- •Dedication
- •Editors and Contributors
- •Foreword
- •Preface
- •Contents
- •PREPARING FOR THE SURGERY CLERKSHIP
- •SURGICAL NOTES
- •COMMON ABBREVIATIONS YOU SHOULD KNOW
- •RETRACTORS (YOU WILL GET TO KNOW THEM WELL!)
- •SUTURE MATERIALS
- •WOUND CLOSURE
- •KNOTS AND EARS
- •INSTRUMENT TIE
- •TWO-HAND TIE
- •COMMON PROCEDURES
- •NASOGASTRIC TUBE (NGT) PROCEDURES
- •CHEST TUBES
- •NASOGASTRIC TUBES (NGT)
- •FOLEY CATHETER
- •CENTRAL LINES
- •MISCELLANEOUS
- •THIRD SPACING
- •COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
- •CALCULATION OF MAINTENANCE FLUIDS
- •ELECTROLYTE IMBALANCES
- •ANTIBIOTICS
- •STEROIDS
- •HEPARIN
- •WARFARIN (COUMADIN®)
- •MISCELLANEOUS AGENTS
- •NARCOTICS
- •MISCELLANEOUS
- •ATELECTASIS
- •POSTOPERATIVE RESPIRATORY FAILURE
- •PULMONARY EMBOLISM
- •ASPIRATION PNEUMONIA
- •GASTROINTESTINAL COMPLICATIONS
- •ENDOCRINE COMPLICATIONS
- •CARDIOVASCULAR COMPLICATIONS
- •MISCELLANEOUS
- •HYPOVOLEMIC SHOCK
- •SEPTIC SHOCK
- •CARDIOGENIC SHOCK
- •NEUROGENIC SHOCK
- •MISCELLANEOUS
- •URINARY TRACT INFECTION (UTI)
- •CENTRAL LINE INFECTIONS
- •WOUND INFECTION (SURGICAL SITE INFECTION)
- •NECROTIZING FASCIITIS
- •CLOSTRIDIAL MYOSITIS
- •SUPPURATIVE HIDRADENITIS
- •PSEUDOMEMBRANOUS COLITIS
- •PROPHYLACTIC ANTIBIOTICS
- •PAROTITIS
- •MISCELLANEOUS
- •CHEST
- •ABDOMEN
- •MALIGNANT HYPERTHERMIA
- •MISCELLANEOUS
- •OVERVIEW
- •CHOLECYSTOKININ (CCK)
- •SECRETIN
- •GASTRIN
- •SOMATOSTATIN
- •MISCELLANEOUS
- •GROIN HERNIAS
- •HERNIA REVIEW QUESTIONS
- •ESOPHAGEAL HIATAL HERNIAS
- •PRIMARY SURVEY
- •SECONDARY SURVEY
- •TRAUMA STUDIES
- •PENETRATING NECK INJURIES
- •MISCELLANEOUS TRAUMA FACTS
- •PEPTIC ULCER DISEASE (PUD)
- •DUODENAL ULCERS
- •GASTRIC ULCERS
- •PERFORATED PEPTIC ULCER
- •TYPES OF SURGERIES
- •STRESS GASTRITIS
- •MALLORY-WEISS SYNDROME
- •ESOPHAGEAL VARICEAL BLEEDING
- •BOERHAAVE’S SYNDROME
- •ANATOMY
- •GASTRIC PHYSIOLOGY
- •GASTROESOPHAGEAL REFLUX DISEASE (GERD)
- •GASTRIC CANCER
- •GIST
- •MALTOMA
- •GASTRIC VOLVULUS
- •SMALL BOWEL
- •APPENDICITIS
- •CLASSIC INTRAOPERATIVE QUESTIONS
- •APPENDICEAL TUMORS
- •SPECIFIC TYPES OF FISTULAS
- •ANATOMY
- •COLORECTAL CARCINOMA
- •COLONIC AND RECTAL POLYPS
- •POLYPOSIS SYNDROMES
- •DIVERTICULAR DISEASE OF THE COLON
- •ANATOMY
- •ANAL CANCER
- •ANATOMY
- •TUMORS OF THE LIVER
- •ABSCESSES OF THE LIVER
- •HEMOBILIA
- •ANATOMY
- •PHYSIOLOGY
- •PATHOPHYSIOLOGY
- •DIAGNOSTIC STUDIES
- •BILIARY SURGERY
- •OBSTRUCTIVE JAUNDICE
- •CHOLELITHIASIS
- •ACUTE CHOLECYSTITIS
- •ACUTE ACALCULOUS CHOLECYSTITIS
- •CHOLANGITIS
- •SCLEROSING CHOLANGITIS
- •GALLSTONE ILEUS
- •CARCINOMA OF THE GALLBLADDER
- •CHOLANGIOCARCINOMA
- •MISCELLANEOUS CONDITIONS
- •PANCREATITIS
- •PANCREATIC ABSCESS
