Term
| What kind of a learning is pedagogy? |
|
Definition
dependent, passive
subject oriented
indoctrination |
|
|
Term
| What kind of a learning is andragogy? |
|
Definition
active
life/experience oriented
self-directed |
|
|
Term
| What are the series of steps when mastering a technique? |
|
Definition
unconsioculy incompetent
consciously incompetent
consciously competent
unconsciously competent |
|
|
Term
| Who said this: they who do not know history are condemned to repeat it? |
|
Definition
|
|
Term
| What kind of surgery did Theodore Coker perfect in the 20th century? |
|
Definition
|
|
Term
| What did surgery evolve from? |
|
Definition
| the treatment of injuries |
|
|
Term
| Who developed the care and tx of wounds during surgery? |
|
Definition
|
|
Term
| Who is the father of our current medical education system? |
|
Definition
|
|
Term
| Age, gender and history are components of the pt history, what types of pathologies are related to these factors? |
|
Definition
congenital diseases
neoplasms
hormonal/sex specific organs
ethnic predilections |
|
|
Term
| What 2 classes of meds do surgeons mostly give? |
|
Definition
|
|
Term
| What 2 classes of meds do surgeons mostly give? |
|
Definition
|
|
Term
| What are the key PE elements when evaluating skin? |
|
Definition
changes in color
texture (clues to nutritional diseases)
turgor (volume issues)
temperature
touch |
|
|
Term
| What are the key PE elements when evaluating the chest? |
|
Definition
look, listen and feel
-alterations in movement
-difference in sounds
-differences in feel (subQ emphysema)
-differences in tympany (dullness or hyperresonance) |
|
|
Term
| What does SubQ Emphysema feel like? |
|
Definition
|
|
Term
| What are the key PE elements when evaluating the heart? |
|
Definition
look listen and feel:
perfusion
heart sounds and rhythm
pulses
temperature |
|
|
Term
| What are the key PE elements when evaluating the abdomen? |
|
Definition
inspect, auscultate, palpate and percuss
scars, masses, pulsations, color
gentler 2 handed systemic evaluation (begin away from area of pain/ concern)
guarding
rebound/ resonance
always a rectal! |
|
|
Term
| What are the key PE elements when evaluating the GU? |
|
Definition
look, listen and feel:
finger in every orifice
manual exam:
-males inguinal anatomy best examined upright
-females: in stirrups with chaperone |
|
|
Term
| A HIDA scan tests the function of what organ? |
|
Definition
|
|
Term
| In the pt history, what needs to be analyzed for surgery? |
|
Definition
|
|
Term
| What does AMPLE stand for when taking a surgical EMERGENCY history? |
|
Definition
Allergies
Medications
PMH
Last Meal
Events preceding emergency |
|
|
Term
| Why is knowledge of the last meal important when performing clinical procedures? |
|
Definition
| increased risk of aspiration (wait 6 hrs after last meal if possible) |
|
|
Term
| What technique is best when intubation is needed during emergency surgery to avoid aspiration? |
|
Definition
| Rapid Sequence Intubation |
|
|
Term
| Medications and their issues with surgery... |
|
Definition
|
|
Term
| Use of beta blockers can cause what? |
|
Definition
loss of chronotropic response to infection or blood loss
-although abrupt discontinuation increases risk of MI
-a BB slows down the rate of the heart |
|
|
Term
| Use of anticoagulants causes what 2 problems? |
|
Definition
exert effects on the synthetic function of the liver
platelet fxn |
|
|
Term
| What needs to be monitored with ventricular antiarrhythmics? |
|
Definition
|
|
Term
| What happens to the absorption of transdermal nitrates perioperatively? |
