L08: Peri-Operative Care of the SA Patient (Kim)

Question 1

SOAP =

Answer 1

subjective
objective
assessment
plan

Question 2

peri-operative includes:

Answer 2

pre, intra, and post-op

• signalment
• presenting complaint
• Hx
• PE
• diagnostics
• tx/stabilization

Question 3

signalment includes:

Answer 3

age, gender, species, breed

Question 4

components of general exam

Answer 4

mentation
vital signs
weight
hydration status
auscult, palpate

Question 5

components of ortho exam

Answer 5

ambulation
swelling, instability
range of motion
pain
(not needed by all patients)

Question 6

components of neuro exam

Answer 6

• intracranial: mentation, CN, ocular
• Spinal cord/peripheral nerves: ambulation, proprioception, reflexes, pain sensation
• Ortho vs. neuro?

Question 7

Common lab tests

Answer 7

PCV/TS/BUN/USG
CBC/Chem/UA
Blood gas analysis
Coag profile
Cross-match/typing
Imaging (rads, U/S)
ECG, blood pressure, SPO2

Question 8

“minimal” surgical risk

Answer 8

little effect of sx, minimal complications, likely normal after Sx

Question 9

“moderate” surgical risk

Answer 9

some potential for complication but high probability of successful outcome

Question 10

“high” surgical risk

Answer 10

serious problems or procedure assoc. with moderate probability of complications

Question 11

“extreme” surgical risk

Answer 11

high chance of major complications, permanent change in health, sx only if necessary for life

Question 12

ASA Class I***

Answer 12

normal p, no systemic dz

ex: elective OHE
tests: PCV/TP Azo

Question 13

ASA Class II***

Answer 13

disease with minimal or no systemic effects

ex: fracture
tests: CBC, chem, UA, rads

Question 14

ASA Class III***

Answer 14

disease with significant systemic effects affecting anesthesia/sx. Not in critical state.

ex: anemia, liver dz
test: CBC, chen, UA, abdominal US

Question 15

ASA Class IV***

Answer 15

severe, potentially life threatening

ex: decompensated heart or renal failure
test: CBC, chem, UA, blood gas, imaging

Question 16

ASA Class V***

Answer 16

moribound, not expected to survive 24 hrs

ex: severe trauma, shock
test: CBC, chem, UA, blood gas, +/- imaging

Question 17

Pre-Op Tx/Stabilization

Answer 17

IV access
fluid therapy
oxygen
analgesia*

Question 18

what should be given pre-op for p with biliary obstruction

Answer 18

vitamin K (b/c can’t absorb fat soluble vitamins)

Question 19

what should be given pre-op for mast cell tumor?

Answer 19

anti-histamines in case of degranulation

Question 20

don’t take animals to surgery with less than what percent PCV?

Answer 20

20-25% (or if PCV has dropped >30%)

Question 21

Pre-op preparation

Answer 21

• Fasting: withhold morning meal, but be careful for hypoglycemic prone animals
• Peri-operative prophylactic abx: controversial; give >30mins but 24hrs after sx. Use abx effective against native flora (ie. cephazolin)

Question 22

intra-op considerations

Answer 22

positioning
anticipate special instrumentation, blood loss, sx time
sponge counts/hemostat counts
appropriate assistance

Question 23

post-op care

Answer 23

-EXAMINE patient!
ancillary monitoring (bloodwork, henodynamic factos, ECG, body weight, urine output, USG)
-analgesia
-protect wound
+/- abx, sedation, fluids, O2, ventilatory support, wound care

Question 24

Nutritional Support

Answer 24

• oral
• feeding tube (NE, esophageal, gastric, jejunal)
• PPN, TPN
• esp. important in cats due to hepatic lipidosis
• animals with illness will have higher energy requirements