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Flashcards in Surgery Deck (44)
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1
Q

How long before surgery should patient fast for ?

A
  • > 2hrs clear fluids

- > 6hrs solids

2
Q

When should thromboprophylaxis be started before surgery ?

A
  • 2hrs before
  • graduated compression stockings (not in PVD)
  • LMWH e.g. Enoxaparin
3
Q

Complications of post op wound infection ?

A
  • haemorrhage
  • sepsis
  • wound dehiscence
4
Q

What antibiotics should be added to pre op prophylaxis in high risk MRSA patients ?

A

Teicoplanin or vancomycin

5
Q

When should IV prophylactic antibiotics be administered before surgery ?

A

30 mins

6
Q

What is the role of post op surgical drains ?

A
  • vacuum to protect against collection, haematoma and seroma formation
  • protect sites where leakage may occur e.g. Bowel anastomoses
  • collect RBCs which can be auto transfused (protects against the risks of allotransfusion)
7
Q

What is a seroma ?

A
  • Pocket of clear serous fluid that sometimes develops in the body after surgery
  • occurs when small blood vessels rupture and blood plasma seeps out
  • inflammation caused by dying injured cells also contributes to the fluid

*in breast can cause necrosis of overlying tissue

8
Q

What should be explained to the patient before giving anaesthetics?

A
  • where they will wake up (or ITU will be frightening)
  • that they may feel ill on wakening
  • risks
9
Q

What are the premedications given before surgery ? (6a)

A
  • anxiolytics (anti anxiety): benzodiazepines e.g. Lorazepam
  • analgesics: pre emptive analgesia not often used- children and anxious adults
  • anti-emetics: 5ht3 antagonists e.g. Ondansetron or metoclopramide
  • antacids: ranitidine/ omeprazole at particular risk of aspiration
  • antisialogues: glycopyrronium - sometimes given to decrease secretions that could block small airways
  • antibiotics: metronidazole/cefuroxime/gentamicin (usually 2 of these, varies depending on site of surgery)
10
Q

Complications of surgery and what causes them?

A
  • no pain sensation -> urinary retention, local nerve palsy (e.g. From arm hanging over bed), diathermy burns
  • consciousness: lack of = can’t communicate e.g. Wrong leg. retained consciousness-> PTSD
  • lack muscle power -> corneal abrasions (must be taped shut), no respiration/cough-> pneumonia/acetelectasis
11
Q

When and what might be used for local anaesthetic in surgery ?

A
  • unfit or unwilling for general
  • local nerve block e.g. Brachial plexus/spinal blocks
  • long acting local anaesthetic e.g. Bupivacaine
12
Q

What is malignant hyperpyrexia ?

A
  • Autosomal dominate condition
  • administration of volatile anaesthetic agents (halothane,suxamethonium) results in 1 degree rise in temp every 30 mins, masseter spasm
  • treat with dantrolene and active cooling
13
Q

Triad of anaesthetics ?

A
  • hypnosis e.g. Proprofol
  • muscle relaxation- only if surgery can’t be done without paralysis e.g. Open abdo
  • analgesia
14
Q

What are the things to consider with emergency surgery that may complicate it

A
  • patient will have full stomach

- pain and drugs administered may have delayed gastric emptying

15
Q

What should be checked on pre op examination of patient ?

A
  • CV and resp - HR, BP, pleural effusions etc
  • potential problems with the airway e.g. Short neck, impaired TMJ
  • mouth and dentition: loose crowns/teeth
  • veins for ease of access
16
Q

What in particular should be checked for in Afro Caribbean patients before surgery if not already documented ?

A

Sickle cell trait

17
Q

How is the airway managed when under general anaesthetic

A
  • laryngeal mask airway unless requires enhanced airway protection
  • in emergency surgery, due to full stomach, will require intubation with rapid induction and cricoid pressure
18
Q

Complications of general anaesthesia?

A
  • damage to mouth or pharynx, including teeth
  • nausea and vomiting
  • CV collapse, resp distress
  • malignant hyperpyrexia
19
Q

Measurements to be recorded during recovery from general anaesthetic ?

A
  • consciousness level
  • O2 sats
  • BP, RR, HR + rhythm
  • pain intensity (verbal scale)
  • temp
  • urinary output
20
Q

What are the different types of local anaesthics?

