Term
| definition of intraoperative hemorrhage |
|
Definition
| EBL >1000, or blood loss requiring transfusion |
|
|
Term
| risk factors for operative hemorrhage - 8 |
|
Definition
| obesity, poor visibility, lack of experience, platelet inhibitors, supplements, blunt dissection, peritonectomy, cytoreduction |
|
|
Term
| effect at 30, 40, and 50% loss of blood volume |
|
Definition
| 30 - cardiovascular instability, 40 - life threatening complications, 50 - lactic acidosis |
|
|
Term
| why does lactic acidosis occur during blood loss - 2 |
|
Definition
| decreased Xa and prothrombin activity |
|
|
Term
| during blood loss what is considered hypothermia and what is the physiologic effect - 2 |
|
Definition
| 91.4-98.6F / 33-37C, impaired tissue factor and platelet function |
|
|
Term
| criteria for consumptive coagulopathy - 4 |
|
Definition
| PLT <50, FIB <100, prolonged PT and PTT |
|
|
Term
| what level of fibrinogen has a 100% PPV for PPH |
|
Definition
|
|
Term
| what is the mass transfusion ratio |
|
Definition
|
|
Term
| when should the mass transfusion protocol be activated - 4 |
|
Definition
| anticipated need of >50% blood volume in 2h, bleeding continues despite 4U PRBC in 1-2h, SBP <90, HR >120 |
|
|
Term
| when should the mass transfusion protocol be terminated - 4 |
|
Definition
| HCT >24%, INR <1.5, PLT >50, fibrinogen >100 |
|
|
Term
| how much does hypogastric artery ligation decrease blood flow - total downstream, pelvic, vascular pulse pressure |
|
Definition
| total downstream 75%, pelvic 50%, vascular pulse pressure 85% |
|
|
Term
| when is vascular mesh good for bleeding |
|
Definition
| large artery injuries where suturing could cause stenosis |
|
|
Term
| how long is packing allowed to be left in place |
|
Definition
|
|
Term
| what is in blood from cell salvage |
|
Definition
| just PRBC, no plasma/PLT/WBC |
|
|
Term
| what suction is needed for cell salvage |
|
Definition
|
|
Term
| what does a cell salvage filter do |
|
Definition
| removes organisms and cells with a nucleus |
|
|
Term
| when does a cell salvage filter need to be changed |
|
Definition
|
|
Term
| compared to PRBC, cell salvage blood has 2 difference |
|
Definition
| mean RBC viability is increased, 2,3-diphosphoglycerate increased |
|
|
Term
| indications for cell salvage - 2 |
|
Definition
| anticipated EBL >1000 or >30% volume loss |
|
|
Term
| contraindications of cell salvage - 5 |
|
Definition
| gross bacterial contamination, cancer, solution causing lysis (sterile water, hydrogen peroxide, alcohol) |
|
|
Term
| relative contraindications of cell salvage - 5 |
|
Definition
| hemoglobinopathies, topical clotting agents, urine contamination, amniotic fluid, bone chips |
|
|
Term
| complications of cell salvage - 2 |
|
Definition
| air embolism, coagulopathy |
|
|
Term
| how to prevent air embolism in cell salvage - 1 |
|
Definition
| transfer blood into secondary reinfusion bag |
|
|
Term
| prognosis of a good mass transfusion protocol |
|
Definition
|
|
Term
| rate of trochar placement injury |
|
Definition
|
|
Term
| risk factors for laparoscopic injury - 8 |
|
Definition
| abdominal surgery, abdominal mesh, PID, ruptured appendix, peritonitis, hernia repair, cardiopulmonary disease, diaphragmatic hernia |
|
|
Term
| risk of adhesions - no prior surgery, 1 prior LSC, prior midline |
|
Definition
| 0.68% no surgery, 1.6% LSC, 51% midline |
|
|
Term
| 50% of all laparoscopic surgical complication cause |
|
Definition
|
|
Term
| reduction of primary trocar placement injury - 3 |
|
Definition
| gastric aspiration, drain bladder, t-bird |
|
|
Term
| signs of hypercapnia from LSC insufflation |
|
Definition
|
|
Term
| management of hypercapnia from LSC insfullation |
