Lecture 6: evaluation of the pre-op patient Flashcards
what is criteria for excellent prognosis
- Potential for complications is minimal
- High probability patient returns to normal after sx
what is criteria for good prognosis
- Some potential for complications
- High probability good outcome
what is criteria for fair prognosis
- Severe complications possible, but uncommon
- Recovery may be prolonged
- Patient may not return to normal pre-sx function
what is criteria for poor prognosis
- Underlying dz or surgery associated with many or severe complications
- Expect prolonged recovery
- Patient unlikely to return to pre-sx function
- Likelihood of death during or after procedure is high
what is criteria for guarded prognosis
outcome is unknown or uncertain
what is ASA status of I and what are some sx examples
healthy, no obvious dz
Ex: elective OVH, neuter
what is ASA status of II and some examples of sx
Healthy with localized or mild systemic disease
Ex: soft palate, patellar luxation
what is ASA status of III and some examples of sx
severe systemic disease
Ex: anemia, pneumonia
what is ASA status of IV and some examples of sx
severe systemic disease that can be life threatening
Ex: heart failure, renal failure, GDV
what is ASA status of V and what are some examples of sx
moribund, patient not expected to survive more than a few hours with or without sx
Ex: severe trauma, endotoxemia, shock
what lab tests will we be running prior to sx
- PCV
- TS
- Glucose
- Azo
what is PCV
estimate of RBC mass
what is TS
estimate of total protein- albumin, globulins via refractometry
what is normal PCV and TS for dogs
PCV: 35-55%
TS: 5.4-7.4 g/dl
what is normal PCV and TS for cats
PCV: 29-48%
TS: 6.6-8.4g/dl
what could it mean if PCV increased and TS normal
dehydration, splenic contraction, polycythemia,
what does it mean with increased PCV and TS
dehydration
what does it mean with increase PCV and decreased TS
Severe dehydration with protein loss
what is could it mean with normal or increased PCV with decrease TS
hemorrhage with splenic contraction, protein loss, decrease protein production (liver)
what could it mean with normal PCV and increased TS
anemia with dehydration, normal hydration, hyperproteinemia or hypoglobinemia
what does it mean with decreased PCV and normal TS
chronic RBC destruction, loss, reduced RBC production, anemia of chronic disease, bone marrow disorders
what does it mean with decreased PCV and Increased TS
anemia of chronic disease, lymphoproliferative disease
what is normal blood volume for dog and cat
dog: 90ml/kg
Cat: 70ml/kg
Why should you never bolus a maintenance fluid
potassium too high, will give potassium bolus
what scenarios do you want to give fresh whole blood, what is general dose and shock dose
anemia, hemorrhage, coagulopathies, shock
General dose: 10-22ml/kg
Shock dose: 22ml/kg/h
what scenarios do you give stored whole blood or packed RBCs
anemia, hemorrhage
what is formula for blood needed
BW (kg) X (desired PCV - recipient PCV)/ donor PCV X 90 (dogs) or X 70 (cats)
what does Azo measure
BUN
what could an increased azo mean
- Pre-renal- dehydration, shock
- Renal failure
- Post renal- obstruction
- Extra renal- recent meal, GI ulcer/bleed
what could decreased azo mean
- End stage liver dz
- Liver shunt
- Low protein diet
- Increased loss via PU/PD
parenteral feeding delivered via __ or __
jugular catheter or central line
what is included in parenteral feeding
glucose, amino acids, electrolytes, fats
what are the three check in points for sx
- Prior to ax
- Prior to incision
- Prior to recovery
define therapeutic abx
given to tx specific infection
define prophylactic abx
given before surgery to prevent infection
define nosocomial infection
healthcare associated infection, acquired during process of receiving care
Give examples when prophylactic antibiotics recommended
- Dirty or contaminated procedures- open fracture
- Clean- contaminated procedures- GIT or oral sx
- Implants, previous implants
- Pacemaker
- Clean procedures >90 minutes
what are some common pathogens associated with sx, typically from patient
- Staphylococcus pseudointermedius
- Staphylococcus aureus
- Enterobacteriae
- Enterococcus
- Pseudomonas
what bacterial spp is a specific concern due to high risk of resistance
staph spp
Skin and reconstructive sx: what bacteria and what abx
bacteria: staphylococcus
Abx: cefazolin
Head and neck surgery: what bacteria and abx
bacteria: staphylococcus, streptococcus, anaerobes
Abx: clindamycin or cefazolin
ortho elective procedures/closed fractures: what bacteria and abx
bacteria: staphylococcus
Abx: cefazolin
thoracic surgery: what bacteria and abx
bacteria: staphylococcus
Abx: cefazolin
abdominal sx what bacteria and abx
bacteria: staphylococcus
Abx: cefazolin
upper GI sx: what bacteria and abx
bacteria: gram + cocci, gram - enteric bacilli
Abx: cefazolin
hepatobillary sx: what bacteria and what abx
bacteria: clostridium gram - bacilli, anaerobes
Abx: cefoxitin
lower GI sx: what bacteria and what abx
bacteria: enterococci, gram negative bacilli anaerobes
Abx: cefoxitin
urogenital sx: what bacteria and what abx
bacteria: E. Coli, streptococcus, staphylococcus, anaerobes
Abx: ampicillin or cefazolin
when should abx be given before sx
30-60 minutes before incision
when should you redose antibiotics
every 2 half lives
what is half life for cefazolin
47 minutes
what is half life for ampicillin
48 minutes
what is half life for clindamycin
124-195 minutes
what is half life for cefoxitin
40-60 minutes
t or f: post-op antibiotics are effective
false- no proof
when should you d/c prophylactic abx given for surgery
within 24hrs
what 4 things does infection depends on
- # and virulence of pathogen
- Host defense
- Tissue damage
- Dead space
how do you reduce risk of SSI
- Minimize dead space, necrotic tissue, and contamination
- Copious lavage
- Aseptic technique
- Appropriate timing of prophylactic abx
what are some signs of SSI
pain, swelling, redness, heat, discharge
how do you dx SSI
culture, cytology
what abx class is commonly given for skin SSI
cephalosorins
what bacteria should you target for GI SSI
gram - rods
