Term
| define clean class 1 - clean |
|
Definition
| uninfected operative wound, no inflammation, no entry to alimentary/urinary/genital tract |
|
|
Term
| closure of clean class 1 - clean |
|
Definition
|
|
Term
| define clean class 2 - clean |
|
Definition
| alimentary/genital/urinary tract entered under controlled conditions, no universal contamination |
|
|
Term
| clean class 3 - clean define |
|
Definition
| major break in sterile technique, gross spillage from GI tract, lesions with inflammation but no purulent discharge |
|
|
Term
| define clean class 4 - dirty |
|
Definition
| operative site with existing clinical infection, perforated visera |
|
|
Term
| antibiotics reduce SSI in hysterectomy % |
|
Definition
|
|
Term
| % time antibiotics are not used right |
|
Definition
|
|
Term
| % time antibitoics are used but not the right ones |
|
Definition
|
|
Term
| % time antibiotics not used but supposed to be |
|
Definition
|
|
Term
| % time antibiotics were used but not supposed to be |
|
Definition
|
|
Term
| GYN surgeries that need antibiotics - 6 |
|
Definition
| hysterectomy, BTA, HSG/SIS if hydrosalpinx/PID, urogyn surgery, SAB D+C, c-section |
|
|
Term
| GYN surgeries that don't need antibiotics - 12 |
|
Definition
| LSC BTL/BSO/cyst, LAP BSO/cyst/fibroid, HSC, ablation, D+C, IUD, EMBx, udodynamics |
|
|
Term
| when are pre-op anntibiotics given |
|
Definition
| 30-60 min before incision |
|
|
Term
| when are pre-op antibiotics redosed - 4 |
|
Definition
| >4h ancef, >6h Glinda, >4h aztreonam, or EBL >1500cc |
|
|
Term
|
Definition
| <80kg 1mg, 80-120kg 2mg, >120kg 3mg |
|
|
Term
| alternative antibiotics for hysterectomy |
|
Definition
| clinda 900mg q6h OR metronidazole 500mg x1 PLUS gent 5mg/kg x1 OR aztreonam 2mg q4h |
|
|
Term
| antibiotic for suction D+C |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| 1-3g ancef depending on weight |
|
|
Term
| antibiotic for hysterectomy |
|
Definition
| 1-3g ancef depending on weight |
|
|
Term
| alternative antibiotics for urogyn - 5 regimens |
|
Definition
| amp/sulbactam, clinda/flagyl, aminoglycoside, aztreonam, quinolone |
|
|
Term
|
Definition
| 1-3g ancef depending on weight + 500mg azithro over 1h if labored |
|
|
Term
| % effective C-section antibiotics are preventing SSI and endometritis |
|
Definition
|
|
Term
| alternative antibiotics c-section |
|
Definition
|
|
Term
| benefit of treating MRSA before procedure |
|
Definition
| nasal muprocin can decrease colonization but not infection, can help |
|
|
Term
| changes in antibiotics if MRSA carrier |
|
Definition
| add a single dose of vanc to any regimen for all surgeries with skin incision |
|
|
Term
|
Definition
| single dose ancef reasonable but not required |
|
|
Term
| % who say they have and really have PCN allergy, % that will have anaphylaxis |
|
Definition
| 10-15% say they have, 0.7-4% really have, anaphylaxis <0.015% |
|
|
Term
| percent incidence cephalosporin allrgery and % anaphylaxis |
|
Definition
|
|
Term
| % with PCN allergy that also have cephalosporin allergy |
|
Definition
|
|
Term
|
Definition
|
|
Term
| antibiotics for manual placental extraction |
|
Definition
|
|
Term
| antibiotics for postpartum D+C |
|
Definition
|
|
Term
| antibiotics for barki balloon |
|
Definition
|
|
Term
| when do you give endocarditis prophylaxis |
|
Definition
| generally you don't in GYN surgery, but if has an active infection (chorio, pyelo) and going to surgery make sure your antibiotics cover for enterococcus (amoxicillin, ampicillin), but we generally do this anyways |
|
|
Term
| options for vaginal prep - 2 |
|
Definition
| 4% chlorhexidine gluconate or providone-iodine |
|
|
Term
| best option for skin prep - 2 |
|
Definition
| 4% chlorhexidine gluconate, shower with antiseptic soap night before surgery |
|
|
Term
| how to do hair removal before surgery |
|
Definition
|
|
Term
| which type of cutting/dissection causes less infection |
|
Definition
| scalpel rather than electrosurgery on skin - contriversial |
|
|
Term
| when should you close the subcutaneous tissue |
|
Definition
|
|
Term
| why should you consider screening for BV prior to surgery - 3 |
|
Definition
| increases cuff cellulitis, pelvic abscess, endometritis |
|
|
Term
|
Definition
| major cardiac events 2-17% MI |
|
|
Term
| categories of cardiac risk assessment - 7 |
|
Definition
| high risk surgery, history of ischemia, CHF, structural heart disease, vascular disease, insulin use, Cr >2 |
|
|
Term
| cardiac risk assessment - 3 high risk surgeriers |
|
Definition
| intraperitoneal, intrathoracic, suprainguinal vascular |
|
|
Term
| a high risk surgery means a baseline cardiac event % of |
|
Definition
|
|
Term
| a low risk surgery means a baseline cardiac event % risk of |
|
Definition
|
|
Term
| cardiac risk assessment - examples of history of ischemia - 5 |
|
Definition
| MI, positive stress test, cardiac chest pain, nitrite use, EKG with Q waves |
|
|
Term
| cardiac risk assessment - examples of CHF - 5 |
|
Definition
