Pre-Op
Terms
undefined, object
copy deck
-
peaked T waves, hyperkalemia.
next step? -
calcium
(stabilize cardiac membranes) -
uremia --> platelet dysfxn --> intraop bleeding.
next step? -
desmopressin (ddAVP)
or
FFP - most common cause of early postop death after LE revascularization
- MI
- LBBB indicative of...
- underlying IHD (never nl)
- general anesthesia drawbacks
-
1.pulmonary complications
2.mild cardiodepression - ASA = reversible/irreversible?
- irreversible (7-10 days)
- poorly controlled diabetics have increased risk of post-op...
- infections!
- cardiomyopathy pts at risk for...
-
1.arrhythmias
2.CHF
3.outflow obstruction
4.sudden death - golytely
- (polyethylene glycol electrolyte solution) causes NO NET secretion/absorption of ions
-
fleets phospho-soda:
contraindicated in... -
1.diabetics
2.salt-restricted diets -
high magnesium levels.
next step? - calcium gluconate
-
bacterial endocarditis prophylaxis:
dental/oral/respiratory tract/esophageal procedures -
1.amoxicillin (1 hr prior)
or
2.clinda/ceph/clarith (1 hr prior) - bacterial endocarditis prophylaxis: GI/GU procedures in high-risk pts
-
high-risk = ampicillin + genta (30 min prior), ampicillin (6 hrs post)
or
vanco + genta (30 min prior) - bacterial endocarditis prophylaxis: GI/GU procedures in moderate-risk pts
-
mod-risk =
1.amoxicillin/amp (1 hr prior)
or
2.vanco (1-2 hr prior) - bowel "prep" purpose
- decrease fecal mass & bacterial content in colon
- most important of bowel preps...
-
mechanical removal:
1.cathartics
2.enemas - abx decreasing bacterial load in gut?
-
1.neomycin
2.erythromycin - bacterial endocarditis prophylaxis - not needed for...
-
1.s/p CABG
2.s/p ASD/VSD
3.MVP w/o regurg
4.murmurs
5.pacemakers - bacterial endocarditis prophylaxis - high risk...
-
1.prosthetic heart valves
2.endocarditis Hx
3.complex congenital HD
4.prosthetic vascular grafts - severe liver failure signs
-
1.jaundice, ascites
2.muscle wasting
3.asterixis, advanced encephalopathy
4.caput medusa
5.splenomegaly
6.gastric/esophag varices - Child's classification
- liver failure
- Child's classification - categories
-
1.bili
2.alb
3.ascites
4.enceph
5.nutrition
6.mortality - cardiac complications - 5 factors assessed
-
1.Q waves
2.Hx ventricular ectopy
3.Hx angina
4.DM
5.age>70 - laparoscopy may increase...
- CO2 in blood
- RR post-op complications in smokers
- 2-6x
- nl urine output
- 0.5-1 ml/kg/hr
- NS [Na+]
- 154
- D5W [glucose]
- 50
- D10W [glucose]
- 100
- lactated Ringer's [Na+]
- 130
- 72 y.o. w/a-fib c/o severe abdominal pain out of proportion to exam
- mesenteric ischemia
- 75 y.o. Hx MI c/o gnawing abdominal pain after eating. 15 lb wt loss in past month
- chronic mesenteric ischemia
-
increased lactate
metabolic acidosis
hypercoagulable state - mesenteric ischemia
- mesenteric ischemia - causes
-
1.atherosclerosis
2.a-fib
3.low-flow state
4.hypercoagulable state - mesenteric ischemia - Tx
-
1.tissue perfusion w/fluids
2.surgery!!! (bypass w/saphenous vein) - AAA - risk factors
-
1.atherosclerosis
2.>5cm (20-40% risk in 5 yrs) -
abdominal/back pain
pulsatile mass in abdomen
hypotension
Hx vascular dz/atherosclerosis - AAA
- AAA Dx
-
A) MRI or CT w/contrast
B) angiogram - AAA Tx
-
1.good IV access, type & cross
2.surgery (if rupture in suspected) -
63 y.o. male
pain in "kidney" for 3 days
Hx MI x2
no back tenderness - AAA
- elderly pts w/abdominal pain - always consider...
-
vascular causes
1.AAA
2.mesenteric ischemia
3.MI - most common cause of post-op fever
- atelectasis