Surgery -branch of medicine Kinds of surgery Emergent -within 24 hours Urgent 48-72hours Plan required weeks to months Optional/elective

elective upon the decision of the patient Optional example. Mas gaganda ang buhay, cataract surgery Elective enhancements lang tulad ng noselift

Diagnostic identify the presence of disease Exploratory extent of the disease Curative Gustong pagalingin 3 types of curative Ablative take out a part of a body Constructive from beginning wala na ung body part nya tulad ng cleft palate, cleft lip Reconstructive pagnasiko ung ilong sa basketball tapos nabali aayusin sya ulit with surgery and alignment

Palliative treating the signs and symptoms Informed Consent process by which it is a go signal for surgery by the patient Done by the physician Prerequisites voluntary, with full disclosure and understanding , competent patients Informed consent can also be implemented if emancipated

Preop Health Teachings Deep breathing exercises and coughing exercises Turning exercises

Foot and leg exercises

Physical Preparation for a surgical Patient Prevent aspiration 6-8 hours npo Remove dentures Bowel prep: enema, laxatives Skin prep: reduce flora (bathing, hair removal) Antibiotic prescribed for surgery is neomycin sulfate

Surgical Environment 3 zones: Unrestricted zone street clothes Semirestricted zone scrub suit, head covers Restricted zone + mask

Narcosis is removal of cns depressants caused by pharmacologic agents General Anesthesia inhalation, IV Stage 1 beginning anesthesia, begins induction ends with LOC Stage 2 excitement stage/delirium stage, restless extremities Stage 3 Surgical (operative) generalized muscle relaxation, depression of vital function Stage 4 Medullary depression (danger) depression of vital signs leading to death Localized Anesthesia topical, simple local infiltration, field block , nerve block , epidural, spinal Antidote for malignant hyperthermia is dantrolene sodium Hydration to prevent spinal headache and flat on bed 6-8 hours Virchows triad alam mo na to haha Respiratory Ventilation movement of air in and out of lungs

Perfusion movement of blood High ventilation perfusion (dead space) Low ventilation perfusion (shunt) Silent unit poor ventilation and poor perfusion Diagnostics Chest X-ray Instruct DBE Remove metals

Broncoscopy look directly in bronchial tree Need informed consent Before: NPO 6-8 hours After: NPO till gag reflex return Side lying position Watch out for bronchial perforation

Bronchography radiographic examination of the bronchial tree Inject with dye Assess for allergies especially seafood and iodine rich foods

ABG assess for acid base balance Before : allens test After: pressure on puncture site

Pulse Oximetry o2 saturation of blood (normal:95-100%) Before: no nail polish Assess perfusion Protect from sunlight

Thoracentesis aspiration of fluid from pleural space Before: informed consent

Secure x-ray Position: upright leaning forward For local anesthetic remain still After: position on unaffected side Place on bedrest Monitor for bleeding

All lung procedures on unaffected side except for pneumonectomy Epistaxis(Nose Bleeding) Etiology Trauma, heat, disease condition Management: prevent aspiration Upright position leaning forward Stop bleeding: pressure, ice packs, nasal packing, vasoconstrictors

Sinusitis Etiology: URTI or allergy leading to congestion and obstruction to outflow of mucus Signs and symptoms: red and edematous nasal mucous membrane Pain congestion Discharge drip

Diagnostic: chest x-ray, ct scan, endoscopy Management: relieve pain and congestion Hydrate Warm packs Nasal irrigation Analgesics and decongestants for 3 days only Surgical: FESS (Functional Endoscopic Sinus Surgery) Cadwell-Luc Surgery incision behind the upper lip

Tonsilitis

Etiology: GABHS Complications: trigger auto immune disease Signs and Symptoms: Sore throat, dysphagia, fever Management: promote comfort, warm saline gargles, analgesics, promote hydration Surgery: Tonsillectomy Before: assess URTI, bleeding parameters After: lateral or prone position, watch out for bleeding, promote comfort, diet modifications Bronchial Asthma chronic inflammatory disease of airway assoc. with recurrent reversible airway obstruction Trigger: bronchospasms, mucousal edema, increase sputum production, airway resistance Signs and Symptoms: DOB, Wheezes, coughing, anxiety Management: avoid allergens, ASA, betablockers, promote hydration, promote expectoration of secretions COPD Not fully reversible Chronic airway limitation Improve airway : bronchodilators, anti inflammatories

