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Surgery I - Intro

to OR & Infections

QuestionAnswer
What is the first line of cellular defense? Macrophages
Most common organism associated with: 1. dog bite 2. cat bite 1. Strep viridans 2. pasteurella
List examples of the following: 1. clean wound 2. clean-contaminated wound 3. contaminated 4. dirty 1. appendectomy, breast biopsy 2. elective colon resection 3. stab wound with colon perforation 4. perforated diverticulitis with abscess
What is the definition of and infection rate in clean cases? No violation of GI, GU or respiratory tracts, with infection rates <5%
When should perioperative antibiotics be given? One hour prior to skin incision
Which antibiotic should be given perioperatively? Depends on the operation: first gen cedphalosporin if no anaerobes expected second gen cephalosporin in anaerobes likely
What is the most common post-operative infection? UTI - increased risk due to Foley catheter
What is the most common cause of post-operative fever in first 3 days? Atelectasis
What are the 5 W's of post-operative fever? Wind (within 48 hrs) - Atelectasis Wound (5-7 days) Water (3 days) - UTI Walk (7-14 days) Wonder Drugs (anytime)
What is the most common cause of diarrhea post-operatively? Clostridium difficile
What is the treatment for C. diff? Plagyl PO
Who is the most knowledgeable person in the OR? Scrub nurse
What area of the gowns are considered sterile? Front, from shoulder to table level, sleeves from two inches above the elbow to the cuff
Name the four basic groups of instruments 1. cutting and dissecting 2. clamping and grasping 3. retracting 4. suctioning
What are the 2 methods of the surgical hand scrub? 1. Anatomic timed scrub (total 5 min) 2. Counted stroke method
Which blade is considered the general purpose surgical blade and is used to incise the skin? #10 blade
What are may scissors used for? To cut suture and other surgical material
What are Metzenbaum scissors used for? All purpose dissection scissors (delicate tissue)
Which clamp is considered the general all-purpose clamp? Kelly clamp *
What is the most commonly used suction? Yankauer
What is the most important aspect of the pre-op check? Medical Hx
When should bowel preps be done? * Prior to intestinal surgery, AAA repair and some endoscopic procedures
How can one determine if bowel prep has been adequate? Stools should be clear/yellow and free of solid matter
What are standard pre-op IV fluids? * D5 1/2 normal saline + 20mEq/L KCl
What modifications must be made to IV fluids in renal failure? Do not add KCl
List the risk factors for post-op cardiac complications 1. S3 gallop or JVD on PE 2. MI in past 6 mo 3. Non-sinus rhythm 4. >5 PVCs/min 5. Interaperitoneal, intrathoracic or aortic operations 6. Age >70 yrs 7. Aortic stenosis - bruits, sx or ateriogram findings 8. Emergency operation 9. Poor medical condition
When do most post-op MIs occur? WIthin 3 days
List important values to look for (sx contraindicated)* 1. CBC: Crit <30, platelets <150 2. Chem 7: K >5, Cr > 1.4 3. PT/PTT: INR > 1.5 4. UA: UTI 5. T&S: needs to be current
When IDDM patient is NPO, how should insulin dosing be adjusted? Cut insulin dose in half
How soon should the post-op check be done? * Within 4 hours
What post-op complications should you watch for in all patients? Pneumonia, UTI, wound infection, DVT
What is the initial treatment for urinary retention? Foley catheter placement for 24-48 hrs
What is the most common cause of low urine output in the first 48 hrs post-op Hypovolemia
What is the treatment for low urine output with no distressing factors? Fluid bolus Send CBC to r/o bleeding Assess renal function - BUN, Cr
How should you treat a patient with hypotension and tachycardia with known hx of steroid use? * Fluid resuscitation and IV hydrocortisone 100mg
Created by: eedavila
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