Pre-admission Testing Flashcards
Pre-admission Testing (PAT) involves ?
stratify risk
direct anesthetic choices
guide postoperative management
often are obtained because of protocol rather than medical necessity
PAT: making decisions base on ?
Clinical history
Comorbidities
Physical examination findings
PAT: labs to run ?
CXR
ECG PT/PTT/INR
CBC/ H&H
BMP
Hgb A1C
Urinalysis
Urine HCG
Type and screen
PAT: quote ?
“these tests often do not change perioperative management, may lead to follow-up testing with results that are often normal, and can unnecessarily delay surgery, all of which increase the cost of care. An extensive systematic review concluded that there was no evidence to support routine preoperative testing.”
CXR indications acute ?
Acute Cardiopulmonary Findings on History or Physical Exam
CXR indications chronic ?
Chronic cardiopulmonary disease in the elderly (>age 70), previous chest radiograph within 6 months not available.
No CXR is ?
Patient is <70 yo and without history or physical findings of cardiopulmonary disease
EKG for patients with ?
Pts with active cardiovascular s/s should undergo ECG
The most widely accepted guideline in the United States advocates against ECG in patients undergoing ?
low-risk surgery.
Risk of cardiac death and nonfatal MI for noncardiac surgical procedures: High risk (>5%) ?
aortic and major vascular surgery, peripheral vascular surgery
Risk of cardiac death and nonfatal MI for noncardiac surgical procedures: Intermediate risk (1-5%) ?
Intraperitoneal or intrathoracic surgery,
carotid endardectomy
head and neck surgery
ortho surgery
prostate surgery
Risk of cardiac death and nonfatal MI for noncardiac surgical procedures: low risk (<1%)
ambulatory surgery
breast surgery endoscopic surgery
superficial procedures
cataract surgery
Revised cardiac index: RF ?
cerebrovascular disease
CHF
Cr > 2.0
DM requiring Insulin
ischemic cardiac disease
Suprainguinal vascular surgery.intrathoracici surgery, intra-abd. surgery
Revised cardiac index: RF points ?
1 point for each
RCI: Risk factors of a major cardiac event - 0 points ?
0.4 % risk
RCI: Risk factors of a major cardiac event - 1 points ?
0.9 % risk
RCI: Risk factors of a major cardiac event - 2 points ?
6.6 % risk
RCI: Risk factors of a major cardiac event - >3 points ?
> 11 % risk
PAT: UA ?
Routine urinalysis is not recommended in asymptomatic patients except in those undergoing surgical implantation of foreign material (e.g., prosthetic joint, heart valve) or invasive urologic procedures.
Electrolytes and Cr testing: Compelling historical findings
?
hypertension,
heart failure,
chronic kidney disease,
complicated diabetes mellitus,
liver disease
Serum creatinine and BUN on pts >40 yo?
Electrolytes and Cr testing: Certain medications ?
diuretics,
angiotensin-converting enzyme inhibitors,
angiotensin receptor blockers,
nonsteroidal anti-inflammatory drugs,
digoxin
Serum creatinine and BUN on pts >40 yo?
PAT: Diabetes Testing ?
Hgb A1C
Random Glucose
BMP
In patients with known diabetes, the preoperative ___ value is more likely to be useful if results would change perioperative management
A1C
Preoperative _______ _________ measurement could be considered in patients at very high risk of undiagnosed diabetes on the basis of history, examination, or use of certain medications (e.g., glucocorticoids), and in patients with signs or symptoms of undiagnosed diabetes.
random glucose
PAT: CBC/H and H indications testing ?
Increased pretest probability of diagnosing anemia (e.g., a chronic inflammatory condition, chronic kidney disease, chronic liver disease, clinical signs or symptoms of anemia)
Procedures in which significant blood loss is anticipated
Consider ordering a type and cross in preparation for a procedure with anticipated blood loss
PAT: PT/INR, PTT. Plt testing goal ?
Goal is to unmask underlying bleeding disorder
PAT: PT/INR, PTT. Plt testing indications ?
Should be reserved for patients with medical conditions associated with impaired hemostasis (e.g., liver disease, diseases of hematopoiesis), patients taking anticoagulants
PAT: PT/INR, PTT. Plt testing indications cont.. ?
Also patients whose history or examination findings suggest an underlying coagulation disorder (e.g., history of spontaneous bruising or excessive surgical bleeding, family history of a known heritable coagulopathy)
______ ________ should be obtained from all surgical patients, and appropriate coagulation testing should be considered if the history is abnormal.
Bleeding history
