Principles of Surgery ppt

Questions and Answers

What distinguishes elective surgery from emergent surgery?

Elective surgery is scheduled at least 24 hours in advance, while emergent surgery is life-threatening and performed within a few hours. (correct)

Elective surgery must be performed immediately, while emergent surgery is scheduled in advance.

Elective surgery can be life-threatening if delayed, while emergent surgery is never scheduled.

Emergent surgery is elective surgery that becomes necessary over time.

Which of the following items is NOT included in the AMPLE history for emergency surgery?

Allergies

Previous surgeries (correct)

Last meal

Medications

What is the primary purpose of the AMPLE history in emergency situations?

To evaluate the patient's psychological state before surgery.

To confirm the patient’s insurance and financial information.

To gather comprehensive details about the patient for future reference.

To quickly identify critical information essential for treatment. (correct)

In the context of surgical procedures, what does 'emergent' primarily refer to?

Surgery required due to a condition that poses immediate life threats. Signup and view all the answers

Which element of the AMPLE history focuses on dietary concerns relevant to anesthesia?

Last Meal Signup and view all the answers

What is the primary concern regarding fluid shifts during postoperative care?

Fluid shifting into the interstitial space Signup and view all the answers

Which vital sign changes indicate acute volume deficit after surgery?

Decreased blood pressure and increased heart rate Signup and view all the answers

What condition is characterized by significant weight gain, JVD, and peripheral edema postoperatively?

Volume overload Signup and view all the answers

What is the recommended protein intake per kilogram of body weight for postoperative patients?

1-2 g Signup and view all the answers

What does the 100/50/20 rule refer to in postoperative care?

Calculating total body water for fluid maintenance Signup and view all the answers

Which of the following best describes the surgical team structure?

Attending surgeons assume ultimate responsibility for patients Signup and view all the answers

Which type of surgical procedure involves the surgeon being remote from the patient?

Robotic surgery Signup and view all the answers

What is the primary goal of fluid and electrolyte maintenance in postoperative care?

To balance fluid replacement with nutritional needs Signup and view all the answers

What is the primary purpose of maintenance fluids in surgical patients?

To preserve water and electrolyte balance Signup and view all the answers

What is a common insensible loss of fluid in adults per day?

600-900 ml Signup and view all the answers

Which method is the best way to monitor fluid status in postoperative patients?

Measuring urine output continuously Signup and view all the answers

In case of a postoperative fever, how should maintenance fluid calculation be adjusted?

Add 2.5 ml/kg per degree C rise in fever Signup and view all the answers

What are sensible losses primarily composed of?

Urine and stool output Signup and view all the answers

Which fluid is often used as a maintenance fluid for patients who are NPO?

D5 ½ NS + 20 mEq KCl Signup and view all the answers

In fluid and electrolyte therapy, why is potassium (K+) given with caution?

It must be infused slowly to avoid cardiac complications. Signup and view all the answers

What is the minimum expected urine output for an adult on maintenance fluid therapy?

30 cc/hour Signup and view all the answers

What type of fluids should be used for rapid volume restoration in a hypovolemic patient?

Large volume isotonic fluids such as Normal Saline Signup and view all the answers

In cases of sepsis, what fluid management consideration is crucial?

Increased volume due to intravascular fluid shifting to the interstitial space Signup and view all the answers

What does the 100/50/20 rule indicate in maintenance fluid requirements?

Fluid volume based on weight brackets of patients Signup and view all the answers

What is the reason behind using isotonic fluids for replacement therapy?

They maintain serum osmolality without large shifts. Signup and view all the answers

Which laboratory values are most important in monitoring fluid and electrolyte status?

Sodium, potassium, and blood urea nitrogen (BUN) Signup and view all the answers

What is one of the main goals of the Enhanced Recovery After Surgery (ERAS) protocol?

Reducing physiological stress during the surgical process Signup and view all the answers

What is the purpose of preoperative carbohydrate loading in healthy adults undergoing elective surgery?

To enhance post-operative insulin sensitivity and reduce hunger Signup and view all the answers

How does major/extensive surgery typically affect the body's fluid and electrolyte balance?

It may cause severe disruption in balance and protein synthesis Signup and view all the answers

What is the main reason for recommending an empty stomach prior to surgery?

To decrease the likelihood of aspiration pneumonia Signup and view all the answers

What is one factor that can increase the risk of aspiration pneumonia in patients before surgery?

Conditions like morbid obesity Signup and view all the answers

What is the net effect of the surgical stress response triggered by surgery?

