History Taking, Airway Flashcards
What information do you get from the OR schedule?
Patient demographics (name, age, sex) Procedure, diagnosis Length of procedure, position Surgeon Type of anesthesia- requested
What are the 3 main questions answered by a preoperative assessment?
- Is the patient in optimal health?
- Could health problems/meds unexpectedly influence perioperative events?
- Should the patient’s physical or mental condition be improved BEFORE surgery?
What are the 6 purposes to the preoperative interview?
- get medical history, 2. form anesthetic care plan, 3. get informed consent, 4. patient education, 5. improve efficiency (reduce cost of perioperative care), 6. Motivate patient to more optimal health status
What is included in the airway physical exam?
Mallampati, Thyromental distance, head and neck movement, neck circumference, interincisor distance, dentition, relevant craniofacial deformities
Look for predictors of difficult airways
Why would you do laboratory tests on a patient preoperatively?
Reduce anesthetic morbidity, increase quality of perioperative care, decrease cost of perioperative care, return patient to desirable functioning
**Lab tests are NOT good disease screening tools. Think, will the results of this test change my plan of care or improve outcomes (Litmus test)?
Sensitivity vs. Specificity?
Sensitivity: positive in a patient that has a disease
Specificity: negative in a patient without a disease
What is the ASA status? What are the different classifications?
Classifies the physical condition of a patient
1: normal healthy patient, no disease
2: mild disease well controlled (ex: mild obesity, pregnancy, smoker)
3: severe systemic disease, functional limitation (chronic renal failure, old MI)
4: severe disease, life-threatening (symptomatic COPD)
5: not expected to live without a procedure (multiorgan failure, sepsis, bleeding
6: brain dead, waiting to donate organs
E: emergency operation required
What is the ASA status of a smoker?
ASA 2
What is the ASA status of a healthy person that needs their appendix out?
ASA 1E
What is the ASA status of a 65 year old with CAD (on meds), hypertension (on meds), PVD, with history of stroke, schedule for hip replacement?
ASA 3 (stroke makes it a 3)
What is the ASA status of a 30 year old smoker involved in MVA with bilateral open femur fractures and liver lac?
ASA 3 if stable vitals
ASA 4 is unstable vitals
How long should a patient be NPO for.. clear liquid diet, breast milk, formula/solids, and for heavy meals
2 hours for clears 4 hours for breast milk 6 hours for formula 8 hours for heavy meals This is ASA guidelines, follow policy guidelines too
Name some patients at risk of aspirating
Old and young, ascites (ESLD, collagen vascular disease), metabolic disorders (DM, obesity, ESRD, hypothyroid), hernia, GERD, esophageal surgery, mechanical obstruction, prematurity, pregnancy, neuro disease
What is included in informed consent?
Explanation of planned anesthetic, explanation of available options, risks/benefits (reasonable clinician standard and prudent patient standard are legal guidelines), patient understands/cooperates
No consent is assault and battery
Signature of patient and witness
List indications for intubation
Airway protection Maintenance of patent airway and oxygenation Apply positive pressure Deliver predictable FiO2 Provide PEEP
