Flashcards in surgery Deck (115)
what lab measuring renal function should be done for preop patients over 40?
who should have their blood glucose tested preop?
family hx, personal hx of DM and patient undergoing grafting for peripheral vascular disease
do routine prep labs show a reduction in mortality and morbidy?
no, do not do for otherwise healthy individuals
warfarin and dig are known for causing what electrolyte abnormality?
ECHO are recommended in all patients older than?
silent MI is most common in what population?
elderly and DM
spirometry is recommend to who?
thoracic and upper abdominal surgery, smokers and dyspnea
for all women of child bearing years
H&P identify previous?
MI, heart failure, chronic pulmonary dz, dm, peripheral vascular disorders, hepatic or renal impairment
index used to measure cardiac risk?
detsky's modified cardiac risk index or Lee's
what does Lee's index look at
high risk surgery, coronary artery dz, congestive heart failure, cerebrovascular dz, insulin dependent DM, and elevated serum creatinine >2
what is the best prophylactic blood thinner to use?
unfractionated heparin 5,000 units subcutaneouly every 8-12 hours, stop once pt is ambulatory
Enoxaparin is also used what is it?
low molecular weight heparin
can warfarin be used
yes, once the initial use of heparin has been completed, but dosing is measured via INR (therapeutic dose ranging between 2-3)
what is fondaparinux
anticoagulant, good for hip surgery
Greenfield filter prevents clots formed in the lower extremities to migrate, patient who are candidates include?
allergic to anticoagulants, trauma (risk of further bleeding), central nervous system procedures
malnourished criteria is
lost more than 10% of lean body mass, or has not has adequate intake in 7 days
malnourishment effects many systems including
GI atrophy, slow cardiac output, decreased vital capacity, immune system and skin healing
what labs may be abnormal of malnourishment
increased creatinine, high lymphocyte count, albumin, transferrin
what is refeeding syndrome?
abnormal glucose, lipid metabolism, thiamine deficiency, hypophosphatemia, hypomag, hypo k
how do you avoid refeeding syndrome?
limit initial feedings to no more than 20kcal/kg during the first week of feedings
basal energy expenditure
harris benedict equation
what is the preferred route of nurtrient replacement
enteral route (tube feeding)
are naso or gastro tube better at preventing aspiration
best tube to avoid aspiration and great for pancreatits
what is hyperalimentation
what are the complications of hyperalimentation
catheter related problems, hyperglycemia, electrolyte abnormalities
leading cause of death between the age of 1-44
unintentional and violence related injuries
leading cause of accidental death
MVA (Etoh is involved in over 1/2)