I (least occlusion) through IV (worst occlusion)
32
Medical clearances that may be needed prior to surgery
Cardiac, Pulmonary, Medical, Social worker
33
4 elements of informed consent for surgery
Is it necessary
Are there other options
What are the risks and benefits
What are side effects
34
Preoperative instructions for surgery
NPO before midnight before surgery
Provide meds to stop taking including OTC and herbals
List of meds to start
Bowel prep if needed
35
Medications to continue on sx day
Cardio meds - BB, ACE, CCB, Nitrates
Anticonvulsants
Anti-Parkinsons
Lithium
Asthma/COPD drugs
Thyroid meds
BPH meds - Terzosin
GERD meds
36
Seven Medications to take up to the day before surgery
Statins
HCTZ diuretics
SSRIs
Benzos - may need to take day of
Insulin -adjust evening dose (can take half morning dose if BS high and insulin long acting
Metformin
Opioids
37
Meds to stop 5-7 days before sx
Oral anticoagulants (2 days with pradaxa)
NSAIDs
OTC Vitamin E containing
Herbals
38
Goal before sx for diabetics
Tight glycemic control before surgery
Check BS before sx
39
Risks of operating in hyperthyroidism
Thyroid storm
Arrhythmias
Goiter affects airway
40
Risks of operating in hypothyroidism
Myxedema
Shock
Hypothermia
Poor wound healing
41
Meds for hyperthyroidism with surgery
Propylthiouracil 1-6 weeks
BB in emergency
42
Meds for hypothyroidism and sx
Start on levothyroxine - weeks to titrate dose up
43
Preoperative work for adrenal insufficiency
Give cortisol
Admit to hospital 2 days prior
Consult Endocrinology
44
Most common cause of perioperative death
MI
45
Time between angioplasty and surgery
Alone - 2-4 weeks
Metal stent - 4-6 weeks
Drug eluding stent - 1 year
46
Management for MVP or prosthetic valves before surgery
2 g amoxicillin 20-60 mins preop
47
Management of pacemaker of defibrilator prop
Must have been checked in the past 3-6 months
48
Patients at risk for endocarditis d/t surgery
Prosthtic heart valves
Prior endocarditis
Cyanotic congenital heart disease
Cardiac transplant w/ valve disease
49
Preop anxiety tx
Give valium (Versed)
50
Day of surgery checklist
Check in
Vitals and Height/Weight
Preop meds
Assessment - update if within 30 days
Confirm anesthesia
Surgery site marked
51
First sedative given to the patient
Versed - can't make decisions after it is given
52
Anesthesia induction
Preoxygenate
Fentanyl for pretreatment
Propafol, Ketamine, Succinylcholine
53
SE of propafol, ketamine, succinylcholine
Propafol - Injection site pain
Ketamine - Hallucinations
Succinylcholine - CI in fam hx of malignant hyperthermia, myalgia
54
Isoflurane
Inhalation anesthetic for children - put in IV after they are asleep
55
Malignant hyperthermia
Response to anesthetic gasses with succinylcholine
Stiff muscles, Increased oxygen consumption, cyanosis, Acidosis
56
1st signs of malignant hyperthermia
Unexplained tachycardia
Increased end tidal CO2
Temperature above 38.8 C
Masseter rigidity
57
Treatment for malignant hyperthermia
Dantrolene to stop calcium release
Oxygen
Body cooling and fluids
Supportive care
58
Surgery on a patient that has fam hx of malignant hyperthermia
Flush the anesthetic machine before use and put first case of day
Can use a muscle biopsy to diagnose predisposition
59
Anesthesia induction timeline
Prep 10 mins before
Preoxygenation 5 minutes before
Pretreatment 3 minutes before
Paralysis with agent!!
