Lecture 2 Flashcards
What is the Goldman’s Criteria
criteria used to determine cardiac risk in non-cardiac procedures
What does the Goldman’s Criteria include
Evidence of CHF on exam (JVD, S3) decompensated
MI = 6 mo
Class IV (>25 points) 22% risk
Pulmonary Risks include
obesity, advanced age, smoking
Cardiac Risks include
previous MI CHF arrhythmia aortic stenosis >70 yrs old
Pt’s BUN and Cr are elevated. How damaged is the kidney?
at least 75-90% compromised
Child’s Classification
risk of mortality in a patient with cirrhosis who undergoes non-cardiac surgery
What does Child’s Classification measure
"A BEAN" ascites bilirubin encephalopathy Albumin nutritional status
Class C–> 50% mortality
Hepatic Dysfunction: failure to clear ammonia
> 150 ng/dl –> 80% mortality
albumin <2.0
Hemostatic risk is best determined by
HISTORY
Shock
condition of cellular metabolic dysfunction secondary to inadequate oxygen delivery resulting from diminished tissue perfusion
neurogenic shock
result of spinal injury–> results in bradycardia
Goal BP in shock resuscitation
> 90 mm Hg SYSTOLIC
How much urine output is acceptable?
1/2 cc/kg/hr
When should you expect a post op patient to start producing full amounts of urine
Post-Op day 3
Normal Saline
154 meq Na + 154 meq Cl
too much can lead to acidosis
Lactate Ringer
130 meq Na + 110 meq Cl + 28 meq lactate + 4 meq K + 3 meq Ca
too much can lead to alkalosis
hypotonic solution
77 meq Na + 77 meq Cl
good for maintenance hydration
How much IV fluid to give (maintenance)
100/50/20 (24 hour period)
100 ml/ kg for 1st 10 kg
50 ml/ kg for next 10 kg
20 ml/ kg for remaining kg
How do you evaluate fluid status?
URINE OUTPUT BP HR ins/outs daily weight elevated Hct/Cr pt complains of thirst
which is the first pulse lost w/ hypovolemic patient?
radial pulse