|
Definition
|
|
Term
| With a diabetic pt on insulin, what should be given intraoperatively and postop? |
|
Definition
| 5% dextrose solutions intravenously |
|
|
Term
| Metformin should be held for at least 1 day preop to prevent what? |
|
Definition
|
|
Term
| SERMs are associated with increased risk of what? |
|
Definition
DVTs
-SERMs should be held for at least 1 wk preop |
|
|
Term
| nutriceuticals and their interactions with surgery... |
|
Definition
|
|
Term
| What can echinecea cause? |
|
Definition
|
|
Term
|
Definition
| vasoconstriction/ MI/ CVA |
|
|
Term
|
Definition
| enhanced sedative effects, withdrawal |
|
|
Term
| What does St. John's Wort interact with? |
|
Definition
|
|
Term
|
Definition
extrapyramidal effects
GI discomfort
HTN
urinary retention |
|
|
Term
| Normal lab results obtained within _______ of elective surgery do not need repeating. |
|
Definition
|
|
Term
| Who should receive a baseline CBC/BMP? (this is usually performed in radical surgeries where blood loss is an issue) |
|
Definition
| Anemia/malignant disease/renal insufficiency/cardiac disease/DM/pregnant/HTN/ hepatic disease/long-term vomiting/elderly/or unable to give any history |
|
|
Term
| What type of pts should get an electrolyte screening? |
|
Definition
| elderly, any pt with a chronic medical dz |
|
|
Term
| What type of pts should get a baseline UA? |
|
Definition
urinary tract symptoms
chronic urinary dz
urology procedures |
|
|
Term
| What pts should receive a baseline CXR? |
|
Definition
| S/S of active pulmonary dz. |
|
|
Term
| What pts need a baseline EKG? |
|
Definition
Male >40
Female >50
Symptomatic CV disease
HTN, DM
If undergoing thoracic, intraperitoneal, aortic, emergent surgery |
|
|
Term
| What 2 events happen postoperatively that put stress on the myocardium? |
|
Definition
1. catecholamine surge in response to the pain and anxiety-->results in increased oxygen requirement
-myocardial blood flow is reduces by vasoconstriction effect of alpha-1 receptor and a reduced diastolic time reducing the time for blood flow thru the myocardium (eg increasHow ed HR)
2. Suppression of th fibrinolytic system (predisposing the pt to thrombosis and then myocardial ischemia |
|
|
Term
| How should the pt who is asymptomatic for heart dz be treated pre-operatively? |
|
Definition
check vital signs
-are there rubs, murmurs or 3rd heart sounds?
-tachy? BP irregularities? JVD? bruits? |
|
|
Term
| A pt with MV insufficiency has increased risk for postoperative what? |
|
Definition
|
|
Term
| Is mild/chornic CHF associated with increased risk of infarction? |
|
Definition
|
|
Term
| What are the 2 cardiac abns that will cause surgery to be postponed? |
|
Definition
|
|
Term
| What do abn 3rd heart sounds/JVD indicate? |
|
Definition
| decompensation of cardiac fxn (in jeopardy of serious heart complications) |
|
|
Term
| What should you order if bruits are heard? |
|
Definition
|
|
Term
| How long after an MI could a pt consider a surgery? |
|
Definition
|
|
Term
| How do you evaluate a pt with heart dz? |
|
Definition
is there a hx of dyspnea, arrhythmias, rheumatic heart dz which would require prophlactic abx (to prevent endocarditis)
hx of CAD, previous MI, pacemaker? |
|
|
Term
| A pt without risks has a ____ chance of MI. A pt with risks has a __ chance of perioperative MI. |
|
Definition
|
|
Term
| A perioperative MI has a __-__% mortality rate. |
|
Definition
|
|
Term
A pt with an MI within 3 mos of OR has a __-__% reinfarction rate.
A pt with an MI within 3-6 mos of OR has a __% reinfarction rate.
