BSSEE flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Revised Cardiac Risk Index

Six predictors of perioperative cardiac events: ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine above 2 mg/dL, and high-risk surgery. Two or more points warrant further evaluation.

4-2-1 maintenance fluid rule

Hourly maintenance fluid equals 4 mL/kg for the first 10 kg, plus 2 mL/kg for the next 10 kg, plus 1 mL/kg for each kilogram above 20, assuming normal renal function.

Wound classification

Surgical wounds are clean, clean-contaminated, contaminated, or dirty-infected. Higher classes carry greater infection risk and influence antibiotic prophylaxis and closure decisions.

Alvarado score

Clinical scoring for appendicitis using migration of pain, anorexia, nausea, right lower quadrant tenderness, rebound tenderness, fever, and leukocytosis. Higher scores support operative management.

Sigmoid volvulus

Colonic torsion causing large bowel obstruction with a coffee-bean sign on imaging. Flexible sigmoidoscopic detorsion with a rectal tube is first-line if no peritonitis or perforation.

Charcot triad

Fever, jaundice, and right upper quadrant pain indicating ascending cholangitis. Requires urgent biliary drainage by ERCP plus antibiotics because sepsis can progress rapidly.

Critical view of safety

Dissection of the hepatocystic triangle clearing fat and fibrous tissue, with only two structures entering the gallbladder, before clipping the cystic duct and artery.

Pancreatic fistula definition

Drain fluid amylase greater than three times the serum upper limit on postoperative day three or later, with clinical impact graded by the International Study Group.

Sentinel lymph node biopsy

Injection of blue dye and radiolabeled colloid to identify the first draining lymph node. Standard for staging clinically node-negative breast cancer and intermediate-thickness melanoma.

Pheochromocytoma blockade order

Alpha blockade with phenoxybenzamine precedes beta blockade to prevent unopposed alpha stimulation and hypertensive crisis. Volume expansion follows before resection.

Primary hyperparathyroidism

Elevated calcium with inappropriately normal or high parathyroid hormone. Most cases are single adenomas; localization with sestamibi and ultrasound enables focused parathyroidectomy.

ATLS primary survey

Sequential assessment of airway with cervical spine protection, breathing, circulation with hemorrhage control, disability, and exposure. Life-threatening problems are treated as found.

Hemorrhagic shock class III

Estimated blood loss of 30 to 40 percent, producing tachycardia, hypotension, narrowed pulse pressure, and altered mental status. Requires blood products and source control.

Positive FAST in unstable patient

Free fluid on focused assessment with sonography for trauma in a hemodynamically unstable patient indicates likely hemoperitoneum and mandates emergent laparotomy rather than CT imaging.

Ankle-brachial index

Ratio of ankle to brachial systolic pressure. A value below 0.90 diagnoses peripheral arterial disease; values below 0.40 suggest critical limb ischemia.

Abdominal aortic aneurysm threshold

Elective repair is indicated at diameter above 5.5 cm in men or 5.0 cm in women, growth exceeding 1 cm per year, or development of symptoms.

Acute limb ischemia six Ps

Pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia. Sensory or motor deficit indicates threatened limb requiring urgent revascularization.

Tension pneumothorax

Hypotension with distended neck veins, absent breath sounds, and tracheal deviation. Immediate needle decompression followed by tube thoracostomy is required before imaging.

Flail chest

Three or more consecutive ribs fractured in two or more places, causing paradoxical segment motion. Management centers on analgesia, pulmonary hygiene, and ventilation if respiratory failure develops.

Empyema stages

Exudative, fibrinopurulent, and organizing phases. Antibiotics plus drainage suffice early; organizing empyema may require video-assisted decortication.

Brain death criteria

Unresponsive coma with absent brainstem reflexes and a positive apnea test showing rising arterial carbon dioxide. Confirmatory testing follows institutional protocol before organ procurement.

MELD-Na score

Liver allocation score using bilirubin, INR, creatinine, sodium, and dialysis status. Higher scores predict three-month mortality and prioritize candidates for transplantation.

Post-transplant lymphoproliferative disorder

Lymphoid proliferation linked to Epstein-Barr virus and intense immunosuppression. Management begins with reducing immunosuppression, followed by rituximab or chemotherapy.

Breslow thickness

Depth of melanoma invasion in millimeters from the granular layer. It determines prognosis, wide excision margins, and whether sentinel lymph node biopsy is indicated.

Tumor lysis syndrome

Metabolic emergency with hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia after rapid tumor cell death. Prevent with hydration and allopurinol or rasburicase.

Septic shock definition

Sepsis with vasopressor requirement to maintain mean arterial pressure of 65 mmHg or higher and lactate above 2 mmol/L despite adequate fluid resuscitation.

ARDS Berlin criteria

Acute onset within one week, bilateral opacities not explained by heart failure, and PaO2/FiO2 ratio of 300 or less on PEEP of at least 5 cm H2O.

KDIGO AKI stage 3

Creatinine three times baseline, rise to 4 mg/dL or more, or urine output below 0.3 mL/kg/hr for 24 hours, or anuria for 12 hours.

Informed consent elements

Diagnosis, nature and purpose of the procedure, material risks and benefits, alternatives including no treatment, and consequences of refusal, documented before the intervention.

Decision-making capacity

Ability to understand information, appreciate consequences, reason through options, and communicate a choice. Capacity is decision-specific and assessed at the time of consent.

SBAR handoff

Structured communication covering situation, background, assessment, and recommendation. Standardized handoffs reduce omissions and adverse events during care transitions.

Never events

Serious preventable incidents such as wrong-site surgery, retained foreign body, or wrong-patient procedures. They require disclosure, root cause analysis, and mandatory reporting.