| pulmonary edema, BL rales, S3 gallop, paroxysmal nocturnal dyspnea, CXR with vascular distribution |
|
|
Term
| cardiac risk assessment - examples of vascular disease - 2 |
|
Definition
|
|
Term
|
Definition
| resting 40yo 70kg male O2 use |
|
|
Term
|
Definition
|
|
Term
| met indicating poor functional capacity |
|
Definition
|
|
Term
| met indicating to get a stress test |
|
Definition
| <4 with 2 or more cardiac risk factor points |
|
|
Term
| when is a pre-op EKG indicated - 3 |
|
Definition
| intermediate to high risk surgery and 1 or more cardiac risk points, high risk procedure, current symptoms |
|
|
Term
| when is a pre-op ECHO indicated - 2 |
|
Definition
| current dyspnea of unknown cause, no ECHO in 1y in someone with a change in clinical status |
|
|
Term
| when is a pre-op exercise stress test indicated - 9 |
|
Definition
| 2 or more cardiac risk points with a intermediate/high risk surgery, unknown functional capacity, cardic risk score 2 or more and MET <4, severe aortic/mitral stenosis, AV block, symptomatic ventricular tachycardia, uncontrolled supraventricular arrhythmia, symptomatic bradyarrhythmia, new ventricular tachycardia |
|
|
Term
| when is a pre-op dobutamine stress test indicated - 1 |
|
Definition
| needed a stress test for appropriate reasons but physically cant do it |
|
|
Term
| indications for pre-op beta blockers - 3 |
|
Definition
| continue if on then, 3 or more cardiac risk points, if needs HTN med and is having surgery choose BB |
|
|
Term
| contraindication to pre-op BB - 5 |
|
Definition
| current wheezing, heart block, heart failure, HR <50, unable to start minimum 1d pre-op |
|
|
Term
| what BP would delay surgery - 2 |
|
Definition
| >170/110 or new onset uncontrolled HRN |
|
|
Term
| diuretics - pre-op plan and SE (1) |
|
Definition
| continue, be aware possible hypoklameia with muscle relaxers |
|
|
Term
| ACEI/ARB - pre-op plan and SE (1) |
|
Definition
| discontinue, if cant make sure to induce slowly can cause hypotension |
|
|
Term
| CCB - pre-op plan and SE (1) |
|
Definition
| continue, abrupt DC can cause vasospasm |
|
|
Term
| BB - pre-op plan and SE (3) |
|
Definition
| continue, abrupt DC can cause HTN, MI, ischemia |
|
|
Term
| what pre-op pulmonary testing is available - 3 |
|
Definition
|
|
Term
| who is pre-op pulmonary testing indicated for - 2 |
|
Definition
| symptoms, worsening symptoms |
|
|
Term
| how to optimize pre-op pulmonary status - 3 |
|
Definition
| quit smoking >6-8wk pre-op, optimize COPD, now wheezing/URI pre-op |
|
|
Term
| how to optimize pulmonary status intra-op - 4 |
|
Definition
| SABA 30min prior to intubation, stress dose steroids as indicated, prefer local over general anesthesia, shorten surgery |
|
|
Term
| how to optimize pulmonary status post-op - 5 |
|
Definition
| ambulation,. IS, pain control, selective NG placement, CPAP for OSA |
|
|
Term
| patient risk factors affecting pulmonary status - 11 |
|
Definition
| COPD, >65yo, ASA >2, smoking, URI/wheezing, poor MET, albumin <3.6, CHF, OSA, morbid obesity, asthma |
|
|
Term
| procedural risk factors affecting pulmonary status - 10 |
|
Definition
| upper abdominal, head, neck, esophageal, thoracic, aortic surgeries. >3h surgery, pancuronium, emergent surgery, routine NG post op |
|
|
Term
| surgical hormonal effect on blood glucose |
|
Definition
| glucocorticoids, GH, catacholmines and glucoagon increase. this causes decreased insulin and hyperglycemia. but the patient doesn't eat so they end up with hypoglycemia |
|
|
Term
| intra-op max glucose goal |
|
Definition
|
|
Term
| intra-op average glucose goal |
|
Definition
|
|
Term
| pre/intra-op what to do if on insulin |
|
Definition
| 50% of NPH or 60-80% of long acting in the AM, drip in OR PRN for long surgery |
|
|
Term
| pre/intra-op what to do if on insulin pump |
|
Definition
| continue basal dose, could turn off in OR and do drip if you want |
|
|
Term
| pre/intra-op what to do if on PO diabetes meds |
|
Definition
| hold in AM, SS insulin PRN |
|
|
Term
| metformin - pre-op recommendation, SE |
|
Definition
| stop 24h pre-op, metabolic acidosis |
|
|
Term
| pre/intra-op what to do if diet controlled DM |
|
Definition
| SS PRN, check BG pre and post op only |
|
|
Term
| how to monitor BG post op in DM |
|
Definition
| q4-6h when NPO, then per usual |
|
|
Term
| when are stress dose steroids NOT indicated - 2 |
|
Definition
| <3wk steroids, alternate day dosing |
|
|
Term
| when are stress dose steroids indicated - 2 |
|
Definition
| >20mg/d prednisolone >3wk cushinoid |
|
|
Term
| stress dose steroids management minor surgeries |
|
Definition
|
|
Term
| stress dose steroids management intermediate surgeries |
|
Definition
| take AM dose, 50mg IV hydrocortisone pre-op, 25mg q8h x24h |
|
|
Term
| stress dose steroids management major surgeries |
|
Definition
| take AM dose, 200mg IV hydrocortisone pre-op, 50mg q8h x24h |
|
|
Term
| how do you choose high or low dose stress dose steroids |
|
Definition
high dose - major surgery
low dose - minor surgery