A pt with an MI within >6 mos of OR has a __-__% reinfarction rate. |
|
Definition
|
|
Term
| Surgery should be avoided with unstable angina, unless the surgery is what? |
|
Definition
coronary artery bypass
-with bypass there is a decrease in danger of post-op infarction at about 1% |
|
|
Term
| There is no clear evidence of increased risk of complications with what? |
|
Definition
|
|
Term
| A pt with a hx of DM, has an increased index of suspicion for what? |
|
Definition
occult cardiac pathology
-increased risk of mortality after MI for DM compared to those without DM |
|
|
Term
|
Definition
Ischemic event w/out symptoms with DM
-often found: breathlessness, mild CHF |
|
|
Term
| If a pt has a hx of DM for 5-10 yrs, what percent have diffuse vascular changes? |
|
Definition
|
|
Term
| If a pt has a hx of DM for >20 yrs, what percent have diffuse vascular changes? |
|
Definition
|
|
Term
| What does a pt with hx of rheumatic fever, prosthetic heart valve or other cardiac abns require? |
|
Definition
pre-op Abx prophylaxis to prevent endocarditis
-dental: amoxicillin (or emycin or clindamycin with pcn allergy
-GI/GU: amoxicillin (or vanco+gentamycin with pcn allergy) |
|
|
Term
| Dropps-American Surgical Association classify cardiac pts from I-V, what does this not identify? |
|
Definition
| pts at risk for post-op MIs |
|
|
Term
| Define the five classes of cardiology pts. |
|
Definition
Class I: healthy
Class II: mild to moderate systemic illness
Class III: severe systemic disturbance
Class IV: life threatening disturbance
Class V: not expected to survive (with or without surgery) |
|
|
Term
| What are the 9 factors that play into Goldman's assessment of individual risk factors of myocardial infarction during surgery? |
|
Definition
third heart sound or JVD
MI in past 6 mos
rhythm other than sinus
>5 PVCs/min
age>70 yrs
Emergency procedure
Hemodynamically significant aortic stenosis
Aortic, intraabdominal, intrathoracic procedure
poor general health |
|
|
Term
| So, age alone then is not a RF HOWEVER for emergent intrathoracic, surgical risk factor is directly related to what? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is given to pts with CAD or risk factors for CAD pre-op and peri-op? |
|
Definition
beta blocker: Atenolol
-reduces MI by 50% in the first 48 hrs
-reduces the 2 year mortality from 21% to 10% |
|
|
Term
| Besides atenolol what else can decrease cardiac events, especially arrhtymias? |
|
Definition
| maintaining perioperative normothermia |
|
|
Term
| Besides normothermia and atenolol, what third thing prevents cardiac events perioperatively? |
|
Definition
| treatment of perioperative hypertension |
|
|
Term
| What is the most common cause of postop morbidity? |
|
Definition
|
|
Term
| What surgical procedures come with increased pulmonary complications? |
|
Definition
abd sx with upper midline incision or involving dissection in upper abdomen
any thoracotomy incision
medial sternotomy
longer surgery time |
|
|
Term
| abdominal incisions-->pain-->decreased fxn residual capacity---> increased what? |
|
Definition
| pulmonary complication rate |
|
|
Term
| Anesthesia produces an __% reduction in functional residual capacity (FRC). |
|
Definition
11
-post-op coughing is also weakened which depresses mucociliary clearence.
-depressed resp drive post-op
-anticholinergic drugs thicken mucus
-infection |
|
|
Term
| What type of colonization of upper airway occurs with tracheal intubation? by suction catheters? |
|
Definition
GN organisms
nosocomial infections |
|
|
Term
| What else is increased secondary to anesthesia? |
|
Definition
|
|
Term
| Smokers need to quit _ _____ prior to surgery. |
|
Definition
|
|
Term
| What general factors predispose a pt to pulmonary complications? |
|
Definition
cigarette smoking
asthma
neuromuscular dz
obesity
nutritional depletion
acidosis
COPD
Prolonged operative time
hypoalbuminemia
extended stay in the hospital (preoperative)
chronic bronchitis
occupational lung dz
coma
tracheal intubation
hypotension
hypoxemia
azotemia
