L1: Pre-Operative Care Flashcards
Factors affecting the extent of pre-op preparation
The rationale (purpose) for pre-op preparation
Classification of surgery
Items of assessment of fitness for surgery
Items of preoperative assessment
Preassessment clinic
- It aims to assess surgical patients with …….. preadmission for elective surgery.
- Preassessmen is timed so that the gap between assessment and surgery is: …….
Principles of Preoperative history taking
Surgical Hx & Main Complaint in Surgical Hx
Drug Hx & Surgical Hx
Social Hx in Surgical Hx
Family Hx in Surgical Hx
Tips for Physical Examination in POC
Types of Ex in POC
Emergency Physical Ex in POC
When to perform a clinical investigation?
(POC)
Consideration When deciding on appropriate investigations in POC
When to order CBC before Surgery?
When to order S.Creatinine & Electrolytes before Surgery?
When to order Blood Glucose before Surgery?
When to order ECG before Surgery?
When to order X-ray Chest before Surgery?
When to order Coagulation studies before Surgery?
When to perform a preoperative amylase & its value?
Cross studies (POC)
ECG in POC
Other Investigations in POC
When Is Chest Radiograph required in POC?
When are Specialized Cardiac investigations required in POC?
when are Specialized Respiratory investigations required in POC?
Deciding To operate
Preoperative Consent & Counselling
It is important to recognize that all patients are different - in their ages, in their beliefs and in their worries.
Presenting information to patients
Preoperative Consent & Counselling
Obtaining Consent
Preoperative Consent & Counselling
Patient Identification
Identification & Documentation
Documentation
Identification & Documentation
Medical documents (medical notes, drug and fluid charts, consent forms and operation notes) are ……. documents.
- All entries to the notes should be written clearly and legibly. Always write the date and time and your name and position at the beginning of each entry.
From a medicolegal point of view, if it is not documented then ……..
Optimizing the patient’s condition gives them the best possible chance of a good surgical outcome.
Patients Optimization Recommendations
It is essential that the acutely ill surgical patient is adequately ………. before theatre.
resuscitated and stabilized
- In extreme and life-threatening conditions this may not be possible (e.g., ruptured abdominal aortic aneurysm or AAA, trauma) and resuscitation ……. definitive treatment.
should not delay
Most emergency patients fall into one of two categories →
hemorrhage or sepsis.
what are The general principles of resuscitation?
Correction of Dehydration
POC
Dialysis for severe renal impairment before theatre
Dehydrated patients may exhibit ……. drops in blood pressure on anesthetic induction and aggressive preoperative fluid management is often required.
Anemia Correction
POC
Pain TTT
POC
Antibiotics
POC
Stomach Decompression
POC
Def of Prophylaxis
Stopping smoking ….. respiratory function even if the patient can only stop for ……
improves, 24 hours.
Stopping medications (e.g., the oral contraceptive pill for a ……., aspirin or clopidogrel for ……. before surgery) to avoid risk of …….
month, two week, DVT
Drugs Gives in POC
Preoperative Marking
Preoperative marking is Important especially when …..
what are Two main prognostic scoring systems which are in current use?
Characters of ASA System
ASA system
APACHE II System
APACHE III System
DVT is common in surgical patients → Can cause ……
pulmonary edema with high mortality.
Risk factor for DVT
Thromboembolic Prophylaxis
what does antibiotic prophylaxis depend on?
Antibiotics according to Classes of operative procedure
Classes of operative procedure
Recommendations
Preoperative Managment of DM
Reasons for good glycemic control
Preoperative Managment of DM
pre-operative precautions in patients with diabetes
Management of type one diabetes mellitus
Preoperative Managment of DM
Management of type two DM
Oral Hypoglycemic Drugs
Preoperative Managment of DM
what to do if
- A patient who has a surgery has acute hepatitis?
what to do if
- A patient who has a surgery has chronic hepatitis?
what to do if
- A patient who has a surgery has obstructive jaundice?
Child’s classification of the severity of chronic liver disease
Pugh’s modification replaces nutrition with prothrombin time.
Risk factors for preoperative bleeding
Hx of Coagulapathy
(POC)
Investigations for Coagulapathy
(POC)
What causes elevated PT?
What causes elevated APTT?
What causes elevated Both PT & APTT?
Managment of severe clotting deficiency
POC
Managment of Low platelet count or abnormal platelets
POC
How to Manage patient on heparin reoperatively?
Nutritional Assessment
POC
Preoperative Considerations in IHD
..
problems of pacemakers and implanted ventricular defibrillators during the surgical period
What are intraoperative precautions regarding pacemakers and implanted ventricular defibrillators?
considerations according to drugs in pre-operative care
Complications of steroid therapy perioperatively
Management of patients on pre-op steroid therapy
MOA of Warfarin
Antidote of Warfarin
Surgical Consideration of Warfarin
Example of Antiplatelet agents
MOA of Antiplatelet agents
Usage of Antiplatelet agents
Surgical Consideration of Antiplatelet agents
Done
