Term
| What are some signs of post-op infection? |
|
Definition
Pain
Fever
Hemodynamic Changes
Wound d/c |
|
|
Term
| What meds can be used for gram + coverage? |
|
Definition
Cefotaxime,
Ceftizoxime,
Ceftriaxone,
Ceftazadime,
Aztreonam |
|
|
Term
| What meds can be used for gram - coverage? |
|
Definition
Gentamycin (ototoxic),
Tobramycin (ototoxic),
Amikacin,
fluoroquinolones (not on pts under 18) |
|
|
Term
| What meds can be used for anaerobic coverage? |
|
Definition
Clindamycin,
Metronidazole ,
Chloramphenicol |
|
|
Term
| What pathogen is the MC cause of necrotizing soft tissue? |
|
Definition
|
|
Term
| What is the treatment for Necrotizing soft tissue? |
|
Definition
Clostridia = Pen-G + Clindamycin
Non-Clostridia = 1st generation Cephalosporin |
|
|
Term
| When does necrotizing soft tissue occur? |
|
Definition
| early in the post-op course (1 - 3 days) |
|
|
Term
| What organism is the common culprit in surgical wounds ↑ the waist? |
|
Definition
|
|
Term
| What organism is the common culprit in surgical wounds in the Axillae? |
|
Definition
| prominent Gram – bacteria |
|
|
Term
| What organism is the common culprit in surgical wounds ↓ the waist? |
|
Definition
| mixed aerobic/ anaerobic Gram - flora |
|
|
Term
| What are signs that the surgical wound is infected? |
|
Definition
purulent drainage
Erythema
Fever |
|
|
Term
| When in the post-op course would a surgical wound infection show up? |
|
Definition
|
|
Term
| What can be helpful in diagnosing an intra-abdominal infection? |
|
Definition
| CT scan may be helpful in Dx - may show abscess |
|
|
Term
| What is the treatment for an intra-abdominal infection? |
|
Definition
Amp/Gent/Clinda
Unasyn, Pipercillin, (both IV meds) etc
Fix the problem (percutaneous drainage, surg) |
|
|
Term
| If pt has been given treatment and is not improving, but worsening instead, what must you consider? |
|
Definition
Rx was inadequate (incomplete drainage)
Complication from treatment
Superinfection (consider colitis)
Inadequate antibiotic choice or dosage |
|
|
Term
| When should you consider d/c IV antibiotic therapy? |
|
Definition
| If pt is afebrile x 48 hrs, consider D/C therapy or change to po Rx for 7-10 days |
|
|
Term
| What are most post-op fevers believed to be caused by? |
|
Definition
believed to be from normal responses to surgical trauma
- cytokine-mediated rise in core temp
- acute phase proteins
- activation of endocrine & immune systems |
|
|
Term
| At what degree temp should a post-op be a cause for concern and an investigation is warranted? |
|
Definition
|
|
Term
| When does an intra-abdominal infection normally show up? |
|
Definition
|
|
Term
| What is the MC pulmonary complication of surgery? When does this complication occur? |
|
Definition
| Atelectasis; occurs within the first 24hrs |
|
|
Term
| What can prevent atelectasis? |
|
Definition
|
|
Term
| What is a common post-op pulmonary complication in the elderly? |
|
Definition
|
|
Term
| For the Wound, what components do you need to worry about? (3) |
|
Definition
Surgical wound infection
Wound abscess
Intra-abdominal infection |
|
|
Term
| For the Wind, what components do you need to worry about? (2) |
|
Definition
|
|
Term
| For the Water, what components do you need to worry about? (3) |
|
Definition
Indwelling foley catheter
Bladder obstruction (Prostatitis, BPH)
Urologic procedures |
|
|
Term
| For the Walk, what components do you need to worry about? (3) |
|
Definition
Deep Vein Thrombosis
Thrombophlebitis
Central Venous Line Infection |
|
|
Term
| What are the components of virchow's triad? |
|
Definition
stasis,
hypercoagulability,
endothelial damage |
|
|
Term
| What are the signs of a DVT? |
|
Definition
Calf edema,
tenderness,
+ Homan’s sign
tachypnea |
|
|
Term
| What is the MC presentation of DVT? |
|
Definition
|
|
Term
| What is used to prevent DVT? |
|
Definition
| LMW Heparin (Lovanox); Intermittent pneumatic Compression devices (IPCs) |
|
|
Term
| What are the risk factors for DVT? |
|
Definition
Age
Obesity
OCs
Malignancy
Leg Trauma, Ortho Surgery
Immobility |
|
|
Term
| What are the signs of thrombophlebitis? |
|
Definition
| Erythema & warmth over a vein, fever |
|
|
Term
| What are the signs and symptoms of a central venous line infection? |
|
Definition
|
|
Term
| What does the final W stand for? |
|
Definition
| Weird drugs, What did we do? |
|
|
Term
| For the last W, what components do you need to worry about? (3) |
|
Definition
Transfusion related fever
Drug related fever
Central Lines put in? |
|
|
Term
| How long should a pt be NPO after a surgery? |
|
Definition
| until bowel sounds are ausculated and pt passes flatus |
|
|
Term
| What is the treatment for a post-op ileus? |
|
Definition
Usually resolves spontaneously
- May need NG tube passed |