if not sure give steroids per surgical recommendation, if time to consynthropin/ACTH stimulation test to see if intermediate dose is ok |
|
|
Term
| % using herbal medications that do not tell their doctor |
|
Definition
|
|
Term
| % using herbal medications that would not stop even if the government did a study saying their unsafe |
|
Definition
|
|
Term
| complications St. Johns wort - 3 |
|
Definition
| SSRI can cause serotonin syndrome, P450 inducer accelerates clearance of many meds, transplant rejection (cyclosporine clearance) |
|
|
Term
| when to stop St. John's wort pre-op |
|
Definition
|
|
Term
| meds St. Johns wort increases clearance of - 10 |
|
Definition
| cyclosporine, tacrolimus, statins, CONTRACEPTIVES, alfentanil, midazolam, HCTZ, LIDOCAINE, CCBs, serotonin antagonists |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| surgical bleeding, perioperative hypoglycemia |
|
|
Term
|
Definition
|
|
Term
| at what age must an EMBx be done before an endometrial ablation |
|
Definition
| 35yo+ (unless zero risk factors for hyperplasia, just do it) |
|
|
Term
| contraindications to endometrial ablation - 8 |
|
Definition
| pregnancy, desiring future fertility, PMP, endometrial cancer/hyperplasia, history of classical/transmural myomectomy, congenital uterine anomaly, IUD in place |
|
|
Term
| complications of endometrial ablation (general combined, not pregnancy) - 12 |
|
Definition
| hematometria, perforation, fluid overload, difficulty detecting endometrial cancer, post-ablation tubal syndrome, vaginal discharge, nausea, vomiting, cramping, thermal injury, infection, vaginal bleeding |
|
|
Term
| incidence of post-ablation tubal syndrome |
|
Definition
|
|
Term
| complications of endometrial ablation if becomes pregnant - 6 |
|
Definition
| SAB, IUGR, PTD, PPROM, abnormal placentation, IUFD |
|
|
Term
| complications specific to novasure - 4 |
|
Definition
| uterine necrosis, difficulty with defecation/urination, air/gas embolism |
|
|
Term
| complications specific to HTA - 3 |
|
Definition
| laceration, retrograde flow, hemorrhage |
|
|
Term
| hysteroscopic ablation techniques - 3 |
|
Definition
| roller ball, YAG laser, hydrothermal ablator |
|
|
Term
| non-hysteroscopic ablation techniques - 3 |
|
Definition
| herOption/cryoablation, NovaSure (radiofrequency), microsulis/microwave |
|
|
Term
|
Definition
| radiofrequency bipolar, impedence controlled CO2 injection of 50 mmHg for 4s to r/o perforation, suction to vaporize and dessicate, activates 1-2min until 50 oms resistance |
|
|
Term
| uterine cavity dimensions limits novasure |
|
Definition
| must be: sound <10cm, length >4cm, width >2.5cm |
|
|
Term
|
Definition
|
|
Term
| contraindications novasure - 2 |
|
Definition
| distorting submucosal fibroids, pacemakers |
|
|
Term
| effectiveness of endometrial ablation |
|
Definition
| 30% amenorrhea, 60% improve, 10% same, overall 95% satisfaction |
|
|
Term
|
Definition
| NS heated to 90C delivered via 7.8mm hysteroscopic sheath under direct visualization for 10 min |
|
|
Term
|
Definition
|
|
Term
| cavity limitations for HTA |
|
Definition
| 6-10.5cm, no length/width limits |
|
|
Term
| fibroid limitation for HTA |
|
Definition
|
|
Term
| contraindications HTA - 2 |
|
Definition
| unable to establish tight seal, nickle sensitivity |
|
|
Term
| effectiveness of UAE % - AUB, bluk symptoms |
|
Definition
| 95-95% AUB improved, 60-96% bulk improved, AUB > bulk improvement overall |
|
|
Term
| long term efficacy 5y for UAE for AUB |
|
Definition
|
|
Term
| % requiring another procedure after UAE for fibroids |
|
Definition
|
|
Term
|
Definition
|
|
Term
| average size reduction of fibroid over time in UAE |
|
Definition
|
|
Term
|
Definition
|
|
Term
| absolute contraindications to UAE - 4 |
|
Definition
| asymptomatic fibroids, pregnancy, active infection, uterine malignancy |
|
|
Term
| relative contraindications to UAE - 3 |
|
Definition
| desiring future fertility, large fibroids, pedunculated fibroids |
|
|
Term
|
Definition
| infracting fibroid leading to death, pregnancy complications, premature ovarian failure, fibroid explusion, post-embolization syndrome, endometritis, chronic discharge, uterine/abdominal adhesions |
|
|
Term
| risk of premature ovaria failure UAE |
|
Definition
|
|
Term
| when does cavity fibroid explusion occur, what are the symptoms 4 |
|
Definition
| weeks to years after procedure, bleeding, pain, vaginal DC, dilated cervix |
|
|
Term
| #1 complication of UAE and rate |
|
Definition
| post-embolization syndrome 30-40% |
|
|
Term
| signs of post-embolization syndrome - 4 |
|
Definition
| fever, nausea, malaise, elevated WBC |
|
|
Term
| timing post-embolization syndrome |
|
Definition
| 1-2d post-op resolves within 7d |
|
|
Term
| rate of endometritis post UAE |
|
Definition
|
|
Term
| rate of chronic discharge after UAE |
|
Definition
|
|
Term
| rate of uterine/abdominal adhesions post UAE |
|
Definition
|
|
Term
| max fluid for electrolyte containing - HSC |
|
Definition
|
|
Term
| energy for electrolyte containing fluid in HSC |
|
Definition
|
|
Term
