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Your patient has a hight bun and CR you do a urine tests, there are epithelial cells. what does this mean?
tubular damage
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you patient who has stomach pain has a WBC of 10,000 with 1,000 eosonophils, what might be the etiology of the stomach pain?
Parasitic
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What would you worry about with a patient who has a 6.0 potassium in surgery? what would you see on EKG
Cardiac excitability.
Peaked T waves
normal value should be 3.5 -5.5
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WHat does hyponatremia (below 135-145) mean?
- the blood is watered down so it means there is excess volume.
- Golgin says restrict water in this situation
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your patient has 4,000 platelets what might you do?
they are likely getting a bone marrow transplant, they may allready be bleeding, give platelets.
1 bag gives raises the platelet level 5500 in a 200 lb patient. so usually give a couple.
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Your patient may die of cancer any day, your anestesiologist says what is ASA American society of anesthesiologists surgical risk classification?
- I healthy
- II HTN essensial , DM
- III, COPD or angina
- IV may die from an illness any day
- V expected to die from illness with in 24hours
- VI allready dead awaiting organ harvest
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When CBC and Chem 7 values get to what level elective surgery should be canceled?
HGB
HCT
WBC
Neutropenia
Plates
K+
glucose
BUN
Cr
Kreatine Kinase
- HGB 10 gm/dl this is very controversial, SOME docs wound consider giving whole blood, many docs won't because it has not been shown to be effective in changing the course of
- HCT 30% or less
- WBC <2400, > 16,000/mm3
- Neutropenia <1,000/mm3 Normal was 57-67% of the normal 4-10,000 range
- Plates <50,000 - 100,000
- K+ 3.5 -5.1 is normal
- glucose reccomendation range from <150- <180 <200, I always hear<200, aviod long acting insulins. Dextrose can be given to increase sugar (dex is an isomer of glucose)
- BUN >18 worry about renal insufficiency >50 cancel surgery according to Pocket Pods (PP)
- Cr 1.2/3.0 & greater renal insufficiency normal is 0.6-1.2
- Kreatine Kinase increased levels may indicate malignant hyperthemia
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you are operating on a rhematiod patient doing a pan met head ressection what special hormone might you need to give this pt
if they have been taking 7.5 or greater mg of presnisone for more than a few weeks the pituatary adrenal axis will be shut down. so you better help
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What are some risk factors to having cardiac complications?
- CHF noted by an s3 of jugular venous distension
- >5 pvc's per minute
- >70 years oldCoronary disease,
- MI within last 6 months
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Who should get prophylaxed for endocarditis whilst undergoing sugery.
- those with valvular heart disease
- Rh fever
- prostetic valve
- Meds are
- iv pen or 1st gen ceph
- if PCN allergic: Clinda300 preop 150 post op
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what are cuases of the following post op fevers?
0-6 post op
24-48 hrs
72+
- intra op -
- transfusion rxn
- malignant
- hyperthermia
- pre-existing sepsis
- 0-6
- post op Pain
- Rebound from cold OR
- Anesthesia RXN
- Endocrine cause
- 24-48 hrsAtelectasis?? some people say this doesnt really cause fever
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