Pre-op Assessment Flashcards
1
Q
Outline the elements assessed in an elective surgery pre-op assessment.
A
- Hx: co-morbid conditions, prev. surgery, tooth extractions, diabetes, hypertension, etc.
- social Hx: religion, cultural practices
- current Rx and known allergies
- O/E: pallor, dehydration, prev. surgical scars, petachiae, purpura
- FBC, U&Es, LFTs, etc.
2
Q
What are the different elements of the pre-op haematological assessment?
A
- Hb = ?anaemia
- platelet count = ?thrombocytopenia (hypersplenism, drugs, ITP, repeat and run full clotting screen)
- Hx = unusual/peri-op bleeding, post-partum haemorrhage, post-op haemorrhage, easy bruising, menorrhagia
- FHx = bleeding disorders
- antithrombotic medication
- ?neutropenia/philia
- Group & Save = confirm patient’s blood group and RBC antibodies
- Group & Crossmatch = mix patient sample with stock sample to ensure compatibility (note: for high risk surgery)
3
Q
What are the elements of emergency pre-op assessment?
A
- Hb < 100g/l = group and crossmatch +/- transfuse packed RBCs
- active haemorrhage = secure haemostasis
- haematinic deficiency = investigate and treat post-op
4
Q
What are the elements of a coagulation screen?
A
PT, APTT, TT, fibrinogen
- Hx of unusual bleeding
- post-op/dental extraction bleeding
- unexplained persistent menorrhagia
- FHx of bleeding disorder
- unexplained thrombocytopenia
- emergency op
- severe sepsis
5
Q
When is stopping anticoagulation pre-op required?
A
Not required: dental extraction, cataract surgery, minor skin procedures
Required:
- 5-6 days for INR < 1.5
- aspirin only: stop temporarily in high risk bleeding procedures
- clopidogrel only: ?pre-op suspension
- aspirin & clopidogrel: consult relevant specialty
6
Q
When is post-op thromboprophylaxis required?
A
PATIENT:
- age
- BMI
- Hx/FHx of VTE, thrombophilia
PROCEDURE:
- orthopaedic op.
- plaster cast immobilisation
- spinal surgery
- pelvic op.
- prolonged anaesthesia
- op. for malignancy