|
Definition
| increase minute ventilation 10-25% |
|
|
Term
| #1 time gas embolism would occur in LSC |
|
Definition
|
|
Term
| risks of gas emboli in LSC - 3 |
|
Definition
| primary insufflation, prior abdominal surgery, venous bleeding |
|
|
Term
|
Definition
| sudden rise in pCO2 and decrease in pO2, hemodynamic collapse, mill wheel murmur, tachycardia, arrhythmia, hypotension, increased CVP, cyanosis, EKG with right heart strain |
|
|
Term
| diagnosis of gas emboli - 2 |
|
Definition
| clinical, gas bubbles by central line into right atrium diagnostic |
|
|
Term
| management gas emboli - 5 |
|
Definition
| release pneumo, hyperventilate with 100% O2, steep t-bird, left lateral decubitus, PAC in RA to aspirate CO2 bubbles |
|
|
Term
| risk factor for cutaneous emphysema |
|
Definition
|
|
Term
| signs of cutaneous emphysema |
|
Definition
|
|
Term
| prevention of cutaneous emphysema - 2 |
|
Definition
| elevation of abdominal wall, repeat at steeper angle |
|
|
Term
| risks for port site metastasis |
|
Definition
| ovarian cancer is #1 esp if stage 3-4, carcinomatosis, or ascites, any cancer stage 3-4, LND |
|
|
Term
| mean time to presentation port site metastasis for ovarian vs cervical cancer |
|
Definition
| ovarian 17d, cervical 5mo |
|
|
Term
| physical risk factors for port site metastasis - 8 |
|
Definition
| port removal, aerosolized tumor cells, gas expelled during decompression, metabolic/immune changes due to CO2, changes in peritoneal humidity, abdominal wall stretching, electrostatic port interaction, increased abdominal pressure |
|
|
Term
|
Definition
|
|
Term
| how must you adjust primary port placement in obese patients |
|
Definition
| the umbilicus will sag lower so use the iliac crest to identify the location of L4 which is the bifurcation of the aorta |
|
|
Term
| veres needle angle obese vs thin |
|
Definition
| 45 deg thin, >45 deg ovese |
|
|
Term
| how do you place trocars to avoid the inferior epigastrics |
|
Definition
| lateral to the rectus muscles |
|
|
Term
| what do you do if you draw back blood on veres |
|
Definition
| remove it and try again, leaving in place may increase the defect |
|
|
Term
| if you put in a transabdominal suture for inferior epigastric bleeding when do you remove it |
|
Definition
|
|
Term
| what is the least effective way to deal with inferior epigastric bleeding |
|
Definition
|
|
Term
| normal amount of abdominal air after laparoscopy and duration |
|
Definition
| 40% will have 2cm pocket of subdiaphragmatic air at 28h which can be seen up to 1wk |
|
|
Term
| signs of visceral injury after laparoscopy |
|
Definition
| ileus, excessive air on imaging |
|
|
Term
| what do you do if you poke an organ with the veres and specifically the bladder |
|
Definition
| remove and restart, no repair, drain bladder 5d |
|
|
Term
| what do you do if you poke an organ with a trocar, and specifically the bladder |
|
Definition
| leave in place to help with identification, x-lap and repair, if bladder |
|
|
Term
| what do you do if you electrocautery an organ |
|
Definition
| resect 102cm of viable tissue and repair primairly |
|
|
Term
| what is likely to have caused an immediate anaphylactic reaction in the OR - 1 |
|
Definition
| PCN, cephs, neuromuscular blockers, hypnotic induction agents |
|
|
Term
| #1 cause of immediate OR anaphylaxis |
|
Definition
|
|
Term
| causes of delayed anaphylaxis after surgery - 5 |
|
Definition
| latex, blood products, colloid volume expanders, protamine, dyes |
|
|
Term
| percent of OR related anaphylaxis that is immediate |
|
Definition
| 90% within 5-10min of exposure |
|
|
Term
| treatment of anaphylaxis - 3 |
|
Definition
| fluids, epinepherine, hydrocortisone |
