Pre and Perioperative Eval of Patient Flashcards
What pre-operative labs are indicated for treatment of the patient?
- CBC, Basic Metabolic Panel, Urinalysis, Coagulation Studies (PT, PTT, INR), pregnancy screening where appropriate
- Chest X-Ray
- Electrocardiogram
What needs to be considered in the cardiopulmonary eval of a preoperative patient?
o Cardiopulmonary Evaluation: • Age • Male • Heredity • Tobacco abuse • Obesity • DM • HTN • Hyperlipidemia • Sedentary lifestyle • Stress
patients without significant medical problems, especially those under 50, are a very low chance for…
perioperative complications.
what are the two most important cardiac complications to screen for prior to surgery?
MI and cardiac death are MOST important
however, also ask about CHF, LV dysfunction, arryhthmias, and unstable angina.
What does the RCRI help to evaluate for?
pre-op cardiac risk assessment
should emergency surgery be delayed because of cardiac problems in the patient?
NO
who should get a resting EKG?
A resting EKG should be obtained in patients with at least one RCRI predictor prior to major surgery.
When do you need to consider stopping surgery or continuing surgery in regard to cardiac problems?
If there is a known valve correction surgery, it should be done FIRST before other elective surgery. Surgery should consider being delayed in severe hypotension, but not in mild to moderate. Drugs can be taken day of. Diuretics and ACEIs should probably be stopped due to increased risk of hypotension and hypovolemia and electrolyte disorders.
What is the ASA score?
surgery score that correlates with the potential for death in the patient. •
ASA Score
o 1 through 5 with an E added for emergency surgery
o 1=Healthy
o 5=Moribund—Not expected to survive with or without the surgery
o Postoperative mortality correlates with this score.
What is the appropriate urine output for an adult? child? on average it should be no less than..?
.5-1 ml/kg/hr, 1 ml/kg/hr, 30 ml/kg/hr…
These all came from 3 different lectures and sources.
What do you need to consider for the fluid status?
Get a preoperative Hgb, they need to be NPO for AT LEAST 6 HOURS!, bowel prep may be necessary
What are three ways to monitor fluid status?
o Triple lumen catheter—Central venous pressure. Usually less than 8 you want to give more fluid. 8-12 is normal.
o Swan-Ganz catheter—Pulmonary capillary wedge pressure
o Arterial line—Blood pressure (usually go through radial artery)
What are some ways to reduce infections?
Reducing Infections: o Preoperative antibiotics o Hair removal o Preoperative shower with chlorhexadine soap o Preoperative bowel prep o Good sterile technique o Patients immune system
How are wounds categorized based on infection status?
I. Clean:
- Uninfected, no inflammation
- Resp, GI, GU tracts not entered
- Closed primarily
Examples: Ex lap, mastectomy, neck dissection, thyroid, vascular, hernia, splenectomy
II. Clean-contaminated:
- Resp, GI, GU tracts entered, controlled
- No unusual contamination
Examples: Chole, SBR, Whipple, liver txp, gastric surgery, bronch, colon surgery
III: Contaminated:
- Open, fresh, accidental wounds
- Major break in sterile technique
- Gross Spillage from GI tract
- Acute nonpurulent inflammation
Examples: Inflamed appy, bile spillage in chole, diverticulitis, Rectal surgery, penetrating wounds
IV: Dirty:
- Old traumatic wounds, devitalized tissue
- Existing infection or perforation
- Organisms present BEFORE procedure
Examples: Abscess I&D, perforated bowel, peritonitis, wound debridement, positive cultures pre-op
How can hemodynamics be assessed on a physical exam? What can you LOOK AT?
Fluid status can be assessed by looking at • Blood pressure • Heart rate • Intake and Output • Mental status • Skin perfusion • CVP • Weight