Protection 30 seconds after
ET tube 45 seconds after
Post intubation management 60 seconds after
60
3 techniques for a difficult intubation
Cricoid pressure
Fiberoptic laryngoscope
GlideScope
61
Spinal vs. Epidural block
Spinal goes into the subarachnoid space and is ONLY at L3/L4
Epidural can be anywhere
62
Places where we do not want to inject epinephrine
Fingers, toes, penis
63
Local anesthesia
Lidocaine with epi, bupivacaine
64
Taking care of pt body during surgery
Cover ALL non-operative body parts
Don't LEAN on patient
Add grounding pads (not over metal)
65
Clean wound
Uninfected, no inflammation - no systemic tracts are entered
66
Clean, contaminated wound
Systemic tracts entered but in a controlled way - vaginal, appendix, lung procedures
67
Contaminated wound
Any trauma, open fracture, GI/GU nick during surgery
Aseptic technique
68
Infected wound
Infected, inflamed wound is being operated on
69
3 phases of primary intention
Inflammatory - hemostasis, fibroblast
Proliferative stage - Collagen formed by fibroblasts, tensile strength increases
Remodeling - Year or longer, scar pales
70
Tensile strength of wound timeline
About 10 percent per week, then 80% at 10 weeks
71
Secondary intension
Dead space left inside closed tissue
Leaves a large scar
Must be filled by granulation tissue
Can't close wound
72
Delayed primary intention
Wound is known to be infected
Debrided
May use cause or a wound vac to keep it open
73
Conventional cutting needle
Skin or sternum
Triangular needle with a cutting edge
74
Reverse cutting needle
Preferred over conventional cutting - cut edge faces down during suturing (opposite direct tension of suture thread
Fascia, ligament, oral/nasal cavity, skin tendon sheeth
75
Side cutting spatula
Eye and microsurgery
76
Taper needle
Usually used for anything that ISN'T skin
Round body with pointed tip
Aponeurosis, billiary tract
GI
Muscle, myocardium
Nerve, Peritoneum
77
Blunt needle
Friable tissue, cervix, intestine, kidney, liver, spleen
78
Memory
Ability to retain shape
79
Elasticity
Return to length when stretched
80
Knot strength
Force for a knot to slip
81
Maximal tissue reaction to a suture
Between days 3 and 7
82
Monofilament sutures
PDS, Monocryl, Nylon
Less trauma and friction, Less infection, More slippage - 5-6 knots needed
Better cosmetic result
83
Multifilament suture
Fibers braided
Vicryl or Silk
Easier to handle and tied, less likely for knots to slip
84
Non absorbable sutures
Silk - Natural
Prolene/Ethilon - Synthetic
May be left permanently or removed later
85
Absorbable sutures
Catgut - 7 days
Chromic catgut - 2-3 weeks to loose sterngth , gone in 3 months - collagen
Vicryl - Evokes less tissue reaction than others, synthetic
86
Suture material sizing
0 -Largest
12/0 - Smallest
87
Suture removal for face
3-4 days
88
Scalp suture removal
5 days
89
Trunk suture removal
7 days
90
Limb suture removal
7-10 days
91
Foot suture removal
10-14 days
92
Three phases of postoperative care
Post anesthesia observation - recovery room under anesthesiologist
Intermediate phase - Post op hospitalization
Convalescent phase - Discharge to full recovery
93
Immediate post op period
Monitoring of vital signs, O2, EKG, Fluid, Mental status, fluid I/O, Pain
Watched by anesthesiologist
94
Time to leave on initial sterile dressing post op
48 hours as long as not saturated
Dry it off if it gets wet
95
Drain orders
How often do you want them checked?