|
|
Term
| signs of adrenal crisis - 6 |
|
Definition
| fatigue, vomiting, abdominal pain, joint pain, salt craving, hyperpigmentation |
|
|
Term
| causes of adrenal crisis - 5, which is #1 |
|
Definition
| exogenous glucocorticoids #1, hyperthyroidism, genetic disorders, autoimmune disease, adrenal hemorrhage |
|
|
Term
| management of adrenal crisis - 3 |
|
Definition
| high dose hydrocortisone, rapid IV fluid infusion, cardiac monitoring |
|
|
Term
| % of lymphedema related to GYN ONC surgeries |
|
Definition
|
|
Term
| risk factors for lymphedema - 3 |
|
Definition
| more nodes taken (independent risk factor), more distal nodes taken, radiation therapy |
|
|
Term
| complications of lymphedema - 3 |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| regional anesthesia instead of general if possible, NSAIDS/regional post op instead of opioids, no PCA, lateral and upright positions |
|
|
Term
| complications of OSA associated with surgery - 4 |
|
Definition
| arrhythmia, acute renal failure, wound complications, post-operative delirium |
|
|
Term
| if someone is not improving with routine OSA management what do you work them up for |
|
Definition
|
|
Term
| #1 cause of abdominal hernia |
|
Definition
|
|
Term
| percent incidence of abdominal hernia |
|
Definition
|
|
Term
| how long does it usually take for an abdominal hernia to form |
|
Definition
| 11-20% by 1-3y, increased incidence at 10y |
|
|
Term
| patient risk factors for hernia formation - 5 |
|
Definition
| obesity, DM, smoking, malignancy, prior laparotomy |
|
|
Term
| operative risk factors for hernia formation - 5 |
|
Definition
| wound infection, wound dehiscinence, immune suppression or steroids, maternal to close wound, suture technique |
|
|
Term
| rate of incarceration and strangulation of hernia |
|
Definition
| incarceration 6-15%, strangulation 2% |
|
|
Term
| management of the 2 types of hernias |
|
Definition
| early: acute, requires repair. Late: painless, repair if symptomatic. |
|
|
Term
| criteria for expectant management of a hernia - 2 |
|
Definition
| wide mouthed, no concern for incarceration |
|
|
Term
| management of a small hernia |
|
Definition
|
|
Term
| management of a medium hernia |
|
Definition
| 3-10cm close with mesh, can be done laparscopically |
|
|
Term
| indications a hernia needs to be repaired via laparotomy - 3 |
|
Definition
| >10cm, prior hernia repair, open wound |
|
|
Term
| type of mesh used in hernia repair and why |
|
Definition
| polypropolene reduces inflammatory reaction which leads to better collagen synthesis |
|
|
Term
| complications of hernia repair - 5 |
|
Definition
| seroma, wound infection, intra-abdominal injury, mesh infection, enterocutaneous fistula |
|
|
Term
| recurrence of a hernia after 1st and 2nd repair |
|
Definition
| 1st 25-54%, second likely to fail |
|
|
Term
| prevention of a hernia - 4 |
|
Definition
| repair all fascia defect >5mm, remove ports under direct visualization, expel CO2 from umbilical port, replace obturator into trocar on removal to stop omentum from coming into hole |
|
|
Term
| define vaginal cuff dehiscinence |
|
Definition
| partial or full separation of the cuff |
|
|
Term
| define vaginal cuff eviceration |
|
Definition
|
|
Term
| incidence of vaginal cuff dehiscinence - cumulative, robotic, TLH, LAVH, TAH, TVH |
|
Definition
cumulative 0.25%
TAH 0.25%
TVH 0.25%
LAVH 0.4%
TLH 2%
robotic sources up to 6% |
|
|
Term
| risks for vaginal cuff dehyscinence - 12 |
|
Definition
| immune compromised, smoking, obesity, DM, chronic cough, poor nutrition, steroids, intercourse, excessive Valsalva, PMP, cuff infection, cuff hematoma |
|
|
Term
| when does vaginal cuff dehiscinence occur |
|
Definition
