Patient Evaluation, Prep & Checklists Flashcards
What is perioperative medicine? What is the purpose of pre-anesthetic assessment?
medical care of patients from the time of contemplation of surgery through the operative period to full recovery, excluding the operation or procedure itself
- determine medical status of the patient and develop a plan
- prepare the patient for anesthesia, surgery, and recovery
- deliver optimal pre, intra, and post-operative care
What is adequate screening for a supposedly healthy patient?
individualized based on PE and Hx - UA, USG, CBC, TP, thoracic rads
SCREEN FOR UNDERLYING DISEASE that may impact peri-operative anesthetic care
Why is it important to assess already known disorders prior to anesthesia?
optimizes patient health prior procedure while determining timing and type of procedure
How can specific plans and alternatives be used during anesthesia?
- drug selection, doses, timing
- different types of anesthesia and analgesia
- support care: fluids, blood products, BP support, ventilatory support, pain management, team support
What should be included in a general pre-anesthesia workup checklist?
- medical record has been reviewed along with past anesthesia records (ET tube size, meds used)
- client interviewed and patient PE
- pertinent tests and consulations have been performed and results reviewed
- list aspects of patient physical condition that impact peri-operative risk and management
- review current medications and confirm appropriate pre-anesthetics
- confirm surgical procedure and related risks
- client has been informed consent and resuscitation status is noted
What questions should be asked to the client to gain a detailed history prior to anesthesia?
- When did the pet last eat and drink?
- How much exercise daily and exercise tolerance?
- Current medications (including herbals)? When were they last administered?
- Any prescriptions not being administered?
- Changes in appetite?
- Recent weight loss?
- Increase in drinking, urinating, or both?
- Vomiting, diarrhea, or other GI signs?
- Decreases in energy level, mobility, or movement?
- Coughing, open-mouth breathing?
- Recent behavior changes?
- Skin disease or allergies?
- Past medical, surgery, or anesthesia issues?
What 3 things are important to confirm with the clients prior to anesthesia?
- client has signed consent for anesthesia and surgery
- client has indicated CPR vs DNR status
- client and clinic have agreed on fees/estimate/deposit
What are the most important aspects of a pre-operative physical exam?
- cardiovascular and respiratory system exam*
- hepatic, renal, and neurological systems evaluated
- behavioral (stress, anxiety)
- body condition scoring and accurate body weight
What is false confidence?
disconnect between reality and the conditions, not knowing what you don’t know
unacceptable practices have become acceptable - only pressure checking anesthesia machine once a day (when it should be done for every patient) because there has never been a problem before
What are 3 major reasons for using checklists?
- anesthesia-related safety incidents are documented in 4% of veterinary patients
- removes hierarchy where the entire team has an equal role is patient safety and any team member can veto
- organizes essential steps and creates structure in a chaotic and stressful environment
What is the 6 step sequence of a basic “to-do” list before every anesthetic or sedation event?
- patient history
- client communication
- physical exam by DVM
- patient prep - labs, enemas
- equipment preparation
- team communication and preparation
Why should a limb or area of surgery always be marked prior to anesthesia?
confirm correct limb or area is being prepared for surgery
unmarked = no anesthesia
Why are serial workups important in patients with pre-existing conditions?
can make note of any trends or concerns
- echo every 6 months
- chronically elevated liver enzymes
What are the 5 stages of ASA status?
ASA 1 - normal healthy patient with minimal risk (elective spay/neuter)
ASA 2 - patient with mild systemic disease (neonatal, geriatric, obese, mild dehydration)
ASA 3 - patient with severe systemic disease (anemia, moderal dehydration, renal disease, liver disease)
ASA 4 - patient with severe systemic disease that is a constant threat to life (ruptured bladder, hemoabdomen, pneumothorax, pyometra)
ASA 5 - patient that is not expected to survive without surgery (head trauma, GDV, end-stage organ failure)
What are the important stages in the drug safety checklist?
- calculating drug dose while confirming drug selection, mg vs mcg, concentration
- draw up drugs, wipe vial with alcohol, use appropriate sized syringe
- administer drugs with verbal confirmation of drug, dose, route, and patient (do not use unlabeled syringes)
