Icu & Surgery Basics

Front 1

Indications for ICU admission

Back 1

1. Intubation & Ventilation
2. Invasive Monitoring
3. Vasoactive meds
4. Anti-arrhythmic meds
5. DKA (intensive nursing care)
& any others requiring close nursing supervision.

Front 2

Arterial Line
- what & why?

Back 2

Blood pressure measurement more acurate than cuff.
Placed in arteries, typically radial & femoral.
Esp used with vasopressors.

Front 3

What vessels provide best access for Swan-Ganz catheter insertion?

Back 3

- Left Subclavian Vein
- Right internal jugular Vein

Front 4

What is the purpose of Swan Ganz catheterization?

Back 4

Pulmonary arter catheter measures pressures in:
- Right Atrium
- Pulmonary Artery
- Pulmonary capillary Wedge pressure = LA pressure & LV End Diastolic Pressure (-Atrial Kick)

Also: Q, mixed venous O2 sat (pulm artery post carotid sinus entry), systemic vascular resistance.

Front 5

Universal recipients

Back 5

AB+ blood group.
Can recieve any donor blood type due to lack of antibodies.
Can only donate to AB+ patients

Front 6

Packed RBCs
- what?
- why?

Back 6

RBCs seperated & concentrated from whole blood,
2/3 volume = RBCells.

best for low Hct
- blood loss
- anemia

Front 7

Autologous blood

Back 7

Blood donated by a patient (weeks) prior to a procedure in case of the patient's need for it. (SAME pt)

esp Elective surgery or chemotherapy.

Front 8

FFP
- what?
- why?

Back 8

Fresh Frozen Plasma
= Blood - RBCs

Use in:
1. warfarin overdose
2. clotting factor deficiency
3. Disseminated intravascular coagulation (DIC)
4. TTP

Front 9

Cryoprecipitate
- what?

Back 9

Clotting factor +vWF-rich precipitate collected in thawing of FFP

Front 10

Cryoprecipitate
- why?

Back 10

Use in:
1. warfarin overdose
2. clotting factor deficiency
3. Disseminated intravascular coagulation (DIC)
4. TTP

Front 11

Cryoprecipitate vs FFP

Back 11

Cryoprecipitate = smaller volume than FFP.
- preferable in cases where large transufion volume is unwanted.

Front 12

Platelets
- Indication for use

Back 12

Thrombocytopenia in cases NOT due to rapid platelet destruction

Front 13

Clotting factors
- What?
- Why?

Back 13

Concentrations of specific clotting factor pooled from multiple donors.

Used in tx/management of specific clotting factor deficiencies.

Front 14

Albumin

Back 14

1. Large volume paracentesis >4L
- maintain intravascular volume.

2. hypovoluemic shock with hypoalbuminemia (colloid)

Front 15

Universal donors

Back 15

O-
RBCs of these pts do not incite antibody reactions in others.

Can only recieve O- blood.

Front 16

Most common cause of serious transfusion reactions?

Back 16

Clerical errors.

Front 17

Cause of delayed hemolytic reactions?

Back 17

Antibodies like Kidd or Rh incompatible with donor.

Front 18

Fever, worsening of anemia & increased unconjugated bilirubin 2-10 days post transfusion

Back 18

Delayed hemolytic reaction.

Front 19

Transfusion reaction commonly experienced by IgA deficient patient?

Back 19

Anaphylaxis.

Rapid onset due to anti-IgA IgG antibodies in donated plasma.

Front 20

Considered prevention of complications of hemolysis?

Back 20

Use of Mannitol or Bicarbonate IV.

prevents debris from clogging vessels.

Front 21

Phenylephrine
- mechanism & effect

Back 21

A1 agonist

Vasoconstriction & Reflexive Bradycardia

Front 22

Norepinephrine
- mechanism & effect

Back 22

A1 & B1 agonist

Vasoconstriction
Mild increased contractility

Front 23

Epinephrine
- mechanism & effect

Back 23

Low doses:
B1 agonist
- Increased Contractility
- Vasodilation

High doses:
A1, B1+2 agonist
- Increased contractility
- Vasoconstriction

Front 24

Dopamine
- mechanism & effect

Back 24

Dopamine agonist.
B1 > A1+2 agonist

↑HR & +Inotropy
Vasoconstriction
(↑renal blood flow)

Front 25

Dobutamine
- mechanism & effect
- use

Back 25

B1 Agonist

↑HR & +Inotropy
Mild Reflexive Vasodilation

CHF & Cardiogenic shock

Front 26

Isoproterenol
- mechanism & effect
- Use

Back 26

B1+2 agonist

↑HR, +Inotropy, Vasodilation

Use: Contractility stimulant in cardiac arrest

Front 27

Vasopressen
- mechanism & effect

Back 27

ADH analog
Weak pressor effect

Vasoconstriction

Front 28

Vasopressin
- uses

Back 28

- Resistant septic shock
- Adjuvant vasopressor
- Replace 1st epi in VFib
- Tx of Diabetes Insipidus, Central.

