Term
| ring around the rosy, pockets full of ______. |
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Definition
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Term
| examples of how surgery creates higher risk for infection |
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Definition
cut skin (first line of defense)
IVs
catheters
ETTs |
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Term
| SCIP (surgical care improvement project) initiatives |
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Definition
appropriate use of prophy ABx
use of appropriate hair removal methods
glucose control in cardiac surgeries
normothermia |
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Term
| most all ABx (except vanco) should be given at what interval prior to cut time |
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Definition
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Term
| the most common in vitro predictor of antimicrobial effect |
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Definition
| minimum inhibitory concentration (MIC) |
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Term
| inhibiting bacterial growth without killing the organism |
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Definition
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Term
| killing or rendering bacteria dysfunctional |
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Definition
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Term
| drug that accounts for most fatal anaphylactic drug reactions |
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Definition
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Term
| structure that is shared by penicillin, cephalosporins, carbapenems and monbactims. it is this structure that drives the allergy to the drug. |
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Definition
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Term
| enzyme produced by bacteria (usually mutated) that breaks down ABx |
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Definition
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Term
| class of ABx that can kill a variety of bacteria that are both gram + and gram - |
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Definition
| broad spectrum (GL's spelling: BRAOD SPECTRIM) |
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Term
| 1st generation cephalosporin, very common ABx for surgery (excellent for skin infections). |
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Definition
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Term
| Cefazolin: adult dosing, time needed for IVP, when to rebolus |
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Definition
adult: 1 gram
give IVP 3-5minutes
rebolus if case is longer than 3hrs (still open and not on skin) |
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Term
| 2nd generation cephalosporins (2). good gram - coverage, commonly used in appys and other bowel surgeries |
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Definition
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Term
| Cefoxitin: adult dosing, time needed for IVP, when to rebolus |
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Definition
1-2 grams
IVP over 3-5min
rebolus at 2hrs |
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Term
| Cefotetan: adult dosing, time needed for IVP, when to rebolus |
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Definition
1-2 grams
IVP over 3-5min
rebolus at 4 hrs |
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Term
| glycopeptide used against gram + organisms. drug most commonly used for MRSA. |
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Definition
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Term
| T/F: Vanco is a substitute for pts with cephalosporin allergy |
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Definition
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Term
| Vancomycin: adult dosing, time needed for IVP, when to rebolus |
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Definition
1 gram
administer over 60 MIN!!! (admin within 120minutes of cut time)
redose at 12hrs |
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Term
| most common adverse effect of vanco (bonus: what can this condition progress to if drug given too fast?) |
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Definition
red man syndrome (due to large histamine release)
bonus: tachycardia and hypotension
benadryl can be given to help alleviate symptoms |
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Term
| category of drug that irreversibly inhibits protein synthesis and is used against gram - organisms. almost completely secreted thru kidney. |
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Definition
| aminoglycosides (ex: Gentamicin, neomycin, tobramycin) |
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Term
| Gentamicin: adult dosing, time needed for IVP |
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Definition
1.5 mg/kg; max dose 240mg (pharmacy doses based on IBW)
30-60min (Can be given IV or IM) |
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Term
| 2 severe side effects of aminoglycosides |
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Definition
| Nephrotoxicity and Ototoxicity |
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Term
| T/F: aminoglycosides prolong NMDR activity (if true, by what mechanism do they prolong NMDR; and how is it treated) |
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Definition
true
inhibition of pre-junctional ACh release and reduction of post-synaptic sensitivity to ACh.
effect can be reversed with neostigmine and calcium improves muscle strength. |
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Term
| pro-drug (meaning something has to cleave a portion off before drug becomes active) that kills anaerobic bacteria, protozoal and parasites |
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Definition
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Term
| metronidazole/flagyl: adult dosing, when to rebolus |
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Definition
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Term
| drug that has significant GI side effects (overgrowth of CDiff) and is only given if other ABx will not achieve the goals |
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Definition
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Term
| mechanism by which clindamycin prolongs effects of NMDRs |
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Definition
| blocks release of ACh at the NMJ |
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Term
| Clindamycin: adult dosing, time needed for IVP, when to rebolus |
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Definition
600-900mg
IV over 30min
redose at 3hrs |
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Term
| 5 risk factors for SSI (surgical site infections) |
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Definition
extremis of age
chronic illness
DM
corticosteroid therapy
immunocompromised |
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Term
| 7 interventions to reduce SSI |
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Definition
prophy ABx within 1hr of incision
increase tissue oxygenation
pain control
avoid hypocapnea (easy to overvent pts - be careful)
avoid hypothermia
avoid hyperglycemia
wound probing |
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Term
| 4 important indicators of SIRS (systemic inflammatory response syndrome) |
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Definition
WBC >11k or <4k (or >20% immature - babies at war)
HR >90 bpm
Temp >38 or <36
RR >20 or PaCO2 <32mmHg |
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Term
| first priority in management of sepsis and septic shock |
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Definition
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Term
| 5 treatment goals to manage sepsis |
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Definition
MAP >65
CVP 8-12
UOP at least 1ml/kg/hr
normal pH without metabolic acidosis
mixed venous O2 saturation >70% |
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Term
| patients who develop SIRS driven sepsis are at risk for _____. |
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Definition
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Term
| treatment of necrotizing soft tissue infections |
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Definition
Surgical emergency!!!
Gram + and - coverage
natural honey (digests necrotic tissue)
hyperbaric (if anaerobic) |
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Term
| most powerful poison known to humans after botulism (botox) |
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Definition
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Term
| condition that suppresses inhibitory pathways thus producing severe muscle spasms (lockjaw/trismus) |
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Definition
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Term
| division of CNS (either symp or parasymp nervous system) associated with tetanus. list s/sx. |
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Definition
sympathetic nervous system (HUGE amts of catecholamines released).
tachycardia, arrhythmias, hypertension, labile BPs |
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Term
| anesthesia considerations for tetanus |
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Definition
intubation/supportive airway
valium for spasms or NDMRs
beta-block for tachy-arrhythmias and HTN
PCN destroys exotoxin
A-line
volatile anesthetics are good (if you have a BP)
lidocaine, esmolol, Mag, nicardipine, nipride, etc |
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