Surgery risk classes - -ANSWER--Class 1: benefits outweigh risk, should be done
Class 2a: reasonable to perform
Class 2b: should be considered
Class 3: rarely appropriateN/NGeneral rules for surgery: testing - -ANSWER--ECG before surgery only if
coronary disease, except when low risk surgery
Stress test not indicated before surgery
Do not do prophylactic coronary revascularizationN/NMeds before surgery - -ANSWER--- Diabetic agents:
Use insulin therapy to maintain glycemic goals(iii) Discontinue biguanides, alpha glucosidase inhibitors,
thiazolidinediones, sulfonylureas, and GLP-1 agonists
- Do not start aspirin before surgery
- Stop Warfarin 5 days before surgery. May be bridged with Lovenox.
- Do not stop statin before surgery
,- Do not start beta-blocker on day of surgery, but may continueN/NAssessment of surgical risk - -
ANSWER--- Unstable cardiac condition (recent MI, active angina, active HF, uncontrolled HTN, severe
valvular disease), concern with CAD, CHF. arrhythmia, CVD
- patient stable or unstable?
- urgency of the procedure (oncology will be time sensitive)
- risk of procedure
- nutritional status
- immune competence
- determine functional capacity (need to be more than 4 METS, more than 10 METs makes low
risk)N/NLow risk surgeries - -ANSWER--catarcts
breast biopsy
cystoscopy, vasectomy
laporascopic procedures
Plastic surgeryN/Nintermediate risk surgeries - -ANSWER--Head/ neck surgery
thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracicN/NHigh risk surgeries - -ANSWER--aortic/ cabg
transplants
spinal reconstruction
peripheral vascular surgeryN/NLee's revised cardiac risk index - -ANSWER--6 points:
High risk surgery = 1
CAD = 1
CHF = 1
Cerebrovascular disease = 1
,DM 1 on insulin = 1
Creat greater than 2 = 1
1 = low risk
2 = moderate risk
3 = high riskN/NSCIP pre-operative infection measures - -ANSWER--- Prophylactic antibiotics should be
received within 1 h prior to surgical incision
- be selected for activity against the most probable antimicrobial contaminants
- be discontinued within 24 h after the surgery end-timeN/NPostoperative infection reduction methods -
-ANSWER--- pre-op hair removal (clippers)
- wash hands
- normothermia
- maintain euglycemia
- urinary catheters are to be removed within the first two postoperative daysN/NOsteoarthritis: what,
incidence - -ANSWER--Slow destruction of bones/ joint followed by production of replacement collagen
which causes inflammatory changes
- older than 60
- more female after 55
- more black than white women
- men and women equal risk between 45 - 55
- abnormal height or weight (obesity)
- repetitive movement
- prior trauma (sprains/ dislocations)
- diabetic neuropathy
- geneticN/NOsteoarthritis findings and diagnostics - -ANSWER--- Pain in weight bearing joints
- stiffness after sitting, gets better when arising
- feeling of instability on stairs
- fine motor skills deficit
- larger affected joints
, - Heberden nodules (bony bumps on the finger joint closest to the fingernail)
- Bouchard's nodules (bony bumps on the middle joint of the finger)
- limited ROM with crepitus
- xr shows narrowing of joint space (need anteroposterior and lateral knee films bilaterally)
- synovial fluid is clear and without WBCN/NOsteoarthritis treatment - -ANSWER--Goal is to relieve
symptoms, maintain/ improve function, and avoid drug toxicity
Hand OA:
- rest/ joint protection, with splinting
- heat/ cold therapy
- topical capsaicin
- topical NSAID (trolamine salicylate) (especially for older than 75)
- Oral NSAIDS, incl COX2 inhibitors such as celecoxib (Celebrex) (may cause cardiac problems)
- tramadol
- no opioids
Hip/ knee OA:
- weight reduction, cardiovascular exercises
- transcutanous external nerve stimulator
- acetaminophen
- Topical NSAIDS (knee)
- intraarticular corticosteroid injections
- surgery (joint replacement)N/NRheumatoid arthritis: what, who - -ANSWER--chronic, systemic
autoimmune disease that causes inflammation of connective tissue, first that of jionts them other soft
tissues (renal, cardiovascular, pulm). TNF-alpha plays a big role
- more women than men
- unknown cause
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