Term
| TB is most prevalent in what type of patients? |
|
Definition
| older population, immigrants, and institutionalized individuals |
|
|
Term
| True or False; bubonic plague has resurfaced? |
|
Definition
| true; the black plague was said to have killed 40 Al Qaeda gunmen at an Algerian camp |
|
|
Term
| First line of defense against infection |
|
Definition
|
|
Term
|
Definition
| surgical improvement project, a CMS initiative to reduce complications through evidenced based care |
|
|
Term
| SCIP sets specific guidlines to reduce the incidence of? |
|
Definition
P/O surg site infections
cardiac events
DVT & VAP |
|
|
Term
|
Definition
appropriate antibiotic prophylaxis
appropriate hair removal methods
glucose control (specifically for cardiac procedures)
normothermia |
|
|
Term
| Antibiotics must be given within what time frame? |
|
Definition
| 30 to 60 minutes of incision |
|
|
Term
| What antibiotic is the exception to the time frame for initial antibiotic prophylaxis? |
|
Definition
| Vancomycin- must be given within 120 minutes of incision |
|
|
Term
| Antibiotic infusion must be COMPLETED prior to this, and sufficient time allowed for tissue saturation. |
|
Definition
| application of the tourniquet |
|
|
Term
| In cases where incision time has been delayed, what is the recommended time frame that requires redosing? |
|
Definition
| > 1 hour since administration will likely require re-dosing/readministration |
|
|
Term
| Responsibilities of the CRNA regarding abx prophylaxis? (part of the assessment & hx) |
|
Definition
determine: if pt is receiving ATC abx; if so, when was the last dose, and when should next dose be given
it is the CRNAs responsiblity to stay on schedule
confirm there is an order in place for abx; if not request an order or have MD document reason abx is not required |
|
|
Term
| True or False, ALL body hair should be removed "clipped" prior to surgery |
|
Definition
| False; only remove hair that interferes w/surgery or is excessive. May be done by CRNA for IV/CL insertion |
|
|
Term
| True or false; SCIP initiatives require every pt have a bear hugger applied in the OR |
|
Definition
| False; SCIP recommends NORMOTHERMIA, but prescriptive requirements for warming devices has been eliminated |
|
|
Term
| Name 2 disease that have re-emerged? |
|
Definition
|
|
Term
|
Definition
| Minimal inhibitory concentration: most common in vitro predictor of antimicrobial effect |
|
|
Term
| True or False; every antimicrobial and microbial pair have the same MIC at which the organism is considered susceptible? |
|
Definition
| False; each pair has a specific MIC associated with it |
|
|
Term
| General rule that determines the best choice for a targeted bacteria? |
|
Definition
| The antibiotic with the lowest MIC is considered the best choice in general |
|
|
Term
| Terms: inhibiting bacterial growth without actually killing the organism itself is? |
|
Definition
|
|
Term
| Killing or rendering bacteria dysfunctional is classified as? |
|
Definition
|
|
Term
| True or false; all antibiotics have a correlation with dose to killing effect? |
|
Definition
| False; some have a dose to killing effect (larger dose- more effective), while others are time dependent- requiring specific tissue concentrations maintained by specific dosing schedule |
|
|
Term
| True/False: Preemptive antibiotic regimen schedules/timing is DIFFERENT than timing regimens in the ICU |
|
Definition
|
|
Term
| What drug accounts for the most FATAL anaphylactic drug reactions? (most reported drug allergy) |
|
Definition
|
|
Term
| PCN allergy is associated with cross sensitivity to what 3 antibiotic classes? |
|
Definition
| Cephalosporins, carbapenems, and monbactims |
|
|
Term
| What structure in PCN/similar abx drives the allergy? |
|
Definition
|
|
Term
| How long does it typically take for an Allergic reaction to drugs to manifest? |
|
Definition
| 5-10 minutes after exposure |
|
|
Term
| Latex reactions typically occur within what time frame? |
|
Definition
| 30+ minutes after exposure |
|
|
Term
| Name the enzyme that bacteria develop that breaks down the beta lactam ring in antibiotics rendering them ineffective? |
|
Definition
|
|
Term
| Name a type of beta lactamase bacteria |
|
Definition
|
|
Term
| Classification of cephalosporins? |
|
Definition
| Broad spectrum (effective against G + & G- bacteria) |
|
|
Term
| What generations of cephalosporins are effective against MRSA? |
|
Definition
Third gen (cefotaxime/claforan, ceftriaxone/rocephin)
Fourth gen (Cefipime/maxipime)