What should be looked for
Can take out in 3-5 days once the output decreases
96
Red flags for JP drains
Straight blood
Bile after gallbladder surgery
97
Pulmonary care post op
Should return to baseline in a week
Use an incentive spirometer
Risk of atelectasis - get patient moving
98
Fluid replacement post op
4:2:1 Rule over 24 hours 4L for first 10kg, 2L for next 10kg, 1L for remaining
Lactated ringers or D5, 0.5NS common
99
Patients needing post op blood transfusion
Under 7 in any patient under 8 in those with heart, lung, or cerebrovascular conditions
100
Postoperative pain control
Opioids, PC or IV for first 48 hours, then switch to oral
As little as possible
Give IV for breakthrough at a certain threshold
Toradol also helps with post op pain but can cause bleeding
101
Post op GI care
Listen for bowel sounds - Ileus
May have constipation of need an NG tube
Stool softener
PPI
Should return after 72 hours
102
Surgery DVT prophyklaxis
Lovenox, Heparin, Early ambulation for all long surgeries
103
Immediate postoperative fever
Normal
Pre-existing infection
Thyroid storm
Necrotizing wound infection - EVALUATE
Drug reaction
104
Acute Postopperative fever
1-7 days after
Pneumonia
UTI
Wound infection
DVT-PE
Medications/Blood products
105
Post op fever after several weeks
Anastomosis leak
Infection of central line
106
Presentation of atelectasis post op
Fever, tachypnea, tachycardia, Hypoxemia 48 hrs post-op
107
Tx for post-op atelectasis
Deep breathing, incentive spirometry, coughing
Chest percussion
Bronchoscopy
Chroncodilators
Early mobilization
Incentive spirometry
108
Post op pneumonia
Due to aspiration, atelectasis, lied about being NPO
3-5 days post-op
Fever, tachypnea, cough
109
Tx for post-op pneumonia
Sputum culture and empiric abx treatment
Rocephin, Unasyn, Levo, Ertapenem
110
Abx for post op resistant pneumonia
Zosyn, Cefepime, Imipenem
111
Abx for post op MRSA pneumonia
Vanc, Linezolid
112
Tx for post op pleural effusion
Drain it
113
Tx for post op pneumonthorax
Chest tube to re-expand
Order a post-op CXR to test for it
114
Tx for post op UTI
MC - E. coli
Risk increases with increased catheterization
Urinalysis
Cipro and Rocephin
115
Tx for post op urinary retention
Painful lack of urine output - feel for it and post void residual bladder scan
Cath bladder if greater than 400mL
Put a catheter in after three times of this occurring
116
Indications for cath during surgery
Long surgery or doing procedure near the bladder - don't want to knick
117
Tx for post op hematoma
Small can resorb on own
Big might have to go in and cauterize
Breat joint and thyroid are MC sites
Neck location is more concerning
CT for depth
118
Seroma tx
Compression dressing and aspirate
Exploration for refractory
Usually when lymph channels have been involved
119
Tx for wound dehiscence
MC in abdomen
Increased risk with age
Post op day 5-6
Debride and left heal by secondary intention w/ wound vac potentially
120
Tx for surgical wound infection
MC-Staph aureus
DM, Smoking also risk factors
5-6 days post-op
Culture and abx
121
Prevention of surgical wound infection
Approximate but don't strangulate wound borders
Operative site shaving is a risk factor
122
Post op GI complications
Ileus or obstruction - ladder sign with tense abdomen
KUB scan
123
Tx for post op fecal impaction
Dx with XR
Manual removal and/or suppositories
124
Tx for c diff
Flagyl and Vanc
125
Highest risk surgery for CVA
Carotid endartectomy
126
Fat embolism post op
MC in orthopedic surgery -fat gets into bloodstream 12-72 hours after
Serious complication of embolism in brain
127
8 Discharge criteria for post op patient
Afebrile for 24 hours
Tolerating oral intake
Return to bowel function
Is ambulatory
