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12/22/25

 


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GS76 General and Thoracic Surgery Toronto Notes 2023

Common Medications

Types Drugs and Dosing

Antiemetics dimenhydrinate (Gravol- ) 25- 50 mg P0/IV/IMq4-6hprn

prochlorperazine (Stemetil ®) 5-10 mg POT'

/.'IM BID-TID prn

metodopramide [Maxeran - ) 10 mgIV,

'

IM q2-3 h prn.10-15 mg P0 010 (30 min before meals andOHS)

ondansetron (Zofran 5) 4 8 mg P0 q8 h prn

granisetron (Kytril:

)1mg P0 810 (for nausea from chemolherapy/radiation)

acetaminophen t codeine (Tylenol 43/plain)12labsq4-6 h P0/PR pin

hydromoiphonc1-2 tabs P0 q4 h prn.0.5-2 mg IV q3- 4 h prn

ibupiofcn 200 400 mg P0 q4-6 h prn

morphine 2.5 -10 mg IM/SC <|4 6 li pm » 12 mg IVglhprn for breakthrough

ketorolac (loradol ' ) 30 60 mg IM/IV q6 h prn

acclammophcn/oxycodone (Percocet 1325/5mg.12 labs P0 q4 6 h pin

heparin 5000 units SC BID. it cancelpatient thenhepaiin 5000units SC TI0/BID

daltepaim fFiagmin -

) 5000 units SC daily

enoxapann (Lovenox ;

) 40 mg SC daily

loperamide (Imodium!

) 4mg P0initially,then 2mgP0 after each loose stool up to 16 mg/d

diphenoxylate -

'

atropine (Lomotil -

) 2 tabs/10 mLPO 0ID

sennosides (Senokol -

) 12 tabs OHS

docusate sodium (Colace - )100 mg P0 8ID

glycerine suppository 1 tab I

ll pin

lactulose 15-30ml P0 010 pin

milk olmagnesia (MOM) 30 - 00 ini P0 010 prn

bisacodylIDulcolax '

110-15 mg P0 pin

zopidone (Imovane '

) 5- 7.5 rng P0 OHS prn

loiaicpam (Alivan '

) 0.5-2 mg P0/SL OHS prn

celatobn (Ancef )1gIV/IM on call to OR or q8 h - CP except Interococcus.GN only f.call , Klebsiello, and Pioteus

cefalexm (Keflex ’) 250-500 mg P0 0ID -listeria.GP except Interococcus, GN only l, cob.Klebsiella,andPioteus

ceftriaxone1-2 g IM/IV q24 h broad coverage includingPseudomonos

ampicillin1-2 g IV q4 -6h-listeria,GP [ Interococcus) except Streptococcusmb 6. coli, oral anaerobes except

gentamicin 3-5 mg/kg/d IM/IV divided q8 h:monitor creatinine,gentamicin levels GN includingPseudomonas

ciprofloxacin 400 mg IV g12 h. 500 mg P0 810 -Gil includingPseudomonas

metronidazole (Flagyl- ) 500 mg PO/IV BIO (500 mg P0 TID lor C.difficile) - anaerobes

clindamycin 600-900 mg IV qS h.150 400 mg PO 0ID - GP except Interococcas.anaerobes

pipcracillin/lazobadam 3.375 g IV qG h - GP.GK.and anaerobes

vancomycin 1g IV q12 h - GP and MRSA

sulfamclhoxazoleftiimdhoprliri OS ISeptra '

) PO 810 - GP. GN including Hocoidia

bismuth subsalicylate (I

cplo-Bismol ) 2 tubs or 30mlPO q30 mm 1 h up to 8 doses /d

side effects:black stools,risk of Reye's syndrome in children

ASA •citrate * bicarbonate (Alka -Seltzer '

) 2 labs in 4 oz wafer P0 q4 h prn, max 8 labs

aluminum hydroxide « magnesium hydroxide (Maalox ) 10 20 ml or 1- 4 tabs P0 prn

calcium carbonate (Turns -

)1-3 g P0 q2 h prn

calcium carbonate and magnesium hydroxide (Rolaids'

-) 2 4 tabsP0 q1h prn. max 12 tabs /d

Analgesics

DVT Prophylaxis

Anlidiarrheals

Laxatives

Sedatives

Antibiotics

Bacteroides

Over-the-Counter

Medications

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GS77 General and Thoracic Surgery Toronto Notes 202.1

Landmark General and Thoracic Surgery Trials

Trial Name Reference Clinical Trial Details

GROIN HERNIAS

Outcomes of

Laparoscopicvs.Open

Repair of Primary

Ventral Hernias

JAMA Surg 2013;148:1043-1048 Title:Outcomes of Laparoscopic vs.Open Repair of Primary VentralHernias

Purpose:To compare outcomes olpatients undergoing laparoscopic ventralhernia repair (LVHR) vs.open ventral hernia repair (OVHR).

