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PT3: L5

DVT/VTE, Stress Ulcer, and Abx Prophylaxis

QuestionAnswer
Know the adverse outcomes associated with DVT/VTE [3] -Recurrent DVTs -Pulmonary Embolism -Death
What are the causes of DVT/VTE [3] Virchow’s Triad: -Trauma to vein wall -Decreased velocity of blood flow -Hypercoagulability
What are the risk factors of DVT/VTE [10] -Major trauma* -Spinal cord injury* -Critical care pt* -Malignancy -Hx VTE (IMPORTANT) -Age -Pregnancy and postpartum -HRT and contraception -Surgery -Hip or knee surgery*
Where to find consensus guidelines on DVT/VTE, stress ulcer and surgical antibiotic prophylaxis? -DVT/VTE: CHEST -Ulcer ppx: ASHSP -ABx ppx: SIP
How to calculate creatinine clearance (CrCl) using Crockoft-Gault equation? -Equation: (140-age) * (Wt in kg) * (0.85 if female) / (72 * Cr) -Use actual body weight in the Crockoft-Gault equation, unless obese (>20% over ideal body weight (IBW)), then use adjusted body weight in the equation.
Contraindications to DVT prophylaxis? -Hx of HIT (no hep or LMWH) -Active major bleeding -Extreme thrombocytopenia -Uncontrolled HTN (SBP >200/DBP>120) -Bacterial endocarditis -Active hepatitis or hepatic insufficiency
What are the signs of clinically important bleeding? -Hematemesis -Bloody gastric aspirate -Melena -Hematochezia -Plus, one of following within 24H of onset: Decrease of SBP 20mmHg, decrease in sitting SBP by 10mmHg, increase in HR by 20bpm, decrease in Hg>2gm/dL with blunted response to blood transfusi
Whats the criteria for pts needing stress ulcer prophylaxis? -Mechanically ventilated patients -Coagulopathy -Thermal injury > 35% -Enteral feedings -Hepatic or renal failure -Hx of GI ulcer or bleeding within 1yr -Major surgery -Sepsis syndrome
What are the mechanisms to prevent stress ulcers and possible agents for them? -Inhibit gastric acid secretion: H2RAs, PPI -Provide protective mechanisms unrelated to gastric acid secretion: Sucralfate -Neutralize gastric acid secretion: Antacids (no longer used)
What are the goals of surgical abx prophylaxis? -Prevent postoperative infection of the surgical site -Prevent postoperative infectious morbidity and mortality -Reduce the duration and cost of healthcare -Have no adverse effects -Have no adv consequence for the microbial flora of the pt or the hosp
What are the 4 surgical procedure classifications and what of their ppx recommendations? -Clean Procedures (Abx ppx indicated/SSI risk low) -Clean-contaminated Procedures (Abx ppx indicated/SSI risk med) -Contaminated Procedures (Abx ppx indicated/SSI risk high) -Dirty procedures (Abx TX/PRESUME INFECTION)
Recommended regimen for Cardiothoracic and vascular surgery? Recommended Regimen -Cefazolin -Cefuroxime -Vancomycin If beta-lactam allergy: -Vancomycin -Clindamycin
Recommended regimen for colon surgery? Recommended Regimen -Cefotetan -Cefoxitin -Ampicillin/sulbactam -Ertapenem OR -Cefazolin or Cefuroxime + metronidazole
Recommended regimen for colon surgery if beta-lactam allergy? -Clindamycin + aminoglycoside -Clindamycin + quinolone -Clindamycin + aztreonam OR -Metronidazole + aminoglycoside -Metronidazole + quinolone
Recommended regimen for hip or knee surgery? Recommended Regimen -Cefazolin -Cefuroxime -Vancomycin If beta-lactam allergy: -Vancomycin -Clindamycin
Recommended regimen for hysterectomy? Recommended Regimen -Cefazolin -Cefotetan -Cefoxitin -Cefuroxime -Ampicillin/sulbactam
Most common types of organisms covered by surgical prophylaxis? -Staphylcocci and Streptococci are common (Cefazolin great + coverage) -Vanco for MRSA -Clinda if need anaerobe cov -Gram – flouroquinolone mono or cefuroxime or cefoxifin -Anaerobic also metronidazole
Timing requirements for abx prophylaxis? -Hour before -Vanco, Levo, clinda, genta, metro all need longer to infuse -Give additional if major blood loss or surgery >4H -D/C within 24H after surgery
Created by: Nami01
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