Salt and water retention to maintain cardiovascular stability Signup and view all the answers

What is a benefit of early enteral feeding post-surgery?

Decreases the risk of complications such as ileus Signup and view all the answers

Which of the following factors does ERAS aim to address regarding pain management post-surgery?

Use of multimodal analgesia to minimize opioid requirements Signup and view all the answers

Which of the following is considered a significant factor that influences total body water (TBW) calculation?

Patient's age and body fat percentage Signup and view all the answers

What is one of the strategies to prevent postoperative nausea and vomiting (PONV)?

Ensure adequate preoperative hydration Signup and view all the answers

What is the primary focus of prehabilitation before surgery?

To enhance the patient's functional capacity for surgery Signup and view all the answers

What role do graduated compression stockings play during the perioperative period?

They assist in venous thromboembolism (VTE) prevention Signup and view all the answers

What is the calculated average blood volume for a female patient weighing 70 kg?

5250 ml Signup and view all the answers

Study Notes

Surgery Classification

Elective Surgery: Scheduled at least 24 hours in advance, non-emergent.
Emergent Surgery: Required for life-threatening conditions, must occur within hours; time frame can vary.

Emergency Surgery Pre-op Questions: AMPLE

AMPLE History: Quick essential history for urgent situations.
- Allergies: Document known allergies, particularly to medications.
- Medications: List current medications with dosages and frequency.
- Past Medical History: Note any significant prior medical conditions and surgeries.
- Last Meal: Record timing and content of the last meal for anesthesia safety.
- Events/Environment: Describe context leading to injury or illness.

Enhanced Recovery After Surgery (ERAS)

A new approach to optimize surgical care across pre, intra, and postoperative phases.
Key outcomes:
- Faster recovery and less physiological stress.
- Decreased hospital stay duration and fewer complications.

Surgical Stress Response

Defined as the body's adaptive response to surgery:
- Increased secretion of pituitary hormones.
- Activation of sympathetic nervous system and renin-angiotensin-aldosterone system (RAAS).
- Effects include salt and water retention, and increased energy mobilization through catabolism.

Preoperative Management

Importance of maintaining an empty stomach (NPO):
- Decreases aspiration risk during anesthesia.
- Clear liquids: 2 hours, light meal: 6 hours, heavy meal: 8 hours before surgery.
Carbohydrate Loading:
- Adequate intake of carbohydrates up to 2 hours prior to surgery can prevent fasting-related complications and improve recovery.

ERAS Key Components

Pre-operative:
- Patient education and emphasizing their role in recovery.
- Advising on smoking and alcohol cessation.
Intra-operative:
- Infection prevention through skin preparation and use of antibiotics.
- Minimizing surgery length and invasive procedures.
Post-operative:
- Emphasis on multimodal analgesia to manage pain while minimizing opioid use.
- Importance of early enteral feeding and mobilization to prevent complications.

Fluid and Electrolyte Management

Monitor fluid status meticulously; urine output is a primary indicator of renal perfusion.
Total Body Water (TBW) averages 60% of weight in adults; divided into intracellular and extracellular compartments.
Calculate maintenance fluid needs:
- 100 ml/kg/day for first 10 kg.
- 50 ml/kg/day for next 10 kg.
- 20 ml/kg/day for weight above 20 kg.
Use isotonic fluids (e.g., Normal Saline, Lactated Ringer's) for rapid volume restoration.

Acute Volume Deficit and Overload

Volume Deficit Signs: Low blood pressure, high heart rate, decreased urine output.
Volume Overload Signs: Weight gain, elevated jugular venous pressure, peripheral edema, rales.

Surgical Team Structure

Attending Surgeon: Senior physician with overall patient responsibility.
Fellows and Residents: Surgeons in various stages of training.
Operating Room Team: Includes anesthesia providers (MD anesthesiologists & CRNAs), scrub nurses, and circulating nurses/techs.

Types of Surgical Procedures

Open Surgery: Traditional technique allowing large access (e.g., laparotomy).
Endoscopic Surgery: Minimally invasive methods (e.g., laparoscopic).
Robotic Surgery: Surgeons operate remotely using robotic technology.

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Description

This quiz covers essential concepts related to surgery classification, emergency pre-op questions, and the Enhanced Recovery After Surgery (ERAS) protocol. Understand the differences between elective and emergent surgeries, as well as the AMPLE history mnemonic. Explore how ERAS can enhance patient recovery and reduce complications.