|
|
Term
| management of vaginal cuff dehiscinence |
|
Definition
| broad spectrum antibiotics, immediate vaginal closure unless you cant reduce bowel or there is bowel trauma |
|
|
Term
| prevention of vaginal cuff dehiscinence - 4 |
|
Definition
| cut/suture don't cauterize cuff, 2 layer cuff closure, bidirectional barbed suture, vaginal closure |
|
|
Term
|
Definition
|
|
Term
| % of bowel injuries unrecognized |
|
Definition
|
|
Term
| method of most bowel injuries |
|
Definition
|
|
Term
| signs of unrecognized bowel injury - 12 |
|
Definition
| infection, obstruction, malabsorption, fistula, peritonitis, sepsis, multiorgan failure, pain at nearest trocar site, fever, diarrhea, abdominal distention, leukocytosis |
|
|
Term
|
Definition
| perpendicular to the long axis |
|
|
Term
| indication for resection/reanastamosis - 3 |
|
Definition
| 2+ areas of injury, required 4U+ PRBC, significant contamination/leakage |
|
|
Term
| repair of a thermal bowel injury |
|
Definition
| resect 3-5cm around the blanched area to prevent further necrosis, reanastamosis |
|
|
Term
| how do you determine if you need to resect a laceration bowel injury |
|
Definition
| <1/2 circumference and no crushed edges can close, >1/2 circumference or crushed edges resect |
|
|
Term
| if you are going to close a laceration bowel injury how do you do it |
|
Definition
serosa/seromuscular - interrupted 3-0 absorbable vicryl in 1-2 layers perpendicular to long axis.
full thickness - double layer, interrupted with 3-0 chromic then inbricated with 3-0 absorbable for serosa perpendicular to long axis |
|
|
Term
| indications for a diverting colostomy - 5 |
|
Definition
| unresectable pelbic mass, carcinomatosis, colon injury with fecal contamination, irradiated operative field, infected/inflammaed operative field (PID, diverticulitis) |
|
|
Term
|
Definition
| leaving a portion of the rectum in a diverting colostomy so you have the option to reverse later |
|
|
Term
| follow up management after bowel injury |
|
Definition
| <1cm, partial thickness, or puncture - none. >1cm , full thickness, delayed, necrotic, infected - clear liquid diet until return of bowel function |
|
|
Term
| risk factors for ileus - 10 |
|
Definition
| prolonged surgery, open surgery, routine NG, lower GI surgery, peritonitis, sepsis, pneumonia, abscess, bleeding, opioids |
|
|
Term
|
Definition
| distention, mild diffuse pain, nausea, vomiting, absent/quiet bowel sounds, delayed flatus, diarrhea |
|
|
Term
|
Definition
| diffuse air including small bowel, no transition point |
|
|
Term
| 3 types of ileus and their physiology |
|
Definition
spastic: muscle contraction no propulsive motility
ischemic: muscle cant make coordinated movements due to ischemia
adynamic: reduced or absent motility |
|
|
Term
| causes of spastic ileus - 2 |
|
Definition
| heavy metal poisoning, porphyria |
|
|
Term
| causes of adynamic ileus - 3 |
|
Definition
| abdominal surgery, metabolic, neuronal |
|
|
Term
| factors that worsen the duration and severity of ileus - 5 |
|
Definition
| age, length of surgery, amount of bowel trauma, lyte imbalances, infection |
|
|
Term
| how long does it take for the small bowel, stomach, and colon to return to function |
|
Definition
| small bowel 24h, stomach 24-48h, colon 48-72h |
|
|
Term
| expectant management for ileus - 4 |
|
Definition
| NPO, reduce narcotics, IV hydration, NG decompression PRN |
|
|
Term
| how long can you wait out an ileus, what do you do then |
|
Definition
| 3-4d, CT abdomen, concern for obstruction |
|
|
Term
| 3 benefits of early post op feeding |
|
Definition
| shorter hospital stay, decreased time to solid food, patient satisfaction |
|
|
Term
