Questions and Answers
What distinguishes elective surgery from emergent surgery?
Which of the following items is NOT included in the AMPLE history for emergency surgery?
What is the primary purpose of the AMPLE history in emergency situations?
In the context of surgical procedures, what does 'emergent' primarily refer to?
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Which element of the AMPLE history focuses on dietary concerns relevant to anesthesia?
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What is the primary concern regarding fluid shifts during postoperative care?
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Which vital sign changes indicate acute volume deficit after surgery?
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What condition is characterized by significant weight gain, JVD, and peripheral edema postoperatively?
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What is the recommended protein intake per kilogram of body weight for postoperative patients?
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What does the 100/50/20 rule refer to in postoperative care?
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Which of the following best describes the surgical team structure?
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Which type of surgical procedure involves the surgeon being remote from the patient?
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What is the primary goal of fluid and electrolyte maintenance in postoperative care?
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What is the primary purpose of maintenance fluids in surgical patients?
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What is a common insensible loss of fluid in adults per day?
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Which method is the best way to monitor fluid status in postoperative patients?
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In case of a postoperative fever, how should maintenance fluid calculation be adjusted?
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What are sensible losses primarily composed of?
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Which fluid is often used as a maintenance fluid for patients who are NPO?
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In fluid and electrolyte therapy, why is potassium (K+) given with caution?
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What is the minimum expected urine output for an adult on maintenance fluid therapy?
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What type of fluids should be used for rapid volume restoration in a hypovolemic patient?
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In cases of sepsis, what fluid management consideration is crucial?
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What does the 100/50/20 rule indicate in maintenance fluid requirements?
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What is the reason behind using isotonic fluids for replacement therapy?
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Which laboratory values are most important in monitoring fluid and electrolyte status?
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What is one of the main goals of the Enhanced Recovery After Surgery (ERAS) protocol?
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What is the purpose of preoperative carbohydrate loading in healthy adults undergoing elective surgery?
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How does major/extensive surgery typically affect the body's fluid and electrolyte balance?
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What is the main reason for recommending an empty stomach prior to surgery?
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What is one factor that can increase the risk of aspiration pneumonia in patients before surgery?
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What is the net effect of the surgical stress response triggered by surgery?
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What is a benefit of early enteral feeding post-surgery?
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Which of the following factors does ERAS aim to address regarding pain management post-surgery?
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Which of the following is considered a significant factor that influences total body water (TBW) calculation?
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What is one of the strategies to prevent postoperative nausea and vomiting (PONV)?
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What is the primary focus of prehabilitation before surgery?
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What role do graduated compression stockings play during the perioperative period?
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What is the calculated average blood volume for a female patient weighing 70 kg?
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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
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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
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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.
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Carbohydrate Loading:
- Adequate intake of carbohydrates up to 2 hours prior to surgery can prevent fasting-related complications and improve recovery.
ERAS Key Components
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Pre-operative:
- Patient education and emphasizing their role in recovery.
- Advising on smoking and alcohol cessation.
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Intra-operative:
- Infection prevention through skin preparation and use of antibiotics.
- Minimizing surgery length and invasive procedures.
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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
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Monitor fluid status meticulously; urine output is a primary indicator of renal perfusion.
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Total Body Water (TBW) averages 60% of weight in adults; divided into intracellular and extracellular compartments.
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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.
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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.