Fifth gen *best (ceftarolin/teflaro) |
|
|
Term
| Which generation of cephalosporins is most effective against gram negative bacteria? |
|
Definition
| second generation: Cefuroxime (ceftin/zinacef), Cefotetan (cefotan) |
|
|
Term
| True or false: Cefazolin (1st Generation) would be the best choice for prophylaxis in a neurosurgical patient? |
|
Definition
| False; Cefazolin does NOT penetrate the CNS |
|
|
Term
| Name a cephalosporin that is ideal for prophylaxis in most cases? |
|
Definition
| Cefazolin- b/c it is broad spectrum, excellent for skin infections, low incidence of SE's, penetrates most tissue (except CNS) |
|
|
Term
| Dose & Administration time for Cefazolin in the adult pt? |
|
Definition
1gm (>100kg or BMI > 30 requires 2 gm)
given over 3-5 min IVP
redosed @ 3 hours |
|
|
Term
| Cefazolin should be redosed when? |
|
Definition
| case is longer than 3 hours and not closed, cases with excessive blood loss (more than 1.5 L) or more than 6 Units PRBCs have been given, if there is a 2nd procedure- prior to 2nd incision or at 3 hours OR time- whichever comes first |
|
|
Term
| Patients scheduled for surgery in which entry into the bowel is expected or a possiblity (ie-appendectomy); prophylaxis should include which abx? |
|
Definition
| 2nd generation cephalosporins- Cefoxitin & Cefotetan |
|
|
Term
| Adult dosing for Cefoxitin & Cefotetan? (2nd gen) |
|
Definition
1-2gms
Rebolus Cefoxitin (1/2 life 40min) at 2 hours
Rebolus Cefotetan (1/2 life 3-5hr) at 4 hours |
|
|
Term
| Antibiotic most commonly used for MRSA infections? |
|
Definition
|
|
Term
| Vancomycin is used against what type of baacteria? |
|
Definition
|
|
Term
| The action of vancomycin is? (fast/slow) |
|
Definition
| slow (works by slowing cell division) |
|
|
Term
| Name a common substitute abx used for pts allergic to cephalosporins? |
|
Definition
|
|
Term
| Administration time (relative to incision time) for vancomycin? |
|
Definition
|
|
Term
| Dose & administration of vancomycin |
|
Definition
Adult: 1 gm (weight based)
Must be given over 60 minutes (give slowly)
redoses at 12 hours |
|
|
Term
| Complications of vancomycin administration caused by giving the drug TOO FAST? |
|
Definition
| progression from red man syndrome to hypotension and tachycardia! Should not be given faster than 1gm per hour |
|
|
Term
| Flushing, rash, and itching particularly in the upper torso as a result of histamine release is an adverse effect of what drug? |
|
Definition
|
|
Term
| What drug can be given to alleviate the symptoms (d/t the histamine release) associated with vancomycin? |
|
Definition
| Benadryl (slowing down the infusion rate may also help decrease symptoms) |
|
|
Term
| What class of antibiotics are most effective when given in large single daily doses? |
|
Definition
| Aminoglycosides (gentamicin) |
|
|
Term
| This type of abx are highly polar thus are poorly absorbed via GI tract and should be given IV or IM? |
|
Definition
|
|
Term
| True or False; Aminoglycosides are effective against gram positive bacteria? |
|
Definition
| False; excellent activity against aerobic gram NEGATIVE organisms |
|
|
Term
| What antibiotic would likely be a poor choice for patients with renal failure? |
|
Definition
| Aminioglycosides; almost COMPLETELY secreted through the kidney. Close monitoring for balance between effectiveness and renal toxicity is required- thus pharmacy should be dosing this abx based on IBW not actual body weight |
|
|
Term
| Dosing for aminoglycosides? (gentamycin) |
|
Definition
Adult: 1.5mg/kg (MAX 240mg)
Given over 30-60 min
Admin w/in 1 hour of incision |
|
|
Term
| What class of abx are nephrotoxic and ototoxic? |
|
Definition
|
|
Term
| Risk factors for Gentamycin toxicity include? |
|
Definition
1. Renally compromised patients
2. Elderly (reduced number of functional nephrons)
3. Large dose administration > 5 days (d/t drug accumulation causes damage to nephrons) |
|
|
Term
| What is the first sign of ototoxicity associated with aminoglycosides? |
|
Definition
| tinnitis; stop infusion immediatly, ringing may continue for 2 wks (if damage occurs to vestibular or cochlear sensory cells occur hearing loss may be permanent) |
|
|
Term
| Non-depolarizing muscle relaxant effects are prolonged by what abx? |
|
Definition
| Gentamycin, tobramycin, and neomycin (aminoglycosides) by inhibiting pre-junctional acetylcholine release and reducing post synaptic senstivity to acetycholine |
|
|
Term
| What two drugs are used to reverse the effects (improve muscle strength)of NDMR? |
