Surgical Care

Question 1

Causes for Post-op fever 6 W’s

Answer 1

Wind (atelectasis), Water (UTI), Wound (post-op infection), Walking (DVT/PE), Wonder (drug), What did we do?

Question 2

Wind POD

Answer 2

1-3

Question 3

Water POD

Answer 3

3

Question 4

Wound POD

Answer 4

5

Question 5

Walking POD

Answer 5

7

Question 6

Wonder POD

Answer 6

anytime

Question 7

Virchows Triad

Answer 7

Stasis, vessel damage, hypercoaguable state

Question 8

When there’s a fever also consider

Answer 8

necrotizing infection (48hrs), malignant hyperthermia, anastomotic leak (POD3-5)

Question 9

necrotizing infection TX

Answer 9

CBC resuscitation, Pen G, surgical debridement

Question 10

Malignant hyperthermia TX

Answer 10

CBC, resuscitation, rapid cooling, IV dantrolene

Question 11

Anastomotic leak TX

Answer 11

place a drain or return to OR

Question 12

Four crucial assessments of Burns

Answer 12

Airway, evaluation of other injuries, estimation of burn size, diagnosis of CO and cyanide poisoning

Question 13

First degree Burn

Answer 13

superficial- no blisters, blanching. 7 days to heal

Question 14

second degree burn

Answer 14

partial thickness- blisters, pain. superficial- 14-21 days to heal. Deep- 3-8 wks to heal

Question 15

third degree

Answer 15

full thickness, no pain, do not heal, need skin grafts. months to heal and leaves scar

Question 16

Fourth degree

Answer 16

life threatening, may extend into tissue and fascia. Multiple surgeries needed.

Question 17

Parkland Formula

Answer 17

LR 4cc x wt (kg) x %BSA= amount given in 24 hrs. half over the first 8 hrs the other half over 16 hrs.

Question 18

Lactated ringers

Answer 18

maintain stable blood pH, contains less Na and Cl than NS

Question 19

CO poisoning SX

Answer 19

HA, lightheadedness, dizziness, confusion, tachypnea, hypoxia

Question 20

When to refer burns

Answer 20

partial thickness burns >10% TBSA, burns on face, hands, feet, genitalia, perineum, 3rd degree, electrical burns, chemical burns, inhalation injury, complicated comorbidity, circumferential burns, Peds, burns requiring special social, emotional or rehab

Question 21

Net Stress response to surgery

Answer 21

1) water and sodium retention to maintain cardiovascular stability
2) increased catabolism to provide energy sources

Question 22

Calorie need

Answer 22

30kcal/kg/day

Question 23

protein need

Answer 23

1g/kg/day

Question 24

Harris-Benedict equation

Answer 24

Weight in KG + Height in cm - age in years

Question 25

phases of wound healing

Answer 25

1) hemostasis and inflammation 0-5 2) Proliferation 5 days-2 wks 3) Maturation 2 wks- several months

Question 26

Local Factors that affect wound healing

Answer 26

edema, infection, mechanical injury, Ischemia, Necrotic Tissue, Radiation effects, Hypoxia, Foreign body

Question 27

Systemic factors that affect wound healing

Answer 27

age, nutrition, obesity, trauma, metabolic disease, Immunosuppression connective tissue disease, smoking

Question 28

Necrotizing Fasciitis organisms

Answer 28

GAS, Staph aureus, Clostridium perfringens, Baceroides fragilis, Aeromonas hydrophila

Question 29

Allografts

Answer 29

transplant between same species

Question 30

Autografts

Answer 30

transplant in same individual

Question 31

Isografts

Answer 31

transplants between genetically identical individuals

Question 32

Xenografts

Answer 32

transplant between different species

Question 33

split transplant

Answer 33

graft divided between two patients

Question 34

"En bloc" transplant

Answer 34

both pediatric organs transplanted into a single adult

Question 35

Kidney transplant placement

Answer 35

extraperitoneal in the RLQ or LLQ in the iliac fossa

Question 36

Pancreas transplant placement

Answer 36

exocrine portion goes into the duodenum, endocrine remains outside

Question 37

Hyperacute rejection

Answer 37

occurs within minutes to hours due to something like mismatched blood

Question 38

Acute rejection

Answer 38

during the first 6 months

Question 39

Chronic rejection

Answer 39

years after transplant, most commonly antibody and cell-mediated

Question 40

Autologous transplant

Answer 40

patients own stem cells

Question 41

Allogenic

Answer 41

stem cells from a donor

Question 42

Is there adequate tissue perfusion?

Answer 42

ABI 0.9-1.2--> refer to vascular surgeon if not

Question 43

is there nonviable tissue?

Answer 43

debridement

Question 44

Is the wound infected?

Answer 44

cultures and antibiotics

Question 45

Is edema present?

Answer 45

check tissue perfusion and consider compression

Question 46

Is the wound bed conducive to healing?

Answer 46

if it's too dry, wet it. If it's too wet, dry it.

Question 47

is tissue growth optimized?

Answer 47

consider NPWT, hyperbaric oxygen, growth factors or skin grafts

Question 48

is offloading or pressure loading appropriate?

Answer 48

consider casting

Question 49

Grade 1 Wagner Classification

Answer 49

superficial Ulcer w/o subq involvement

Question 50

Grade 2 Wagner Classification

Answer 50

penetrates through the SubQ. May expose bone, tendon, ligament or joint capsule

Question 51

Grade 3 Wagner Classification

Answer 51

extensive ulceration with exposed bone

Question 52

Grade 4 Wagner Classification

Answer 52

gangrene of toes or foot

Question 53

Grade 5 Wagner Classification

Answer 53

gangrene of the whole foot

Question 54

ideal wound care product

Answer 54

maintain moisture, conformability, painless, odor control, nonallergenic and nonirritating, permeability to gas, nontraumatic removal, cost effective, convenient

Question 55

criteria for transfusion

Answer 55

acute hemorrhage | Hgb

Question 56

Fresh Whole Blood indications

Answer 56

Massive hemorrhage when more than 10 units of blood is required