age >60 yrs
thoracic/ abd procedure. |
|
|
Term
| What pulmonary complications are you looking for when preoperatively evaluating a pt? |
|
Definition
pursed lip breathing, clubbing, cyanosis
respiratory pattern
chest wall A/P diameters |
|
|
Term
| An obese pt has decreased what (3)? and increased what (4) |
|
Definition
decreased lung capactiy, FRC, VC
increased WOB/ATX/secretions/hypoxemia |
|
|
Term
| With unxeplained dyspnea, cough, reduced exercise tolerance, OSA, wheezes, rhonchi, increased expiratory time, decreased bowel sounds or loose rattle with forced cough the pt is ___ times more likely to develop pulmonary complications. |
|
Definition
|
|
Term
| If the pt is over 40, what should be considered pre-operatively? |
|
Definition
|
|
Term
| Is there a role for routine use of ABGs? |
|
Definition
|
|
Term
| Who should have risks of death PNA, long term ventilation explained in full terms? |
|
Definition
|
|
Term
| When should formal pulmonary fxn tests be done? |
|
Definition
| in any pt with significant abns |
|
|
Term
|
Definition
|
|
Term
| Should a pt be denied a necessary procedure based on a hx of renal dz alone? |
|
Definition
|
|
Term
| What are the electrolyte values in patients with renal dysfxn? |
|
Definition
increased: K, Mg, Phos
decreased: Ca, HCO3
these labs are important to check before surgery bc they can be readily reversed by giving them bicarb or K-succinate |
|
|
Term
| What should be avoided with renal failure pts? |
|
Definition
nephrotoxic agents
succinylcholine: causes increased K |
|
|
Term
| What needs to be monitored in renal dysfxn pts? |
|
Definition
volume status
electrolytes
BUN/Cr
CBC |
|
|
Term
| What abx should bot be given to a pt with kidney failure? |
|
Definition
| aminoglycosides and some others |
|
|
Term
| what can be done pre-op to improve electrolytes and volume status in renal failure pts? |
|
Definition
|
|
Term
| In the MIVF (maintenance IV fluid), what electrolyte should not be included? when should MIVF be given? |
|
Definition
K
should be given NPO
-Be judicious with the MIVF (don't give them as much a you might give someone else bc they aren't excreting it as well) |
|
|
Term
| What is the cornerstone of mgmt of a pt with liver dz (with or without ascites)? |
|
Definition
|
|
Term
| In pts with primary hepatic dysfunction, what happens to sodium levels? |
|
Definition
excretion of Na is decreased
intravascular Na is also depleted
so not in the blood or being excreted!!! (need to Na restrict) |
|
|
Term
| Withdrawal symptoms occur within 1-5 days, what treatment can be done to help this? |
|
Definition
| treat pt with benzos prophylactically |
|
|
Term
| Alcoholics have an altered platelet fxn, in what way? |
|
Definition
vitamin K dependent coag factors are decreased, causing increased bleeding
-this can be seen as esophageal varices |
|
|
Term
| Why should thiamine be given in alcoholics? |
|
Definition
to help with vitamin deficiencies and to prevent ataxia, opthalm probs, confusion (Wernicke Korsakoff)
-delirium tremens could kill pt |
|
|
Term
| What are the 3 etiologies of liver dz? |
|
Definition
nutritional (alcohol abuse)
infectious
idiopathic |
|
|
Term
| What is the lab work up of a surgical pt with liver failure? |
|
Definition
| LFTs, hepatic screening (before surgery), PT/INR/PTT, platelets, bleeding time. |
|
|
Term
| with liver disease, you need to protect what you can during surgery, via what? |
|
Definition
FFP
Vit K
anticipate bleeding/complications. |
|
|
Term
| In a diabetic pt, what is desired before surgery? |
|
Definition
euglycemia or modest hyperglycemia
-if blood glucose is too low, death is quick due to starvation of glucose dependent tissue (esp the brain) |
|
|
Term
| Diabetic pts are at an increased risk for what? |
|
Definition
metabolic problems
CV problems
infection |
|
|
Term
| What needs to be done with a diabetics meds perioperatively? |
|
Definition
change oral meds to insulin
reduce AM insulin dose to 1/2 of regular or intermediate
continuous infusion of D5
Fingerstick q6h, maintain 150-200 |
