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What medications provide protection from postoperative GI bleeding?
H2 blockers, PPI (proton-pump inhibitor)
What measures provide protection from postoperative atelectasis/pneumonia?
Incentive spirometry, coughing, smoking cessation, ambulation
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
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)
How long should “prophylactic antibiotics” be given
What treatment provides protection from oral/esophageal fungal infection during IV antibiotic treatment?
What measures prevent ventilator-associated pneumonia (VAP)?
Head of bed> 30 degrees, handwashing, patient oral hygiene, avoidance of gastric overdistention
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)
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
What treatment provides protection from endocarditis with faulty heart valve or prosthetic heart valve?
Antibiotics prior to dental procedure or any surgery
What treatment provides protection from tetanus infection?
Tetanus toxoid (and tetanus immune globulin, if one or no previous toxoid with dirty wound)
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.
To avoid Wernicke’s encephalopathy in alcoholics, when do you give the glucose?
AFTER Thiamine administration!
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
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