| does chewing gum, early feeding, coffee, and ambulation help ileus |
|
Definition
|
|
Term
| % of patients with ovarian cancer that get a SBO |
|
Definition
|
|
Term
|
Definition
| tension on surface of a cylinder proportional to diameter and pressure - ie - tension on the bowel cuts off the venous return but not the arterial in causing complete vascular insult (necrosis, peritonitis, septic shock, perforation) |
|
|
Term
| what is the weakest part of the colon |
|
Definition
|
|
Term
|
Definition
| simple: intact blood supply, strangulated: compromised mesenteric vessels |
|
|
Term
| causes of simple SBO 5 and their categories |
|
Definition
| obstruction of lumen (gallstone, bezor), extrinsic compression of lumen (chrons, tumor), intrinsic compression of lumen (adhesion) |
|
|
Term
| causes of strangulation SBO - 4 |
|
Definition
| adhesions, torsion (hernia, volvus, intussception) |
|
|
Term
|
Definition
| nausea, vomiting (bilious, feculent), anorexia, distention, severe colicky pain, delayed flatus, high pitched tinkling or absent bowel sounds |
|
|
Term
|
Definition
| air fluid levels in dilated loops, air fluid levels with stair stepping, proximal bowel dilation and distal collapse, gasless abdomen |
|
|
Term
|
Definition
| fluids, lytes, NPO, NG tube, parentrail hyperalimentation if >10d NPO, surgery is last resort |
|
|
Term
|
Definition
| minimize bowel handling and packing, hemostasis, avoid peritoneal contamination, advance diet slowly, ambulate |
|
|
Term
| causes of large bowel obstruction - 3 |
|
Definition
| tumor, scarring, radiation |
|
|
Term
| major complication large bowel obstruction |
|
Definition
|
|
Term
| management of large bowel obstruction - 3 options |
|
Definition
| emergent surgery - colostomy by transverse loop or end colostomy. cecostomy tube is ostomy not feesible. clonic stenting good if pallative |
|
|
Term
| definition of oliguria - 2 |
|
Definition
| <400-500 mL/d or <17-21 mL/h |
|
|
Term
| initial step if post-op oliguria |
|
Definition
| check foley, I/o or bladder scan |
|
|
Term
| second step if post-op oliguria |
|
Definition
| fluid challenge with isotonic fluid LR/NS |
|
|
Term
| third step if post-op oliguria |
|
Definition
|
|
Term
| labs to get if oliguria - 5 |
|
Definition
| FENA, urine microscopy, urine osmolality, BUN, Cr |
|
|
Term
| imaging to consider if post op oliguria - 3 |
|
Definition
| renal US #1 because can indicate back up if enlarged, bladder US, abdominal US |
|
|
Term
| 4 labs indicating pre-renal etiology |
|
Definition
| FENA <1%, urine osmo >550 omosm/kg, bland urine sediment, BUN 10x Cr |
|
|
Term
| 3 labs indicating renal etiology |
|
Definition
| FENA >3%, urine osm 250-300 mosm/kg, active urine sediment |
|
|
Term
| 3 signs indicating post-renal etiology |
|
Definition
| anuria, elevated PVR, hydronephrosis |
|
|
Term
| causes of pre-renal oliguria - 7 |
|
Definition
| volume depletion, bleeding, hypotension, renal vascular stenosis or thrombosis, cardiac failure, sepsis |
|
|
Term
| causes of renal oliguria - 7 |
|
Definition
| drug necrosis, AKI, interstitial nephritis, glomerulorapathy, TTP, HUS, HELLP |
|
|
Term
| causes of post renal oliguria - 5 |
|
Definition
| bladder or ureter injury or obstruction, urinary retention |
|
|
Term
| long term complications of AKI - 5 |
|
Definition
| permanent renal damage, ischemic bowel, delirium, stroke, MI |
|
|
Term
| % of hospitalized that have AKI |
|
Definition
|
|
Term
| $ of critically ill that have AKI |
|
Definition
|
|
Term
| acute complications of AKI - 3 |
|
Definition
| fluid overload, electrolyte imbalance, coagulopathy |
|
|
Term
| drugs to avoid in AKI - 5 |
|
Definition
| NSAIDs, radiocontrast, aminoglycosides, ACEI/ARB, diuretics |
|
