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19 Cards in this Set
- Front
- Back
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pre-op fasting guidelines |
clear fluids: 2 hours food: 6 hours |
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Principles of enhanced recovery after surgery (ERAS) |
Good preoperative and intraoperative care early mobilisation post-op early nutrition post-op expectation for post-op recovery |
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metabolic & pathological consequences in refeeding syndrome |
hypophosphataemia hypokalaemia hypomagnesaemia abnormal fluid balance multi-organ failure |
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refeeding protocol |
start refeeding slowly supplement thiamine aggressively replace any electrolytes regular monitoring - U&Es 6 hrs post feed |
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methods for the prevention of post-operative complications |
antibiotic prophylaxis good diabetes management limited/no use of bowel prep good communication |
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The WHO surgical safety checklist |
before induction of anaesthetic before skin incision before patient leaves the operating room |
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early cardiovascular complications post op |
hypotension MI / cardiac arrest Arrhythmia Haemorrhage DVT / PE |
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early respiratory complications post op |
basal atelectasis pneumonia aspiration pneumonia PE |
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early gastrointestinal complications post-op |
ileus post-operative nausea and vomiting obstruction anastomotic leak starvation abscess diarrhoea incl c.diff duodenal ulceration |
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early urogenital complications post-op |
UTI retention oliguria |
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early neurological complications post-op |
neuropraxia TIA/stroke confusion pain |
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General complications post-op |
wound infection wound dehiscence pressure sores cannula site infection sepsis psychological |
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late complications post-op |
scarring, hernia, chronic pain, infection, recurrence, obstruction, disability, psychological, psychosexual |
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indications for IV insulin sliding scale in patients with diabetes |
Major surgery (>1hr) for type 1 & type 2 diabetics intermediate surgery (<1 hr) if insulin-dependent diabetic |
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perioperative management of patient on warfarin for paroxysmal/uncomplicated AF or >3 months post DVT (soft indications for warfarin) |
if low risk operation, stop warfarin 3-5 days before surgery if high risk operation, follow periop warfarin protocol |
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perioperative management of patient on warfarin for complicated AF, recurrent DVT, non-tissue prosthetic heart valve (hard indications for warfarin) |
follow periop warfarin protocol |
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periop warfarin protocol |
1. admit at least 24hrs pre-op 2. stop warfarin 3 days prior to admission 3. check INR & APT on admission 4. start IV UFH infusion when INR <2.0 5. stop UFH 6 hours pre-op 6. patient 1st on list, inform anaesthetist 7. restart IV UFH infusion post-op 8. restart warfarin 2-4 days post op 9. stop UFH when INR >2.0 |
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post-op fluid maintenance protocol over 8 hours |
1. 1L NaCl + 20mmol KCl 2. 1L 5% dextrose + 20mmol KCl 3. 1L 5% dextrose + 20mmol KCl |
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additional fluid requirements to cover losses post op |
as according to fluid balance chart, aim for positive 500ml |