A
  • topical
  • infiltrative
  • nerve blocks
  • IV regional blocks
  • plexus blocks
  • extradural and spinal
21
Q

What are the different local anaesthetic agents ?

A
  • lidocaine: 1-2 hrs
  • bupivacaine - 3+ hrs
  • prilocaine
  • EMLA cream (lidocaine and prilocaine)
  • duration can be doubled with addition of adrenaline (constrictsits vessels and so reduces absorption)
22
Q

Why should HRT and contraceptive pill be stopped 4 weeks before surgery ?

A

Increases risk of DVT/PE

23
Q

Reasons for fasting before surgery ?

A
  • ## prevent pulmonary aspiration of stomach contents when under general anaesthesia
24
Q

What is post operative ileus ?

A

Severe or absolute constipation and intolerance of oral intake (vomiting) due to non mechanical factors that disrupt the normal coordination of propulsive motor activity of GI tract
* certain degree is normal physiological response to surgery

25
Q

How long after surgery should gut motility reappear ?

A

2-3 days

26
Q

Presentation of post operative paralytic ileus

A
  • vague, mild abdo pain and bloating
  • nausea, vomiting, anorexia
  • constipation
27
Q

Difference between ileus and intestinal obstruction

A
  • obstruction: pain more severe + cramping (not seen in ileus)
  • obstruction = tinkling bowel sounds, ileus = absent
  • obstipation more likely in obstruction
28
Q

When does secondary post operative haemorrhage start ?

A

1-2 weeks post op

29
Q

Warning sign of wound dehiscence

A

Serous pink discharge from wound

30
Q

What general post op complications may present immediately ? (4)

A
  • primary haemorrhage (starting during surgery or on Post opincreased BP - reactive bleeding)
  • acetelectasis (minor lung collapse)
  • shock: blood loss, acute MI, PE, septicaemia
  • low urine output: inadequate fluid replacement intra or post operative lay
31
Q

What is usually the cause of secondary post op bleeding ?

A

Infection

32
Q

What complications may occur a within days post op ? (Early complications)

A
  • acute confusion: dehydration, sepsis
  • nausea and vomiting: analgesia/anaesthetic related or ileus
  • fever
  • secondary haemorrhage
  • pneumonia
  • wound dehiscence
  • DVT
  • acute urinary retention
  • UTI
  • infection
  • bowel obstruction
33
Q

Late complications of surgery

A
  • bowel obstruction due to fibrous adhesions
  • incisional hernia
  • keloid formation
34
Q

What complications are likely to present 3-5 days post op?

A
  • sepsis, wound infection, abscess
  • DVT
  • bronchopneumonia
35
Q

Factors affecting healing rate of surgical wounds ?

A
  • poor blood supply
  • excess suture tension
  • long term steroids
  • immunosuppressive therapy
  • radiotherapy
  • severe rheumatoid disease
  • malnutrition
36
Q

Risk factors for incision hernia ?

A
  • obesity
  • poor muscle tone
  • wound infection
  • multiple use of same incision site
37
Q

Signs of post op acetelectasis

A
  • usually mild and asymptomatic
  • slow recovery from op, poor colour, mild tachypnoea, tachycardia
  • may be associate with early post op fever
38
Q

Signs of acute respiratory distress ?

A
  • Rapid, shallow breathing, severe hypoxaemia with scattered crepitations
  • usually 24-48 hrs after surgery
  • no cough, chest pain or haemoptysis
39
Q

What is a post op fever ?

A
  • Mild fever (
40
Q

When is sepsis, wound infection or abscess formation post surgery likely to present post op?

A

Day 3-5

41
Q

What type of surgery do cellulitis and abscesses usually form after ?

A

Bowel-related surgery

42
Q

How does acetelectasis occur post surgery ?

A

Alveolar collapse usually due to bronchial secretions obstructing airway

43
Q

Management of aspiration pneumonitis

A
  • urgent bronchial suction
  • positive pressure ventilation
  • prophylactic antibiotics
  • IV steroids
44
Q

Pain on passive dorsiflexion of the foot post op is suggestive of what ?

A

DVT