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SURG - Admission Note

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Questions and Answers

What is NOT a element of your admission note?

OLDCARTS, Last PO, N/V
Type and amount of anesthesia used (correct)
Medical/Surgical Hx
Asking about Coagulopathies, Anesthesia Complications, and Current medication use

If there is high bleeding risk or life-threatening hemorrhage risk, what correctly matches anticoagulation agents?

Heparin:Protamine, Warfarin:Praxbind, DOAC:KCentra
Heparin:KCentra, Warfarin:Protamine, DOAC: Praxbind
Heparin:Praxbind, Warfarin:VitK, DOAC:Protamine
Heparin:Protamine, Warfarin:VitK, DOAC:KCentra (correct)

A nasogastric tube placement MUST be confirmed with x-ray. It should be centrally located distal to the carina (does not deviate laterally) and continues inferiorly.

True (A)

Indications!

restoration of intestinal continuity is not feasible = Ostomies decompression or administration of medications or enteral nutrition = Nasogastric Tube Maintenance IVF, Resuscitation IVF = Fluids Urinary retention, Strict I/Os monitoring, Hourly urine output in select patients = Foley Cath Signup and view all the answers

Complications for ostomy: Early v Late complications

Hypokalemia, hyponatremia = early Stomal necrosis, retraction = early Skin breakdown, dermatitis, fungal infection = late Stomal prolapse = late Signup and view all the answers

Esophageal stricture, bleeding varices, skull base fractures are still OK to get a NG tube.

False (B) Signup and view all the answers

What catheter should I use?

Female difficult Foley due to atropy = 18F Coude + UroJet enlarged prostate = 18F Coude + UroJet used to irrigate bladder post- op or for clot retention/hematuria CBI = continuous bladder irrigation = 3-way catheters Traumatic catheter removal (with balloon inflated) = LARGE Foley Signup and view all the answers

PPN- peripheral parenteral nutrition VERSUS TPN- total parenteral nutrition

Lower concentration and Short time periods (<2 weeks) = PPN Contraindicated for patients that cannot tolerate large fluid volumes = PPN Requires central access (PICC or central line) and made of Mixture of amino acids, dextrose, lipids, vitamins, minerals, and electrolytes = TPN Indicated when no enteral feeding > 7 days or non-functional GI tract = TPN Signup and view all the answers

You should have a DVT/PE Prophylaxis plan and timing of restarting chemical DVT PPx post-op (if app) in the admission note.

True (A) Signup and view all the answers

What is a sign of URGENT surgery?

Fever, leukocytosis, tachycardia, tachypnea, radiography free air sign (swirl sign) (C) Signup and view all the answers

When it comes to the interruption of DOAC for Elective Surgery for a high risk bleeding procedure, when should the patient STOP their DOAC?

Two days prior to surgery (C) Signup and view all the answers

When it comes to interruption of DOAC for Elective Surgery, when should a patient stop their regular DOAC for a low risk of bleeding surgery?

1 days before surgery (C) Signup and view all the answers

A patient takes DOAC/anticoagulation medications on a regular basic and needs emergent surgery. What do you need to consider if there is a high risk of bleeding or life threatening hemorrhage?

Reversal Agent Signup and view all the answers

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Study Notes

Elements of Admission Note

Admission note should include patient's DVT/PE prophylaxis plan and timing of restarting chemical DVT prophylaxis post-op, if applicable.

Nasogastric Tube Placement

Nasogastric tube placement must be confirmed with x-ray.
The tube should be centrally located distal to the carina and continue inferiorly without lateral deviation.

Contraindications for Nasogastric Tube Placement

Esophageal stricture, bleeding varices, and skull base fractures are not contraindications for nasogastric tube placement.

Parenteral Nutrition

PPN stands for peripheral parenteral nutrition.
TPN stands for total parenteral nutrition.

Anticoagulation Agents

In cases of high bleeding risk or life-threatening hemorrhage, anticoagulation agents should be carefully managed.
For elective surgery with high risk of bleeding, DOACs should be stopped 2-3 days before surgery.
For elective surgery with low risk of bleeding, DOACs can be stopped 1-2 days before surgery.
If a patient is taking DOACs regularly and needs emergent surgery, the risk of bleeding or life-threatening hemorrhage should be carefully considered.

Urgent Surgery Indications

Urgent surgery is indicated in life-threatening situations.

Ostomy Complications

Early complications of ostomy include bleeding and infection.
Late complications of ostomy include bowel obstruction and hernia.

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