Chronic Bronchitis presence of cough and sputum production for 3 months for 2 consecutive years Emphysema over inflation of respiratory zone Genetic lack of alpha 1 antitrypsin + smoking Management: sitting upright leaning forward Decrease o2 demand to rest Promote oxygenation: o2 supplement (max 3Lpm) Hydration CPT chest physiotherapy

Dietary modification: high cal high chon low cho

Right Sided Heart Failure (Cor Pulmonale) Pleural Effusion Collection of fluids Signs and Symptoms: hypoxia, chest pain, asymmetry, mediastinal shifting Management: High fowlers, promote lung expansion, high flow oxygen, thoracentesis

Pneumothorax Types: Close, Open, Tension Signs and Symptoms: hyperresonance, diminished breath sounds, reduced mobility of affected chest, mediastinal shifting, hypotension, hypoxia Management: Open pneumothorax occlusion of wound chest tube insertion Tension pneumothorax immediate decompression

ARDS shock lung, white lung, stiff lung, wet lung, DaNang lung Non cardiogenic pulmonary edema due to acute injury to lung parenchyma Shifting of fluids and proteins into alveoli Signs and symptoms : refractory hypoxia, severe dyspnea, use of accessory muscles, crackles , ronchi, increase pulmonary artery pressure

Circulatory System Heart : primary pump Blood vessels: roadways Blood: transportation

Lab Tests CBC hct percent formed elements Erythrocyte Sedimentation Rate Prothrombin Time (PT) evaluate Coumadin therapy

Normal value: 11-16 sec. if in therapy 1.5-2

Partial thromboplastin time (PTT) evaluate heparin therapy Normal value: 60-70 sec.

Blood Lipids NPO 10-12 hours Normal Cholesterol : 150-200 mg/dl Normal Triglycerides: 140-200 mg/dl

Cardiac Enzymes CK-MB: Onset(3-6hours) Peak (12-18hours) Duration (3-4days) Trop I: O(2-4hours) D(4-7days) LDH: O(12hours) P(48hours) D(12-13days)

Diagnostics ECG graphical representation of hearts elasticity activity P wave atrial depolarization PR interval travel time from SA to AV node QRS complex ventricular depolarization ST Segment plateau of action potential T wave ventricular repolarization Ischemic Changes Myocardial ischemia: ST segment depression Myocardial injury: ST elevation Myocardial infarction: Q wave

Central Venous Pressure Blood pressure within SVC/R-atrium Normal Value 5-12 Cm H2o PAP/PCWP within the pulmonary vasculature Normal Value : 4-12mmhg (if >25mmhg = pulmonary edema)

Cardiac catheterization and angiography Insert catheter in coronary bv, admister dye, radiographic examination

Coronary Artery Disease Ischemic Heart Disease Angina: chestpain due to imbalance of o2 demand and supply Stable angina: increase demand, relieved by rest, less than 15 mins. Unstable angina: decrease supply occurs even at rest, prolonged, same time of day Variant angina: due to artery spasm, longer even at rest

Myocardial Infarction Nitroglycerine 3-5min max of 3 doses Betablockers decrease HR and oxygen demand CA blockers vasodilate decreased afterload Treatment revascularization therapy PTCA, CABG Signs and symptoms : pain (unrelieved by NTG, Levines sign CHF Fails as a primary pump Pump blood from systemic circulation to pulmonary circulation Pharmacotherapy digitalis therapy BANDAV Monitor hypokalemia toxicity Diuretic therapy furosemide

Valvular Disease Stenosis: narrowing Regurgitation backflow of blood through incompetent valve Prolapse bulging of leaflets during systole HPN

Essential HPN unknown cause 90-95% of all cases

Secondary HPN due to known cause Aneurysms ballooning outpouching of artery due to weakening of tunica media Usually caused by HPN Prevent rupture (control HPN)

Reynauds Disease women 18-40yrs old Vasospasms of arteries in digits or fingers because of exposure to cold stress

Deep Vein Thrombosis Cause: virchows triad Signs and symptoms: pain in calf edema Beurgerss Disease Thromboplebitis obliterans Common cause cigarette smoking Aplastic anemia erythropoietin destroys bone marrow All are low rbc wbc

Pernicious Anemia decrease vit b12 Signs and symptoms pallor, beefy red tongue, activity intolerance

IDA hemoglobin formation Fluid and Electrolytes Normal Values NA 135-145 K 3.5-4.5 CA 8.5-10.5 PH 7.35-7.45 Pac02 35 -45

Bicarb 22-26 Aralin mo ung acid base balance! Ayan lang ung lahat ng notes.