Live book 5

Candidate Shift — Perioperative Fluids & Nutrition: Balanced Crystalloids, Early Enteral Feeding, Refeeding Guard (Addendum Summary, Ch 8)Resuscitate with balanced crystalloids toward near-zero balance, feed enterally within 24–48 hours, reserve TPN for prolonged intestinal failure — and give thiamine before calories in the malnourished.Practice Shift — Perioperative GLP-1 / Dual GIP-GLP-1 Agonists: Risk Stratification Replaces the Blanket Hold (Table 8.1, Pathway 8C)Replace the 2023 blanket one-dose GLP-1 hold with risk stratification: continue therapy in patients without elevated delayed-emptying risk, and jointly choose a 24-h liquid diet, modified anesthesia plan, gastric POCUS, postponement or a targeted hold in those with it.Practice Shift — Perioperative SGLT2 Inhibitors: Label Holds Kept Distinct, euDKA Vigilance, Clinical Restart (Table 8.1, Pathway 8B)Keep SGLT2 guidance sources separate: hold to the U.S. FDA label intervals (>=3 days; >=4 days for ertugliflozin) as the conservative default for major surgery, never delay emergency source control to complete a hold, and never let a normal glucose exclude euglycemic DKA.Practice Shift — VTE Prophylaxis: Separate Inpatient from Extended 28-Day Post-Discharge Prophylaxis (Table 8.1, Pathway 8D)Separate inpatient prophylaxis from post-discharge prophylaxis: give high-risk abdominopelvic cancer patients 28 days of LMWH after discharge — and stop applying extended prophylaxis as a blanket rule to all general and bariatric surgery, with every dose adjusted for weight, CrCl, bleeding risk and epidural timing.Stepwise Clinical Decision Pathway — Metabolic & Perioperative (§8.2)Run the five perioperative pathways in order — bariatric eligibility, SGLT2 holds, GLP-1 risk-stratification, VTE separation, WIfI limb salvage.

Codes 2

PER-DEL-PREV-01 — Postoperative deliriumUp to ~1 in 4 frail patients · 27% · 31% — Incident delirium after surgeryPER-DM-THR-01 — Hypoglycaemia threshold — Level 1 alert value<70 mg/dL — Level 1 hypoglycaemia alert value (ADA classification) in diabetic patients, perioperative and beyond.

Memory 15

5 Ws — VERSIONS DISPUTECauses of post-operative fever, by timing — kept as a versions-dispute cardI LACK OPDrugs to stop / adjust before surgeryPINCH MECauses of delirium (including postoperative)I WATCH DEATHCauses of deliriumFasting 6-4-2 rulePre-operative fasting timesHolliday-Segar 100-50-20Daily maintenance fluids in children4-2-1 ruleHourly maintenance fluids in children60-40-20 ruleBody fluid compartmentsMUSTMalnutrition Universal Screening Tool (name-device; three components)WHO Surgical Safety Checklist — Sign In, Time Out, Sign OutWHO Surgical Safety Checklist phases (name-device)SCDMechanical VTE prophylaxis (name-device)BRADENBraden Scale for pressure-injury risk (name-device; six subscales)A²B²C²D²E²F²G²Pre-anaesthetic assessmentNICE 5 RsIV-fluid therapy framework (NICE CG174)NRS-2002Nutritional risk screening — the score's components