Lecture 1: DONT STUDY

Question 1

What parts of the PMH are important for surgery and should be asked?

Answer 1

Anesthesia complications
Cognitive impairments
Female –> pregnant?

Question 2

If a 40 y/o woman, who is occasionally still having periods, is coming in for pre-op screening, does she need a pregnancy test?

What is the preferred pregnancy test?

Answer 2

YES, if a women cant be confirmed as post menopausal, you must r/o pregnancy

Beta HCG (serum quantitative)

Question 3

For pre-op surgical patients what items should you ask the patient to remove prior to surgery?

Answer 3

1. Contacts
2. Hearing aids
3. Loose teeth (in case intubate)
4. Piercings

Question 4

What medications are important to ask about for surgical patients?

Answer 4

1. Anticoags
2. ASA
3. NSAIDs (kidney fx)
4. Steroids (adrenal insuff)
5. Herbals/OTC

Question 5

How do you distinguish b/t an SE and a true allergy?

Answer 5

Ask the patient what the rxn is.

Allergy: hives, rash, itching, airway compromise, swollen face, HoTN, skin sloughing

Question 6

What skin rxn does Vancomycin cause and why?

Answer 6

Red-Man Syndrome, infusion rate too fast

Question 7

If someone has a egg or soy allergy what drug should they not be given? What about shellfish allergies?

Answer 7

Egg, soy - no propofol

Shellfish - no iodine

Question 8

What is the pneumonic for the components of Admit Orders?

Answer 8

ADC A VANDIMLS

Question 9

What does the C in ADC A VANDIMALS stand for, and what the 4 categories of it?

Answer 9

Condition

1. Good
2. Fair
3. Serious
4. Critical

Question 10

What is POD #0?

Answer 10

The day of surgery

Question 11

When writing a SOAP note what should be done for ABXs?

Answer 11

Include how many days on ABX and expected end day

Ex: Levaquin #2/8

Question 12

Reasonable alternatives, who is performing, risks & freq, benefits, probability of success, Expected post-op course, and comprehension are all components of _______.

Answer 12

Informed Consent

Question 13

When is informed consent required (other than surgery)?

Answer 13

Anesthesia, conscious sedation, PICC/central lines, bronchoscopy, chest tube, IR, LP

BLOOD PRODUCTS (every time they’re given)

Question 14

Identifying the correct pt/side, plan for procedure, equipment needed, explain positioning/monitoring, and verifying consent obtained are all components of a _________.

Answer 14

Procedural Time-out

Question 15

When is a witness required for informed consent?

Answer 15

ALWAYS - doesn’t matter what mode used to obtain consent

Question 16

When would you want to consider a competency evaluation?

Answer 16

1. AMS
2. Pt refuses a recommended Tx
3. Hasty decision making

Question 17

Who is the first person to give consent for a patient who is incompetent?

Answer 17

Health Care Proxy

Question 18

What is required if an unconscious man is brought to the ER w/out identification or family/friends but needs surgery?

Answer 18

Two-physician consent

Question 19

What 4 circumstances must be met to treat a patient using emergency consent?

Answer 19

1. Pt incapable of making decision
2. Tx = emergency in nature
3. Another person legally able to give consent not immed available
4. Physician determines pt has substantial risk of death/harm if delay Tx