|
Definition
| Neostigmine & Calcium - improves muscle strength |
|
|
Term
| indications of renal toxicity (associated w/aminioglycoside administration) |
|
Definition
| increased creatinine, decreased creatinine clearance, and high trough levels. |
|
|
Term
| True or False; nephrotoxicity associated with gentamycin administration is permanent |
|
Definition
| False; if caught early it is usually reversible |
|
|
Term
| definition prodrug? and give an example |
|
Definition
| Something (bacteria) has to cleave a portion off before the drug becomes active; Metronidazole (flagyl) |
|
|
Term
| Alcohol insumption must be avoided with this abx? |
|
Definition
|
|
Term
| Drug used to treat anaerobic bacterial, protozoal and parasitic infections |
|
Definition
|
|
Term
| Dose/administration of metronidazole? |
|
Definition
| adult dose 500mg, given 60 min before incision and redosed at 6 hours |
|
|
Term
| Most common complaints associated w/ metronidazole? |
|
Definition
|
|
Term
| Antibiotic associated w/significant GI side effects specifically the overgrowth of C-diff? |
|
Definition
| Clindamycin (cleocin); thus only given when pt is allergic to first line tx like flagyl or other abx will not achieve the goals |
|
|
Term
| Class/mode of action of clindamycin |
|
Definition
| Lincosamide, broad spectrum (positive and negative anaerobic activity) |
|
|
Term
| This abx blocks the release of acetycholine at the NMJ pronlonging the effect of NDMRs? |
|
Definition
|
|
Term
| dose/schedule for clindamycin |
|
Definition
adult dose 600-900mg given over 30 minutes
within 60 min of incision
redosed @ 3 hours |
|
|
Term
| What operative site is associated with a higher risk for SSI? |
|
Definition
| INTRA-abdominal surgery (20% compared to extra-abdominal surgery) |
|
|
Term
| Risk factors for SSIs include? |
|
Definition
1. extremis of age (infant/elderly)
2. chronic ilness
3. DM
4. Corticosteroid therapy
5. Immunocompromised |
|
|
Term
| Scientifically supported strategies to reduce SSIs include? |
|
Definition
1. prophylactic abx w/in 1 hour of incision
2. increased tissue oxygenation (PROVEN for colorectal sx)
3. Pain control (increases oxgyen tension at wound sites)
4. Avoid hypocapnia (hypocapnia occurs frequently in anesthesia, Low PaC02 produces peripheral VASOCONSTRICTION, while hypercapnia produces vasodilation- increasing perfusion to skin)
5. Avoid hypothermia: b/c causes vasoconstriction
6. Avoid hyperglycemia: high BG inhibits leukocyte function, and promotes bacterial growth
7. wound probing: closure w/staples, probing between staples |
|
|
Term
|
Definition
| cascade of events leading to significant vasodilation, ramping up of inflammatory system and complement cascade, encompasses infection (blood or tissue), sepsis and septic shock |
|
|
Term
| Laboratory/hemodynamic indications of SIRS: |
|
Definition
1. WBC <4K or >11K (or >20% immature forms- babies sent to war)
2. HR >90 bmp
3. Temp <36 or >38
4. RR >20 bmp or PaCO2 <32 mmHg (attempt to compensate for metabolic acidosis) |
|
|
Term
| Intraoperative mgt of sepsis/septic shock includes |
|
Definition
First priority is antibiotics and baseline labs
CL for vasopressors
Arterial lines
CVP
Fluids
Glucose control (important for organ survivial)
Coagulopathy (esp DIC) is common |
|
|
Term
| Treatment goals for Sepsis/septic shock |
|
Definition
1. MAP > 65
2. CVP 8-12
3. urine output 1ml/kg/hour minimally
4. normal pH (without metabolic acidosis)
5. mixed venous oxgyen saturation > 70% |
|
|
Term
| Necrotizing soft tissue infections include? |
|
Definition
| Gas gangrene, toxic shock syndromes, severe cellulitis, flesh-eating infections |
|
|
Term
| A subclass of sepsis & are SURGICAL EMERGENCIES? |
|
Definition
| necrotizing soft tissue infections |
|
|
Term
| Treatment of necrotizing soft tissue infectons |
|
Definition
| gram positive and negative (broad) coverage, natural honey to digest necrotic tissue, hyperbaric (if anaerobic) |
|
|
Term
| Anesthetic challenges associated with necrotizing soft tissue infections |
|
Definition
1. Treatment of hypotension
2. central line placement (art line/cvp)
3. catecholamine/cortisol depletion
4. multiorgan failure-adequate urine output
5. Blood/FFP/Platelets |
|
|
Term
| Patients who develop SIRS driven sepsis are at risk for what? |
|
Definition
|
|
Term
| most powerful poison known to humans second only to botulism |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| d/t gram negative macillus clostridum tetani, tetanospasm spreads centrally along motor nerves to spinal cord and enters circulation proceeding to the CNS-suppressing inhibitory pathways producing severe muscle spasms (tetany) |