|
Term
| when in AKI do you need to do dialysis for sure |
|
Definition
|
|
Term
|
Definition
| DM, HTN, sepsis, hypovolemia |
|
|
Term
| in AKI what is directly associated with a risk of death |
|
Definition
|
|
Term
| name that renal etiology for oliguria - hypertension, hemolytic anemia, thrombocytopenia - 3 |
|
Definition
|
|
Term
| name that renal etiology for oliguria - hypertension, proteinuria, hematuria, RBC casts, dysmorphic RBC |
|
Definition
| glomerular - steroids, cyclophosphomide |
|
|
Term
| name that renal etiology for oliguria - toxin, rash, fever, eosinophilia |
|
Definition
| interstitial nephritis - steroids, eliminate toxin |
|
|
Term
| name that renal etiology for oliguria - ischemia, coarse brown granular casts |
|
Definition
| acute tubular necrosis - eliminate toxin, supportive |
|
|
Term
| what are the 4 phases of healing |
|
Definition
| hemostasis, inflammation, migration/epithelization, remodaling |
|
|
Term
| what occurs in the hemostasis phase of healing - 5 |
|
Definition
| clotting cascade, then platelet aggregation, release of growth factors, cytokines, and fibrin matrix |
|
|
Term
| what occurs in the inflammation phase of healing - 2, how long does it take |
|
Definition
| complete within 3d, increased vascular permability, cellular recruitment |
|
|
Term
| what occurs in the epithelization phase of healing - 2 |
|
Definition
| basal cell proliferation, epithelial migration |
|
|
Term
| what occurs in the remodeling phase of healing - 4 |
|
Definition
| collagen cross linking, collagen remodeling, wound contraction, repigmentation |
|
|
Term
|
Definition
| collection of serum in the subcutaneous tissue |
|
|
Term
|
Definition
| collection of blood in the subcutaneous tissue |
|
|
Term
| wound type more common to get hematoma |
|
Definition
|
|
Term
| leading cause of superficial wound separation |
|
Definition
|
|
Term
| when does hematoma/seroma occur |
|
Definition
|
|
Term
| management of hematoma/seroma |
|
Definition
| small expectant, large drain and back, allow to close by secondary intention, can close when granulation tissue present if no signs of infection |
|
|
Term
| prevention of hematoma/seroma - 2 |
|
Definition
| meticulious hemostasis, drains |
|
|
Term
| drains decrease ___ but increase ____ |
|
Definition
| hematoma/seroma, infection |
|
|
Term
| incidence of wound infection in operations |
|
Definition
|
|
Term
| management of wound infections - 5 |
|
Definition
| systemic antibiotics, open wound, drain purulence, debride, wet to dry dressing, close by secondary intention |
|
|
Term
| define fascial dehiscinence |
|
Definition
| separation of all abdominal wall layers except peritoneum |
|
|
Term
| define fascial evisceration |
|
Definition
| separation of all abdominal wall layers including peritoneum |
|
|
Term
| causes of fascial dehiscinence - 3 |
|
Definition
| necrosis from tight sutures, too much tension, knot failure |
|
|
Term
| preferred diagnostic method fascial dehiscinence |
|
Definition
|
|
Term
| prevention of fascial dehiscinence - 3 |
|
Definition
| 1-0 or 2-0 delayed absorbable monofilament suture, bites >1cm, non-strangulation |
|
|
Term
| management of fascial dehiscinence |
|
Definition
| wound exploration in the OR, mass closure with continuous or retention sutures, skin closed by primary or secondary intention |
|
|
Term
| 3 types of necrotizing fasciitis |
|
Definition
1 - polymicrobial
2 - GAS, S. aureus, MRSA
3 - gas gangrene |
|
|
Term
| microbs in polymicrobial necrotizing fasciitis - 3 |
|
Definition
| C. septicum, C. sodtelli, bowel flora |
|
|
Term
|
Definition
|
|
Term
| location of polymicrobial necrotizing fasciitis |
|
Definition
|
|
Term
