Exam 1 Pre-Op Evaluation Flashcards
Goals of pre-op evaluation include
- Obtaining pt’s medical hx
- Formulate an assessment of pt’s peri-operative risk / mitigate risk
- Develop a plan for any clinical optimization
- Plan post-op pain management
- Lay out expectations for to patient.
What are the benefits of Pre-op Evaluation from the Patient’s standpoint?
- Reduce Anxiety
- Provide Education (Options)
- Discuss Meds
- Reduce Post-op Morbidity
- Answer Q’s
- Advocate what CRNAs do
What are the benefits of Pre-op Evaluation from Anesthesia’s standpoint?
- Learn Medical Conditions.
- Devise an anesthetic plan (Intra/Post-op)
- Time for consultants
- DNR
What are the benefits of Pre-op Evaluation from the surgeon/hospital’s standpoint?
- Decrease cost of peri-operative care
- Improve efficiency
- Decreases cancellation/delays
Surgical procedures performed under anesthesia requires _________.
Preoperative Evaluation
Correct diagnosis can be made in ____% of cases on the basis of history alone.
56%
What are the components of a medical history?
- Underlying condition requiring surgery
- Known medical problems/past medical issues
- Previous surgeries/anesthetic history
- Anesthetic related complications
- Review of systems
- Medications
- Allergies
- Tobacco/ETOH/Illicit drug use
- Functional capacity
What are some examples of anesthetic-related complications?
- MH
- AChesterase deficiency
- Difficult airway
- PONV
What is the formula for BMI in both metric and imperial
Metric (BMI = kg / m2)
Imperial (BMI = 703 x lbs / in2)
What BMI is considered underweight
BMI < 18.5
What BMI is considered normal
BMI 18.5 - 24.9
What BMI is considered overweight
BMI 25.0 - 29.9
What BMI is considered obese
BMI 30.0 and above
What are the components to emergent physical examination (AMPLE)?
- Allergies
- Medications
- Past Medical History
- Last Meal Eaten
- Events leading up to need for surgery/ procedure
What are the components of an airway examination?
- Mallampati classification
- Inter-incisors gap
- Thyromental distance
- Forward movement of mandible
- Range of cervical spine motion: flexion and extension
- Document loose or chipped teeth, tracheal deviation
Cardiovascular complications account for ____ perioperative mortalities
Almost half
What court case in 1957 established what the practice of informed consent was suppose to look like in the practice of modern medicine?
Salgo v Trustees of Leland Standford Hospital
What are the three goals of shared decision making?
- Communicating with pts about risk, benefits of possible interventions
- Elicit pt’s goals, values, and concerns
- Assist pts in how to conceptualize the risk and benefits/ how to approach the decision.
What are THREE types of DNR orders in the perioperative period, and what do they entail
- Full attempt at resuscitation
- Limited attempt at resuscitation defined with regard to specific procedures
a) May refuse certain resuscitation procedures
b) Anesthesia should inform pt/surrogate about which procedures are essential and not essential for the success of the anesthetic and proposed surgery - Limited attempt at resuscitation defined with regard to the pt’s goals and values
a) Allows anesthesia and surgical teams to use clinical judgement in determining appropriate resuscitation procedures
What is the percent chance of mortality in a high risk procedure?
Greater than 5%
What is the percent chance of mortality in an intermediate risk procedure?
1%-5%
What is the prediction tool used to estimate risk of cardiac complications after surgery?
Revised Cardiac Risk Index
What is the percent chance of mortality in a low risk procedure?
Less than 1%
What are examples of a high risk procedure?
- Aortic and major vascular
- Peripheral vascular