Pestana- Preop and postop care

lizruns33's version from 2016-01-21 19:10


Question Answer
What ejection fraction poses prohibitive cardiac risk for operation?<35%
What clinical sign most indicates cardiac risk?JVD
Treatment for JVDB blocker, ACEI, diuretic, digitalis
What is operative mortality for recent MI?40% within 3 months and 6% within 6 months
What findings are used for predicting hepatic risk?Ascites, hepatic encephalopathy, bilirubin, albumin, and INR
What indicates severe nutritional depletion?Loss of 20% of body weight over a couple months, serum albumin below 3, anergy to skin antigens, and transferring level of less than 200
Absolute contraindication to surgeryDiabetic coma (DKA)
What anesthetics can lead to malignant hyperthermia?Halothane and succinylcholine
Temperature in malignant hyperthermia?Exceeds 104
Metabolic acidosis and hypercalcemia with 104 temp following surgeryMalignant hyperthermia
Treatment of malignant hyperthermiaIV dantrolene, O2, correction of acidosis, cooling blankets
How quickly is bacteremia seen following an invasive procedure?Within 30-45 minutes
Treatment for bacteremiaBlood cultures x3, start empiric antibiotic
Severe wound pain and very high fever within few hours of surgeryGas gangrene
Post op fever range101-103
Fever post op day 1 Atelectasis
Treatment for atelectasisDeep breathing and coughing, postural drainage, incentive spirometry... bronchoscopy as a last resort
Fever postop day 3Pneumonia, UTI
Treatment for pneumoniaSputum culture and antibiotic
Workup for UTIUrinalysis, urine culture
Fever post op day 5DVT
Fever post op day 7Wound infection, PE
Fever post op day 10-15Deep abscess
When does post op MI usually occur?Within 2-3 days
Treatment of MI in perioperative settingNO clot busters... treat with emergency angioplasty and coronary stent
Clinical presentation of PEAnxious, diaphoretic, tachycardia, SOB, pleuritic pain, JVD
What do blood gases show for PE?Hypoxia and hypocapnia
Diagnosis of PECT angio
Risk factors for PEAge >40, pelvic or leg fractures, venous injury, femoral venous catheter
Prevention of aspiration pneumoniaNPO and antacids before induction
Treatment of aspiration pneumoniaLavage with bronchoscopy followed by bronchodilators and respiratory support
Intraoperative tension pneumothoraxBP steadily declines and CVP steadily rises
Treatment of intraoperative tension pneumoIf abdomen is open, decompression through the diaphragm. If closed insert a needle through the anterior chest wall "under the drapes"
What's the first thing you suspect when a post-op patient gets confused and disoriented?Hypoxia
Therapy for ARDSPEEP, but not too excessive ventilatory volume (barotrauma)
When does delirium tremens develop?2nd or 3rd day post op
Treatment for delirium tremensIV benziodiazepines or IV alchohol (5% in 5% dextrose)
Hyponatremia symptoms Confusion, convulsions, eventually coma
Fluids given for hyponatremia 500 mL of 3% hypertonic or 100 mL of 5%, maybe add osmotic diuretic
Symptoms of hypernatremiaConfusion, lethargy
Causes of hypernatremiaHypovolemia, osmotic diuresis, surgical damage to the posterior pituitary (Diabetes insipidus)
Diabetes insipidus can cause this Hyponatremia
Fluids to use for hypernatremia D5 1/2 or D5 1/3
Ammonium intoxication patientCirrhotic patient with bleeding esophageal varies who undergoes a portocaval shunt
When should in and out cath be done in a post op patient if no UOP?6 hours
What to do for low UOP (< 0.5 mL/kg/hr)Give a fluid challenge
Fluid challengeBolus of 500 mL given over 10-20 min
Urinary sodium in a dehydrated patientLess than 10-20 mEq/L
Urinary sodium in a renal failure patientGreater than 40 mEq/L
Presentation of paralytic ileusNo bowel function, mild dissension, NO pain
What prolongs paralytic ileus?Hypokalemia
Ogilvie syndromeParalytic ileus of the colon that does NOT follow abdominal surgery ... often seen in old sedentary patients
Treatment of Ogilvie syndromeColonoscopy to suck out the air and place a long rectal tube
What day post op is wound dehiscence seen?5th
Treatment for wound dehiscenceReoperate
What are potential consequences of wound dehiscence1. Evisceration 2. Ventral hernia down the road
What day post op are wound infections seen?7
What are potential problems of GI fistulas?Fluid and electrolyte loss, nutritional depletion, erosion and digestion of the belly wall
When do fistulas not heal?FETID: foreign body, epithelialization, tumor, irradiated tissue, IBD, distant obstruction
Causes of hyponatremia ADH, loss of isotonic fluid from GI tract which results in retaining water
Treatment of hyponatremiaAcute: 3% or 5% hypertonic saline Slowly developing: water restriction
Treatment of hyponatremia caused by hypovolemia in a dehydrated patientRinger lactate
Cause of hypokalemiaGi loss, loop diuretics, too much aldosterone
Speed limit of IV potassium administration10 mEq/h
Causes of hyperkalemia Renal failure, crushing injuries, acidosis
Treatment of hyperkalemiaDialysis, diuretics, kayexylate, insulin, NG suction, IV calcium
Causes of metabolic acidosisDiabetic ketoacidosis, lactic acidosis, loss of bicarb, renal failure
pH and bicarb levels in metabolic acidosispH<7.4, serum bicarb <25
Anion gap Greater than 10 or 15. NOT due to loss of bicarb
pH and bicarb levels in metabolic alkolosispH >7.4, serum bicarb >25
Treatment of metabolic alkalosis Give KCl 5-10 mEq/h and kidney will correct problem
Impaired ventilationRespiratory acidosis
Abnormal hyperventilationRespiratory alkalosis
What are CT scans best used forHead trauma, cervical spine, abdomen, kidney stones
Measures flowDoppler

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