Surgery High Yield Facts

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PAIN MEDS Flowsheet:

Level 1: Tylenol

Level 2: NSAIDS (ibuprofen, naproxen, ASA, ketorolac(Toradol), ketoprofen)Tramadol (Ø seizures)

Level 3: Codeine

a. Tylenol w/ Codeine (T2-20/325, T3-30/325, T4-40/325)- 20 codeine/325 acetominophen

b. Propoxyphene: Darvocet N (50/625): 50 propoxy/625acetominophen

Level 4: Hydrocodone

a.  Vicodin 5/500 (hydroc/acetomin) Norco 5/325Lortab 2.5, 5, 7.5, 10 hydrocodone dose options (comes in elixir)

Level 5: Oxycodone

a. Percocet 5/325RoxicetTylox

b. Oxycontin (time release oxycodone)

Level 6: Fentanyl Patch (Fent doses: 25, 30, 75, 100, 150)

Level 11: Hydromorphone: Dilaudid  (1-2 mg PO)

IV PAIN MEDS: PCA starting doses

  1. Morphine: 4 mg start then ↑
  2. Dilaudid: 0.2-0.4 mg
  3. Demerol: 25-50 mg (only 48hrs, renal)
  4. Fentanyl: 25 mcg

Definitions:

Abbreviations

D/C = discharge, discontinue

PCA = patient controlled analgesia

HAL = hyperalimentation

TPN = total parenteral nutrition

SCDs- sequential compression devices

EBL: estimated blood loss

B9: Discharge paperwork with discharge meds.

Foley catheter – kept in until patient can ambulate to bathroom; hard to walk around with catheter in

PICC line (peripherally inserted central catheter) – inserted into vein in arm and threaded to SVC; used to take blood samples, deliver drugs, or hyperalimentation; less likely to be infected and can be kept for long periods of time compared to IV lines and central lines

JP drain – Jackson Pratt drain is a suction drain used to pull excess fluid out of a surgical site.  It’s bulb is shaped like a hand grenade.

HL IV – Heparin Lock Intravenous – flushes IV line, maintains patency

VP shunt – ventriculoperitoneal shunt; fluid shunted from ventricles in brain to abdominal cavity to reduce intracranial pressure

Prealbumin – used as marker for protein-calorie malnutrition; earliest indicator of nutritional status; correlates with patient outcomes; highest ratio of essential:nonessential amino acids

Sequential Compression Devices (SCD) - placed on legs to enhance blood circulation to prevent DVTs

Silver nitrate – used to cauterize leaky blood vessel (also in hemophiliacs)

TPN – total parenteral nutrition; must be administered via PICC line or central line

PPN – peripheral parenteral nutrition (without lipids); can be adminstered via IV line

Maintenance Fluid Requirements:

These apply to adults and children—just calculate based on the appropriate weight.

Per DAY Per HOUR

First 10 kg x 100 cc/ kg/ d x 4 cc/ kg/ hr

Second 10 kg x 50 cc/ kg/ d x 2 cc/ kg/ hr

Remaining kg x 20 cc/ kg/ d x 1 cc/ kg/ hr

Ex. 70 kg adult fluids for one day:  100 cc/ kg x 10 kg + 50 cc/ kg x 10 kg + 20 cc/ kg x 50 kg =maintenance fluid requirement of 2500 cc/ day

Burn formulas:

1)   Parkland formula:  used to estimate volume (V) of crystalloid needed for initial resuscitation of a burn patient

V = burn surface area (%) x weight (kg) x 4

 Give ½ of calculated volume in first 8 hours, second ½ of V over next 16 hrs

2) “Rule of Nines”  to estimate burn surface area

each upper extremity: 9% of total body SA

each lower extremity: 18%

anterior trunk:  18%

back:  18%

head and neck:  9%

perineum and genitalia:  1%

Commonly Pimped questions:

*see Surgical Recall for more details.

* Sources of post-op fever (The 5 W's): see Surgical Pocket Card

* Layers of the abdominal wall:

Skin

subcutaneous fat/ Camper's fascia

Scarpa's fascia

external oblique

internal oblique

transversus abdominus

transversalis fascia

preperitoneal fat

peritoneum 

*Anterior Rectus Sheath (Above Arcuate Line):  External Oblique, ½ of Internal Oblique aponeurosis

*Anterior Rectus Sheath (Below Arcuate Line):  External Oblique, Internal Oblique, Transversus abdominus aponeurosis

*Beck's Triad:  Pts with cardiac tamponade  JVD, decreased/ muffled heart sounds, hypoyrndion

*Charcot's Triad:  cholangitis  fever/ chills, jaundice, RUQ pain

*Reynold's Pentad:  suppurative cholangitis  Charcot's triad plus: mental status changes, shock/ sepsis

*Cushing's Triad: increased intracranial pressure  Hypertension, Bradycardia, Irreg. respiratory pattern

*Normal daily dietary requirements for adults:

Protein:  1 g/ kg/ day

Calories: 20 kcal/ kg/ day