Term
| What are the four groups of conditions for which prophylaxis for endocarditis should be considered before surgery? |
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Definition
1. Prosthetic cardiac valve or repair
2. Previous infective endocarditis
3. Congenital heart defects: recently, incompletley or unrepaired defect
4. Transplant patient who has developed valvulopathy |
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Term
| In pre-operative evaluation, what are the criteria for high risk for VTE? |
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Definition
VTE in the past 3 months
or
Severe thrombophilia (e.g. protein S, C or antithrombin deficiency, APLA)
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Term
| In pre-operative evaluation, what are the 4 groups of moderate-risk for VTE? |
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Definition
1. VTE in the past 3-12 months
2. Nonsevere thrombophilic conditions
3. Recurrent VTE
4. Active cancer (treated in the past 6 months or palliative) |
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Term
| In preoperative evaluation, which patients are considered to be at low risk for VTE? |
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Definition
| Single VTE >12 months ago |
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Term
| How should various anticoagulants be handeled before and after surgery? |
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Definition
Warfarin - stopped 5 days pre-op
Antiplatelets (aspirin, clopidogrel) - stopped 7-10 days pre-op
NSAIDs: short half-life (indomethacin, ibuprofen) - day of surgery; intermediate (naproxen, celecoxib) - 2-3 days pre-op; long half-life (>20hrs) - 10 days pre-op
INR≥1.5 1-2 days pre-op - give 1-2mg vitamin K PO
Vitamin K antagonists and antiplatelet drugs resumed 24-48hrs post-op |
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Term
| When performing bridging with low-dose LMWH or heparin for a patient at risk for VTE, when should the last dose of therapeutic LMWH be given pre-op, and when should it be resumed? |
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Definition
Last therapeutic dose is given on the morning the day before surgery.
Treatement resumed 24hrs after a minor procedure, 48-72hrs after a major procedure. |
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Term
What is the relative risk of post-op pulmonary complications in the following situations?
a. COPD
b. Age
c. ASA class ≥II
d. Functional dependence
e. CHF
f. Smoking
g. Obesity
h. Mild or moderate asthma |
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Definition
a. COPD - RR=1.8
b. Age - 60-69 - RR=2; ≥70 - RR=3
c. ASA class ≥ II - RR=4.9
d. Completely functionally dependent - RR=2.5; pariatlly dependent - RR=1.7
e. CHF - RR=3
f. Smoking - RR=1.26
g. Obesity - not significant
h. Mild or moderate asthma - not significant |
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Term
| How does femoral nerve injury present? |
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Definition
| Weakness or inability to flex the hip and extend the knee, parasthesia over the anterior and medial thigh and medial aspect of the calf. |
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Term
| How does obturator nerve injury present? |
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Definition
| Sensory loss in the upper medial thigh and motor weakness in the hip adductors |
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Term
| Which two nerves are at risk for injury in a Pfannenstiel (low transverse abdominal) incision is performed? |
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Definition
Ilioinguinal
Iliohypogastric |
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Term
| Under what conditions should VTE prophylaxis be administered? |
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Definition
Brief or laparoscopic procedure in a patient with risk factors
Major gynecologic procedure
Start just prior to surgery and continue until discharge. In patients with active malignancy, continue for 2-4 weeks. |
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Term
| What are the options for VTE prophylaxis? |
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Definition
Low-dose heparin twice daily
LMWH once daily
Intermittnet pneumatic compression (IPC) for the exteremeties |
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Term
| What is the classification of hysterectomies for risk of infectious complications? What, if any, antibiotics should be perscribed pre-op? |
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Definition
Clean-contaminated
Give cefazolin 1gr pre-op |
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Term
| How does necrotizing fasciitis present? |
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Definition
Clinical triad: sepsis, inordinate pain, unilateral edema
Affected skin is usually cool, gray, boggy and may reveal crepitus |
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