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What medications provide protection from postoperative GI bleeding?
H2 blockers, PPI (proton-pump inhibitor)
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What measures provide protection from postoperative atelectasis/pneumonia?
Incentive spirometry, coughing, smoking cessation, ambulation
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What treatments provide protection from postoperative DVT?
protection from postoperative DVT?Low-molecular-weight heparin (LMWH), subcutaneous low-dose unfractionated heparin, sequential compression device (SCD) for lower extremities, or both; early ambulation
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What measures provide protection from wound infection?
Shower the night before surgery with chlorhexidine scrub Never use a razor for hair removal (electric shavers only) Ensure adequate skin prep in O.R. Do not close the skin in a contaminated case Ensure preoperative antibiotics in the bloodstream before incision Ensure no excess Bovie (necrotic tissue)
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How long should “prophylactic antibiotics” be given
<24 hrs
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What treatment provides protection from oral/esophageal fungal infection during IV antibiotic treatment?
PO nystatin
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What measures prevent ventilator-associated pneumonia (VAP)?
Head of bed> 30 degrees, handwashing, patient oral hygiene, avoidance of gastric overdistention
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What is the classic preoperative “bowel prep?"
- 1. Bowel prep: Lower bacterial count in colon by catharsis (GoLYTELY or Fleets)
- 2. PO antibiotics (neomycin, erythromycin) preoperatively
- 3. Preoperative IV antibiotic with spectrum versus anaerobes (e.g., Cefoxitin)
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What treatment provides protection from OPSS (overwhelming post splenectomy sepsis) a er splenectomy?
Immunization against H. in uenzae, Streptococcus, Meningococcus, and penicillin when illness/fever occurs
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What treatment provides protection from endocarditis with faulty heart valve or prosthetic heart valve?
Antibiotics prior to dental procedure or any surgery
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What treatment provides protection from tetanus infection?
Tetanus toxoid (and tetanus immune globulin, if one or no previous toxoid with dirty wound)
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What treatment provides protection from Wernicke’s encephalopathy?
Rally pack (a.k.a. banana bag because the IV is yellow with the vitamins in it); pack includes thiamine, folate, and magnesium.
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To avoid Wernicke’s encephalopathy in alcoholics, when do you give the glucose?
AFTER Thiamine administration!
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What is Wernicke’s encephalopathy
- encephalopathy?Condition resulting from thiamine de ciency in patients with alcoholism, causing a triad of symptoms; think “COA”: 1. Confusion
- 2. Ophthalmoplegia
- 3. Ataxia
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What treatment decreases the risk of perioperative adrenal crisis in a patient on chronic steroids?
“Stress-dose” steroids: 100 mg hydrocortisone administered preoperatively, continued postoperatively q 8 hours, and then tapered off
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