Guidelines/Indications/Risk Factors Flashcards
ASA recommendations for preop EKG
Age greater than 50. Good for 1 year if 50-69. Good for 6 months if over 69
Hx of CV disease or HTN. Good for 6 weeks if significant CV disease. Mandatory if the pateint has a change in cardiac sx: SOB, CP, etc
Hx DM: EKG required if age greater than 40 or if patient has had DM greater than 10 years
Central nervous system disease: required
indicatios for an a line
1- continuous real time bp monitoring
2- planned pharm or mechanical cardiovascular maniopulation
3- repeated blood samplings (ABG, hct, glucose)
4 - failure of indirect arterial bp management
5- supplementary diagnostic information from the art waveform (art pulse contour analysis - systolic pressure variation; pulse pressure variation)
6- patient with end organ dz
7- patient w large fluid shifts
Indications for central line
cvp monitoring transvenous cardiac pacing required for insertion of PA catheters temporary hemodialysis drug admin: drugs irritating to periph veins - vasoactive drugs, hyperalimentation, cehmo, prolonged abx
rapid infusion of fluids: trauma, major surgery
major surgery with large fluid shifts
aspiration of venous air embolus
inadequate peipheral access
sampling site for repeated blood testing
PAC measurements
cardiac output cardiac index PA pressure CVP calculation of oxygen delivery assessment of cardiac work mixed venous oxygen saturation (MVO2) pulmonary capillary wedge pressure systemic vascular resistance
PAC indications
Cardiac: CHF, low EF, left sided, valvular heart disease, CABG, aortic cross clamp
Pulmonary: COPD, ARDS
Complex fluid management: shock, burns, acute renal failure
High risk OB care: ecclampsia, placental abruption
Neurological: sitting craniotomy, venous air embolus
Situations to consider intraop TEE over PA catheter
anticipated hemodynamic swings that may not be tolerated by the patient
pateints who are persistently hypotensive despite interventions that shouldve corrected the hypotension
pateints undergoing procedures where there is a significant risk for venous air emboli
any case where a cardiac abnormality is suspected and where knowledge of the abnormality would alter clinical care
Draw the Mapleson circuits
Draw them
Indications for intubation
Mechanical function: resp rate > 35, Vital capacity < 15mL/kg (10 for child), Neg insp force less than 20-25 cm H2O
Gas exchange function: PaO2 <60 on FiO2 of 50%, A-a gradient >350 on FiO2 of 100, PaCo2 >55 (unless chronically elevated CO2), Dead space ventilation/tidal volume (Vd/Vt) ratio >0.6 (normal = 0.3)
Unstable vital signs
INabilty of the patient to protect his airway 2/2 agitation, airway burns, facial trauma, neurologic injury
discharge criteria
Aldrete: activity breathing circulation (BP) consciousness o2 sat score 9 or greater for discharge
PADSS vitals (bp/hr) activity N/V pain surgical bleeding 9 or greater for discharge
deleterious effects of hypotehermia
coagulopathy
cardiac dysrhythmias
impaired renal function
poor wound healing
RCRI
history of ischemic heart dz hx compensated or prior heart failure hx cerebrovascular dz (stroke/TIA) IDDM Renal insufficiency (Cr >2) Undergoing supra-inguinal vascular, intraperitoneal, or intrathoracic surgery
0-1 = low risk of MACE
2 or more = elevated risk of MACE
stent delay guidelines
BMS 30 days
balloon angio 14 days
DES 6 months (can be 3 if weigh risks/benefits)
risks of COPD
RV dysfunction bullae formation (increased pnx risk) bronchospasm
level for spinal for TURP
T10, above T9 can bask pain from bladder perf (shoulder/abdomen) or prostatic capsule perf (lower abdomen and back)
type of case for infective endocarditis ppx
in high risk patients undergoing dental procedure that may perforate oral mucosa, manipulate gingiva or periapical region of the teeth