|
|
Term
| What is the regular pattern of return of gastric function? |
|
Definition
#1 - Small Bowel
#2 - Stomach (returns in 24 - 48 hrs)
#3 - Colon (returns after 48 hrs) |
|
|
Term
| What complication of surgery is described as loss of normal propulsive activity of the GI tract? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| serous fluid with lipids, cellular debris |
|
|
Term
| What is a collection of blood, usually in the subcutaneous layer of a recent incision? |
|
Definition
|
|
Term
| What is a collection of liquefied fat, serum, and lymphatic fluid , often opened or aspirated? |
|
Definition
|
|
Term
| What term means the intestines bulge out through scars that are a result of a previous surgery? |
|
Definition
|
|
Term
| Which type of surgery type is described as wound edges are opposed & closed by either sutures, clips, tapes or dermal adhesives? |
|
Definition
|
|
Term
| Common name for 2-octylcyanoacrylate |
|
Definition
|
|
Term
| Common name for butyl-2-cyanoacrylate |
|
Definition
|
|
Term
| Which type of wound repair is described as wound edges are left unopposed, and sometimes a dressing is placed in the cavity to absorb fluids and prevents the wound from sealing over? |
|
Definition
|
|
Term
| Which types of wounds are repaired with secondary intention? |
|
Definition
| For “dirty” or contaminated wounds |
|
|
Term
| Which type of closure is described as a contaminated wound may initially be treated by repeated debridement or antibiotics for several days to prevent infection and closure occurs after several days through suturing, flap closure or by skin grafting? |
|
Definition
| Tertiary Intention – AKA Delayed Primary Closure |
|
|
Term
| What are the risk factors for poor wound healing? |
|
Definition
DIDNT HEAL
D= Diabetes
I = Infection
D = Drugs
N = Nutritional Problems
T = Tissue Necrosis
H = Hypoxia
E = Excessive Tension on wound edges
A = Another concurrent wound
L = Low temp |
|
|
Term
| What is the MC pathogen causing post-surgical infection? |
|
Definition
|
|
Term
| Besides S. aureus, what are the other most common pathogens involved in post-surgery infections? |
|
Definition
Staphylococcus coagulase negative
Enterococcus
Escherichia coli |
|
|
Term
| What nutritional deficiencies can impact wound healing? |
|
Definition
Low protein
Vitamin A, C, K
Zinc |
|
|
Term
| What can impede vitamin K, and therefore impede wound healing? |
|
Definition
| antibiotics. - affects gut flora responsible for synthesizing Vitamin K |
|
|
Term
| What type of wound classification in respect to microbial content would heart surgery be? |
|
Definition
|
|
Term
| What type of wound classification in respect to microbial content would biliary and gastric surgeries be? |
|
Definition
|
|
Term
| What type of wound classification in respect to microbial content would colon surgeries be? |
|
Definition
|
|
Term
| What type of wound classification in respect to microbial content would appendicitis and colecistitis be? |
|
Definition
|
|
Term
| What are the MC cause of a post-op fever on day 1-2? |
|
Definition
|
|
Term
| What are the MC cause of a post-op fever on day 3-5? |
|
Definition
|
|
Term
| What are the MC cause of a post-op fever on day 5-7? |
|
Definition
|
|
Term
| What are the MC cause of a post-op fever on day 7+? |
|
Definition
|
|
Term
| What must you monitor when pt is on Heparin? |
|
Definition
|
|
Term
| What study is the BEST for evaluating a PE? |
|
Definition
|
|
Term
| What are the signs of a PE? |
|
Definition
Dyspnea
Tachycardia
CP
Hemoptysis |
|
|
Term
| What is the cause of malignant hyperthermia? |
|
Definition
Autosomal dominant heredity
Intracellular calcium metabolism is disrupted |
|
|
Term
| What condition is described as aberrancies in receptors allows massive build-up of calcium to be released from the sarcoplasmic reticulum→ violent, sustained muscle contraction & rigidity, heat production & acidosis? |
|
Definition
|
|
Term
| During surgery pts body temp begins to rise from 98 to 100F over 5 min, what condition might you suspect? |
|
Definition
|
|
Term
| What are the triggers for malignant hyperthermia? |
|
Definition
| Inhaled halothane anesthetic agents, specifically Succinylcholine |
|
|
Term
| What is the gold standard for diagnosing malignant hyperthermia? |
|
Definition
| IVCT – in vitro contracture test |
|
|
Term
| What is the treatment for malignant hyperthermia? |
|
Definition
D/C triggering anesthetic
Dantrolene via rapid IVP |
|
|
Term
| What are the complications of malignant hyperthermia? |
|
Definition
Rhabdomyolysis
Renal failure
Myopathy
Death |
|
|
Term
| In what days post-op does an anastamotic leak occur? |
|
Definition
|
|
Term
| What may be the cause of post-op fever weeks after? |
|
Definition
Endocarditis
Infected Prostheses |
|
|
