Term
| Where is the greatest risk for a TPN central line? |
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Definition
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Term
| What are crystalloid solutions |
|
Definition
| contain electrolytes and non-electrolytes which difuse into all body fluid compartments. Ex: Ringers Lactate & 5% dextrose in water |
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Term
| When do you start thinking about nutritional supplements? |
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Definition
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|
Term
| Best lab to check protein status for nutritional assessment? |
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Definition
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Term
| What fluid is most commonly used for surgery and fluid resuscitation? |
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Definition
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|
Term
| What is normal osmolality |
|
Definition
280-300
2xNa+BUN/2.8+glc/18 |
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Term
| The purpose of intake and output measurements of patients |
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Definition
| Make sure patient isnt dehydrated or edematous |
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Term
| Avg insensible fluid loss per day in post surgical patients |
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Definition
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Term
| Why is testing Albumin for nutritional status important |
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Definition
| To prevent hypoalbuminemia which is associated with mortality in post-op complications |
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Term
| Why is testing pre-albumin important in determining nutritional status |
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Definition
| Pre-elbumin is increased in renal failure and with steroids and decreased in liver failure and with infection |
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Term
| What is the major intracellular cation |
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Definition
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Term
| How are the caloric needs affected in patients having surgry/trauma/burns |
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Definition
| Increased. Burn patients need 200% above baseline |
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Term
|
Definition
TBW=0.5xBW
BWD=TBWx(serumNa-140)/140 |
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Term
|
Definition
| when enteral feedig can not be donw and bowel recovery >7days |
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Term
| What are the major lines used for TPN and complications |
|
Definition
| IJV, SCV, PICC & line infections |
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Term
| Can you use hypertonic solutions in peripheral veins fo nutrition? |
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Definition
| NO. need to use isosmotic solution. |
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Term
| What are the 4 goals of general anesthesia |
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Definition
| unconsciousness, amnesia, analgesia, NM blockade |
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Term
| What is the best fluid replacement for NG fluid loss by suction |
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Definition
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Term
| How do you treat an abscess |
|
Definition
| Incision and drainage with regular dressings and antbx |
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Term
|
Definition
| Nonabsorbale, Absorbable, Monfilament, Multifilament |
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Term
| Describe the use, risk and reaction of nonabsorbable sutures |
|
Definition
For interrupted suture
Tensile strength >60days, walled off by bodys fibroblasts & remain encapsulated. Used when h/o rxn to absorbable sutures
For prosthetic atachment
Nylon, silk, stainless steel, prolene, polyester |
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Term
| Describe the use, reaction risk and size of absorbable sutures |
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Definition
Tensile strength <60days, used to hold edges together temporarily, maybe treated chemically to lentghen aborption time, colored artificially, digested naturally by body enzymes
vicryl, dexon, PDS, plain gut, chromic gut |
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Term
| Name types of surgical wounds |
|
Definition
Clean - uninfected, no resp or GU tracts entered
Clean/containated - uninfected, resp or GU tracts entered
Contaminated - open wounds with GI spillage causing infection
Dirty contaminated - infecetd prior to operation, heavily contaminated |
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Term
| Factors affecting wound healing |
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Definition
| cold, pain, hypovolemia, fear, b-blockers, cigarettes, hypoxemia, age, weight, nutritional status, blood supply, immune responses, chronic diseases, radiation therapy, inadequate closure |
|
|
Term
|
Definition
| bedspores or pressure ulcers |
|
|
Term
|
Definition
| Closure with suture; hairline scar |
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|
Term
|
Definition
|
|
Term
|
Definition
| For management of contaminated & dirty, infected wounds where tissue loss is extensive & chances of infection high. Debride nonviable tissue and leave wound open & covered by (wet) gauze If there is no evidence of infection after 3-5 days, wound is sutured |
|
|
Term
|
Definition
occurs w/in 30 days usually btw day 5-10
Accompanied by purulent discharge and one of the following: pain, tenderness, local swelling, redness, heat, fever, erythema >2cm, fluctuance, dehiscance |
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|
Term
|
Definition
| any technique to render part of the body insensitive to pain without affecting consciousness. i.e. lidocaine |
|
|
Term
|
Definition
local anesthetic that is used to numb the surface of a body part. i.e. EMLA cream patch
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|
|
Term
|
Definition