| causes/associations with polymicrobial necrotizing fasciitis - 3 |
|
Definition
| surgery, trauma, abdominal abscess |
|
|
Term
| necrotizing fasciitis type 2 locations |
|
Definition
| extremities, unless from a surgical site |
|
|
Term
| necrotizing fasciitis which type progresses rapidly |
|
Definition
|
|
Term
| necrotizing fasciitis type 2 who does it usually affect |
|
Definition
| young, immune compormised |
|
|
Term
| signs of necrotizing fasciitis - 10 |
|
Definition
| fever, tachycardia, hypotension, tense edema, bullae, SQ gas, crepitus, dish water discharge, pain out of proportion, necrosis of skin |
|
|
Term
| necrotizing fasciitis CT signs - 2 |
|
Definition
|
|
Term
| necrotizing fasciitis CT sensitivity for diagnosis |
|
Definition
|
|
Term
| necrotizing fasciitis antibiotics |
|
Definition
| carbapenem/unisym + vanc/dapto (for MRSA) + clinda |
|
|
Term
| #1 factor in decreasing mortality in necrotizing fasciitis |
|
Definition
| debridment within 24h, if not 9d death |
|
|
Term
| necrotizing fasciitis when do you stop debriding |
|
Definition
|
|
Term
| necrotizing fasciitis when do you use hyperbaric oxygen |
|
Definition
| severe cases, decreases mortality |
|
|
Term
| necrotizing fasciitis overall mortality |
|
Definition
|
|
Term
| define post-operative fever |
|
Definition
| >101.4F/38C x2 >6h apart or >/= 101.5 x1 |
|
|
Term
| causes of immediate post-operative fever - 7 |
|
Definition
| transfusion reaction, anesthesia reaction, trauma, infection before surgery, malignant hyperthermia, antibiotic reaction, other drug reaction |
|
|
Term
| what factors released cause trauma itself to cause fever - 4 |
|
Definition
|
|
Term
| causes of fever 1-7d post-op - 9 |
|
Definition
| SSI, cath associated UTI, atelectasis, pancreatitis, MI, PE, thrombophlebitis, ETOH withdrawal, acute gout |
|
|
Term
| causes of fever 1-4wk post-op - 12 |
|
Definition
| SSI, UTI, abscess, cellulitis, unrecognized bowel or bladder injury, central line infection, c. diff, thrombophlebitis, DVT, PE, meds |
|
|
Term
| causes of fever >4wk post op - 5 |
|
Definition
| blood product virus infection, implanted medical device infection, delayed cellulitis, endocarditis, thrombophlebitis |
|
|
Term
| work up for post-op fever - 9 |
|
Definition
| physical exam, CXR, UA, UCx, CBC, BCx, LE dopplers, CT A/P, TTE |
|
|
Term
| management of post-op fever of unknown location |
|
Definition
| empiric antibiotics - Levaquin/flagyl, unasyn if no response in 48h repeat work up |
|
|
Term
| what if you have a post-op fever of unknown origin and you had no response to empiric antibiotics in 48h and you redid the work up and it is still negative, what do you do |
|
Definition
| treat for thrombophlebitis |
|
|
Term
| risk factors for septic pelvic thrombophlebitis - 2 |
|
Definition
|
|
Term
| signs of septic pelvic thrombophlebitis - 8 |
|
Definition
| persistent high fevers despite antibiotics, non-toxic appearing, tachycardia, ileus, nausea, vomiting, pelvic pain, potential leukocytosis |
|
|
Term
| chances youll see septic pelvic thrombophlebitis on CT/MRI |
|
Definition
|
|
Term
| chances you see septic pelvic thrombophlebitis on US |
|
Definition
|
|
Term
| septic pelvic thrombophlebitis - treatment |
|
Definition
| broad spectrum antibiotics, heparin or lovenox, DC all when afebrile for 48h |
|
|
Term
| how long does septic pelvic thrombophlebitis last |
|
Definition
| fevers usually last 2-5d after starting treatment |
|
|
Term
| risk factors of C. diff - 4 |
|
Definition
| extremes of age, nursing home, prolonged hospitalization, prolonged antibiotics |
|
|
Term
|
Definition
|
|
Term
| what do you NEVER do if you suspect c. diff |
|
Definition
| barium enema or endoscopy leads to perforation |