Controlled with PO meds
Voiding spontaneously
Hemodynamically stable
Safe disposition (somewhere to go)
128
Follow up post op
2 weeks with surgeon
2-4 weeks with PCP
129
Adson forceps
Teeth or no teeth, often used for suturing
130
Adson Brown forcep
For grapping hardier tissue -has a saw toothed edge
131
Debakey Forceps
Vascular Pick up forceps
Used to grasp soft tissue, fascia, vessels
Straight carbon inlay
Can be long
132
Russian tissue forcep
Meatier
Teeth around sides
For heftier tissue
133
Hemostat
Come in curved or straight
Clamp off and burn
134
Mosquito hemostat
Smaller hemostat - have baby mosquito that are even smaller
135
Kelly clamp
Larger, stronger hemostat
136
Kochner
AKA - Oschner
Clamp fascia together and grasp small masses
Pull things out of the way
Little teeth on the end
137
Allis clamp
Grasping tougher skin surfaces and fascia - laparoscopy incision or hysterectomy
Serrated end
138
Babcock
Less destructive clamp
Used to grab bowel of fallopian tube
139
Towel clamp
Has a single tooth that goes through tissue - used to secure towels and for skin that will be excised
140
Mayo-Hegar needle holders
Used for suturing more commonly - size depends on suture size
Smaller jaws than a hemostat
141
Castroviejo needle holders
For microsurgery - have the looped around ends
142
Senn Retractor
Smooth arm and rake arm - pull skin away
143
Rake retractor
Just a big rake
144
Army Navey Retractor
Two smooth sides, one deeper than the other
145
Richardson retractors
Small and large look like a mini gold clud
146
Deaver retractor
Bent end flat retractors
Vaginal hysterectomy - hold open
147
Goulet retractor
Small smooth curved ends
148
Ribbon retractor
Can be bent
Come in wide or narrow
149
Gelpi retractor
Bent tongs that lock open, single tooth
150
Weitlander
Multiple teeth retractor
151
Balfour retractor
Pull out and lock in place with wingnuts
For large openings
152
Metzenbaum scissors
NOT FOR SUTURES
Cutting and dissection of skin and soft tissue
153
Mayo scissors
Suture cutting - thicker tissues - scissors are thicker and more meaty
154
MC blades for initial incision
10,20,21,22
155
Blade used for punctures and incision into a vessel
No. 11
156
Blade for smaller, more delicate dissection
Blade No. 15
157
Applying blade to scalpel
Use a hemostat - never use hands
158
Periosteol elevator
Used for scraping away fascia, etc.
159
Suction tips
Yankauer - like at UVSH
Pool - Straighter
160
Trocar
10-15 mm used for laparoscope
5mm for most instruments
Usually disposable
161
Laparoscopic instruments
Laparoscope, Graspers, Needle Holders, Scissors
162
Bipolar cautery
Grasp between electrodes and burn/cut
163
Cautions for electrocautery
Must be grounded, No metal in patient, Caution around O2 or alcohol
164
4 Goals of suturing
Stop bleeding
Approximate wound edges
Close dead space
Minimize scar formation
165
Peritoneum suture
3-0 Vicryl
166
Fascia suture
0-Vicryl
167
Deep space suture
3-0 vicryl
168
Simple interrupted
Low tension areas
Equal in depth and spacing
Usually non-absorbable
169
Rule of halves for SIS
Start in middle, then suture halfway in between ends and stich
170
Simple running
Suture towards yourself
Good for bleeding skin edge
Common on scalp
171
Mattress suture
For skin edges that won't evert
High tension
Verticle and horizontal
Far-Far-Near-Near
172
CI to mattress suture
Face, Palms, Soles, Areas where blind deep suture should not be done
173
Subcuticular suture
Interrupted or running
Indicated in wounds under little tension and keloid prone patients
Not is at the bottom of the wound
174
Suture material for subcuticular
Absorbable - Vicryl or monocryl
175
Minimum number of throws needed for a surgeons knot
3 - often do more
176
Indications for staples
