Pre-op Assessment Exam 1 Flashcards
What is the (metric) formula for BMI?
BMI = kg / m²
What are the BMI parameters for underweight, normal, overweight, and obese?
- BMI < 18.5 = underweight
- BMI 18.5-24.9 = normal
- BMI 25-29.9 = overweight
- BMI > 30 = obese
What is the (imperial) formula for BMI?
(703 x lbs.) / (inches²)
What mnemonic guides an emergent physical examination?
AMPLE
- Allergies
- Medications
- Past medical history
- Last meal
- Events leading up to need for surgery
What does the airway examination include?
- Mallampati class
- inter-incisors gap
- thyromental distance
- forward movement of mandible
- Range of cervical spine motion: flexion and extension
- Document loose or chipped teeth, tracheal deviation
What is the revised cardiac risk index?
Prediction tool recommended by ACC/AHA
Estimates risk of cardiac complications after surgery
What factors are worth 1 point on the Revised Cardiac Risk Index? (6)
- High risk surgery
- Ischemic heart disease
- Hx. of CHF
- Hx. of CVA
- DM w/ insulin
- Creatinine > 2 mg/dL
What surgeries have the highest risk (>5%)?
Aortic and major vascular
peripheral vascular
What are intermediate risk surgeries? (1-5% risk)
- intrathoracic and intraabdominal
- head and neck
- carotid endarterectomy
What sort of risk would be seen on the Revised Cardiac Risk Index with a score of 0?
What about with a score of 3 or greater?
0 = 0.4% risk for major cardiac events
1= 1%
2 = 2.4%
3 = 5.4% risk for major cardiac events
*A score equal or greater than 2 is elevated risk
What are METs? What is one MET equal to?
Metabolic Equivalent of Tasks (measurement of rate of energy consumption).
Poor functional capacity = increased perioperative risk
1 MET = 3.5 mL (O2)/kg/min
How would one assess functional capacity? What is the range of this assessment?
Through METs
1 MET = eating, working at computer, etc
5 MET = climbing 1 flight of stairs, dancing, or bicycling
12 MET = running rapidly for long distances
What are the three levels of urgency of surgery? Time Frames?
Emergent - Life or limb threatened, sx needed within 6 hours, no cardiac pre-op necessary.
Urgent - Life or limb threatened, sx needed within 6-24 hours.
Time-sensitive - delays exceeding 1-6 weeks would adversely affect patient.
What ASA level would an otherwise healthy 22-year-old who got in a car wreck with massive trauma necessitating emergent surgery have?
ASA V (won’t live without sx)
AAA, MODS, ischemic bowel, CVA hemorrhage
What ASA level would a healthy non-smoking 27-year-old with well-controlled diabetes have coming in for an EGD?
ASA II (mild disease, well-controlled)
pregnancy, obesity, mild disease
What ASA level would a 56-year-old male who had an MI 2 months ago have for his follow up TEE today?
ASA IV (severe systemic disease CONSTANT threat to life)
Recent (<3 months), active cardiovascular disease, coagulopathy, renal failure, sepsis, etc.
What ASA level would a 12 year old girl with no hx have coming in for a routine tonsillectomy?
ASA I (no hx, healthy, routine sx)
What ASA level would a 42 year old male with COPD and poorly controlled DM have?
ASA III (severe systemic disease, no threat to life)
What is an ASA VI score?
Declared brain-dead patient, TOSA evaluation
What is the most common anaphylactic drug allergy? What are other common causes of anaphylaxis?
NMBs (most common)
Antibiotics (most common)
chlorhexidine (most common)
latex
opioids
what food allergies cross react with latex allergy?
- mango
- kiwi
- avocado
- passion fruit
- bananas
- chestnuts
What antibiotics are most commonly associated with allergic reactions?
PCN and cephalosporins
Vancomycin (allergy vs red man syndrome)
What conditions would prompt you to order coagulation studies?
- coagulopathy
- bleeding disorder
- hepatic disease
- anticoagulant use
- ASA 3-4; undergoing intermediate-major risk surgery
What cross-reactivity allergies are possible for someone who has a known neuromuscular blocking agent allergy?
Neostigmine & Morphine
