Pre-Op Care w/Existing Comp

Question 1

Extend your pre-operative evaluation to encompass patients with the following conditions:
•	Diabetes
•	Cardiac Disease
•	Renal Failure 
•	Pulmonary Disease
•	Adrenal Insufficiency
•	Pregnancy

Answer 1

k

Question 2

Create a plan for the pre- and post-operative management of patients with the conditions listed above.

Answer 2

k

Question 3

Given a specific patient scenario, summarize the risk factors that would alert you to any of the conditions listed previously.

Answer 3

k

Question 4

Compare and contrast the special needs of a geriatric patient versus a normal adult patient.

Answer 4

k

Question 5

What is the risk benefit assessment?

Answer 5

Is the potential gain from surgery worth the risk?

If surgery indicated, how to best optimize the patients chances of a good out come?

Question 6

What is the overall risk of major/fatal CV post operative complication in someone >40yrs?

Answer 6

5.8% (1977)

Question 7

What portion of CV complications are MIs? What is the mortality?

Answer 7

5-10%

mortality= 32-69%

Question 8

What are the risk classifications for CV procedures along with their risk of incident?

Answer 8

high (>5%)
Intermediate (1-5%)
low (<1%)

Question 9

What operations are considered high CV risk?

Answer 9

aortic or other major vasculatory surgery, peripheral, vascular surgery

Question 10

What operations are considered intermediate CV risk?

Answer 10

intraperitoneal and intrathoracic surgery, carotid enderterectomy, head and neck surgery, orthopedic surgery and prostate surgery

Question 11

What operations are considered low CV risk?

Answer 11

endoscopic procedures, superficial procedures, cataract surgery, breast surgery, ambulatory surgery

Question 12

What are types of risk assessment models?

Answer 12

Revised cardiac risk index (RCRI)

National Surgical Quality Improvement Program (NSQIP)

Question 13

What are the NSQIP and RCRI used for?

Answer 13

contain algorithms to dictate further investigations

Question 14

What goes into the work up for assessing a CV patient?

Answer 14

H&P: history of heart problems or DM and functional capacity meds
PE:BMI, Pulse, BP, Heart, lung, ab and lower extremity exams

Question 15

Cardiac patient post op:

Answer 15

discontinue cardiac meds (except BB and Statins)
restart the meds gradually
restart anti coags ASAP
hemodynamic control, fluid management

Question 16

What is the management for an MI?

Answer 16

DX: 2/3(symptoms, EKG, cardiac enzymes)

tx: OH BATMAN, MONAB, etc
oxygen, heparin, BB, statins, morphine, asprin, Nitroglycerin
potential angiography, revascularization if STEMI

Question 17

What is the complication rate amoung all procedures for the development of pulmonary disease?

Answer 17

6.8%

Question 18

I will finish this later

Answer 18

kk