|
|
Term
| What muscles can be effected by tetanus? |
|
Definition
| ALL! (laryngeal, pharyngeal, diaphragm) |
|
|
Term
| Stimulus that can precipitate spasms in tetanus? |
|
Definition
| light, loud noise, suctioning - anything really. Spasms are tonic/clonic & excrutiatingly painful |
|
|
Term
| Sympathetic nervous system involvement in tetanus presents as? |
|
Definition
| tachycardia, arrhythmias, hypertension, labile blood pressure d/t excessive catecholamine release |
|
|
Term
| Anesthetic goals for pts w/tetanus |
|
Definition
1. early intubation/supportive airway measures
2. valium for muscle spasms or NDRMs
3. Beta antagonists (propranolol or esmolol) for tachy-arrythmias and htn
4. penicillin (destroys exotoxin)
5. Arterial line
6. Volatile anesthetics are good (if you have a pressure)
7. Lidocaine, esmolol, magnesium, nicardipine, nitropresside) |
|
|
Term
| Most common nosocomial infection in the ICU |
|
Definition
|
|
Term
| Best treatment for VAP is: |
|
Definition
Prevention! 1. meticulous handwashing
2. aspiration of secretions (esp during extubation)
3. Early extubation
4. Choosing approriatness of ventilatory support |
|
|
Term
|
Definition
normal flu- typically very young & very old effected
H1N1-children & young adults also affected
SARS (severe acute respiratory distress syndrome)-many deaths included healthcareworkers
new strain H5N1 (bird flu) can jump species
MERS (middle east respiratory syndrome)-many healthcare workers affected |
|
|
Term
| True or False, Flu viruses are highly contageous and spread by droplets |
|
Definition
|
|
Term
| Anesthetic implications for pts with the flu |
|
Definition
| Stict iso, contact precaustions, negative pressure roms, N95 pt and provider, full wipe down & circut change for ventilator according to protocols |
|
|
Term
|
Definition
| nonproductive cough, night sweats, chest pain, weight loss, hemoptysis |
|
|
Term
|
Definition
| droplets (often pts are asymptomatic initially) |
|
|
Term
|
Definition
| CXR, sputum smears, cultures, direct blood tests, TB skin tests |
|
|
Term
|
Definition
| continued for 6 months, longer for TB outside of the lungs |
|
|
Term
| Anesthesia related implications for TB |
|
Definition
postpone elective procedures until pt is no longer infectious
negative pressure environment
tight fighting N95
high efficiency air filter in circuit between Y connector and the mask,LMA or ETT.
bacterial filter placed on exhalation limb of circuit
sterilize equipment
isolation p/o |
|
|
Term
| HIV resides in what cells |
|
Definition
| CD4+ helper T cells (98% of these cells reside in the lymph nodes) |
|
|
Term
| Hallmark of initial HIV infection |
|
Definition
sore, swollen lymph glands (persist until tx is initiated)
May appear asymptomatic and look healthy |
|
|
Term
| Rapid decline in CD4+ T cell count occurs with? |
|
Definition
| HIV conversion to AIDS (T cells are destroyed) |
|
|
Term
| Common features associated with HIV include? |
|
Definition
| abnormal echocardiograms (up to 50%), LV dilation, premature CAD, pericardial effusions, aortic aneurysms |
|
|
Term
| neurological manifestions in HIV occur early and can include? |
|
Definition
| meningitis and intracranial masses |
|
|
Term
| The most frequent neurological complication of HIV is |
|
Definition
|
|
Term
| True of false; HIV related pulmonary complications are caused by opportunistic infections |
|
Definition
|
|
Term
| In HIV, endobronchial sarcoma may cause? |
|
Definition
|
|
Term
| Endocrine manifestations of HIV include? |
|
Definition
| adrenal insufficiency & glucose intolerance |
|
|
Term
| Renal manifestations of HIV include? |
|
Definition
| ATN & kidney stones, ARF r/t disease process & drug regimen |
|
|
Term
| Anesthetic implications r/t HIV |
|
Definition
Drug holidays, drug therapy may increase M &M, CBC, LFTs, RFTs, coagulation studies, CXR and ECG
Meticulous pulmonary care and early extubation if possible |
|
|
Term
| What type of anesthesia should be avoided in pts with AIDS |
|
Definition
| NO SAB or Epidural b.c neurological lesions can increase intracerebral pressure |
|
|
Term
| Upregulation of ACH nicotinic receptors may occur in HIV pts (d/t peripheral neurapathy), therefore caution should be taken with use of? |
|
Definition
succinylcholine-autonomic instability, arterial line may be helpful
Also peripheral neuropathy may preclude use of regional |
|
|