| types of electrolyte containing fluid for HSC - 2 |
|
Definition
|
|
Term
| two categories of electrolyte free fluid for HSC |
|
Definition
| hypo-osmolar, iso-osmolar |
|
|
Term
| 2 hypo-osmolar HSC fluids |
|
Definition
| glycine 1.5%, sorbitol 3% |
|
|
Term
| 2 iso-osomolar HSC fluids |
|
Definition
| mannitol 1.5%, glycine 2.2% |
|
|
Term
| max fluid for electrolyte free fluid in HSC |
|
Definition
750cc - if comorbidities
1000cc - if no comorbidities |
|
|
Term
| energy used for electrolyte free fluid in HSC |
|
Definition
|
|
Term
| SE of electrolyte free fluid in HSC - 5 |
|
Definition
| hyponatremia, hypoosmolality, seizure, cerebral edema, death |
|
|
Term
| type of high viscosity HSC fluid and its components |
|
Definition
| hyskon - dextran 5% + glucose |
|
|
Term
| complications of hyskon - 3 |
|
Definition
| anaphylaxis, pulmonary edema, DIC |
|
|
Term
| SE of CO2 as hysteroscopic medium - 3 |
|
Definition
| longer OR time, shoulder pain, vasovagal syncope |
|
|
Term
| barriers to office hysteroscopy - 6 |
|
Definition
| cervical stenosis, poor visualization of the cervix, patient anxiety, significant comorbidities, limited staff trained, anesthesia safety |
|
|
Term
| overall rate of HSC complications |
|
Definition
|
|
Term
| rate of uterine perforation in HSC |
|
Definition
|
|
Term
| top 3 causes of HSC uterine perforation |
|
Definition
| adhesions > myomectomy > septum excision |
|
|
Term
| signs of uterine perforation - 3 |
|
Definition
| sudden decrease in distention, increased bleeding, visualization of bowel/omentum |
|
|
Term
| management of uterine perforation |
|
Definition
| fundal - observe if little bleeding and small, lateral or electrocautery - laparoscopy |
|
|
Term
| rate of fluid overload in HSC |
|
Definition
|
|
Term
| risks associated with HSC fluid overload - 6 |
|
Definition
| myomectomy, LOA, septum incision, high intrauterine pressure, long length of surgery, defects in endometrium |
|
|
Term
| management of HSC fluid overload - 4 |
|
Definition
| stop surgery, notify anesthesia, give Lasix, consider hypertonic saline |
|
|
Term
| how is hypertonic saline dosed for fluid overload |
|
Definition
| Na 1-2 mL/h but no more than 12meq in 24h |
|
|
Term
| complication of hypertonic saline |
|
Definition
| central pontine myelinosis |
|
|
Term
| prevention of air embolism in hysteroscopy - 3 |
|
Definition
| minimize T bird, flush all tubing, minimize insertions through the cervix |
|
|
Term
|
Definition
| life/limb threatened within 6h |
|
|
Term
|
Definition
| life/limb threatened within 24h |
|
|
Term
| define time sensitive surgery |
|
Definition
| delay of >1-6wk will cause a negative outcome |
|
|
Term
|
Definition
| delay of >1y would not change outcome |
|
|
Term
| suture with best knot security |
|
Definition
|
|
Term
| suture with good knot security - 3 |
|
Definition
| vicryl rapid, vicryl/polyglactin, monocryl/poliglecaprone |
|
|
Term
| suture with fair knot security - 3 |
|
Definition
| chromic gut, polydioxanone/PDS, polyglyconate/maxon |
|
|
Term
| suture with least tensile strength |
|
Definition
|
|
Term
| suture with most tensile strength - 2 |
|
Definition
| polyglyconate/maxon, polydioxanone/PDS |
|
|
Term
| suture with good tensile strength - 2 |
|
Definition
| polyglactin/vicryl, polyglycolic/dexon |
|
|
Term
| suture with worst tensile strength - 4 |
|
Definition
| vicryl rapid, surgical gut, monocryl/poliglecaprone, chromic gut |
|
|
Term
| how long does fast absorbing gut last |
|
Definition
|
|
Term
| how long does vicryl rapid last |
|
Definition
|
|
Term
| how long does surgical gut last |
|
Definition
|
|
Term
| how long does monocryl/poliglecaprone last |
|
Definition
|
|
Term
| how long does chromic gut last |
|
Definition
|
|
Term
| how long does polyglactin/vicryl last |
|
Definition
|
|
Term
| how long does polyclycolic/dexon last |
|
Definition
|
|
Term
| how long does polydioxanone/PDS last |
|
Definition
|
|
Term
| how long does polygluconate/maxon last |
|
Definition
|
|
Term
| which suture has highest reactivity - 3 |
|
Definition
| fast absorbing gut, surgical gut, chromic gut |
|
|
Term
| which suture has minimal reactivity - 5 |
|
Definition
| vicryl rapide, monocryl/poliglecaprone, polyglactin/vicryl, polyglucolic/dexon |
|
|
Term
| which suture has least reactivity - 2 |
|
Definition
| polydioxanone/PDS, polyglyconate/maxon |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is the worst way to hold a needle driver |
|
Definition
| bipod grip is unstable, no control |
|
|
Term
| what is the best way to hold a needle driver and 3 types |
|
Definition
| tripod grip - palm grip, 1/4 holes 2/4 shaft, thumb hole, 4/5 around hole 2/3 shaft |
|
|
Term
| which is the needle driver grip that is most precise, what is its downfall |
|
Definition
| palm grip, must reposition to open |
|
|
Term
| what is the needle driver grip does does not require repositioning |
|
Definition
|
|
Term
| what is the needle driver grip with the best combined advantages |
|
Definition
| thumb in hole, 4/5 around hole, 2/3 on shaft |
|
|