- •PANCREATIC NECROSIS
- •PANCREATIC PSEUDOCYST
- •PANCREATIC CARCINOMA
- •MISCELLANEOUS
- •ANATOMY OF THE BREAST AND AXILLA
- •BREAST CANCER
- •DCIS
- •LCIS
- •MISCELLANEOUS
- •MALE BREAST CANCER
- •BENIGN BREAST DISEASE
- •CYSTOSARCOMA PHYLLODES
- •FIBROADENOMA
- •FIBROCYSTIC DISEASE
- •MASTITIS
- •BREAST ABSCESS
- •MALE GYNECOMASTIA
- •ADRENAL GLAND
- •ADDISON’S DISEASE
- •INSULINOMA
- •GLUCAGONOMA
- •SOMATOSTATINOMA
- •ZOLLINGER-ELLISON SYNDROME (ZES)
- •MULTIPLE ENDOCRINE NEOPLASIA
- •THYROID DISEASE
- •ANATOMY
- •PHYSIOLOGY
- •HYPERPARATHYROIDISM (HPTH)
- •PARATHYROID CARCINOMA
- •SOFT TISSUE SARCOMAS
- •LYMPHOMA
- •SQUAMOUS CELL CARCINOMA
- •BASAL CELL CARCINOMA
- •MISCELLANEOUS SKIN LESIONS
- •STAGING
- •INTENSIVE CARE UNIT (ICU) BASICS
- •INTENSIVE CARE UNIT FORMULAS AND TERMS YOU SHOULD KNOW
- •SICU DRUGS
- •INTENSIVE CARE PHYSIOLOGY
- •HEMODYNAMIC MONITORING
- •MECHANICAL VENTILATION
- •PERIPHERAL VASCULAR DISEASE
- •LOWER EXTREMITY AMPUTATIONS
- •ACUTE ARTERIAL OCCLUSION
- •ABDOMINAL AORTIC ANEURYSMS
- •MESENTERIC ISCHEMIA
- •MEDIAN ARCUATE LIGAMENT SYNDROME
- •CAROTID VASCULAR DISEASE
- •CLASSIC CEA INTRAOP QUESTIONS
- •SUBCLAVIAN STEAL SYNDROME
- •RENAL ARTERY STENOSIS
- •SPLENIC ARTERY ANEURYSM
- •POPLITEAL ARTERY ANEURYSM
- •MISCELLANEOUS
- •PEDIATRIC IV FLUIDS AND NUTRITION
- •PEDIATRIC BLOOD VOLUMES
- •FETAL CIRCULATION
- •ECMO
- •NECK
- •ASPIRATED FOREIGN BODY (FB)
- •CHEST
- •PULMONARY SEQUESTRATION
- •ABDOMEN
- •INGUINAL HERNIA
- •UMBILICAL HERNIA
- •GERD
- •CONGENITAL PYLORIC STENOSIS
- •DUODENAL ATRESIA
- •MECONIUM ILEUS
- •MECONIUM PERITONITIS
- •MECONIUM PLUG SYNDROME
- •ANORECTAL MALFORMATIONS
- •HIRSCHSPRUNG’S DISEASE
- •MALROTATION AND MIDGUT VOLVULUS
- •OMPHALOCELE
- •GASTROSCHISIS
- •POWER REVIEW OF OMPHALOCELE AND GASTROSCHISIS
- •APPENDICITIS
- •INTUSSUSCEPTION
- •MECKEL’S DIVERTICULUM
- •NECROTIZING ENTEROCOLITIS
- •BILIARY TRACT
- •TUMORS
- •PEDIATRIC TRAUMA
- •OTHER PEDIATRIC SURGERY QUESTIONS
- •POWER REVIEW
- •WOUND HEALING
- •SKIN GRAFTS
- •FLAPS
- •SENSORY SUPPLY TO THE HAND
- •CARPAL TUNNEL SYNDROME
- •ANATOMY
- •MISCELLANEOUS
- •NOSE AND PARANASAL SINUSES
- •ORAL CAVITY AND PHARYNX
- •FACIAL FRACTURES
- •ENT WARD QUESTIONS
- •RAPID-FIRE REVIEW OF MOST COMMON CAUSES OF ENT INFECTIONS
- •THORACIC OUTLET SYNDROME (TOS)
- •CHEST WALL TUMORS
- •DISEASES OF THE PLEURA
- •DISEASES OF THE LUNGS
- •DISEASES OF THE MEDIASTINUM
- •DISEASES OF THE ESOPHAGUS
- •ACQUIRED HEART DISEASE
- •CONGENITAL HEART DISEASE
- •CARDIAC TUMORS
- •DISEASES OF THE GREAT VESSELS
- •MISCELLANEOUS
- •BASIC IMMUNOLOGY
- •CELLS
- •IMMUNOSUPPRESSION
- •OVERVIEW OF IMMUNOSUPPRESSION MECHANISMS
- •MATCHING OF DONOR AND RECIPIENT
