characteristics of a surgical PA

Question 1

members of a surgical team

Answer 1

-pre-admissions testing
-booking secretary
-transporter
-surgeon
-surgical tech
-anesthesiologist
-anesthesia tech
-certified registered nurse anesthetist (CRNA)
-operating room nurse
-circulating nurse
-surgical tech
-residents or medical students
-APPs*- advanced
-medical device company representative

Question 2

preadmission

Answer 2

-comprehensive hx is MOST important
-when not possible- AMPLE- allergies, meds, PMHx, last meal, events preceding the emergency
-allergies
-reactions to anesthesia
-meds, especially those that can cause bleeding
-critical diseases- cardiopulmonary, endocrine, cirrhosis, renal disease, immunosuppression, prior surgical procedures (adhesions)
-ex. aspirin takes 7 days to clear, will need to give quality platelets
-ex. antibiotics prior

Question 3

glucose

Answer 3

must be > 100 before surgery

Question 4

preop labs

Answer 4

-BMP- dont do
-CBC- H/O anemia or possible blood loss expected- Hmg <7 -> transfuse
-serum electrolytes- meds affectd by K, renal failure, usually more important post op
-creatinine- nephrotoxic meds?, expected blood loss, dye usage aorta cross clamping
-glucose- current or family H/O DM
-coagulation studies- critical for neuro CNS cases (not as important normally)
-U/A- not as routine, check WBC, think prosthetics (bc bacteria in blood will infect foreign prosthetics)

Question 5

whats the best way to know coagulation studies

Answer 5

-history
-quality over quantity of platelets

Question 6

CXR

Answer 6

• if > 40 or with underlying cardiac pulmonary disease

Question 7

EKG

Answer 7

-age over 40

Question 8

spirometry

Answer 8

-smoker or dyspnea hx

Question 9

other considerations

Answer 9

-prophylaxis
-nutrition - obese, diet
-antibiotics for prophylaxis- DVT, GI bleeds…
-preoperative fluids- bowel prep, IV for NPO pts,

Question 10

anesthesia

Answer 10

-cardiopulmonary suppressants
-volume constricting
-bp can crash

Question 11

-characteristics

Answer 11

-specialist knowledge for accurate dx of a pts conditions
-good communications
-bright eager mind, manual dexterity, physical skills for performing operation
-extensive experience of preop and postop
-ability to adapt and learn
-leadership
-inspire confidence in others
-emotional resilience

Question 12

system based practice

Answer 12

-societal, organizational, economic environments in which health care is delivered
-awareness of and re
-cost effective- order appropriate tests
-provide a safe environment*

Question 13

7 step process of root cause analysis

Answer 13

-define problem
-gather data
-find the causes
-find solutions
-develop strat to correct/prevent
-report out
-monitor solutions and close the loop
-revisit over time