Download High Yield Surgery Shelf Exam Review Complete PDF

TitleHigh Yield Surgery Shelf Exam Review Complete
File Size422.2 KB
Total Pages11
Document Text Contents
Page 1

High Yield Surgery Shelf Review

PRE-OP EVALUATION
Contraindications to surgery
– Absolute? Diabetic Coma, DKA
– Poor nutrition? albumin <3, transferrin <200, weight loss <20%.
– Severe liver failure? bili >2, PT >16, ammonia > 150 or encephalopathy
– Smoker? stop smoking 8wks prior to surgery
If a CO2 retainer, go easy on the O2 in the post-op period. Can suppress respiratory drive.
Goldman Index: Who is at greatest risk for surgery
#1 = CHF

• Check? EF. If <35%, no surg.
#2 = MI w/in 6mo (ischemic disease)

• Check? EKG  stress test  cardiac cath  revasc.
#3 = arrhythmia
#4 = Old (age >70)
#5 = Surgery is emergent
#6 = Aortic stenosis, poor medical condition, surg in chest/abd

• Murmur of AS: Late systolic, crescendo-decrescendo murmur that radiates to carotids. ↑ with
squatting, ↓ with decr preload

Meds to stop
2 wks: Aspirin, NSAIDs, vit E
5 days: Warfarin – drop INR to <1.5 (can use vit K)
!  Take thyroid meds morning of surgery
If CKD on dialysis

 Take ½ morning dose of insulin if IDDM
 Dialyze 24 hours pre- & post-op

• Why check BUN/Cr? Increased risk of post-op bleeding 2/2
– If BUN > 100: Uremic platelet dysfunction.

– Coag panel: Normal platelets but prolonged bleeding time

VENT SETTINGS
• Assist-control: set TV and rate but if pt takes a breath, vent gives the volume.
• Pressure support: pt rules rate but a boost of pressure is given (8-20).

*Important for weaning.*
• CPAP: pt must breathe on own but + pressure given all the time.
• PEEP: pressure given at the end of cycle to keep alveoli open (5-20).

*Used in ARDS or CHF*
• Best test to evaluate vent management? ABG
• LowPaO2? increase FiO2
• High PaO2? decrease FiO2

• Low PaCO2 (pH is high)? Decr RR or TV
• High PaCO2 (pH is low)? Incr rate or TV
TV is more efficient to change.

Page 6

Eyes 4, verbal 5, motor 6
GLASGOW COMA SCALE

1 2 3 4 5 6
Eye Does not open eyes Opens eyes to pain Opens eyes to voice Opens eyes spontaneously

Verbal No sounds Incomprehensible sounds Inappropriate words Confused, disoriented Converses normally
Motor No movements Decerebrate posturing Decorticate posturing Withdraws from pain Localizes pain Obeys commands

Increased ICP: Hematoma, edema, tumor
 Symptoms: Headache, vomiting, altered mental status
 Treatment: Elev. head, hyperventil. to pCO2 28-32, diuresis (furosemide, mannitolwatch renal fxn)
 Surgical: Burr hole, ventriculostomy

Neck Trauma
Penetrating trauma vs. GSW

Zone 3 = ↑ angle of mandible
 Aortography and triple endoscopy

Zone 2 = Angle of mandiblecricoid
 2D doppler +/- exploratory surgery

Zone 1 = ↓ cricoid
 Aorto/angiography

Abdominal Trauma
Penetrating Abdominal Trauma: Do not pass go! Go directly to exploratory laparotomy.

 GSW to abdomen: Ex-lap. (plus tetanus prophylaxis)
 Stab wound w/unstable ptrebound tenderness & rigidity OR evisceration: Ex-lap. (plus tetanus

prophylaxis)
o Stab wound w/stable pt: FAST exam; diag. peritoneal lavage (DPL) if FAST is equivocal

 Ex-lap if either are positive.
Blunt Abdominal Trauma: w/hypotn/tachycardia, Ex-lap.
If stable OR stable w/epigastric pain: Abdominal CT

 Lower rib fx + abd. bleed: Spleen or liver lac.
 Lower rib fx + hematuria: Kidney lac.

Similer Documents