- •REJECTION
- •ORGAN PRESERVATION
- •KIDNEY TRANSPLANT
- •LIVER TRANSPLANT
- •PANCREAS TRANSPLANT
- •HEART TRANSPLANT
- •INTESTINAL TRANSPLANTATION
- •LUNG TRANSPLANT
- •TRANSPLANT COMPLICATIONS
- •ORTHOPAEDIC TERMS
- •TRAUMA GENERAL PRINCIPLES
- •FRACTURES
- •ORTHOPAEDIC TRAUMA
- •DISLOCATIONS
- •THE KNEE
- •ACHILLES TENDON RUPTURE
- •ROTATOR CUFF
- •MISCELLANEOUS
- •ORTHOPAEDIC INFECTIONS
- •ORTHOPAEDIC TUMORS
- •ARTHRITIS
- •PEDIATRIC ORTHOPAEDICS
- •HEAD TRAUMA
- •SPINAL CORD TRAUMA
- •TUMORS
- •VASCULAR NEUROSURGERY
- •SPINE
- •PEDIATRIC NEUROSURGERY
- •SCROTAL ANATOMY
- •UROLOGIC DIFFERENTIAL DIAGNOSIS
- •RENAL CELL CARCINOMA (RCC)
- •BLADDER CANCER
- •PROSTATE CANCER
- •BENIGN PROSTATIC HYPERPLASIA
- •TESTICULAR CANCER
- •TESTICULAR TORSION
- •EPIDIDYMITIS
- •PRIAPISM
- •ERECTILE DYSFUNCTION
- •CALCULUS DISEASE
- •INCONTINENCE
- •URINARY TRACT INFECTION (UTI)
- •MISCELLANEOUS UROLOGY QUESTIONS
- •Rapid Fire Power Review
- •TOP 100 CLINICAL SURGICAL MICROVIGNETTES
- •Figure Credits
- •Index
Chapter 65 / Surgical Intensive Care 477
What is the best way to report urine output in the ICU?
What are the possible causes of fever in the ICU?
24 hrs/last shift/last 3 hourly rate “urine output has been 2 liters over last 24 hrs, 350 last shift, and 45, 35, 40 cc over the last 3 hours”
Central line infection Pneumonia/atelectasis UTI, urosepsis Intra-abdominal abscess Sinusitis
DVT Thrombophlebitis Drug fever
Fungal infection, meningitis, wound infection
Endocarditis
What is the most common bacteria in ICU pneumonia?
What is the acronym for the basic ICU care checklist (Dr. Vincent)?
Gram-negative rods
“FAST HUG”:
Feeding
Analgesia
Sedation
Thromboembolic prophylaxis
Head-of-bed elevation (pneumonia prevention)
Ulcer prevention Glucose control
INTENSIVE CARE UNIT FORMULAS AND TERMS YOU SHOULD KNOW
What is CO?
What is the normal CO?
What factors increase CO?
What is CI?
Cardiac Output: HR (heart rate) SV (stroke volume)
4–8 L/min
Increased contractility, heart rate, and preload; decreased afterload
Cardiac Index: CO/BSA (body surface area)
478 Section II / General Surgery |
|
What is the normal CI? |
2.5–3.5 L/min/M2 |
What is SV? |
Stroke Volume: the amount of blood |
|
pumped out of the ventricle each beat; |
|
simply, end diastolic volume minus the |
|
end systolic volume or CO/HR |
What is the normal SV? |
60–100 cc |
What is CVP? |
Central Venous Pressure: indirect |
|
measurement of intravascular volume status |
What is the normal CVP? |
4–11 |
What is PCWP? |
Pulmonary Capillary Wedge Pressure: |
|
indirectly measures left atrial pressure, |
|
which is an estimate of intravascular |
|
volume (LV filling pressure) |
What is the normal PCWP?