Methods:Single centre,retrospective study of S32 consecutive patients who underwent an elective PVH repair.The outcomes of the LVHR

and OVHR were compared in terms of the primary outcomes olinterest SSI.hernia recurrence,and bulging.

Results:T9 patients with LVHR matched lo 79 patients with OVHR with mesh with a median follow-up of 56 mo.LVHR was associated with

fewer SSIs (7.6 o vs.34.1%) but mote cases of bulging (21.5% vs.1.3%) and port

-site hernia (2.5% vs.0.0%).No differences in recurrence

were observed.

Conclusions:LVHR isassociated with fewer SSIs bulmore clinical cases ol bulging and risk of developing a port-site hernia,compared to

OVHR.

ACUTE CHOLECYSTITIS

Title:laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis inhighrisk patients (CH0C0LA1E):

multicentrc randomised clinicaltrial

Purpose:To assess whether laparoscopic cholecystectomy issuperior to peicutaneous catheter drainage inhigh risk patients with acute

calculous cholecystitis.

Methods:142patients were randomiced to either the laparoscopic cholecystectomy group or to the percutaneous catheter drainage group.

Results:Although rate of death did not differ significantly between the laparoscopic cholecystectomy and percutaneous catheter drainage

group,the complication rate in the laparoscopic cholecystectomy was significantly lower than that of the percutaneous catheter drainage

(12% vs.65%).The drainage group compared to thecholecystectomy group required reintervention ata higher rate,had recurrent biliary

disease more frequently.and had longer lengths of stay.

Conclusions:Laparoscopic cholecystectomy comparedwith percutaneous catheter drainage reduced the rale of ma|or complications in high

risk patients with acutecholecystitis.

CHOCOLATE BMJ 2018:363:1(3965

BREAST CANCER

Title:10 Year Survival aftci Breast-Conserving Surgery Plus Radiotherapy Compared with Mastectomy in Early 8reast Cancer in The

Netherlands: A Population-Based Study

Purpose:To evaluate10 yr overall and bieasl cancer -specific survival after breast conserving surgery plus radiotherapy compared with

mastectomy in Dutch women withearly breast cancer.

Methods:Population study of women from the Netherlands Cancer Regisliy diagnosed with primary,invasive,stage 11-2,NO 1,MO breast

cancer,undergoingeither breast-conserving surgery plus radiotherapy or undergoing mastectomy.

Results:Breast-conserving surgery plus radiotherapy showedimproved10 yr overall and relative survival compared with mastectomy in

early breast cancer,but 10 yr distant metastasis-free survival was improved with breast-conserving surgery plus radiotherapy compared

with mastectomy in theUNO subgroup only,indicating a possible role of confounding by severity.

Conclusions:Breast-conserving surgery plus radiotherapy is al least equivalent to mastectomy with respect to suvrval and may influence

treatment decisions for patients.

10 Year Survival

alter Breast

Conserving Surgery

Plus Radiotherapy

Compared with

Mastectomy in Early

Breast Cancerin

The Netherlands:A

Population-Based

Study

lancet Oncol 2016;17(8):1158

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GS78 General and Thoracic Surgery Toronto Notes 2023

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Geriatric Medicine

lmaan Zcra Khcrani aiul Saba Manzoor, chapter editors

Karolina Gacbe and Alyssa Li, associate editors

Wei hang Dai and Camilla Giovino, E8M editors

Dr. Jillian Alston, Dr. Vicky Chau, and Dr.Thiru Yogaparan,stall'

editors

Acronyms

Physiology and Pathology of Aging

Framework for the Approach to the Older Adult

Presentations in Older Adults

Constipation

Delirium

Elder Abuse

Falls

Frailty

Immobility

Incontinence

Malnutrition

Presbycusis

Presbyopia

Pressure Injuries

Driving Competency

Reporting Requirements

Conditions That May Impair Driving

Hazards of Hospitalization

Healthcare Institutions

Geriatric Pharmacology.

Pharmacokinetics

Pharmacodynamics

Polypharmacy

Inappropriate Prescribing inOlder Adults

Common Medications

Landmark Geriatric Medicine Trials

References

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