Pestana 17: Pre Op And Post Op 2

Front 1

Why do MIs occur in surgery?

Back 1

usually from hypotension

Front 2

how would you know?

Back 2

it shows up on EKG

Front 3

what type of ST changes?

Back 3

this is subendocardial, so it will be ST depression and T wave flattening

Front 4

If it's a post op MI when does it occur?

Back 4

in the ensuing 48 to 72 hours

Front 5

do most pts have chest pain?

Back 5

no this isn't very sensitive

Front 6

most reliable dx test

Back 6

troponins

Front 7

is mortality higher or lower in these patients vs those who are having an MI not post op?

Back 7

much higher

Front 8

mgmt of a perioperative MI

Back 8

do NOT give tPA or heparin or aspirin etc.

just do emergent coronary angioplasty or stent

Front 9

sudden onset, pleuritic chest pain, shortness of breath

Back 9

pulm embolus

Front 10

what do you see on the veins?

Back 10

they're severely distended

Front 11

what do you see on ABG in PE?

Back 11

hypoxemia and hypocapnia

Front 12

what is the gold std for dx of PE?

Back 12

pulm angiography

Front 13

but this is rarely done, so what do we use?

Back 13

spiral CT aka CT angio

Front 14

indications for a IVC filter

Back 14

recurrent PE on anticoagulation

contraindication to anticoags

Front 15

what patients CANNOT use SCDs

Back 15

those with leg fractures

Front 16

preventive measures for aspiration

Back 16

NPO, antacids

Front 17

when is aspiration a big risk

Back 17

during rapid sequence intubation

Front 18

mgmt if they do aspirate

Back 18

bronchoscopic washout of the stomach acid and respiratory support

Front 19

do steroids help

Back 19

no

Front 20

patient with recent blunt trauma with punctures by broken ribs subjected to positive pressure breathing

Back 20

intraop pneumothorax

Front 21

the patient becomes progressively more difficult to bag

Back 21

and CVP steadily rises

Front 22

what do you first suspect when a patient has confusion and disorientation?

Back 22

hypoxia

possibly due to sepsis

Front 23

mgmt for the confused patient

Back 23

check ABG and provide resp support

Front 24

patient with a complicated post-op course often complicted by sepsis as a precipitating event now with respiratoy distress

Back 24

ARDS

Front 25

ARDS shows bilateral pulmonary infiltrates and hypoxia.

Back 25

no evidence of CHF

Front 26

what is the main centerpiece of therapy for ARDS/?

Back 26

PEEP while avoiding excessive volume and barotrauma

Front 27

what is the other big mgmt goal for ARDS

Back 27

find a source of sepsis and correct it

Front 28

alcoholic whose drinking is interrupted suddenly by surgery. they get confused, have hallucinations, and become combative.

Back 28

DTs

Front 29

mgmt for DTs

Back 29

benzodiazepines

Front 30

hyponatremia can be quickly induced by liberal D5W administration in a post-op patient

Back 30

ok

Front 31

but in a patient with severe trauma they may have

Back 31

SIADH

Front 32

manifestations of hyponatremia

Back 32

coma
confusion
convulsions
death

Front 33

mgmt if hyponatremia does develop

Back 33

usually use a small amount of hypertonic saline

Front 34

what can develop if a patient has a large rapid loss of water?

Back 34

hypernatremia

Front 35

Chart review on these patients shows rapid urinary losses, rapid weight loss, and w/o fluid replacement.

Back 35

they get rapid hypernatremia

can be due to unrecognized osmotic diuresis

Front 36

mgmt if this rapid hypernatremia develops

Back 36

D5 1/2 or D5 1/3 to avoid overly rapid correction

Front 37

common source of coma in a cirrhotic patient with bleeding esophageal varices, postop postcaval shunt

Back 37

high ammonium levels

Front 38

after surgery in the lower abdomen, pelvis, perineum, or groin commonly leads to...

Back 38

post op urinary retention

Front 39

Do these patient have the urge to void?

Back 39

yes, but they can't

they require in/out cath by 6 hous post op

Front 40

when do you think about just placing a foley instead of in/out?

Back 40

by the second or third episode of urinary retention

Front 41

What has usually happened if a patient has ZERO UOP post op?

Back 41

it's usually a mechanical obstruction in the foley or something. look for a plugged or kinked catheter

Front 42

What are two things that cause low UOP post op (in absecnce of shock)?

Back 42

fluid deficit or acute renal failure

Front 43

So how do you distinguish between the two causes?

Back 43

do a fluid challenge of 1/2 L bolus and see if their UOP increases

Front 44

What is a better way?

Back 44

to look at FeNa

urinary sodium should be less than 10 to 20 mEq/L in a dehydrated patient

Front 45

A renal failure

Back 45

patient does not compensate in this way and the urinary sodium is up to 40 mEq/L

Front 46

FeNa under 1%

Back 46

indicates dehydration (prerenal azotemia)