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Flashcards in Test 1 Deck (98):
1

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

Decreases likelihood of aspiration pneumonia

2

Conditions that elevate intra abdominal pressure and therefore increase aspiration risk

Morbid obesity
Pregnancy

3

Conditions that delay gastric emptying and therefore increase aspiration risk

Gastroparesis
Pregnancy
Abdominal trauma

4

Minimum fasting period for clear liquids

2 hours

5

Minimum fasting period for breast milk

4 hours

6

Minimum fasting period for infant formula

4 hours for < 3 months
6 hours for > 3 months

7

Minimum fasting period for nonhuman milk

6 hours

8

Minimum fasting period for light meal

6 hours

9

Why does a patient need a preoperative bowel prep?

Decreases abdominal contamination in the event of bowel entry

10

Emergency surgery pre-op questions

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

11

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

2/3 intracellular
1/3 extracellular

12

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

3/4 interstitial
1/4 intravascular

13

Plasma volume is _____ or about _____% of TBW

1/12
8.3

14

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

0.6

15

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

100 ml/kg/d

16

Fluid maintenance requirement for next 10 mg of body weight

50 ml/kg/d

17

Fluid maintenance requirement for all subsequent kg of body weight

20 ml/kg/d

18

Electrolyte requirements for maintenance of sodium

1-2 mEq/kg/d

19

Electrolyte requirements for maintenance of potassium

0.5-1 mEq/kg/d

20

Signs of fluid shifts out of intravascular space

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

21

Volume excess signs

Weight gain, pulmonary edema, peripheral edema, S3 gallop

22

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

POD #3

23

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

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

24

Differential diagnosis of a postop fever

Wind (atelectasis, pneumonia)
Water (UTI)
Wound (wound infection, abscess)
Walking (DVT, PE)
Wonder drug or what did we do?

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