Approach to surgical patient Flashcards
what is the purpose of the preoperative evaluation?
to evaluate the patient at higher risk of complication and implement interventions to mitigate or reduce that risk
what is the KEY factor in improving outcome and lowering length of hospital stay in our patients?
mitigating or decreasing stress response to surgery and anesthesia
when will complete gastric emptying occur in normal individuals?
90 minutes
between 90-120 in the rest
why is keeping gastric emptying time in mind important when prepping your patient for surgery?
keep them NPO when necessary and possible, but if they need food give it outside this range
a patient’s _______ _______provides valuable prognostic information regarding likelihood of developing intra-operative and post-operative complications
patient’s functional capacity
question the patient with regards to exercise tolerance
what are the four components of a preoperative physical exam review?
1) BP (both arms)
2) thorough lung exam
3) cardiac exam with pulses
4) EKG looking for rhythm abnormalities
it is important to try to avoid surgery for several months if patient has had a recent _____
MI
recent hx of MI markedly increases risk for a postoperative recurrent MI and mortality
do patients with a 20+ pack year who stop smoking 2 months prior to surgery reduce their risk of peri and postoperative complications by much?
yes! significantly
how long must a patient with a 20+ pack year stop smoking prior to surgery in order to have rates of complications similar to non-smokers?
6 months
what is the predominant pathogen seen in endocarditis?
staph aureus
what 2 factors must be present for endocarditis to occur?
1) endothelial injury or defect
2) PLUS bacteremia
under what 6 circumstances do we give ABX PPX for high risk patients for endocarditis?
1) acquire valve disease with stenosis or regurgitation
2) those with congenital heart defect
3) those with prosthetic heart valve (all types)
4) hypertrophic cardiomyopathy
5) prior HX of endocarditis
6) heart transplant recipients
if patient reporting for surgery has a HX of recurrent epistaxis, gum bleeding, and exceptionally heavy menses, how should you proceed?
inquire as to family hx of bleeding disorders
if bleeding diathetsis suspected: CBC, platelet count, PT/PTT/INR
what is the ASA classification system?
system utilized for assessing fitness of patients before surgery
a normal healthy patient with no operative risk is considered what class and grade?
class 1, grade 1a
a patient with mild systemic disease or a normal healthy patient with some operative and anesthetic risk is considered what class and grade on the ASA system?
class 1, grade 1a
who falls under class 4 on the ASA classification system?
patient with an incapacitating systemic disease that is a constant threat to life; patient with severe systemic disease that limits activity
who falls under class 5 on the ASA classification system?
moribund patient not expected to survive 24 hours with or without operation
under the current guidelines, what types of patients should receive beta blockers prior to surgery?
1) CAD
2) angioplasty
3) CABG
4) use of nitrates for chest pain
5) TIA or CVD
6) serum creatinine more than 2
7) pts with poorly controlled T2DM
what is the benefit to using a beta blocker prior to surgery?
lower the heart rate which in turn reduces heart muscle O2 demand during stress of surgery and anesthesia
who gets an echocardiogram prior to surgery?
all patients with clinical signs of heart failure and MURMUR
describe the murmur of aortic stenosis
mid-systolic crescendo-descrescendo ejection murmur heard best over the right 2nd intercostal space with radiation into the right neck
a palpably slow rise of the carotid upstroke may make you consider what valve dysfunction?
aortic stenosis
aortic stenosis is a progressive disease, describe the typical course of symptoms throughout a patients life
mnemonia = ASC
1) Angina (early; usually stable)
2) Syncope (later; w exercise)
3) CHF (bc of hypertrophied LV)
