Exam 1 - Preop Assessment Flashcards
What are the components of a complete medical history?
- Past medical history
- Reason for surgery
- Review of systems
- Previous anesthetic complications
- Medications
- Allergies
- Drug use
- Functional capacity
What is the (metric) formula for BMI?
BMI = weight (kg) / height (m)²
What is the (imperial) formula for BMI?
703 · BW (lbs) ÷ height (inches)²
What is a normal BMI?
What is an obese BMI?
Why is BMI not very accurate?
Normal: 18.5-24.9
Obese: > 30.0
BMI does not account for muscle mass
Why is it important to complete a baseline neuro exam?
To determine patients pre-surgical baseline to be able to catch any new defecits post-op
What mnemonic guides an emergent physical examination?
AMPLE
- Allergies
- Medications
- Past medical history
- Last meal (assume full stomach)
- Events leading up to need for surgery
What are the components of a pre-op airway examination?
- Mallampati
- Inter-incisors gap
- Thyromental distance
- Forward movement mandible
- Range of cervical spine (flexion and extension)
- Loose/chipped teeth (ensure patient is aware of danger of loss of teeth during intubation)
- Tracheal deviation (mass?)
What complications account for almost half of perioperative mortalities?
Cardiovascular complications
What is the most significant adverse respiratory event that can occur during anesthesia?
Hypoxemia
What court case helped establish the practice of informed consent in modern medicine?
Salgo v. Leland Stanford Jr. University Board of Trustees(1957)
What is frailty?
A state of increased vulnerability to physiologic stressors
What group of surgeries has the highest risk?
Vascular (Aortic, major, & peripheral vascular) > 5%
What is the Revised Cardiac Risk Index (RCRI)?
What are the components?
Estimates risk of cardiac complications after surgery
What is functional capacity?
Assesses cardiopulmonary fitness and estimates risk for major post-op morbidity and mortality
How is funcitonal capacity measured?
What is its units?
What level is desired before surgery?
- METs (metabolic equivalent of task)
- 1 MET = 3.5 mL O2/kg/min
- > 4 METs is desired (need to climb one flight of stairs without getting short of breath or chest pain)
What are the three levels of urgency of surgery?
- Emergent - Life or limb threatened, sx needed within 6 hours, no cardiac pre-op necessary.
- Urgent - Life or limb threatened, sx needed in 6-24 hours.
- Time-sensitive - delays exceeding 1-6 weeks would adversely affect patient.
Who described the 6 degree ASA Physical Status grading?
Meyer Saklad
Describe an ASA I patient?
A normal healthy patient
Describe an ASA II patient?
A patient with mild systemic disease without functional limitations (smoker, social drinker, pregnancy)
Describe an ASA III patient?
A patient with severe systemic disease with substantive functional limitations (poorly controlled DM or HTN, COPD, CVA, morbid obesity)
Describe an ASA IV patient?
A patient with severe systemic disease that is a constant threat to life (recent <3 months MI, CVA, or stents, sepsis, ARDS, severe valve dysfunction)
Describe an ASA V patient?
A moribound patient that is not expected to survive without surgery (ruptured AAA, massive trauma, ischemic bowel with MODS)
Describe and ASA VI patient?
A declared brain-dead patient whose organs are being removed for donation
When should pre-op testing be ordered?
If it can identify abnormalities, change the diagnosis or management plan, or change the patients outcome.