Speed for bleeding wound
Common on the scalp and abdominal skin
177
Cons of staples
Need to be removed and cause more scarring
178
Technique of stapling
One person holds the stapler and another everts the skin
179
Dermabond use
Closure of low tension easily approximated wounds
180
CI for dermabond
Infected wounds
Mucosal surfaces
High moisture areas
181
Steri strip use
Placed after suture/staple removal
For hidden sutures
Small easily approxed wounds
182
Steri strip technique
Cut to leave 2-3 cm on each side of skin edge
Place several mm apart
Perpendicular to long axis of the wound
Allow to fall off on own
183
Hemostasis for surgical wounds
Start with pressure, then electrocautery
Coag or cut
184
Bovie use in malignancies
Avoid use - vaporizes tissue
185
Hemostasis from bleeding vessel - pressure
Apply pressure for 5-7 minutes
186
Hemostasis of bleeding vessel - electrocautery
Can be done if vessel is small (1-2mm)
Use coag setting
187
Vessel tie off
regular (ties around) or stick tie (sutured closed) using suture
188
Indications for tonsilectomy
Sleep apnea
Recurrent throat infections
Peritonsillar abcess
189
Contraindications for a tonsillectomy
Cleft palate
Coagulopathy/anemia
Active infection
190
Indications for adenoidectomy
Nasal obstruction
Chronic sinusitis
Recurrent OM
191
MC bacteria to infect tonsils
Group B strep
192
Complication of tonsilectomy
Bleeding from surgical eschar - emergent
193
2 options for tracheostomy
Open and percutaneous (uses a guidewire)
194
Indication for traceostomy
Cannot be weaned from vent
Sedated patients
195
Percutaneous tracheostomy advantages
Shorter, less expensive, no OR required
196
Percutaneous tracheostomy CI and risks
Greater risk of injury
CI: Under 15, Uncorrectable bleeding diathesis, neck distortion, infection
197
Early Complications of tracheostomy
Obstruction
Pneumothorax
198
Late complications of tracheostomy
Tracheal stenosis/malacia
Tracheoarterial fistula
Hoarseness
199
Tracheostomy changing
Depends on hospital
First change in 7-14 days then changes every 1-2 months
200
Decannulation
Reversal of tracheostomy
201
3 Decannulation indications
No upper airway obstruction
Must have theri own secretions that are neither copious or thick
Have an effective cough
202
Process of decannulation
1 - Tube downsizing/capping trial
2 - Removal of tube
Closing of stoma
203
Tube downsizing/capping trial
Done during a sleep study
Assess tolerance of breathing
204
Removal of tracheostomy tube
Stoma is covered with an occlusive dressing
Observe for 24-48 hours
205
Closing of tracheostomy
Close and heal on own
Close surgically if not closed after 6 months
Change dressing daily
206
Indications for thyroidectomy
Thyroid adenoma
Thyroid cyst
Hashimotos disease
Multinodular goiter
Iodine deficiency
Cancer
207
Diagnostics for thyroid nodule
TSH
US
FNA
Radionucleotide - cold nodules are worse
208
MC thyroid cancer
Papillary
Anaplastic = Most aggressive
209
Indications for total thyroidectomy
Multifocal nodules
Nodule over 1 cm
Nodule across the isthmus
Metastatic of anaplastic
210
Nerve not to cut in thyroidectomy
Recurrent laryngeal nerve - causes hoarseness
211
Complications of thyroidectomy
Laryngeal nerve injury - vocal cord paralysis
Parathyroid resection - Hypocalcemia (muscle spasms. dementia, chvostek, trousseau)
Hypothyroidism
212
Indications for parotidectomy
Blockage of parotid duct
Parotid mass or tumor
Usually a visual dx - can use CT
213
Nerve near parotid gland
Facial nerve
214
4 Complications of parotidectomy
Facial nerve paralysis
Seroma
Hematoma
Wound infection
215
Indications for carotid endartectomy
Carotid stenosis - symptomatic or asymptomatic w/ 70-99% occlusion
GS - angiography, may use US first
216
