VTE Risks/PPX
This is the most common inherited thrombophilia and is caused by resistance to activated protein C.
What is Factor V Leiden mutation?
This is the full name of the pathway that "ERAS" stands for.
What is Enhanced Recovery After Surgery?
This is the most commonly used transverse incision for gynecologic surgery and offers excellent cosmetic results.
What is the Pfannenstiel incision?
This type of surgical error includes operating on the wrong patient, wrong side, or wrong procedure.
What is wrong-site surgery?
This capacity is presumed in all adult patients unless formally determined otherwise.
What is decision-making capacity?
This rare heritable coagulopathy is the most thrombogenic, and is characterized by lack of the anticoagulant protein which directly binds and inactivates factors IXa, Xa, XIa, and XIIa.
What is antithrombin deficiency?
This traditional (old-fashioned?) preoperative practice is discouraged in ERAS because it worsens insulin resistance and delays recovery.
What is prolonged fasting (NPO after midnight)?
In this incision, the rectus muscle tendons are transected 1–2 cm above the symphysis pubis and reflected cephalad.
What is the Cherney incision?
This Joint Commission protocol includes preprocedure verification, site marking, and a time out to prevent surgical errors.
What is the Universal Protocol?
This element of informed consent includes explaining risks, benefits, alternatives, and the option of no treatment.
What is disclosure of relevant information?
This mutation leads to excess prothrombin levels, which can increase thrombin generation and hypercoagulability.
What is the prothrombin G20210A mutation?
ERAS guidelines allow intake of clear fluids up to this many hours before anesthesia without increasing complications.
What is 2 hours?
This incision is preferred when rapid entry and minimal blood loss are priorities.
What is a midline vertical incision?
According to the Universal Protocol, this marking practice is specifically discouraged because it can create ambiguity.
What is marking the wrong site with an “X” or “No”?
A pregnant patient with decision-making capacity refuses a medically indicated cesarean delivery. This is the ethically appropriate next step.
What is respect the patient’s decision (honor refusal of care)?
Combined oral contraceptives can be stopped at least this many weeks prior to elective surgery to reverse hypercoagulable changes.
What is 6 weeks?
ERAS guidelines allow intake of solid food up to this many hours before anesthesia without increasing complications.
What is 6 hours?
These vessels must be ligated before muscle transection in a Maylard incision.
What are the inferior epigastric vessels?
If a surgeon pulls in the CPT codes utilized for billing a hysterectomy into the operative note as the procedure text, this is an important aspect of the surgery that will be hard to interpret from that part of the operative note.
What are the adnexal structures removed (tubes and/or ovaries)?
This practice is ethically unacceptable and involves withholding relevant medical information from a patient out of concern it may cause distress.
What is therapeutic privilege?
A patient scheduled for TAH has a Caprini score of 6, but is consider to have a major risk of bleeding post-operatively. The best initial prophylaxis strategy is this.
What is mechanical prophylaxis (preferably intermittent pneumatic compression) until bleeding risk decreases and pharmacologic prophylaxis can be started?
A patient undergoing laparoscopic hysterectomy is kept NPO until bowel function returns, receives high-dose opioids, and continues IV fluids for several days. These practices violate these three ERAS principles.
What are early oral feeding, opioid-sparing multimodal pain control, and early transition to PO intake?
A surgeon begins with a Pfannenstiel incision but requires more exposure to the pelvis and retropubic space. The best next step is to convert to this incision.
What is a Cherney incision?
A brief operative note written immediately after surgery must include at least these core elements to meet Joint Commission standards (5).
What are procedure performed, surgeon, findings, estimated blood loss, and postoperative diagnosis?
In a life-threatening emergency where the patient lacks capacity and no surrogate is available, physicians may proceed with treatment under this ethical principle.
What is presumed consent?