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Surgery: Blue PANCE book
Surgery: Blue PANCE book
76
Accounting
Graduate
05/01/2012

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Term
DVT Prophylaxis options:
Definition
- Unfractionated Heparine 5000 units subcu every 8-12 hours started before surgery and contined until ambulatory
- Enoxaparin 40 mg subcu daily, started 12 hours before or after surgery and contined until ambulatory or until 14 days following surgery
- Warfarin can be used in ortho patients after initial heparin use
- Fondapariunix lower DVT incidence in hips surgery patients
- Sequential compression devices

Stockings NOT recommended
Term
define malnutrition:
Definition
- lost 10% of his/her leand body mass and/or
- has not had adequate nutritional intake for more than 7 days
Term
catheter related problems with tube feedings:
Definition
- Air embolus
- Sepsis
- Pneumothorax
- Hemothorax
- Hydrothorax
- Cardiac rupture
Term
Solution related problems with tube feedings:
Definition
- Hyperglycemia
- Hepatic steatosis
- Electrolyte abnormalities
- Trace element/vitamin deficiencies
Term
leading cause of death b/w ages 1 and 44:
Definition
trauma
Term
Leading cause of accidental death in US:
Definition
MVA
Term
Most common indication for intubation:
Definition
Altered Mental Status
Term
tension pneumothorax PE findings:
Definition
- Hypotension
- Tracheal deviation away from injury site
- Jugular venous distention
- Lack of or decreased breath sounds on affected side
- Hyperresonance on affected side
- Subcutaneous emphysema
Term
Flail chest is characterized by ___ __.
Definition
paradoxical breathing
Term
lactated ringers may cause ___.
Definition
hyperkalemia
Term
What is Beck's Triad and what does it characterize:
Definition
Beck's Triad= Cardiac Tamponade
- Jugular Venous Distention
- Hypotension
- Muffled Heart Sounds
Term
Most penetrating chest traumas can be managed with ___ alone.
Definition
thoracostomy
Term
Test of choice for Blunt Abdominal Trauma:
Definition
FAST examination (Focused Assessment with Sonography for Trauma)
Term
FAST exam is used to evaluate pts with blunt abdominal trauam. It assesses the abdominal cavity for air or fluid in what areas?
Definition
- Perihepatic
- Perisplenic
- Pericardial
- Pelvic regions

A specific dx of an injured organ doese NOT have to be made

CT may be added as needed to clarify FAST results

CT and other tests should only be given if pt is hemodynimically stable
Term
FAST exam of abdomen reveals inraperitoneal air, what next?
Definition
Laparotomy
Term
In a pt with penetrating abdominal trauma with signs of __, __ __, or ___, an immediate ___ is indicated.
Definition
- shock
- peritoneal irritations
- evisceration
- laparotomy
Term
Useful diagnostic tests for determining arterial injury:
Definition
- Arteriography
- Ankle-brachial index
Term
Glasgow coma scale, mild head injury score:
Definition
13-15
Term
Glasgow coma scale, moderate head injury score:
Definition
9-12
Term
Glasgow coma scale severe brain injury score:
Definition
8 or less
Term
Glasgow coma scale:
Definition
Motor
- 6: Obeys commands
- 5: Localizes pain
- 4: Withdraws to pain
- 3: Abnormal flexion
- 2: Abnormal extension
- 1: None
Verbal
- 5: Oriented
- 4: Confused
- 3: Inappropriate words
- 2: Incomprehensible sounds
- 1: None
Eyes:
- 4: Spontaneous opening
- 3: Open to voice
- 2: Open to pain
- 1: None
Term
PE findings of basilar skull fracture:
Definition
- Rhinorrhea
- Otorrhea
- Raccoon eyes (bruising of lids)
- Battle's Sign (ecchymosis behind ears)
Term
Epidural hematomas are caused by injuries to the __ __ __.
Definition
middle meningeal artery
Term
An ___ hematoma is characterized by a brief period of unconciousness, followed by a lucid interval.
Definition
epidural
Term
Brain herniation triad:
Definition
- Coma
- Dilated fixed pupils
- Decerebrate posturing

