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Flashcards - Surgery
Flashcards - Surgery
Flashcards - Surgery
risk. manage?
1. Q waves on ECG
2. h/o ventricular ectopy requiring tx
3. h/o angina
4. DM (pt taking meds)
5. age >/ 70
ASA classification
1- normal healthy
2- mild systemic diz, no limitations
3- mod to sev systemic diz, some limitations
4- sev systemic diz, constant threat to life, functional limitations
5- moribund. not expected to survive 24 hrs with or w/o surgery
6- braindead, organs are being harvested
E- procedure is an emergency
1-5% (intermediate)
6-12
potassium-sparing diuretics (epithelial Na ch blockers- amiloride, triamterene; aldosterone
antagonists- spironolactone, eplerenone) and sodium and water restriction
(recheck electrolytes prior to surgery since diuretics can cause abnormalities)
give vitamin K
suppurative thrombophlebitis
infected thrombus in vein and around indwelling catheter
surgically excise infected vein to the first patent, non
infected collateral branch, give IV abx, leave wound open
EF that's risky
under 35%
7-10; 2
both can cause platelet dysfunction due to inhibition of
cyclooxygenase, preventing prostaglandin synthesis
(aspirin's effect is irreversible)
surgical repair
pulmonary
atelectasis
smoking
compromised ventilation (high PCO2, decreased FEV1)
eval FEV1, if abn, eval ABGs. stop smoking 8 wks,
respiratory therapy before surgery
0.5-1 ml/kg/hr
ABGs on RA- PaO2 less than 60 is pulm HTN, PaCO2 more than 45 assoc
with increase preoperative morbidity. If not urgent, use spirometry,
bronchodilator therapy, etc to improve pulm status prior to surgery. If
you have to operate, do the above, minimize anesthesia duration,
mobilize pt postop asap to prevent atelectasis
cardioversion to normal sinus rhythm or betablockers to control heart rate. Anticoagulation pre
and possibly post surgery
exercise stress test (or substitute) to check for reversible ischemia. If so,
CORONARY BYPASS is necessary before surgery.
(Non Q-wave MI- non transmural infarct, meaning that the affected
myocardium is at risk for further infarction during and after surgery)
1. CBC
2. electrolyte panel
3. ECG- men above 40, women above 55, or regardless of age if known
h/o cardiac diz
4. CXR
...
treat uti
TMP/SMX, ciprofloxacin
epidural
atrial fibrillation
high-grade AV block
symptomatic ventricular arrhythmias
uncontrolled supraventricular arrhythmias
DM
injectable insulin only (if blood sugar >250 give 2/3 of dose; if less, give
1/2 of dose). No oral agents.