7.27.2012

Surgery Cheat Sheet


Here are some things that your surgery rotation cheat sheet should contain. I suggest making a cheat sheet for every rotation with pertinent information that 1) you will need daily or 2) you can study during down time when you don't have a book with you.

Blood Products:
RBC - 1 unit of PRBCs increases Hct about 3-4 pts
When to give it? symptomatic anemia, hemorrhage, continuing blood loss, low Hct (< about 21-30 this differs at different institution, but the literature say 21)

Plts - 1 unit of plts increases plts about 5-10K (often given in "6 packs" - 6 units)
When to give this? Plt count of less than 20K because it can result in spontaneous bleeding or plt count of <50 with active bleeding or if pt is prepping for the OR.

Layers of the Abdominal Wall (8) *favorite pimping question
  1. skin
  2. subcut tissue
  3. scarpa's fascia
  4. external oblique
  5. internal oblique
  6. transversus abdominus
  7. tranversalis fascia
  8. peritoneum
Post-Op Fever Workup (The W's)

Wind = pneumonia, atelectasis (esp 1-2 days post-op)
Water = UTI (esp if pt has foley)
Wound = Abscess or infx (5-7 days)
Walk = DVT, PE (get your pts out of bed [OOB])
Wonder drugs = Drug fevers (esp if on antibx for long time or new meds)
Whole blood = transfusion rxn

Causes of Fistulas *another favorite pimping question

"FRIENDS"
Foreign body
Radiation
Inflammation
Epithelialization
Neoplasm
Distal obstruction

IV to PO Antibx Changes When D/Cing Patients

Unison IV --> Augmentin PO
Levoquin IV --> Cipro PO
Kefzol, Ancef, Rocephin IV --> Keflex PO

Essential Meds for Surgery = 6Ps

PRNs
Tylenol 650 PO/PR q4-6hrs PRN (do not exceed 4g in 24hrs)
Reglan 10mg PO/IV with meals (30min prior)
Zofran 8mg PO/IV q8hrs PRN
Ambien 5-10mg PO before bed
Benadryl 25-50mg PO/IV q4-6hrs PRN

PAIN
Morphine 2.5-5 mg IV q2-3 hrs PRN
Demerol 25-50 mg IV q3-4 hrs PRN
Dilaudid 1-4 mg IV q4-6hrs PRN
Percocet 325/5mg 1-2 PO q4-6hrs PRN (Tylenol + Oxycodone HCl)
*Remember to take into account that Percocet contains Tylenol - esp if your pt is on a standing dose of Tylenol daily
 Vicodin 500/5 1-2 tabs PO q4-6hrs PRN

PROPHYLAXIS
Protonix 40mg PO/IV daily
Heparin 5000 U SQ q8-12hrs

POOP
Docusate 100-200 mg PO twice a day

PARASITES (Antibx) 
*These are only prophylactic doses
Ancef (Kefzol) 1g IV q6hrs
Unasyn 1.5-3g IV q6hrs
Zosyn 3.375 IV q6hrs
Metronidazole 500mg PO QID
Cefoxitin 1-2g IV q6-6 hrs

PRE-OP MEDS
Don't forget to start pt back on home meds when appropriate!

*NOTE: Drug dosages listed are *general* you must obviously take into account your pt's comorbidities and current condition. This list is meant only to be a reference for you while you are on your surgery rotation to help you think systematically about post-op patients. Be aware of medication SE and complications prior to giving them!

1 comment:

  1. This is a really great resource for studying for the PANCE or PANRE. I'm using your blog as a supplament to a full PANCE Online Review Course.

    ReplyDelete