may occur with epidural hematoma
Term
How do you dx epidural hematoma and what do you do about it?
Definition
- Dx: CT
- Emergent craniotomy
Term
Subdural hematomas occur from injury to the __ __. They are associated with severe head injury and can result in signifcant __ injury even after evacuation.
Definition
- bridging veins
- axonal injury
Term
Chronic subdural hematomas are more common in:
Definition
- Elderly
- Alcoholics
Term
Dx and management of subdural hematoma:
Definition
- Dx: CT
- Managment: Burr holes over hematoma for clot evacuation
Term
First degree burns involve minor damage to the __.
Definition
epidermis
Term
Second degree burns are divided into __ __ __ burns that extend into the __ __, and __ __ __ that extend into the __ __.
Definition
- superficial partial-thickness burns that extend into the papillary dermis
- deep superficial burns that extend into the reticular dermis
Term
2 classes of 2nd degree burns:
Definition
- Superficial partial thickness: extend into the papillary dermis
- Deep superficial burns: extend into the reticular dermis
Term
Third degree or __ __ burns, destroy the __ and __.
Definition
- full thickness
- dermis and epidermis
Term
4th degree burns destroy the:
Definition
- skin
- subcutaneous tissue
- fascia, muscle, bone, and other structures
Term
____ burns are the most common type of burn.
Definition
Scald
Term
Characteristics of first degree burns:
Definition
- Erythema
- Tenderness
- NO blisters
Term
You are examining a burn that has thin-walled blisters, is blanchable, moist, and painful to pressure. How would you classify this?
Definition
2nd degree superficial burn
Term
You are examining a burn that has thick walled blisters, many of which are ruptured, and is a mixture of erythema and pallor. It is painful to pressure. How would you classify this?
Definition
Deep 2nd degree burn
Term
Necessary labs for burn patients?
Definition
- Hematocrit
- Electrolytes
- BUN
- Cr
- Urinalysis
- Chest radiography

(may also consider a arterial blood gas, EKG, carboxyhemoglobin, glucose level)
Term
Review the rule of 9's
Definition
Term
White phosphorous burns require neutralization with __ __ ___ and adminstration of __ __ to address hypocalcemia.
Definition
- 1% copper sulfate
- calcium gluconate
Term
How do you treat burns caused by hydrofluouric acid?
Definition
- copious lavage for at least 30 minutes
- calcium gluconate gel to affected area
Term
Parkland formula for fluid needs in a burn patient:
Definition
%age of burn area x body weight(kg) x 4mL/hour= total amount of fluid needed in next 24 hours

- Half of this fluid is given in the first 8 hours, with the rest given over the remaining 16 hours
- Ringer's lactate solution is recommended
- Monitor urine output as a measure of adequate circulation and hemodynamic stability
Term
Burn patients need a __ __to avoid gasstric distention.
Definition
nasogastric tube
Term
Required urine output in an adult and child:
Definition
- Adult: at least 0.5ml/kg/hour
- Child: at least 1ml/kg/hour
Term
___ probably needs to be done on circumferential burns of the extremities and anterior trunk as these may cause compartment syndrome or make ventilation difficult.
Definition
Escharotomy
Term
Most commonly used topical burn ointment:
Definition
Sulfadiazine (Slivadene)

