Pre-op assessment pearls Flashcards
Pneumonic for standard preop questions
AMPLE
What does A stand for?
A = allergies and anesthesia history
What does the M stand for?
M = Medical history and meds
- include diagnosis
- include meds they are currently taking (what did they continue to take today and what did they hold, for how long?)
What does the P stand for?
P = previous surgeries
- more past anesthesia
- FHx of anesthesia problems
- PONV in the PACU last time?
- precipitating factors for PONV (female, non-smoker, hx of motion sickness etc)
What does the L stand for?
L = last meal eaten
- What was it? clear liquids or a full meal
What does the E stand for?
E = Events leading up to or causing need for this surgery
- have they been in pain for a while?
- are they on meds for this specifically
- Questions speicifc to surgery: i.e. for knee surgery what is the baseline so we know if something went wrong, or tumor in throat = difficult airway?
Questions to ask for anesthesia history
- Why are you having the procedure done?: s/s causing to have this done
- Problems with anesthesia in the past
- Trouble waking up?
- PONV?
- have you had an epidural or spinal before (if you are doing one):
- FHx of anesthesia problems (what happened?)
- Consider if the age is normal for this procedure - this can give you insight to their general health
What are the two biggest systems we need to get a good picture on for anesthesia?
Lungs and Heart
Questions to ask about heart stuffs
- CV disease? and history?
- if you have someone who doesn’t go to the Dr. always treat them like they have some underlying CV disease - especially with high risk categories (middle age man, smoker, drinker etc - i.e. NEED BASELINE EKG
- HTN? BP baselines?
- Are they seeing a cardiologist? do they have cardiac clearance
- have they ever been told something was wrong with his heart?
- MI in the past?
- CV surgery in the past?
- Can you lay flat without issue?
- Rheumatic fever? valve issues?
- can you do a fligth of stairs without resting, do house chores without resting? - helps us know their cardiac reserve
Questions to ask about the tennis courts lol
- breathing problems
- asthmatic? triggers? - and last attack and what they needed to break the attack
- NSAIDS (toradol) is contraindicated with severe asthmatics (remember - inhibits COX pathway so the body shifts to the Leukotriene pathway causing more severe s/s of ASA)
- COPD
- SOB with exercise
- smoke? MJ too?
- Vape? - vaping causes popcorn lung yuck
- URI (active or recent) is a huge flag for reacitve airway (bronchospasm and secretions - albuterol prior to sleep? or prior to waking up? pulm lavage?
- HF - can lead to pulm edema
- are they on steroids? - may need stress dose for chronic use
- Home O2? how many L? - goal is to try to get on same L prior to get to PACU (doesn’t always happen tho)
- OSA? (they rest in a hypoxic state = plum bronchoconstriction) be prepared with an oral airway
Questions to ask about renal
- any kidney problems?
- whats the creatnine and whats the baseline?
- dialysis? whats the last set of e-lytes keep an eye on K
- ## no toradol with renal pts - can put them into kidney failure (15mg for someone >60yo is plenty - avoid with >80yo)
Questions for liver
- Look for things like jaundice, hepatitis
- Liver disease?
- alcohol abuse? - extreme caution with OG tube for varicies (may want visual)
- Coag studies
Questions for neuro
- previous stroke?
- residuals? BL?
- seizure hx? meds? last dose? (may need it in the OR)
- triggers for sz?
Questions for GI?
- Heart burn?
- GERD?
- What have they had to eat or drink? coffee with cream is a big one that increases bile production
- hiatal hernia? more likely for reflux
Questions for endocrine
- Tyroid problems - meds
- DM: meds? when? insulin pump (stay on top of it - glucometer)
