Dr. Pestana's Surgery Notes |verified| Jun 2026

Dr. Pestana’s Surgery Notes High-Yield Review for the ABSITE & Surgery Clerkship Fifth Edition — Condensed & Updated

Part I: Perioperative & Critical Care 1. Shock

Hypovolemic – Tachycardia, cool extremities, low CVP. Give fluids/blood. Distributive – Warm extremities, wide pulse pressure.

Septic : Fever, ↑WBC, lactate. Start broad abx, fluids, vasopressors if refractory. Neurogenic : Bradycardia + hypotension (after spinal cord injury). Atropine + vasopressors. Anaphylactic : Urticaria, wheezing. Epinephrine IM, antihistamines. dr. pestana's surgery notes

Cardiogenic – JVD, pulmonary edema, low output. Inotropes ± afterload reduction, avoid excess fluids. Obstructive (tamponade, tension pneumothorax, massive PE) – Distended neck veins, clear lungs.

Tamponade: pulsus paradoxus, echo → pericardiocentesis. Tension pneumothorax: deviated trachea, hyperresonance → needle decompression.

2. Fluid & Electrolytes

Hyponatremia – Check volume status.

Hypovolemic: NS infusion. Hypervolemic (CHF, cirrhosis): fluid restriction ± diuretics. SIADH: euvolemic, high urine Na → fluid restrict ± demeclocycline.

Hyperkalemia – Peaked T waves, wide QRS. Give fluids/blood

Emergency: IV calcium gluconate (cardioprotection), then insulin+glucose, albuterol, kayexalate/dialysis.

Post-op hyponatremia – Think TURP syndrome (glycine absorption) or hypotonic fluids in elderly → risk of cerebral edema. Hypertonic saline if symptomatic.