surgery mnemonics-1

**alap** · 05-04-2007, 02:17 AM

Post-operative fever causes

Six W's:
Wind: pulmonary system is primary source of fever first 48 hours, may have pneumonia
Wound: infection at surgical site
Water: check IV for phlebitis
Walk: deep venous thrombosis, due to pelvic pooling or restricted mobility related to pain and fatigue
Whiz: urinary tract infection if urinary catheterization
Wonder drugs: drug-induced fever

Scrotum: scrotum swelling differential

THE THEATRES:
Torsion
Hernia
Epididymytis, orchitis
Trauma
Hydrocoele, varicocele, hematoma
Edema
Appendix testes (torsion, hemorrhage)
Tumour
Recurrent leukemia
Epididymal cyst
Syphilis, TB

Post-operative complications (immediate)

"Post-op PROBS":
Pain
Primary haemorrhage
Reactionary haemorrhage
Oliguria
Basal atelectasis
Shock/ Sepsis

Fistulas: conditions preventing closure

FETID:
Foreign body
Epithelialization
Tumor
Infection
Distal obstruction

Oedema causes: generalised

"HILARI IS SAVE" (Hilary):
Heart failure
Iatrogenic
Liver causes
Aldosterone increased/ ADH increased
Renal cause
Inadequate protein in blood (hypoalbuminaemia)
· Causes for the inadequate protein in blood are:
Intake Inadequate (Kwashiorkor)
Secretion fro pancreas decreased (pancreatitis)
Synthesis decreased (liver failure)
Absorption decreased (Crohn's disease)
Vomit (pyloric stenosis)
Excretion increased (nephrotic)

Oedema causes: localised

ALIVE:
Allergic (angio-oedema)
Lymphatic (elephantiasis)
Inflammatory (infection, injury)
VEnous (DVT, chronic venous insufficiency)

GI bleeding: causes

ABCDEFGHI:
Angiodysplasia
Bowel cancer
Colitis
Diverticulitis/ Duodenal ulcer
Epitaxis/ Esophageal (cancer, esophagitis, varices)
Fistula (anal, aortaenteric)
Gastric (cancer, ulcer, gastritis)
Hemorrhoids
Infectious diarrhoea/ IBD/ Ischemic bowel

Melanoma sites

"Mel SEA" (Pronounced "Mel C" from the Spice Girls)
· Melanoma sites, in order of frequency:
Skin
Eyes
Anus

Fistulas: conditions preventing closure

FRIEND:
Foreign body
Radiation
Infection/ Inflammation (Crohn)
Epithelialization
Neoplasia
Distal obstruction

Appendicectomy: complications

WRAP IF HOT:
Wound infection
Respiratory (atelectasis, pneumonia)
Abscess (pelvic)
Portal pyemia
Ileus (paralytic)
Fecal fistula
Hernia (r. inguinal)
Obstruction (intestinal due to adhesions)
Thrombus (DVT)

Oesophageal cancer risk factors

PC BASTARDS:
Plummer-Vinson syndrome
Coeliac disease
Barrett's
Alcohol
Smoking
Tylosis
Achalasia
Russia (geographical distribution)
Diet
Stricture

Disease description: organization of answer

"In A Surgeon's Gown, Physicians May Make Some Clinical Progress":
Incidence
Age
Sex
Geography
Predisposing factors
Macroscopic appearance
Microscopic appearance
Spread
Clinical features
Prognosis

Abdomen: inspection

5 S's:
Size
Shape
Scars
Skin lesions
Stoma

Swollen leg: unilateral swelling causes

TV BAIL:
Trauma
Venous (varicose veins, DVT, venous insufficiency)
Baker's cyst
Allergy
Inflammation (cellulitis)
Lymphoedema

Ulcers: edge types

F PURE:
Flat (eg venous)
Punched-out (eg trophic, arterial)
Undetermined (eg pressure, TB)
Rolled (eg BCC)
Everted (eg SCC)

Pancreatitis: treatment

MACHINES:
Monitor vital signs
Analgesia/ Antibiotics
Calcium gluconate (if deemed necessary)
H2 receptor antagonist
IV access/ IV fluids
Nil by mouth
Empty gastric contents
Surgery if required/ Senior review

Appendicitis: Alvarado's scoring system for diagnosis

MANTRELS:
Migratory pain (1)
Anorexia (1)
Nausea (1)
Tenderness (2)
Rebound tenderness (1)
Elevated temperature (1)
Leucocytosis (2)
Shift to left (1)
· Score 3-4 = no appendicitis. Score 5-6 = doubtful. Score 7 or more = appendicitis is confirmed

.

Child-Pugh classification

"Pour Another Beer At Eleven":
PT
Albumin
Bilirubin
Ascites
Encephalopathy
·Scoring (each is either 1, 2 or 3 points):
PT (greater than 12 sec.): 1-3 or 4-6 or >6.
Albumin: >3.5 or 2.8-3.5 or less than 2.8
Bilirubin: less than 2 or 2-3 or >3.
Ascities: none or slight or moderate
Encephalopathy: none or 1-2 (subjective) or 3-4 (subjective)
· Interpretation:
Class A: 5-6 points (candidate for surgical liver resection).
Class B: 7-9 points (consider chemoembolization or RFA).
Class C: 10-15 points (consider options in B or no therapy).

TPN indications

"MISIPPI Burning":
Major visceral injury
IBD
Sepsis
Ileus
Post-op
Paralysis
Intestinal fistula
Burns

Surgical discharge checklist

FLAG COUP:
Lucid
Ambulatory
GP letter sent
CVS checked (BP, pulse
Operation site OK
Urinating OK
Prescription

**bladder** · 10-22-2007, 04:03 AM

nice list alap. just to add to:

Six W's:
Wind: pulmonary system is primary source of fever first 48 hours, may have pneumonia
Wound: infection at surgical site
Water: check IV for phlebitis
Walk: deep venous thrombosis, due to pelvic pooling or restricted mobility related to pain and fatigue
Whiz: urinary tract infection if urinary catheterization
Wonder drugs: drug-induced fever

The timing of fever relative to the postoperative day (POD) will indicate the most likely cause. The five W's of postoperative fever - Wind, Water, Walking, Wound and Wonder drugs - as a useful memory tool could help a physician when he is following patients after surgery.[15],[16]

POD 1-2: Wind: Atelectasis (without air) often cause fever. Reasons include being on a ventilator, inadequate sighs during surgery and (in the general surgery patient) incisional pain on deep breathing. This is treated with incentive spirometry because there is evidence that deep inspiration prevents atelectasis better than just coughing .

POD 3-5: Water: Urinary tract infections (UTIs) are common here. Foley catheters are sometimes still in place.

POD 4-6: Walking: Deep venous thrombosis can occur. This is more of a problem in patients undergoing pelvic orthopedic or general surgery than in head and neck surgery. Subcutaneous low dose heparin and venous compression devices reduce the incidence of thromboembolization . Walking the patient on POD1 is the best way to prevent this complication.

POD 5-7: Wound : Most wound infections occur during this period. Preoperative antibiotics are important to prevent or reduce the risk of infection in head and neck surgery that crosses mucosal linings.

POD 7+: Wonder drugs : Drugs can cause fevers.(Note that in obstetrics and gynaecology, this W is "womb" and it precedes "Wonder drugs").