Term
| two hemostatic agents derived from humans |
|
Definition
| topical thrombin liquid (thrombin JMI), fibrin sealent liquid (tisseal) |
|
|
Term
| form all thrombin agents come in |
|
Definition
|
|
Term
| form all fibrin agents come in |
|
Definition
| liquid, with exception of 1 dressing |
|
|
Term
| topical thrombin aka, what is it derived from |
|
Definition
| thrombin JMI, bovine, human |
|
|
Term
| thrombin gelatin aka, what is it derived from |
|
Definition
|
|
Term
| thrombin collagen aka, what is it derived from |
|
Definition
|
|
Term
| side effect of all thrombin agents - 4 |
|
Definition
| Ab to bovine, decreased coagulation, increased PT/INR |
|
|
Term
| how long does thrombin gelatin last |
|
Definition
|
|
Term
| how long does thrombin collagen last |
|
Definition
|
|
Term
| how long does fibrin sealent last |
|
Definition
|
|
Term
|
Definition
|
|
Term
| complication of fibrin sealent |
|
Definition
|
|
Term
| what is also in a dry fibrin dressing |
|
Definition
|
|
Term
| 3 hemostatic agents with longest time sticking around |
|
Definition
| floseal/thrombin gelatin 6-8wk, microfiber collagen/avetine >8wk, bone wax forever |
|
|
Term
| 3 hemostatic agents with shortest time sticking around |
|
Definition
| tisseal immediate, micrporous polysaccharide spheres 24-48h, ostene 48h |
|
|
Term
| two dressing hemostatic agents |
|
Definition
| dry fibrin dressing, chitosan |
|
|
Term
| 3 thrombin specific hemostatic agents |
|
Definition
| topical thrombin / thrombin JMI, thrombin gelatin / floseal, thrombin collagen / CoStasis |
|
|
Term
| 1 fibrin specific hemostatic agent |
|
Definition
|
|
Term
| 6 hemostatic agents that primarily work via absorption |
|
Definition
| absorbable gel / gelfoam or surgaform, oxidized regenerated cellulose / SNoW, microfiber collagen / avetine, microporous polysaccharide spheres / arista, chitosan / HemCon, seolite / QuikClot |
|
|
Term
| absorbable gel hemostatic agent - source |
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Definition
|
|
Term
| absorbable gel hemostatic agent - forms - 2 |
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Definition
|
|
Term
| absorbable gel hemostatic agent - absorption |
|
Definition
|
|
Term
| absorbable gel hemostatic agent - side effects - 4 |
|
Definition
| infection, abscess, fibrosis, clot |
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|
Term
| oxidized regenerated cellulose hemostatic agent - source |
|
Definition
|
|
Term
| oxidized regenerated cellulose hemostatic agent - form |
|
Definition
|
|
Term
| oxidized regenerated cellulose hemostatic agent - absorption |
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Definition
|
|
Term
| oxidized regenerated cellulose hemostatic agent - SE - 4 |
|
Definition
| foreign body reaction, infection, adhesions, brown-black appearance (it isn't poo) |
|
|
Term
| microfiber collagen - source |
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Definition
|
|
Term
| microfiber collagen - form - 2 |
|
Definition
|
|
Term
| microfiber collagen - absorption |
|
Definition
|
|
Term
| microfiber collagen - side effects - 2 |
|
Definition
| allergic reaction, granuloma |
|
|
Term
| microporous polysaccharide spheres - source |
|
Definition
|
|
Term
| microporous polysaccharide spheres - form |
|
Definition
|
|
Term
| microporous polysaccharide spheres - absorption |
|
Definition
|
|
Term
| microporous polysaccharide spheres - side effects |
|
Definition
| >50g can lead to hyperglycemic in diabetics |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| calcium loaded aluminum silicate |
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|
Term
|
Definition
| very low moisture granule |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| bone wax - absorption time |
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Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| alkaline oxidase copolymeres |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| albumin-glutaraldehyde - source |
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Definition
|
|
Term
| albumin-glutaraldehyde - form |
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Definition
|
|
Term
| albumin-glutaraldehyde - complications |
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Definition
|
|
Term
| incidence of each type of hysterectomy |
|
Definition
| TAH 50%, TVH 20%, TLH 30% |
|
|
Term
| when should a TAH be done with a midline incision |
|
Definition
|
|
Term
| benefitis of a midline TAH incision - 5 |
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Definition
| less bleeding, good upper abdomen exposure, rapid access, easy to extend |
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|
Term
| risks of a midline TAH incision - 2 |
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Definition
| more painful, increased dehiscinence |
|
|
Term
| benefitis of a phaffensteil TAH incision - 1 |
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Definition
|
|
Term
| risks of a pfannelsteil TAH incision - 3 |
|
Definition
