Created by TheStudyFix143 diseases · 72 criteria · structured C/P · Inves · Mng
Goal: Reduce surgical stress to retain anabolic homeostasis.
Golden Rule: Treat the PATIENT, not the number.
Use: Pain assessment in children or non-verbal patients. Total score 0–10 (Merkel et al, 1997).
| Category | Score 0 | Score 1 | Score 2 |
|---|---|---|---|
| Face | No particular expression or smile | Occasional grimace or frown, withdrawn | Frequent/constant frown, quivering chin, clenched jaw |
| Legs | Normal position or relaxed | Uneasy, restless, tense | Kicking or legs drawn up |
| Activity | Lying quietly, normal position, moves easily | Squirming, shifting back and forth, tense | Arched, rigid, or jerking |
| Cry | No cry (awake or asleep) | Moans or whimpers; occasional complaint | Crying steadily, screams or sobs, frequent complaints |
| Consolability | Content, relaxed | Reassured by touching, hugging, talking; distractible | Difficult to console or comfort |
Frequency: Every time vital signs are taken.
Use: Systematic check for principal sources of postoperative fever. Fever = temperature >38°C (occurs in ~40% of post-op patients).
Early causes (1–3 days): atelectasis (traditional). Late causes (~2 weeks): septic thrombophlebitis (from IV line); occult intra-abdominal abscesses.
Use: Mnemonic for correctable causes of postoperative delirium. Postop delirium ~50% of cases (especially elderly + orthopaedic surgery).
Other causes to consider: electrolyte disturbance, hypo/hyperglycaemia, acid-base disturbance, organ failure, sedatives, hypoxia or hypercapnia.
| Vaccine status | Wound type | Action |
|---|---|---|
| Up to date | Standard | No further vaccine |
| Up to date | High risk (e.g., manure) | + Human tetanus immunoglobulin |
| Not up to date | Tetanus-prone | Reinforcing Td/IPV + Immunoglobulin |
| Not up to date | Non-prone | Reinforcing Td/IPV only (or start course) |
Use: Biphasic metabolic model of the stress response to injury
Use: Peak resting energy expenditure (%REE) by injury type (peaks ~days 10-12 post-injury)
Use: Peak daily nitrogen excretion by insult
Use: Classification of toxic factors in the stress response
Use: Intra- vs post-operative triggers of the surgical stress response
Use: compare shock types across haemodynamic parameters
Use: substrate handling by metabolic state (fed / starvation / trauma & operations / sepsis)
Use: classify capillary/osmotic/membrane forces and net restitution by haemorrhage severity
Use: intraoperative vs postoperative triggers of the surgical stress response
Use: classify the sources of tissue injury
Use: Two-phase model of the metabolic recovery process after injury.
Use: Row-by-row contrast of simple starvation vs the stressed metabolic state.
Use: How multi-organ dysfunction develops after injury.
Use: Approximate peak resting energy expenditure vs normal by insult.
Use: Approximate peak urinary nitrogen loss (g/day) by insult.
Use: Modifiable drivers that worsen the stress response - avoid for speedy resolution.
Use: Severity of perforated diverticular disease (Case 7 community-acquired severe sepsis).
Use: Order of stratification when assessing perioperative nutritional risk.
Use: Two-part nutrition screening tool for hospitalized/surgical patients
Use: Predicts risk of complications from nutritional status
Use: Skin-antigen induration score feeding into the PNI
Use: Grades immune/nutritional depletion
Use: Classifies weight-for-height / degree of malnutrition
Use: Estimates daily basal energy expenditure (kcal/day)
Use: Daily protein target by stress level
Use: Adjusts baseline calorie need by degree of stress
Use: Additional nutritional indices (alongside BMI and PNI)
Use: Clinical/lab flags of a metabolic stress state
Use: Formal cancer staging to predict prognosis and select the correct treatment.
Use: Degree of tumour differentiation; feeds into staging & prognosis.
Use: Three axes used to classify any neoplasm.
Use: Organising framework of malignant cell biology.
Use: Most cancers = a complex combination of exogenous and/or endogenous factors, not a single physical/chemical/biological factor.
Use: Prophylaxis stratified by the patient's baseline risk state, plus the tools used.
Use: Prophylaxis has two approaches — risk assessment and screening. Risk assessment stratifies who needs prophylaxis across four axes. (Note: this lecture names screening as a prophylaxis tool but does not enumerate formal screening criteria.)
Use: When chemotherapy is given relative to surgery.
Use: When (setting) and how (route) radiotherapy is delivered.
Use: Active vs passive immune approaches in cancer.
Use: Substances produced by the tumour or by the body's response to it.
Use: Mathematical model of tumour growth with the key doubling figures.
Use: Core framework for grouping every external abdominal hernia
Use: Single groin zone of weakness — origin of ALL groin hernias
Use: Distinguishes direct from indirect inguinal hernia
Use: Laparoscopic no-tack zone — iliac vessels
Use: Laparoscopic no-tack zone — nerves
Use: Laparoscopic no-tack zone — profuse bleeding
Use: Anterior (open) vs posterior (laparoscopic) repair landmark
Use: Classify pain by onset, mechanism + site
Use: Map any analgesic to where it acts on the pathway
Use: Predict opioid efficacy + ceiling from binding class
Use: Convert between opioids + routes
Use: Choose drugs acting at different sites for balanced analgesia
Use: Structured menu of acute-pain treatment options
Use: Mnemonic for the precipitants of post-op myocardial infarction
Use: Bedside triage of a post-op arrhythmia
Use: Classify causes of post-op hypotension via BP = CO × SVR
Use: Time-based classification of post-op haemorrhage
Use: Framework for the predisposing factors to post-op complications
Use: Assess for a difficult airway before intubation in trauma.
Use: Stepwise airway management in trauma.
Use: Exclude and treat these in the Breathing (B) step of the primary survey.
Use: Structured trauma handover from the prehospital team (ATMIST) / prehospital ED alert (ATMISTE).