anaesthesia affecting only a large part of the body, such as a limb. Lung fxn preserved. Blood loss minimized. Aspirate before injection
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|
|
Term
| MAC (monitored anesthesia care) |
|
Definition
| often referred to as twilight sleep, is a type of light anesthesia used for minor procedures |
|
|
Term
|
Definition
| unconsc, amnesia, analgesia, NM blockade, w/in 3-5 min |
|
|
Term
|
Definition
| into intrathecal space; headache common and hypotension may occur. block innervation of bladder |
|
|
Term
|
Definition
| into extradural space. mm fxn preserved |
|
|
Term
| Most common side afect of general anesthesia |
|
Definition
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|
Term
| Time needed for blood typing and crossmatching |
|
Definition
| 5 min for typing and 45 min for cross matching |
|
|
Term
| What blood type is the universal donor |
|
Definition
|
|
Term
| What blood type is the universal recipient |
|
Definition
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|
Term
| Most important part of pre-op evaluation |
|
Definition
|
|
Term
|
Definition
Cancer/Contraceptives
Obesity
Myocardial dysfunction
Prior Hx of DVT
Age >45
Surgery
Travel/Trauma |
|
|
Term
|
Definition
| collection of fluid other than pus or blood |
|
|
Term
|
Definition
|
|
Term
|
Definition
| partial or total disruption of any or all layers of operative wound |
|
|
Term
| Major cause of fat embolus |
|
Definition
|
|
Term
| ASA classifications of patient risk before surgery |
|
Definition
1. No issues
2. mild-mod issue may/may not related (diabetes)
3. Severe issue may/may not related (HTN, heart disease)
4. Severe life threatening issie w/ or w/o surgery (CHF, angina)
5. Litle chance of survival, surgery last resort (ruptured aneurysm)
E - pt needs emergency operation |
|
|
Term
| Common infection 2nd to atbx use |
|
Definition
|
|
Term
| W's of post surgical causes of fever |
|
Definition
Wind (atelectasis most commong)
Wound (SSI)
Water (UTI or sepsis)
Walking (thrombo)
Wonder drug (Rx rxn)
Whopper (deep abscess) |
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|
Term
| Are you allowed to take instruments off the Mayo tray |
|
Definition
|
|
Term
| Does the patient have hairy areas shaved w/ a razor before surgery? |
|
Definition
| Electric shaver day of surgery |
|
|
Term
| If pt is allergic to betadine what else can be used |
|
Definition
|
|
Term
| Single or double glove for surgery |
|
Definition
|
|
Term
| Maximum amount of plain lidocaine that can be safely injected into adult pt |
|
Definition
| 4.5mg/kg not to exceed 300 mg |
|
|
Term
| Max amount of lidocaine w/ epi safely injected into an adult pt |
|
Definition
| 7 mg/kg not to exceed 500 mg |
|
|
Term
| When to intubate on Gladcow Coma score |
|
Definition
|
|
Term
| Soot in nose and mouth needs? |
|
Definition
|
|
Term
|
Definition
4mlxBSA%xkg=adults
3mlXBSA%xkg=kids |
|
|
Term
|
Definition
| epidermis only. no blisters |
|
|
Term
|
Definition
| into dermis but not through dermis |
|
|
Term
|
Definition
| destruction of epidermis and dermis |
|
|
Term
| Name 4 categories of shock |
|
Definition
Hypovolemic
Distributive
Cardiogenic
Obstrtuctive |
|
|
Term
| How are lab tests affected in shock |
|
Definition
BUN and Cr are increased
La- is increased
Glucose is increased |
|
|
Term
| Treatment of Hypovolemic shock |
|
Definition
| control bleeding, blood transfusion if loss >20%, isotonic electrolytes, AVOID vasopressors |
|
|
Term
| TReatment of Cardiogenic shock |
|
Definition
| Reversal of undelrying disease (ischemia, LV critical mass >40%); diuretics and vasodilators to reduce pre and afterload; b-blockers reduce myocardial O2 consumption, inotropic agents increase myocardial contractility, IABP if hypotensive and not responsive |
|
|
Term
|
Definition
| control etiology by antbx, epi, antihx, steroids, volume expansion, support organ fxn, AIRWAY |
|
|
Term
|
Definition
| Needle decompression, chest tube (tension pneumothorax); volume expansion, pericardiocentesis (cardiac tamponade); inotropic agents, thrombolysis, embolectomy-rare (pulmonary embolism) |
|
|
Term
| Signs and symptoms of a patient in shock |
|
Definition
alterd mental status, HR>100 bpm, RR >22bpm, PCO2 <32mmHg, La->4mmol/L; Urine output <0.5cc/kg/hr, SBP <90mmHG for >20 min, arterial base deficit >5mEq/L
**4 of these symptoms must be present |
|
|
Term
| When does pt begin to have BP changes w/ fluid loss |
|
Definition
|
|
Term
| At what fluid level does HR change in hypovolemic shock |
|
Definition
|
|
Term
|
Definition
Focused Assessment with Sonography for Trauma
cheap, fast, effective, easily reproducible |
|
|
Term
| Tx for tension pneumothorax |
|
Definition
| immediate decompression w/ 14 gauge catheter 2nd MCICS |
|
|
Term
| What constitutes and is the treatment of flail chest |
|
Definition
| Frx of rib in >2 places. Treat by intubation. Think thoracic aortic anurysm/rupture |
|
|
Term
| Becks triad for cardiac tamponade |
|
Definition
| Hypotension, venous distention, muffled heart sounds |
|
|
Term
| Most common cause of life threatening hemorrhage in automobile accidents |
|
Definition
|
|
Term
| 3 indications for damage control surgery (Triad of death) |
|
Definition
| Hypothermia, coagulopathy, acidosis |
|
|
Term
| 3 goals of damage control surgery |
|
Definition
| Hemorrhage control and repair of vascular injuries, stop GI contamination, temp abdominal wound closure |
|
|
Term
| 3 stages of abdominal damage control surgery |
|
Definition
Stage I - limited operation for control of hmorrhage and contamination
Stage II - resuscitation in ICU
Stage III - reoperation |
|
|
Term
|
Definition
Intertrochanteric
neck of femur
head of femur
Hip had EBL od 8-10 units |
|
|
Term
| Difference btw Gustilo and Tscherne classifications systems |
|
Definition
| Gustilo is commonly use din open frx and emphasizes on size of skin injury. Tscherne is based on extremity of soft tissue damage |
|
|
Term
| How to classify exercise tolerance in regards to surgical survival |
|
Definition
| poor exercise tolerance = inability to climb 2 flights of stairs or walk 4 blocks |
|
|
Term
| When is it safe to take a patient for elective surgery after angioplasty? Bare metal stent? Drug eluding stent? |
|
Definition
Balloon angioplasty <14d since PCI
Bare metal stent <30-45d since PCI
Drug eluding stent < 365d since PCI |
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