Lec 16: Pre-op Patient Assessment and Prep SA Flashcards
what is a pre op assessment
PE followed by appropriate lab work
why do we perform a pre-op assessment
allows us to compare the animal’s status before and after sx
pre-op assessment consists of:
patient hx, PE, labs, associated underlying disease, patient stabilization
what kind of lab work should a young, healthy animal get undergoing an elective procedure?
“big 4” or “quats” at the minimum
what is the “big 4”
PCV, TP, BG, BUN
what kind of lab work should an animal older than 5-7 years OR having systemic signs (dyspnea, heart murmur, anemia, ruptured bladder, GDV, shock, hemorrhage) get?
minimum data base lab work
what is minimum data base lab work
CBC, Chem, UA
what can change in your sx plan when you have identified underlying disease in a patient?
pre op management, the surgical procedure, prognosis, post op care
if your sx patient has neoplasia, what do you want to look for & what additional diagnostics do you want to run before going to surgery?
we want to evaluate the patient for metastasis.
we can do this by thoracic radiographs, abdominal ultrasound, lymph node aspirate
if your sx patient has cardiac disease, what additional diagnostics do you want to run before going to surgery?
thoracic radiographs, cardiac ultrasound scan, electrocardiogram
if your sx patient has experienced trauma, what diagnostics do you want to do before going to surgery?
thoracic radiographs
(patient could have a diaphragmatic hernia, pneumothorax, pleural effusion, pulmonary contusions –> these all decrease the chances of doing well under anesthesia)
should you test for endemic disease?
yes! (ex: heartworm)
what ASA status?
healthy with no discernible disease
ex: elective procedure (OVH, neuter, declaw)
ASA I
what is the ASA status?
healthy with localized disease or mild systemic disease
ex: patellar luxation, skin tumor, cleft palate without aspiration pneumonia
ASA II
what ASA status?
severe systemic disease
(ex: pneumonia, fever, dehydration, heart murmur, anemia)
ASA III
what ASA status?
severe systemic disease that is life threatening
(ex: heart failure, renal failure, hepatic failure, hypovolemia, severe hemorrhage)
ASA IV
what ASA status?
moribund, patient not expected to live longer than 24 hours with or without surgery
(endotoxic shock, multiorgan failure, severe trauma)
ASA V
what does it mean if you add an E to your ASA status?
E indicates EMERGENCY surgery
the risk of the surgical procedure may…
outweigh its potential benefits
(ex: removal of an apparently benign skin mass may not be warranted in an animal with hepatic or renal dysfunction)
what important factor must be considered for veterinary patient’s undergoing surgery?
quality of life
what is the surgical prognosis?
potential for complications is minimal, high probability that patient will return to normal
Excellent
what is the surgical prognosis?
some potential for complications, high probability of a good outcome
Good
What kind of surgical prognosis:
serious complications are possible but uncommon, recovery may be prolonged, may not return to presurgical function
Fair surgical prognosis
what kind of surgical prognosis?
many and/or severe complications, recovery expected but PROLONGED, likelihood of death during or after procedure is high, unlikely to return to presurgical function
Poor surgical prognosis
what is the surgical prognosis?
when the outcome is highly variable or unknown
Guarded
what should owners be informed of before surgery via client communication?
diagnosis, surgical and non surgical options, potential complications, post op care, prognosis, cost
what are a couple important things to keep in mind about cost when discussing with owners?
- cost cannot always be predicted due to unanticipated complications
- owners should be kept informed of animal’s status and of procedures that may affect the initial cost estimate
if the disease is hereditary than what should you reccomend?
neutering the patient