What is anion gap?
What are the normal values for anion gap?
Why do you get an increased anion gap?
What are the causes of increased anion gap acidosis in surgical patients?
5–15
Na (Cl– HCO–3)
10–14
Unmeasured acids are unmeasured anions in the equation that are part of the “counterbalance” to the sodium cation
Think “SALUD”:
Starvation
Alcohol (ethanol/methanol)
Lactic acidosis
Uremia (renal failure)
DKA
Define MODS. |
Multiple Organ Dysfunction Syndrome |
What is SVR? |
Systemic Vascular Resistance: |
|
MAP – CVP / CO 80 (remember, |
|
P F R, Power FoRward; and |
|
calculating resistance: R P/F) |
What is SVRI? |
Systemic Vascular Resistance Index: |
|
SVR/BSA |
|
Chapter 65 / Surgical Intensive Care 479 |
What is the normal SVRI? |
1500–2400 |
What is MAP? |
Mean Arterial Pressure: diastolic blood |
|
pressure 1/3 (systolic–diastolic |
|
pressure) |
|
(Note: Not the mean between diastolic |
|
and systolic blood pressure because |
|
diastole lasts longer than systole) |
What is PVR? |
Pulmonary Vascular Resistance: |
|
PA(MEAN) – PCWP / CO 80 (PA is |
|
pulmonary artery pressure and LA is left |
|
atrial or PCWP pressure) |
What is the normal PVR value?
What is the formula for arterial oxygen content?
What is the basic formula for oxygen delivery?
What is the full formula for oxygen delivery?
What factors can increase oxygen delivery?
What is mixed venous oxygen saturation?
100 50
Hemoglobin O2 saturation (SaO2) 1.34
CO (oxygen content)
CO (1.34 Hgb SaO2) 10
Increased CO by increasing SV, HR, or both; increased O2 content by increasing the hemoglobin content, SaO2, or both
SvO2; simply, the O2 saturation of the blood in the right ventricle or pulmonary artery; an indirect measure of peripheral oxygen supply and demand
Which lab values help assess adequate oxygen delivery?
SvO2 (low with inadequate delivery), lactic acid (elevated with inadequate delivery), pH (acidosis with inadequate delivery), base deficit
What is FENa? |
Fractional Excretion of Sodium (Na ): |
|
(UNa Pcr / PNa Ucr) 100 |
What is the memory aid for Think: YOU NEED PEE U (Urine)
calculating FENa? |
N (Na ) P (Plasma); UNa Pcr; for |
|
the denominator, switch everything, |
|
PNa Ucr (cr creatinine) |
480 Section II / General Surgery
What is the prerenal FENa value?
How long does Lasix® effect last?
What is the formula for flow/pressure/resistance?
What is the “10 for 0.08 rule” of acid-base?
What is the “40, 50, 60 for 70, 80, 90 rule” for O2 sats?
One liter of O2 via nasal cannula raises FiO2 by how much?
1.0; renal failure from decreased renal blood flow (e.g., cardiogenic, hypovolemia, arterial obstruction, etc.)
6 hours LASIX LAsts SIX hours
Remember Power FoRward: Pressure
Flow Resistance
For every increase of PaCO2 by 10 mm Hg, the pH falls by 0.08
PaO2 of 40, 50, 60 corresponds roughly to an O2 sat of 70, 80, 90, respectively
3%
What is pure respiratory acidosis?
What is pure respiratory alkalosis?
What is pure metabolic acidosis?
What is pure metabolic alkalosis?
List how the body compensates for each of the following:
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
What does MOF stand for?
What does SIRS stand for?
Low pH (acidosis), increased PaCO2, normal bicarbonate
High pH (alkalosis), decreased PaCO2, normal bicarbonate
Low pH, low bicarbonate, normal PaCO2
High pH, high bicarbonate, normal PaCO2
Increased bicarbonate
Decreased bicarbonate
Decreased PaCO2
Increased PaCO2
Multiple Organ Failure
Systemic Inflammatory Response
Syndrome