|
|
Term
|
Definition
| no anti-diarrheals, flagyl 500mg TID 10-14d, vanc 125-500mg q6h PR, fecal transplant if severe |
|
|
Term
| do you do a TOC for c. diff |
|
Definition
| no, will be positive for weeks |
|
|
Term
| complications of c. diff - 5 |
|
Definition
| toxic megacolon, pseudomembranous colitis, necrotizing colitis, perforation |
|
|
Term
|
Definition
|
|
Term
| incidence of post-op abscess in GYN surgery |
|
Definition
|
|
Term
| single consistent association with post-op abscess |
|
Definition
|
|
Term
| risk factors for post-op abscess - 6 |
|
Definition
| blood transfusion, >80yo, obesity, diabetes, immune suppression, surgery >3h |
|
|
Term
| rate of post-op abscess per method of hyst |
|
Definition
|
|
Term
| what should you consider if your treating cuff cellulitis and it isn't working |
|
Definition
|
|
Term
| treatment of post-op abscess |
|
Definition
| IV for 48h AND - abscess is shrinking, leukocytosis is resolving, and clinical improvement - followed by 14d of PO abx |
|
|
Term
| IV antibiotics for post-op abscess - 3 regimens |
|
Definition
| piperacillin-tazobactam 3.375 IV q6h OR ceftriaxone + clinda or metronidazole OR aztreonam + clinda or metronidazole |
|
|
Term
| when should you remove a post-op abscess in the OR - 2 |
|
Definition
| hemodynamically unstable, peritoneal signs |
|
|
Term
| PO regimens for after IV in post-op abscess - 2 |
|
Definition
| metronidazole 500mg q12h + Bactrim 1600/800mg q12h OR amoxicillin clavulanate 875/125mg q12h |
|
|
Term
| management of post op abscess based on size |
|
Definition
| >/= 7cm IR drainage and abx, 2-7cm consider IR draining do abx, <2cm abx only |
|
|
Term
| prevention of post-op abscess - 3 |
|
Definition
| treat BV, stabilize pre-existing medical conditions, antibiotic prophylaxis |
|
|
Term
| risks factors for ovarian remnant syndrome - 4 |
|
Definition
| dense pelvic adhesions, IBD, endometriosis, perioperative bleeding |
|
|
Term
| which side is ovarian remnant syndrome more common on and why |
|
Definition
| left, limited visibility of the IP ligament when sigmoid is attached to pelvic brim |
|
|
Term
| diagnosis of ovarian remnant syndrome - 3 |
|
Definition
| definitive requires surgical resection with histology, suggestion on TVUS 90% of time, stimulation with clomiphene for 10d and repeat TVUS if cant see |
|
|
Term
| % of non-cardiac surgeries with a MI |
|
Definition
|
|
Term
| % of non-cardiac surgeries with significant M/M due to cardiac complications |
|
Definition
|
|
Term
| discontinuation of ACEI 24h before surgery improves - 3 |
|
Definition
| decreases mortality, MI, CVA |
|
|
Term
| prophylactic BB need to be started when before surgery to have what benefit |
|
Definition
| starting within 1d of surgery reduces MI but has more deaths, starting within 1wk of surgery improvs outcomes in high risk patients |
|
|
Term
| should you DC HCTZ before surgery |
|
Definition
| consider, may have lyte abnormalities, hypovolemia, delirium in elderly, does not help risk reduction |
|
|
Term
| risks for post-operative delirium - 4 |
|
Definition
| >65yo, severe illness, comorbidities, limited mobility |
|
|
Term
| causes of post-operative delirium (not meds) - 6 |
|
Definition
| febrile illness, intoxication, electrolyte imbalance, CVA, pneumonia, PE |
|
|
Term
| meds that can cause post-op delirium - 6 |
|
Definition
| anticholinergics, sedatives, hypnotics, meperidine, diphenhydramine, benzos |
|
|
Term
| prevention of post op delirium - 4 |
|
Definition
| avoid causative medications in elderly, minimize polypharmacy, ensure has eye glasses and hearing aids, low dose anti-psychotics if all measures fail |
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