|
|
Term
| Although we don't want hypoglycemia in the diabetic pt, watch out for DKA (glucose is too high), what are the signs? What should you check for? |
|
Definition
mimics ileus: N/V/abd distention/polyuria
check urine ketones |
|
|
Term
| What is DKA dependent on? |
|
Definition
on the absence of insulin (not on the presence of glucose)
-give them IV insulin SQ |
|
|
Term
| Diabetic men are at a _x greater risk of CV mmortality and women are at a _x greater risk. |
|
Definition
|
|
Term
| With gastroparesis, have an increased chance of what? what should be done before these s/s develop? |
|
Definition
aspiration
place an NG tube |
|
|
Term
| How is the diabetic at an increased risk for infection? |
|
Definition
hyperglycemia affects phagocytes
warm medium with food for bacteria
decreased blood flow w/ vascular pathology slows healing |
|
|
Term
| What two anatomical things need to be kept in mind with the pregnant patient? |
|
Definition
uterus can displace abdominal viscera
IVC can be compressed |
|
|
Term
| What are the physiologic changes during pregnancy? |
|
Definition
increased HR, SV, plasma volume and Hgb
decreased PCO2, gastric emtying |
|
|
Term
| Which trimester is the optimal time for surgery? |
|
Definition
2nd trimester
1st: risk of miscarriage is highest
3rd: uterus is too big |
|
|
Term
| The pt with a hemostatic disorder might have what on PE? |
|
Definition
ecchymosis
HSM (Henoch Schonlein Purpura) |
|
|
Term
|
Definition
| the halting of blood flow |
|
|
Term
| What are the lab tests of bleeding fxn? |
|
Definition
PT/INR: prothrombin time
PTT partial thromboplastin time: intrinsic pathway and common pathway
pltlt count quantifies pltlts
TEG study |
|
|
Term
| What does a PT/INR measure? |
|
Definition
factor VII and common pathway factors
-factor X, prothrombin/thrombin, fibrinogen, fibrin |
|
|
Term
| What does the TEG studt measure? |
|
Definition
thrombosis tendencies
-tests the efficiency of coagulation in the blood
-tests how well or poorly different factors are contributing to clot formation
-how wel lthe blood can perform hemostasis |
|
|
Term
| What are 4 iatrogenic anticoagulation agents? |
|
Definition
warfarin
aspirin
heparin
thienopyridines |
|
|
Term
| How does warfarin work? how is it's effect measured? in general where do we want pts PT/INR? |
|
Definition
Blocks vit K dependent factors (II, VII, IX, X)
Effect measured with PT / INR
In general, want patients < 1.5 |
|
|
Term
| How does aspirin affect coag? |
|
Definition
Irreversibly acetylates COX production, which blocks production of thromboxane A2
decreases platelet aggregation
Renders platelet dysfunctional for life |
|
|
Term
| The higher the INR, the _______ their blood is. |
|
Definition
|
|
Term
| How are the effects of heparin measured? |
|
Definition
|
|
Term
| What reaction might heparin cause? |
|
Definition
| Heparin induced thrombocytopenia |
|
|
Term
| Does lovenox require less or more frequent monitoring than heparin? |
|
Definition
|
|
Term
| What does a thienopyridine inhibit? what is one example? |
|
Definition
ADP-induced pltlt aggregation
Plavix (clopidogrel) |
|
|
Term
| Pregnancy is a _____coaguable state. |
|
Definition
|
|
Term
| What are 3 inherited bleeding disorders? |
|
Definition
hemophilia A
hemophilia B (Christmas Dz)
von Willebrand's Dz |
|
|
Term
| Hemophilia A involved which coag factor? |
|
Definition
|
|
Term
| Hemophilia B involves which coag factor? |
|
Definition
|
|
Term
| von Willebrand/s Dz is a deficiency of which coag factor? |
|
Definition
|
|
Term
| What are the 3 purposes of the medical record? |
|
Definition
1. common and accessible place to record data and tx plan
2. transmit instruction about pt care
record of events that occurred during patient care |
|
|
Term
| Should notes be used to relay messages among consultants about personal opinions? |
|
Definition
| No, if disagree with plan, give reasons to support plan |
|
|
Term
| The medical record should not be repetitively documenting the tx course... when is this okay? |
|
Definition
