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Test 1 Flashcards

1
Q

Why is it optimal for a patient to have an empty stomach prior to surgery?

A

Decreases likelihood of aspiration pneumonia

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2
Q

Conditions that elevate intra abdominal pressure and therefore increase aspiration risk

A

Morbid obesity

Pregnancy

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3
Q

Conditions that delay gastric emptying and therefore increase aspiration risk

A

Gastroparesis
Pregnancy
Abdominal trauma

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4
Q

Minimum fasting period for clear liquids

A

2 hours

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5
Q

Minimum fasting period for breast milk

A

4 hours

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6
Q

Minimum fasting period for infant formula

A

4 hours for < 3 months

6 hours for > 3 months

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7
Q

Minimum fasting period for nonhuman milk

A

6 hours

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8
Q

Minimum fasting period for light meal

A

6 hours

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9
Q

Why does a patient need a preoperative bowel prep?

A

Decreases abdominal contamination in the event of bowel entry

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10
Q

Emergency surgery pre-op questions

A

AMPLE
Allergies
Medications - when did you most recently take them
Past medical and surgical history
Last meal
Events that immediately preceded this surgery

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11
Q

Total body water is distributed with about _____ existing intracellularly and _____ found in extracellular spaces

A

2/3 intracellular

1/3 extracellular

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12
Q

The extracellular portion of body water is _____ interstitial and _____ intravascular

A

3/4 interstitial

1/4 intravascular

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13
Q

Plasma volume is _____ or about _____% of TBW

A

1/12

8.3

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14
Q

Total kg (body weight) x _____ = total body water

A

0.6

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15
Q

Fluid maintenance requirement for first 0-10 kg of body weight

A

100 ml/kg/d

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16
Q

Fluid maintenance requirement for next 10 mg of body weight

A

50 ml/kg/d

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17
Q

Fluid maintenance requirement for all subsequent kg of body weight

A

20 ml/kg/d

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18
Q

Electrolyte requirements for maintenance of sodium

A

1-2 mEq/kg/d

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19
Q

Electrolyte requirements for maintenance of potassium

A

0.5-1 mEq/kg/d

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20
Q

Signs of fluid shifts out of intravascular space

A

Changes in vitals: blood pressure, heart rate, central venous pressure
Decreased urine output

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21
Q

Volume excess signs

A

Weight gain, pulmonary edema, peripheral edema, S3 gallop

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22
Q

When does third-spaced fluid tend to mobilize after surgery?