CI 1 abs and 4 rel for carotid endartectomy
ABS -Asymptomatic complete occlusion
REL - Hx of head/neck radiation, Tracheostomy, hx of radical neck dissection, unacceptably high medical risk
217
Preop prep for carotid endartectomy
Start on ASA and statin
Admit - often done
BP control
Abx
218
MC area for carotid plaque
Bifurcation
Surgery pulls it out
219
Complications for carotid endartectomy
CVA
MI - MC
Vagus, facial, recurrent laryngeal injury
Hematoma
220
Post op care for carotid endartectomy
Neuro checks every hour
BP check every 2 hours
Tele or ICU admit
Aspirin and statins
Inpatient 3-5 days
f/u 3-6 weeks for US
221
Laparotomy
Open all layers of the abdomen
222
Laparoscopy
Minimally invasive - Trochar and scope with less recovery time
223
Gas used to inflate belly for surgery
CO2
224
Laparotomy/Laparoscopy anesthesia
Need full anesthesia
Laparoscopy may not be possible in those with comorbidities
225
Dx of choice for appendicitis
CT scan
226
Indications for appendectomy
Any acute appendicitis dx - any concern for perforation
Some may opt for abx rocephin and flagyl
227
Open appendectomy incision
DIagonal line along the right pelvis
228
Laparoscopic appendecttomy surgical incision
Umbilicus
Suprapubic
Right anterior flank
229
3 things you need for appendectomy
Scope
Cautery
Grasper (pull appendix out through navel)
230
Procedure for a laparoscopic appendectomy - 8 steps
Pneumoperitoneum achieved
3 ports established
Patient in trendelenburg
Cecum identified
Grasp cecum and find appendix
Grasp appendix tip and divide from mesoappendix
Staple and cut
Irrigate and inspect if perfed
231
Open appendectomy procedure
Split through layers - there are a lot
Find cecum and appendix
Ties off, clamp and cut
Close all the layers
232
Post op care for appendectomy
Same day d/c for uncomplicated laparoscopic appendectomy
233
Abx for appendectomy
Single preop dose if uncomplicated
Rocephin and Flagyl if perfed
234
Indications for cholecystectomy
Cholelithiasis - symptomatic
Risk of GB cancer
Acalculous cholecystitis
Polyps over 0.5 cm
Porcelain gallbladder
235
Contraindications to cholecystectomy
Diffuse peritonitis
Hemodynamic compromise
Uncontrolled bleeding disorder
236
Lap vs. Open cholecytsectomy
Try to do laparoscopic unless suspect cancer or cannot tolerate pneumoperitoneum
237
Number of trochars for cholecystectomy
Scope and 3 port sites (4 total)
238
Calots triangle
Inferior surface of liver (superior)
Common hepatic duct (Medial)
Cystic duct (Inferior)
239
Complications of cholecystectomy
Common bile duct injury, leak, obstruction
Suspect with fever or abdominal pain
2-10 days post op
Confirm with US or CT
Peritonitis
240
Tx for common bile duct injury from cholecystectomy
US guided percutaneous drainage with ERCP to stent/repair CBD
241
Post op care for uncomplicated lap chole
D/C same day
Give PO pain meds
No Abx
F/u in 5-7 days
242
Post op care for open or complicated laparoscopic cholecystectomy
Admit 1-3 days
Pain meds
No abx unless contaminated
Monitor for complications
243
2 colon surgeries that include the anus
Total proctocolectomy
Abdomino-perineal resection
244
2 colon surgeries that include the rectum but not the anus
High and Low anterior resection
245
Indications for colon surgery
Tumor
UC
Perfed Diverticulitis
Ischemic colitis
246
Running the bowel
Run bowel through fingers to find masses
247
Indications for laproscopic colectomy
Similar to open colectomy
Can be for benign or neoplastic disease
Takes more time than open
248
Complications of colectomy
Anastomosis leak
Intraabdominal abcess
Bleeding
Bowel obstruction
249
Indications for a colostomy
Gangranous/perforated bowel
Colorectal cancer
IBD
Trauma
Fecal diversion (Para/Quad patients with decubitis ulcers - think UVSH)