| in teaching hospitals with students, residents and attending physicians. |
|
|
Term
| What should be recorded in the input/output portion of a medical record? |
|
Definition
output of fluid from drain/tube
fluid intake: surgical drain, tube. |
|
|
Term
| What should be recorded in the fluids portion of the medical record? |
|
Definition
|
|
Term
| There is a preop, operative and a post-op note, what all is included in the operative note? |
|
Definition
procedure
diagnosis
estimated blood loss (EBLs)
crystalloid/ blood replaced
anesthesia
complications
tubes
drains
disposition
signature |
|
|
Term
|
Definition
|
|
Term
| What are the 4 types of GI tract tubes? |
|
Definition
nasogastric
nasobiliary
T-tube
Gastrotomy tube
Jejunostomy tube |
|
|
Term
| What does a nasogastric tube do? |
|
Definition
| evacuates gastric contents for ileus/obstruction |
|
|
Term
| What are the two types of NG tubes and what does each do? |
|
Definition
sump tube: prevents suction bw tube and gastric wall; continuous suction
non-sump tube: intermittent suction to break seal bw tube and gastric wall |
|
|
Term
| How do you confirm the placement of an NG tube? |
|
Definition
|
|
Term
| If you don't drain the stomach during an ileus or obstruction, what complications could occur? |
|
Definition
aspirations
more obstruction
nausea
vomiting |
|
|
Term
| What is the fxn of a nasobiliary tube? How is it placed? |
|
Definition
drains biliary tree when there is an obstruction (stone, tumor, stricture, fistula)
it is placed endoscopically |
|
|
Term
| What is the fxn of the t-tube? |
|
Definition
| it is placed within the common bile duct to drain bile |
|
|
Term
| What does a gastrotomy tube (PEG or G-tube) used for? |
|
Definition
|
|
Term
| What is a jejunostomy tube (J-tube) used for? |
|
Definition
used for feeding
-bypasses stomach and tube feeds directly into the intestine |
|
|
Term
| What are the 3 respiratory tract tubes? |
|
Definition
chest tube
endotracheal tube
tracheostomy tube. |
|
|
Term
| What is the purpose of a chest tube? |
|
Definition
| placed into pleural cavity to evacuate air, blood or fluid |
|
|
Term
| A chest tube is connected to a three-chamber system, what are those three chambers? |
|
Definition
collecting chamber
suction system (permits constant suction)
water seal (prevents air entering into pleural space) |
|
|
Term
| What is the purpose of an endotracheal tube? |
|
Definition
| short term mechanical ventilation |
|
|
Term
| What is the purpose of a tracheostomy tube? |
|
Definition
placed directly into trachea
used for long term mechanical ventilation |
|
|
Term
| What is the goal as soon as you get a pt off of a ventilator? |
|
Definition
|
|
Term
| What are the 2 urinary tract tubes? |
|
Definition
bladder/foley catheter
nephrostomy tube |
|
|
Term
| When and where is the bladder/foley cath placed? |
|
Definition
when pt undergoing trauma or surgery, so pt doesn't contaminate the bed.
placed directly into the bladder |
|
|
Term
| Where is the neprhostomy tube placed, and what does it do? |
|
Definition
into the renal pelvis (above ureter)
drains urine above an obstruction |
|
|
Term
| What are the 3 types of surgical drains? |
|
Definition
closed suction
sump suction drain
passive tube (Penrose) |
|
|
Term
| What are the two types of closed suction drains? |
|
Definition
Jackson Pratt: connected to a collapsable bulb
Hemovac:connected to a compressible box on a spring |
|
|
Term
| What do closed suction drains do? |
|
Definition
| evacuate actual or potential fluid collections. |
|
|
Term
| What type of suction does the sump suction drain do? |
|
Definition
| continuous suction used when drainage is thick |
|
|
Term
| What type of drainage does passive tube (penrose) do? |
|
Definition
| maintains a pathway for fluid to follow without suction |
|
|
Term
| What is primary intention wound healing? |
|
Definition
| wound edges have been apposed (sutures, staples, dermal adhesive) |
|
|
Term
| What is secondary intention wound healing? |
|
Definition
wound edges left unapposed.
