OnlineMedEd: Surgery: General - "Preop Evaluation"

Question 1

For elective surgery, it’s recommended to wait at least ________________ after an MI.

Answer 1

6 months

However, it is still 6% chance of death at 6 months!

Question 2

What ejection fraction is considered safe for surgery?

Answer 2

Above 35%

Someone with an EF less than 35% who is volume-overloaded has a 75% chance of dying in the surgery.

Question 3

The ____________ index predicts likelihood of surgicla complication.

Answer 3

Goldman

Question 4

What are some of the big ticket (i.e., high point) items on the Goldman index?

Answer 4

• JVD (EF less than 35%)

* Recent MI (less than 6 months)

Question 5

In a patient with heart disease, what workup do you need to do prior to surgery?

Answer 5

• ECG
• Echo
• Stress test

Question 6

You need to ensure what two pulmonary variables in the preop evaluation of someone with lung disease?

Answer 6

• Oxygenation ability
• CO2 level

CO2 level is the more important variable (as a surrogate for ventilation), because O2 can be corrected by increasing FiO2 in the OR. High levels of CO2 cannot be corrected and may lead to dangerous pH imbalances.

Question 7

What patients often require pulmonary evaluations prior to surgery?

Answer 7

• COPD
• Asthma
• DPLD

Question 8

_______________ are usually done for preop pulmonary evaluations.

Answer 8

PFTs and ABG

Question 9

What pulmonary treatments can be given to someone with pulmonary disease?

Answer 9

• O2
• Smoking cessation for at least 8 weeks prior to surgery
• Bronchodilators

Question 10

What two scores are often done to evaluate someone with liver disease preoperatively?

Answer 10

• MELD

* Childs-Pugh (A = good, B = medium, C = severe disease)

Question 11

Review the five factors that you need to assess in a patient with liver disease prior to elective surgery.

Answer 11

• Albumin
• PT/PTT
• Total bilirubin
• Ascites
• Encephalopathy

Any one of these makes surgical mortality 40%. All five makes it 100%.

Question 12

These tests can help evaluate the ability of skin to heal: ____________________.

Answer 12

• Albumin (less than 3 is bad)
• Skin anergy (not reacting to antigens is bad)
• Loss of greater than 20 pounds in the last three months
• Prealbumin low
• CRP high

All of these indicate low-protein states.

Question 13

Why do you check glucose in diabetics prior to surgery?

Answer 13

DKA or dehydration are potentially lethal in surgery.