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55 Cards in this Set
- Front
- Back
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Indications for pre-op CBC |
Surgery for malignancy, one with lots of blood loss |
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Indications for pre-op Electrolytes |
Older, diabetes, liver/kidney failure, diuretics |
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Indications for pre-op PT/PTT |
Bleeding, on anticoagulants, liver dz
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Indications for pre-op ECG |
men>40, women>50, known cardiac history |
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ASA 1 |
normal |
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ASA 2 |
mild systemic dz w/o limitations
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ASA 3 |
moderate dz, some functional limits
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ASA 4 |
severe dz, life threatening
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ASA 5 |
won’t survive 24hrs w/o surgery |
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ASA 6 |
brain dead, being harvested
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Local Anesthesia
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fewer physiologic consequences, but can have more pain
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Spinal Anesthesia
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fewer pulmonary complications than general, but may be dangerous in heart dz
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General anesthesia
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excellent anesthesia & amnesia w/ physiologic control but increased pulm complications & cardio depression |
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Previous MI/high risk cardiac
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EKG, ECHO, refer to cardiology, exercise stress test and maybe cardiac catheterization to determine if coronary revascularization needed before surgery |
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DM |
NPO and no oral hypoglycemics the night before surgery; (1/2 morning dose). Sugars should be <250 morning of surgery à give 2/3 NPH if too high |
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Anemia
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must work up cause before surgery (same w polycythemia)
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High blood sugar
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delay until glucose <250; give insulin w dextrose solution; higher incidence of infection |
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Dysuria
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get U/A, culture & delay until UTI resolved |
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Infection
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wait until resolved
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Diastolic BP >110
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assoc w/ CV complications (malignant HTN, MI, CHF); beta blockers may decrease risk |
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Pre-op smoker |
ask # cigs/day, duration, recent change in sputum. -2-6x higher risk of post-op complications -advise to quit 6-8 weeks before surgery |
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Emergency surgery in COPD |
get ABG (PaO2 <60, PCO2 >45 = bad) CXR ask if use O2 at home baseline spirometry
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5 factors that predict cardiac complications after vascular surgery |
Q waves, hx of ventricular ectopy requiring tx, hx of angina, DM, age 70+ |
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MI and surgery |
try to delay surgery at least 30 days after an MI |
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percutaneous transluminal coronary angiography |
delay surgery several weeks after PTCA, it may induce procoagulant state |
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PVCs on EKG |
get stress test and ECHO |
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carotid bruit |
do carotid duplex (US of carotids) and endarterectomy if >70% stenosis |
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signs of liver failure |
ascites, hepatic encephalopathy, poor nutrition, jaundice, asterixis, varices, albumin, bilirubin, PT, platelets |
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pre-op liver failure |
no alcohol 6-12 wks prior to surgery Control ascites w/ K-sparing diuretics, restrict Na/water give VitK to normalize long PT |
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pre-op for kidney failure pt |
dialyze 24 hours before surgery give periop steroids if pt has taken them in past take K+ right before OR Give desmopressin for intraoperative bleeding (platelet dysfunction) |
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Hyperkalemia in kidney failure pt |
peaked T waves; give IV calcium gluconate immediately, + IV insulin and glucose. Probably needs hemodialysis |
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surgery and cardiac valvular dz |
Cardio referral, ECHO if MS; give ppx AB - amox 1 hr before procedure |
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golytely |
polyethylene glycol used for colon prep; no net absorption or secretion of ions |
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magnesium citrate |
poorly absorbed; an osmotic agent that draws fluid into bowel lumen. don't give in renal failure |
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Fluid replacement |
replace every 1mL EBL w/ 3mL isotonic fluid **b/c 2/3 of IV fluid goes intracellularly** |
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maintenance fluids for most pts |
D5 + 1/2NS + KCl20 **after large blood loss, use LR or NS |
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calculating fluid requirements |
Amount to give = (EBL x 3mL isotonic fluid/1mL EBL) + urine output - IVF from OR |
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normal urine output |
0.5 - 1mL/kg/hr |
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common causes of post-op fever |
5 w's: water, wind, wound, walking, wonder drugs UTI, atelectasis, wound are key |
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most common cause of post-op fever |
atelectasis; can be due to decreased compliance of lung tissue, impaired regional ventilation, retained airway secretions, and/or postoperative pain that interferes with deep breathing |
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atelectasis |
loss of lung volume due to collapse of alveolar tissueD |
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dx and tx of atelectasis |
dx: CXR tx: increased pulmonary toilet, IS |
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UTI |
usually seen on POD3; get UA and culture. Tx is bactrim or cipro. |
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primary intention |
wound edges closed. don't lift lots of weight until 6th week after surgery. Complete remodeling and maturation can take 6 months. |
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wound infection |
drain and debride nonviable tissue. most don't need AB |
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secondary intention |
contaminated wounds left open; granulation tissue fills in. |
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split-thickness skin graft |
surgically removed skin that contains epidermis + dermis is capable of revascularizing |
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third intention |
close wound using sutures later on |
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clean wound |
low infection risk; close primarily w/o AB; no entry into GI, GU or respiratory tracts |
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clean-contaminated wound |
<10% chance of infection; GI, RT or GU tract entered |
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contaminated wound |
leave open and tx w/ saline-soaked wound. major contamination. |
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PPX AB |
Give in contaminated wounds, those implanting a prosthetic, immunosuppressed or w/ poor blood supply. Give 1 hour pre-op and a single dose post-op |
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what counts as a fever |
>38.5 C, aka >101.3 F |
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replacing blood loss post-op |
pRBC mL for mL lost OR w. 0.9NS 3mL saline for 1mL blood loss |
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what to do w/ low urine output after surgery |
fluid challenge w/ 1-2L NS. If no response, measure CVP to assess hydration -normal CVP but no output >> pulmonary artery catheter -low PCWP = hypovolemia |