| limited upper abdomen exposure, increased surgical time, increased blood loss |
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|
Term
|
Definition
| 2cm above pubic symphysis |
|
|
Term
| what low transvers TAH incisions can be converted to eachother |
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Definition
|
|
Term
|
Definition
| lower than pfannsteil, rectus muscles incised at insertion to pubic symphysis leaving 1cm of tendon for reattachment with mattress suture |
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|
Term
| describe maylard incision |
|
Definition
| through skin and all layers of muscle, transsecting epigastric vessels |
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|
Term
| contraindications to maylard incision - 2 |
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Definition
| aorto-iliac atherosclerotic disease, lower extremity claudication |
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|
Term
| how long does it take the peritoneum to re-epithelize |
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Definition
|
|
Term
| tensile strength of fascia at 1wk post op |
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Definition
|
|
Term
|
Definition
| better perfusion, but overall same complication rates |
|
|
Term
| describe smead jones closure classic |
|
Definition
| interrupted stitches, 1-2cm bites fascia only then next bite mass closure |
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|
Term
| describe smead jones closure modified |
|
Definition
| running stitches, 1-2cm bites fascia only then next bite mass closure |
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|
Term
| what is the most cosmetic way to close skin |
|
Definition
| staples = subcuticular closure |
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|
Term
| what way to close skin is better tolerated by patients and cheaper |
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Definition
|
|
Term
| physiology of negative pressure wound therapy - 8 |
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Definition
| reduces wound edema, reduces tissue formation by drawing edges together, increases blood flow, reduces bacterial burden, decreases inflammatory response, increases VEGF/fibroblasts/FGF2 |
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|
Term
| candidate for TVH criteria - 8 |
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Definition
| spacious introitus, pubic arch >90 deg, tenaculum test, <12wk - 16wk, pathology confined to uterus, parous, prolapse, minimal potential adhesions |
|
|
Term
| relative contraindications to TVH - 4 |
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Definition
| prior CD, nulliparity, adnexal mass, obesity |
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|
Term
| absolute contraindications to TVH - 2 |
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Definition
| contracted pelvis, no decent, extensive adhesions |
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|
Term
| indications for TLH/LAVH - 6 |
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Definition
| LOA, endometriosis treatment, ligation of IPs in difficult ovarian removal, inspection of cuff closure, management of fibroid, evaluation of pelvis to proceed with TVH |
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|
Term
| disadvantages of LAVH/TLH - 3 |
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Definition
| longer operating time then TVH, higher complications, expensive |
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|
Term
| advantages of supracervical hysterectomy - 5 |
|
Definition
| faster recovery, less injury, less infection, less change in sexual function, lower EBL |
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|
Term
| does supracervical hysterectomy prevent POP |
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Definition
|
|
Term
| contraindications to supracervical hysterectomy - 3 |
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Definition
| suspected cancer, cervical dysplasia, endometrial hyperplasia |
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|
Term
| complications of supracervical hysterectomy - 3 |
|
Definition
| 5-20% mensturation, endometrial cancer, 1-3% reoperation for trachelectomy |
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|
Term
| advantages to robotic hysterectomy - 4 |
|
Definition
| ergonomic, less fatigue, less tremor, shorter hospital stay |
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|
Term
| disadvantages to robotic hysterectomy - 8 |
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Definition
| longer surgery, expensive, higher cuff dehiscinence, higher UTI, higher SBO, higher wound infection, higher abdominal wall pain, higher abscess |
|
|
Term
| does robotic hysterectomy have less transfusion rates |
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Definition
|
|
Term
| TVH vs TLH vs TAH - hospital stay |
|
Definition
|
|
Term