A

POD #3

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23
Q

Fever associated cytokines are _____, ______, ______, and ______

A

IL-1
IL-6
TNF-alpha
IFN-gamma

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24
Q

Differential diagnosis of a postop fever

A 
Wind (atelectasis, pneumonia)
Water (UTI)
Wound (wound infection, abscess)
Walking (DVT, PE)
Wonder drug or what did we do?
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25
Most common onset of atelectasis or pneumonia
Atelectasis POD #1 | Pneumonia POD #1-3
26
Most common onset of UTI
POD #3
27
Most common onset of wound infection or abscess
POD #5
28
Most common onset of DVT or PE
POD #7
29
Risk factors for post-op UTI
Female gender Older age Diabetes Immobilization
30
Virchow's Triad
Stasis Vascular damage Hypercoagulability
31
Treatment for malignant hyperthermia
Resuscitation, rapid cooling, IV dantrolene
32
New onset abdominal pain, abdominal distention, peritoneal signs post surgery
Anastomotic leak
33
Fever, tachycardia, hypotension post surgery with abdominal signs
Anastomotic leak
34
Raise threshold for CNS toxicity of local anesthetics
Benzodiazepines
35
ADRs of sedation, disorientation
Benzodiazepines
36
Tolerance observed in patients with chronic use of alcohol
Barbiturates
37
ADRs of cardiac and respiratory depression (monitoring important)
Barbiturates
38
Avoid in porphyria
Barbiturates
39
Potent ultra-short acting hypnotic without analgesic properties
Etomidate
40
Works on GABA receptors
Etomidate | Propofol
41
Must follow with analgesic and muscle relaxant drugs
Etomidate
42
ADRs of hypotension, cardiac dioxide retention, suppresses corticosteroid synthesis at adrenal cortex
Etomidate
43
ADRs of respiratory depression, N/V, constipation
Opioids
44
Associated with unconsciousness, analgesia, and amnesia; ER use with orthopedic indications and children
Ketamine
45
Allows fractures to be reduced in a safe and effective method
Ketamine
46
ADRS of hallucinations, bad dreams, increased muscle tone/rigidity
Ketamine
47
Lipophilic, cannot see through this IV anesthetics
Propofol
48
Used often in neuro ICU, it's rapid onset in less than a minute and it's lasting effects of < 15 minutes makes it widely used and hugely effected
Propofol
49
ADRs of significant respiratory depression, hypotension, injection site pain
Propofol
50
Agents include nitrous oxide, sevoflurane, isoflurane, desflurane
Inhaled anesthetics
51
ADRs include N/V, malignant hyperthermia, caution in patients with renal/hepatic dysfunction
Inhaled anesthetics
52
Includes lidocaine, bupivacaine, prilocaine, dibucaine
Amino amides
53
Use for bupivacaine
Used in epidurals
54
Use for dibucaine
Suppository use for pain relief from hemorrhoids
55
Includes benzocaine, cocaine, procaine, and tetracaine
Amino esters
56
Concentration, max dose, onset, and duration of lidocaine
1-2% 4.5-5 mg/kg < 2 min 0.5-1 hour
57
Concentration, max dose, onset, and duration of lidocaine with epinephrine
1-2% 7 mg/kg < 2 min 4-6 hours
58
Concentration, max dose, onset, and duration of bupivacaine
0.25% 2.5 mg/kg 5 min 2-4 hours
59
Concentration, max dose, onset, and duration of bupivacaine with epinephrine
0.25% max 225 mg 5 min 3-7 hours
60
Concentration, max dose, onset, and duration of procaine
0.25-0.5% 350-600mg 2-5 min 0.25-1 hour
61
Primary site of action is spinal nerve roots
Epidural anesthesia
62
ADRs of spinal anesthesia
Hematoma, headache, infection
63
Risk factors that affect pain control in perioperative settings
Preoperative pain (higher baseline), anxiety, genetics, female gender, opioid tolerance
64
Alpha2-receptor agonist in areas of brain
Dexmedetomidine
65
Used in ICU setting for sedation and in anesthesia for brief procedures
Dexmedetomidine
66
ADRs: monitor HR, blood pressure, sedative effects
Dexmedetomidine
67
Risk factors for PONV
``` Female gender Motion sickness/previous PONV Non-smoking status Post-operative use of opioids Use of inhaled anesthetics ```
68
Recommended anxiolytic for PONV reduction
Benzodiazepines
69
Pharmacologic Treatment options for PONV
``` Serotonin antagonists (ondansetron, granisetron) Neurokinin inhibitors (aprepitant) Steroids (dexamethasone) Butyrophenones (Droperidol) Benzodiazepines ```
70
ADRs of HA, diarrhea, constipation, arrhythmia
Serotonin Antagonists | Ondansetron, Granisetron
71
ADRs of HA, diarrhea, weakness, dizziness
Neurokinin inhibitors | Aprepitant
72
ADRs of dizziness, mood change, nervousness
Steroids | Dexamethasone
73
ADRs of sedation, confusion, dry mouth, urinary retention
Antihistamines
74
ADRs of prolonged QT interval (black box warning), hypotension, tachycardia, extrapyramidal symptoms
Butyrophenones | Droperidol
75
Four crucial assessment for burn evaluations
1. airway management 2. evaluation of other injuries 3. estimation of burn size (burn depth and %TSA) 4. diagnosis of CO and cyanide poisoning
76
Parkland formula for burns
LR 4cc x kg x %BSA | Half over the first 8 hours, half over the next 16 hours
77
Potential complications of electrical burns
Cardiac arrhythmias Compartment syndrome Rhabdomyolysis
78
Treatment for smoke inhalation
Fluids and supportive care Oxygen Possible intubation Bronchodilators (albuterol)
79
Signs/symptoms of carbon monoxide poisoning
Headache, lightheadedness, dizziness, confusion, tachypnea, hypoxia
80
ASA Risk of normal, healthy patient
0.1%
81
ASA Risk of mild systemic disease
0.2%
82
ASA Risk of severe systemic disease
1.8%
83
ASA Risk of severe systemic disease that is a constant threat to life
7.8%
84
ASA Risk of moribund patient, not expected to survive without an operation
9.4%
85
Risk factors for post op pneumonia
``` Upper abdominal or cardiothoracic procedures Prolonged anesthesia (> 4 hrs) Age > 60 Tobacco abuse (> 20 p/y) COPD/HF/OSA/Pre-op sepsis Hypoalbuminemia Impaired cognition ```
86
___% mortality if hemodialysis is required
50
87
How many calories does a surgical patient need?
30 kcal per kg per day
88
Protein and nonprotein calories for wound healing
1 gram protein/kg/day | 150 nonprotein calories per 6.25 gm of protein
89
Phase of wound healing that begins immediately and lasts for the first few days
Hemostasis and inflammation
90
Phase of wound healing that starts after the first few days and lasts for several weeks
Proliferation
91
Phase of wound healing that begins after 2-3 weeks and lasts several months
Maturation
92
Phase of wound healing with platelet activation and release of cytokines. Initial cells are platelets quickly followed by neutrophils and macrophages
Inflammatory Phase
93
Fibroblasts are the principal cell involved. These cells are activated by the many cytokines released by WBCs. Initially type III collagen is laid down and over time this is replaced by type I collagen. Endothelial cells, leading to new blood vessels (granulation tissue). New skin is formed.
Proliferation Phase
94
During this phase, there is maturation of the wound collagen with collagen breakdown. Scar remodeling continues for up to 12 months
Maturation Phase
95
A wound will eventually reach about ____% of its original strength
80
96
Superficial infections make up ___% of all surgical site infections, while deep infections make up ___%
75% | 25%
97
Causes of necrotizing fasciitis
Group A strep, staph aureus, clostridium perfringens, bacteroides fragilis and aeromonas hydrophila
98
Administered pre-anesthesia reduces PONV for up to 48 hours after surgery
Neurokinin Inhibitors | Aprepitant

Surgical Care (2 decks)

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