also can use Mafenide (Sulfamylon)- be careful b/c large amounts may cause metabolic alkalosis
Term
Deep dermal burns and fill thickness burns are excised on __ __.
Definition
day 3
Term
Common complications of burns:
Definition
- Inhalation injury
- Hypovolemic shock
- Nuerogenic shock secondary to pain
- Renal fialure
- Multiorgan system dysfunction
- Gastric/duodenal ulceration (Curling's ulcers)
Term
Chronic healilng burns wounds can undergo malginant transformation into a __ __ __ called a __ __.
Definition
- squamous cell carcinoma
- Marjolin's ulcer
Term
5 W's that may cause post-op fever:
Definition
- Wind
- Water
- Wound
- Walking
- Wouder drugs/Whopper
Term
__ is usually the cause of fever in the first 24-48 hours postoperatively. examination may reveal __ __ and in very severe cases, the trachea may be deviated.
Definition
- Atelectasis (Wind)
- bronchial breathing
Term
Explain the "Water" cause of post-op fevers and when it most likely occurs:
Definition
- UTI
- most commonly develops 48-72 hours post-op
Term
__ __ are the most common cause of post op fevers after 72 hours. __ __ is MC pathogen. There may be mild changes in vital signs with or without pain at site. Superficial infections involve the __ and __ __, while deep infections involve the areas below the __.
Definition
- Wound infections
- Staphylococcus aureus
- skin and subcutaneous tissues
- fascia
Term
Explain the "Walking" cause of post-op fevers:
Definition
- Thrombophlebitis, after 72 hours
Term
Superficial thrombophlebitis, which may cause a post op fever (walking), is commonly associated with __ __. What might you see on physical exam of this?
Definition
- intravascular catheters
- purulent drainage around indwelling catheter with induration of the vein
Term
Deep thrombophlebitis can be associated with __ __ __ or ___.
Definition
- indwelling central lines
- DVT
Term
Thrombophlebitis of the LE may be associated with __ __ or __ __ of the extremity.
Definition
- Homan's sign
- Unilateral edema of the extremity
Term
Wonder drugs like __, __ __ __, and others may cause a post-op fever greater than __ __ post op. This is a dx of exclusion and should only be considered after there has been a negative sepsis work up.
Definition
- anesthetics
- sulf containing antibiotics
- 1 week
Term
Explain the "Whopper" cause of post-op fever:
Definition
- postoperative abscess
- if intra-abdominal fluid collected > occult abscess> ileus
- polymicrobial culture suggests anastomitic leakage
Term
6 Ws of post op fevers:
Definition
1. Wind
2. Water
3. Wound
4. Walking
5. Wonder drugs
6. Whopper
Term
work up of post-op fever:
Definition
- CBC
- wound culture
- sputum culture
- blood culture
- chest xry
- abdominal CT
Term
atelectasis xray;
Definition
- shfiting of mediastinum TOWARD the affected side
Term
when atelectasis develops post-op what should be done?
Definition
- incentive spirometry
- mucolytics
- expectorants
- inhaled beta agonists
Term
In critically ill pts on multipel abx, a UTI may be caused by :
Definition
candida
Term
Managment of superficial thrombophlebitis as source of post-op fever:
Definition
- termination of IV lines at that site
- warm compresses
- systemic symptoms, immunocompromised, or diabetic> abx that coer staph and strep
Term
management of septic thrombophlebitis:
Definition
vein stripping of affected site b/c will act like abscess and make abx penetration difficult
Term
possible tmt for keloid scar:
Definition
Topical triamcinolone (steroid), 40 mg/mL in a dosage of 2 mL every 6-8 weeks
Term
topical steroids may cause:
Definition
- dermal atrophy
- telangiectasias
- hypopigmentation
Term
tmt of pressure ulcer:
Definition
- Removal of pressure
- Nutritional support
- Surgical intervention (skin graft or rotation flaps
- Abx only for those with sepsis
Term
Necrotizing fascitis is mc in:
Definition
- diabiteics (20-30%)
- alcholics
- IV drug abusers
Term
MC associated disease with necrotizing fascitis:
Definition
Diabetes
Term
pathogens with Necrotizing fascitis:
Definition
- Polymicrobial
- Group A Strep
- Clostridal infections
- Salwater fascitis= Vibrio species
Term
Necrotizing Fascitis triad;
Definition
- WBC elevated (>14,000)
- BUN elevated (>15)
- Hyponatremia (<135)
Term
Necrotizing fascitis treatment:
Definition
- Surgical debridement is mainstay
- Abx: PCN G, Clindamycin, Gentamycin
- Monitor renal function
Term
pressure ulcer stages:
Definition
Stage I is the most superficial, indicated by nonblanchable redness that does not subside after pressure is relieved. This stage is visually similar to reactive hyperemia seen in skin after prolonged application of pressure. Stage I pressure ulcers can be distinguished from reactive hyperemia in two ways: a) reactive hyperemia resolves itself within 3/4 of the time pressure was applied, and b) reactive hyperemia blanches when pressure is applied, whereas a Stage I pressure ulcer does not. The skin may be hotter or cooler than normal, have an odd texture, or be painful. Although easy to identify on a light-skinned patient, ulcers on darker-skinned individuals may show up as shades of purple or blue in comparison to lighter skin tones.
Stage II is damage to the epidermis extending into, but no deeper than, the dermis. In this stage, the ulcer may be referred to as a blister or abrasion.
Stage III involves the full thickness of the skin and may extend into the subcutaneous tissue layer. This layer has a relatively poor blood supply and can be difficult to heal. At this stage, there may be undermining damage that makes the wound much larger than it may seem on the surface
Stage IV is the deepest, extending into the muscle, tendon or even bone. A graphic presentation of severe stage IV ulcers is visible here.
Unstageable pressure ulcers are covered with dead cells, or eschar and wound exudate, such that the depth cannot be determined.
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