Wound
A 56 year old obese male undergoes an open umbilical hernia repair with primary closure. He presents 8 days later with fullness at the surgical site without overlying skin changes or drainage. CT A/P shows a fluid collection in the subcutaneous tissue without air. What are the potential diagnoses and management?
Seroma or hematoma. Watch and wait for 2 weeks, consider aspiration after
What are three ways to treat hypothermia?
Warm blankets, warm infusions, warm irrigation
What is the most common cause of post-operative fever in the first 48 hours?
Atelectasis
A patient develops chest pain and SOB 12 hours post-operatively, what imaging and labs do you order?
EKG, troponin, and CXR
What is normal UOP for a post-operative patient?
0.5cc/kg/hr
What levels can a SSI occur at and how do you manage each layer?
Superficial, deep, organ space
I&D, I&D, drain
What is the work-up for a post-operative fever?
CXR, UA & culture, Blood cultures x2
What is the time line associated with CAP vs HAP?
CAP: <48 hours from admission
HAP: >48 hours from admission
What medications should be given during a peri or post-operative MI?
Beta blocker, high dose ASA, and nitroglycerin
How many hours after a foley is removed should a patient urinate?
7 hours
What are the classification of surgical wounds & their definitions?
Clean: elective, no hollow viscus entered
Clean-contaminated: controlled hollow viscus entry
Contaminated: Uncontrolled spillage from viscus
Dirty: Perforated viscus
What are the five W's of post-operative fever?
Wind
Walking
Water
Wound
Wonder drugs
What is the definition of ARDS based off Sabiston?
PaO2/FiO2 ratio <200, bilateral fluffy infiltrates on CXR, and PCWP less than 18mmHg
What 5 interventions should be instituted with an unresponsive patient suffering from cardiogenic shock for a post-operative MI?
Intubate, Swan-Ganz catheter, medications, IABP, ventricular assist devices
What are the three categories of renal failure and what are the causes?
Pre-renal: Dehydration or pump issue
Intrinsic: ATN
Post-renal: Obstruction
What are the two most common microbial organisms isolated from superficial/deep SSI's?
Coagulase negative Staph & Enterococcus
What are the two mechanisms of hypothermia causing MSOF?
Loss of shivering and vasoconstriction
What are the labs and tests used to diagnose PE? Which is the gold standard test for pulmonary embolism?
D-dimer, V/Q scan, CTA chest, and Pulmonary angiogram.
Pulmonary angiogram
What is the most common cause of tachyarrhythmias in a post-operative patient in the SICU?
Sepsis, sepsis, sepsis
What are all of the ways to reduce serum potassium with hyperkalemia?
Loop diuretics, insulin, albuterol, bicarbonate, Lokelma, and hemodialysis
What are 5 risk factors associated with wound dehiscence?
Technical error, emergent surgery, any wound infection, advanced age, increased intra-abdominal pressure, obesity, steroids, malnutrition, radiation, systemic comorbidities
What is the treatment and dosage for malignant hyperthermia?
Dantrolene, 2.5mg/kg bolus
What is the ARDSnet protocol?
High PEEP & low FiO2 or Low PEEP and high FiO2
Tidal volume 6-8 cc/kg
Peak pressure 35 cm H2O
What two pharmacologic medication groups have been proven to decrease mortality in patients with heart failure?
ACE inhibitors and Beta blockers
What are the indications for hemodialysis?
A: Acidosis
E: Electrolyte imbalances
I: Intoxication
O: Fluid overload
U: Uremia