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Questions and Answers
What is the primary purpose of ASA classification in surgical care?
to determine the degree of perioperative risk
What is the main predictor of surgical site infection (SSI)?
post-op hyperglycemia >140 mg/dL
What is the purpose of the RCRI (Revised Cardiac Risk Index)?
to assess the risk of developing postoperative cardiac complications
What is the recommended timing for administering prophylactic antibiotics in surgical care?
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What is the primary difference between conscious sedation and monitored anesthesia care (MAC)?
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What is the significance of the arcuate line in abdominal wall anatomy?
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What is the purpose of Calot's triangle in laparoscopic cholecystectomy?
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Why are toothed forceps/skin hooks preferred in tissue handling?
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What is the 2 midnights rule in admission criteria?
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What is the ADC VANDIMALS acronym used for in admit orders?
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Study Notes
Surgical Care 101
- Obtain a history and physical (H&P) within 30 days prior to surgery
- ASA classification is used to determine the degree of perioperative risk, ranging from ASA I (healthy) to ASA VI (brain dead)
- RCRI (Revised Cardiac Risk Index) is used to assess the risk of developing post-cardiac complications, and cardiac consult is only necessary if the result will change care
- VTE (Venous Thromboembolism) risk is assessed using the Caprini risk assessment tool
Infection Prevention
- Surgical site infection (SSI) is predicted by post-op hyperglycemia >140 mg/dL, emphasizing the need to tightly control diabetes
- Hypoalbuminemia carries a 5x risk for SSI post-op
Pre-Operative Care
- Give prophylactic antibiotics 1 hour before incision
- Consider holding antibiotics until after culture with concern for abscess, septic joint, etc.
Anesthesia
- Anesthesia options range from local to general, with monitored anesthesia care (MAC) and conscious sedation being intermediate options
- Monitored Anesthesia Care (MAC) involves IV sedation (propofol), allowing patients to breathe on their own
- Conscious sedation involves IV sedation and analgesic (fentanyl and versed), allowing patients to breathe and be conscious
Abdominal Wall Anatomy
- The layers of the lateral abdominal wall, from superficial to deep, are: skin, subq, superficial fascia, deep fascia, musculoaponeurotic layers, investing fascia, fascia transversalis, and pre-peritoneal fatty tissue/extraperitoneal fat
- The arcuate line marks the lower boundary of the posterior rectus sheath, and C-sections are performed below this line (Pfannenstiel incision)
Vascular Anatomy
- Hasselbach's triangle is the anatomical region used for laparoscopic inguinal hernia repair, bounded by the lateral border of rectus abdominus, inferior epigastric artery, and inguinal ligament
- Calot's triangle is the anatomical region used for laparoscopic cholecystectomy, bounded by the cystic duct, cystic artery, and common hepatic duct
- The epigastric arteries and iliohypogastric/ilioinguinal nerves are important structures to avoid during laparoscopic surgery
Tissue Handling
- Toothed forceps/skin hooks are preferred over regular forceps to handle wounds and avoid crushing wound edges
Admission Criteria
- Patients requiring IV treatment or meeting the 2 midnights rule (requiring 2 nights of inpatient care) are candidates for admission
- Admit orders should follow the ADC VANDIMALS format, including admit to, diagnosis, condition/code status, vitals, activity, nursing instructions, diet, IV fluids, meds, allergies, labs, and special studies/consults/instructions
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Description
This quiz covers the essential components of preoperative evaluation in surgical care, including ASA classification, RCRI, VTE risk assessment, and SSI prevention.