| TVH vs TLH vs TAH - return to activity |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| TVH vs TLH vs TAH - satisfaction |
|
Definition
|
|
Term
| TVH vs TLH vs TAH - infection |
|
Definition
|
|
Term
| TVH vs TLH vs TAH - operating time |
|
Definition
|
|
Term
| TVH vs TLH vs TAH - GU injury |
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Definition
|
|
Term
| TVH vs TLH vs TAH - abdominal wall infections |
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Definition
|
|
Term
| risks of routine cystoscopy - 4 |
|
Definition
| time, injury, UTI, failure to identify injury |
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|
Term
| benefits of routine cystoscopy - 1 |
|
Definition
| early detection of injury |
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|
Term
| 1:___ women with a morcellated fibroid will disseminate a sarcoma |
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Definition
|
|
Term
| risks of a fibroid having a sarcoma - 6 |
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Definition
| >65yo, large fibroid, rapid fibroid growth, lynch syndrome, tamoxifen, pelvic radiation |
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|
Term
| indications for prophylactic BSO (age ALONE) |
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Definition
|
|
Term
| indications for prophylactic BSO other than age - 9 |
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Definition
| patient request, family history ovarian cancer, prevention of ovarian cancer, menstural migraines, PMDD, PMS, endometriosis, PID, TOA |
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|
Term
| complications of prophylactic BSO - 6 |
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Definition
| need for hormone replacement, ureter injury, heart disease, osteoporosis, cognitive impairment, lower libido |
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|
Term
| in whom does a prophylactic BSO highest risk cognitive impairment |
|
Definition
| increased risk of dementia <50yo removal |
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|
Term
| how much does a prophylactic BSO reduce the risk of ovarian cancer in the AVERAGE person |
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Definition
|
|
Term
| how much does a risk reducing salpingectomy reduce the risk of ovarian cancer int he average person |
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Definition
|
|
Term
| how much does a tubal ligation reduce the risk of ovarian cancer in the average person |
|
Definition
|
|
Term
| what is the re-operation rate for BSO when you don't do one |
|
Definition
|
|
Term
| #1 laparoscopy complication |
|
Definition
|
|
Term
| #2 laparoscopy complication |
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Definition
|
|
Term
| overall laparoscopy complication rate |
|
Definition
|
|
Term
| #1 time that injury occurs during laparoscopy |
|
Definition
| 50% during trocar placement |
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|
Term
| % of laparoscopy complications not recognized intra op |
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Definition
|
|
Term
| which port placement has highest risk of bowel injury |
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Definition
|
|
Term
| which port placement has lowest risk of bowel injury |
|
Definition
| other than direct, their all the same, but open may recognize earlier |
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|
Term
| what are the indirect types of port placement - 2 |
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Definition
|
|
Term
|
Definition
| 3cm below the mid left costan margin |
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|
Term
| indications for palmars point placement - 4 |
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Definition
| large pelvic mass, pregnancy, umbilica/midline mesh, prior laparoscopy |
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|
Term
| what opening pressure indicates probably in abdomen |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is the max abdominal pressure |
|
Definition
|
|
Term
| what abdominal pressure is associated with complications, what are they 1 |
|
Definition
| >20 mmHg, hemodynamic changes |
|
|
Term
| benefits of CO2 for laparoscopy |
|
Definition
| lower embolism risk due to blood solubility |
|
|
Term
| benefits of NO2 for laparoscopy and 1 risk |
|
Definition
|
|
Term
| best surgical incision closure for obese patients |
|
Definition
|
|
Term
| how do you decide incision location in obese patients |
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Definition
|
|
Term
| which type of dissection is best for obese patients |
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Definition
|
|
Term
| airway changes in obese patients - 4 |
|
Definition
| resistance increases, chest wall compliance decreases, functional residual capacity decreases, total lung volume decreases |
|
|
Term
| what is the obesity paradox |
|
Definition
| women with class 1 obesity BMI 30-34 suffer fewer post operative complications than other women |