250
Post op care for colectomy
4-6 day admission for lap, 6-12 for open
NPO for first 24 hours, 24 hours full liquid, then regular if tolerated
Abx indicated
Pain management
Ambulate starting day 2
F/u 5-7 days post d/c
251
Direct inguinal hernia
Near the opening of the inguinal canal -stress related to age/straining
252
Indirect inguinal hernia
At the inguinal canal - through it (MC)
Due to congenital non-closure
Bulge ABOVE inguinal ligament
253
Confirmation for hernia
Use a CT scan after suggestive PE
254
Femoral hernia
Below inguinal ligament
255
Hernias in women
More at risk for incarceration and herniation
256
Repair for indirect inguinal hernia
Explore spermatic cord
Remove spermatic cord and nerve from herniated sac
Externalize and open sac
Tie sac closed
257
Post op herniorrhaphy complications
Hematoma/Seroma
Chronic pain
Infection
Recurrence
Infection of surgical mesh
258
Indications for lumpectomy of breast
Fibroadenoma
Ductal carcinoma in situ
Invasive breast cancer
259
Indications for mastectomy
Prior radiation to breast/chest wall
Radiation is contraindicated
Pregnancy
Inflammatory breast cancer
Diffuse malignant appearing calcifications
Widespread disease in multiple quadrants
Positive margins after repeat incisions (after 2 total)
260
MC area for breast cancer
Upper outer0breast
261
Sentinel lymph node biopsy
Avoid arm lymphedema
Inject radioactive media into tumor to find out which nodes are draining the tumor
Biopsy nodes that light up during surgery - remove nodes until we get a negative
262
Post op care for breast surgery
Admit for day or two
Pain medication
Wound care
F/u within a week
263
Complications of breast surgery
Winging scapula d/t axillary nerve damage
DVT
Infection
Flap ischemia
Fat necrosis
264
Indications for lung surgery
Epyema
Lung cancer
BUllous lung (air space in lung)
Reduction for COPD
265
VATS
Video assisted thorascopic surgery
Laparoscopy in the chest
266
Post ip care for lung sugery
Admit to ICU
Chest tube
Pain control
WOund care
267
Complications from lung surgery
Pneumothorax
A fib
Infection
Bleeding
268
Indications for CABG
Congenital defect repair
3 vessel blockage
Left main stem artery stenosis
Heart valve dysfunction
Infection
Pericardial tamponade
Ventricular wall rupture
269
Location of CABG
Comes from the aorta usually - often harvest saphenous vein for use
270
CABG post op care
ICU and intubation
Chest tube
Pain control and wound care
271
Peripheral venous line indications
Short term access for hydration, medication, blood products
Patient in need of frequent blood draws
272
CI for peripheral venous line
Vascular damage
Presence of thrombosis
Cellulitis or infection
Collapsed or sclerosed veins
273
Complication of peripheral lines
Phlebitis
Infiltration
Clotting
274
Indications for central venous line
Long term access for chemotherapy, abx, parenteral nutrition
Medication may cause peripheral vein damage
275
Contraindications for central venous lines
Coagulopathy
Infection at site
Hypotension or shock
THrombocytopenia
276
3 possible sites for central line placement
Internal jugular
Femoral
Subclavian
277
Central line administration
US guided
Sterile procedure
Patient in trendelenburg
278
Cut down venous access
Cut down to the vein and put the line in directlu
279
Indications for cut down venous access
Emergency
Failure of traditional methods
Peds patients with small veins (sometimes)
280
CI to cut down venous access
Infection
Vascular compromise
Patient refusal
281
Indications for IO line insertion
Emergency
Cardiac arrest/shock
Pediatric pt last resort
282
MC place for IO line
Proximal tibia
283
vNOTE
Laparoscopic procedure done through vagina in women - usually for GYN surgeries