-moist gauze packed into wound/ tract to heal from inside out (ie abscess) |
|
|
Term
| With regards to pain management and the intubated pt, how much is enough? |
|
Definition
| enough to be kept comfortable but not overly sedated |
|
|
Term
| Post-op, when is pain the worse? |
|
Definition
|
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Term
| Can PAs write narcotics in the state of tn? |
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Definition
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Term
| Virchow's triad defines the risk factors for DVT, what are they? |
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Definition
venous stasis
-due to alterations in blood flow (varicose veins, immobility)
hypercoaguability
-pregnancy, malignancy
Vessel injury
-trauma and venipuncture |
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Term
| What is used for chemical DVT prophylaxis? |
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Definition
heparin
low molecular weight heparin (lovenox) |
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Term
| If giving a pt heparin, and they have had heparin induced thrombocytopenia before, what should you do? |
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Definition
| pltlt count check at least every other day |
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Term
| Lovenox tends to be used except when? |
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Definition
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Term
| Lovenox should be checked every _ days, while heparin is everyday. |
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Definition
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Term
| What is used for mechanical DVT prophylaxis? |
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Definition
IPC (Intermittent Pneumatic Compression) Devices
-prevents blood stasis |
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Term
| What 5 post-op complications are we worried about? |
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Definition
malignant hyperthermia
atelectasis
surgical wound failure (dehiscence)
surgical site infections
fever |
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Term
| What is malignant hyperthermia? |
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Definition
Life threatening autosomal dominant condition resulting in disruption of the calcium release channel (ryanodine receptor)
-massive build up of intracellular calcium-muscle contraction
-heat production
-acidosis |
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Term
| What does malignant hyperthermia lead to? |
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Definition
| violent and sustained muscle contractions leading to rhabdo and muscle necrosis |
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Term
| What are some triggers of malignant hyperthermia? |
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Definition
inhalational halogenated anesthetic agents
succinylcholine (depolarizing muscle relaxant) |
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Term
| What are the first signs of malignant hyperthermia? |
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Definition
abrupt rise in end tidal carbon dioxide
temp elevation may not present for up to 36 hrs. |
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Term
| After you discontinue the offending agent, how is malignant hyperthermia treated? |
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Definition
| dantrolene (m. relaxant blocks calcium release) |
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Term
| What is the supportive care of malignant hyperthermia? |
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Definition
| mechanical ventilation to correct respiratory component of acidosis |
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Term
| Atelectasis is the _____ _______ of alveoli of lung. |
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Definition
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Term
| How can atelectasis be prevented? |
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Definition
inspiratory exercises
re-expansion techniques (incentive spirometer)
early mobilization to help improve lung inflation |
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Term
| Who does micro-collapse hapen to? |
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Definition
| pretty much anybody under anesthesia, that's why you want to take preventative measures to prevent atelectasis |
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Term
| What is surgical wound failure (dehiscence)? |
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Definition
disruption in fascial closure of wound
-force exerted across the wound is greater than the strength off the suture. |
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Term
| What can cause dehiscence? |
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Definition
| sutures being closed too tightly resulting in ischemia of tissue |
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Term
| What is the first sign of wound failure? |
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Definition
| copious serous fluid drainage |
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Term
| Can dehiscience of abd closure have evisceration of abd organs? what should you do? |
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Definition
yes
-cover with sterile towels soaked in saline and return to operating room immediately |
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Term
| What can dehiscience be a sign of? |
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Definition
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Term
| What are 5 signs of surgical site infection? |
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Definition
Redness (rubor)
Swelling (tumor)
Localized heat/erythema (calor)
Increased pain (dolor)
Tachycarida may be first sign |
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Term
| When is a fever a high enough to initiate investigation? |
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Definition
101.5 (per UT)
38.3 C or 100.9 F (per the book) |
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Term
| What are some nosocomial causes of a fever? |
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Definition
Ventilator associated pneumonia
Catheter related sepsis-gram negative
Clostridium difficile colitis
Complicated wound infectinos |
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Term
| What are some non-infectious causes of fever? |
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Definition
post-transfusion
MI
Subarachnoid hemorrhage
IV contrast reaction
DVT |
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Term
| The increase in metabolic demand that is associated with fever is poorly tolerated in who? |
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Definition
elderly
cardiac
pulmonary conditions |
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