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|
Term
|
Definition
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|
Term
|
Definition
| 50cc (but generally give a 6 pack) |
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|
Term
|
Definition
|
|
Term
|
Definition
| 40cc (but general give 10 U) |
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|
Term
| volume albumin is expanded in |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| RBC, inactive WBC, inactive PLT, plasma |
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|
Term
|
Definition
| PLT, inactive RBC/WBC, plasma |
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|
Term
|
Definition
| whole blood spun down to clotting factors, lots of clotting factors to include V, XI, XII, fibrinogen |
|
|
Term
| components of cryoprecipitate - 5 |
|
Definition
| fibrinogen, vWF, XIII, VIII, fibrinocten |
|
|
Term
| components of prothrombin complex concentrates - 6 |
|
Definition
| II, VII, IX, X, protein C/S |
|
|
Term
|
Definition
| raises HCT 3% and Hbg 1 g/dL |
|
|
Term
| 1U PLT and 6pk PLT rise in PLT |
|
Definition
| 1U 7500 mm3, 6pk 40,000 mm3 |
|
|
Term
| how much does FFP increase fibrinogen |
|
Definition
|
|
Term
| how much does 5% albumin expand volume |
|
Definition
|
|
Term
| how much does 25% albumin expand volume |
|
Definition
|
|
Term
| how much does hemastarch expand volume |
|
Definition
|
|
Term
| contraindications to FFP - 2 |
|
Definition
| INR <1.4, many PRBC units |
|
|
Term
|
Definition
| coagulopathy/DIC, warfarin reversal, low vitamin D, liver failure |
|
|
Term
|
Definition
| little need for volume, hemophilia A, vWD, hyperfibrinogemia |
|
|
Term
| complications of hemastarch |
|
Definition
|
|
Term
| excretion and T1/2 hemastarch |
|
Definition
|
|
Term
| indication of prothrombin complex concentrates |
|
Definition
|
|
Term
| why can an epidural cause a fever |
|
Definition
| increased IL6 in nulliparous women |
|
|
Term
| complications of epidural - 10 |
|
Definition
| fever, hypotension, transient NRFHT, pruritic, headache, epidural hematoma, complete spinal blockade, abscess, meningitis, neurotoxicity |
|
|
Term
| what can help prevent hypotension after epidural |
|
Definition
| 500-1000cc crystalloid, little data |
|
|
Term
| rate of severe epidural complications |
|
Definition
|
|
Term
| fatality rate due to epidural |
|
Definition
|
|
Term
|
Definition
| gas remaning after forced expiration |
|
|
Term
| define total lung capacity |
|
Definition
| residual volume + vital capacity |
|
|
Term
| define expiratory reserve volume |
|
Definition
| primary determinant of O2 reserve during apnea |
|
|
Term
| define functional residual capacity |
|
Definition
| gas remaining after passive expiration (residual + expiratory reserve volume) |
|
|
Term
| physiologic cause of increased and reduced functional residual capacity |
|
Definition
| reduced - reduced compliance, increased - increased compliance |
|
|
Term
| causes of reduced compliance and thus reduced functional residual capacity - 10 |
|
Definition
| lung injury, pulmonary edema, fibrosis, atelectasis, obesity, pleural effusion, <10% when supine, T-bird, insufflation, ventilator weakness |
|
|
Term
| causes of increased compliance and thus increased functional residual capacity |
|
Definition
|
|
Term
| increased function residual capacity changes what other lung measurement |
|
Definition
| decreased expiratory reserve |
|
|
Term
| complications of reduced functional residual capacity - 6 |
|
Definition
| arterial hypoxia, difficult to ventilate, barotrauma, increased pulmonary pressures, increased O2 need, increased CO2 |
|
|
Term
| management of reduced functional residual capacity - 5 |
|
Definition
| less t-bird, less insufflation, dense paralysis, decrease tidal volume, permissive hypercapnia |
|
|
Term
| how do you need to monitor if you do permissive hypercapnia - 2 |
|
Definition
| monitor pulmonary pressures and end tidal CO2 |
|
|
Term
| complications of malnutrition in regard to surgery - 5 |
|
Definition
| increased M/M independent risk factor, infection, impaired immune function, prolonged mechanical ventilation, lower ICU stays |
|
|
Term
| 3 physiologic responses to enteral nutrition |
|
Definition
| maintains structural integrity of gut mucosa and flora, decreases oxidative stress, downregulates systemic immune response |
|
|
Term
| what is the optimal caloric intake for malnutrition for surgical outcomes |
|
Definition
|
|
Term
| why is 2/3 caloric intake recommended for malnutrition - 3 |
|
Definition
| less vomiting, smaller gastric residual, improved MM |
|
|
Term
| complications of enteral nutrition - 6 |
|
Definition
| refeeding syndrome, aspiration, tube malposition, tube clogging, vomiting, diarrhea |
|
|
Term
| 2 methods to reduce complications of enteral nutrition |
|
Definition
| elevate head of bed to reduce aspiration, prokinetics (metoclopramide, erythromycin) reduces high residuals |
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