Front 29

What is required for clearance of a young healthy patient for surgery?

Back 29

a normal EKG

Front 30

What test should be done at minimum for pre-surgical screening for patients >40?

Back 30

Stress Test (as well as resting EKG).

Front 31

5 major areas consistent with high surgical risk.

Back 31

1. Age > 70
2. Pulmonary
- FEV1/FVC <70% expected
- Pco2 > 45mmHg
- pulmonary edema
3. Cardiac:
- MI within 30 days.
- poorly controlled non-sinus arrhythmia
- pathologic Q waves on preop EKG
- Severe Valvular disease
- decompensated CHF with poor ejection fraction
4. Renal: Cr >2 or 150% of baseline.
5. High risk surgery type with anticipated blood loss, vascular or cardiac involvement.

Front 32

When is greatest risk for post-op MI?

Back 32

Within initial 48 hrs post-op.

Front 33

How can COPD patients be optimized for surgery?

Back 33

Screening CXR
antibiotic therapy
PFTs and assessment of Resp Capacity & anticipation of lengthy ventilation/tracheostomy

Front 34

Pre operative CXR is a pre-op screening tool for which patient groups?

Back 34

1. age >50 yrs
2. hx of pulmonary disease
3. anticipated surgical time >3 hrs

Front 35

Postoperative measures to improve pulmonary function?
& reduce what complications?

Back 35

1. Incentive spirometry & Deep breathing exc
2. Pain control
3. Physical Therapy
4. Bronchodilators & inhaled/po steroids in pre-existing dx

Prevents
- atelectasis
- pneumonia
- pulmonary embolism
- exacerbation of previous dx

Front 36

How long is optimal for smoking cessation prior to surgery?

Back 36

8 weeks

Front 37

What can/should be used for prevention of IV contrast nephropathy?

Back 37

1. Acetylcysteine 24 hrs before and after Contrast administration.
2. Optimize IV fluids
3. HCO3 before & 6 hrs after contrast administration

Stop Metformin at least 24 hrs pre & post (lactic acidosis)

Front 38

When should warfarin be stopped in relation to surgery?

Back 38

3-4 days prior to surgery.

INR should be kept <1.5 if anticipate bleeding.

Front 39

Potential lab findings of hepatic cirrhosis

Back 39

1. Increase Bilirubin
2. Decreased Albumin
3. Prolonged bleeding time (INR or PT)
4. hepatic encephalopathy
5. Decreased lipids (lack of production)
(Decreased platelets)

Front 40

How to manage pts requiring anticoagulation & surgery?

Back 40

Stop warfarin 3-4 days prior to surgery. Use heparin or LMWHeparin until surgery.

Restart Warfarin post-op & LMWH/Heparin 12 hrs post-op, until INR is therapeutic (>2.0) then stop the heparin.

Front 41

When should aspirin be stopped in relation to surgery?

Back 41

5-7 days prior to surgery.

Front 42

Common causes of nipple discharge.

Back 42

1. Lactation

1. Duct ectasia
2. Intraductal papilloma
3. Carcinoma

Front 43

Cause of bloody nipple discharge?

Back 43

1. Papilloma (often benign)
2. Carcinoma

Front 44

Causes of milky nipple discharge in non-lactating female.

Back 44

- Hyperprolactinemia (pituitary tumor)
- Hypothyroidism
- Drugs:
Antipsychotic Rx
Oral contraceptives / HRTx
others

Front 45

What does discharge from fibrocystic condition appear like?

Back 45

Green or Brownish
Most noticeable just before menstruation.
Spontaneous and multiple ducts.

Front 46

Charcot's Triad

Back 46

Associated with Cholangitis

1. Fever
2. Jaundice
3. RUQ pain

Front 47

Reynold's Pentad

Back 47

Associated with Ascending/Septic Cholangitis

1. Fever
2. Jaundice
3. RUQ pain
4. Altered mental status
5. Shock/Hypotension

Front 48

What is the outpatient treatment of Diverticulitis?

Back 48

1. Bowel Rest
- Liquid only x 3 days

2. PO Antibiotics:
- Fluroquinolone + Metronidazole
- TMP-SMX + Metronidazole
- Amoxicillin-Clavulanate.