Pre-op eval Flashcards
1
Q
Risk assessment- ASA 1
A
Normal, healthy patient
- Excludes very young and old
- No organic, psych, or physic disturbance`
2
Q
Risk assessment- ASA 2
A
- Mild systemic disease
- No fxn limits
- Well controlled one system disease
- No COPD, peripheral neuropathy
- Pregnancy
3
Q
Risk assessment- ASA 3
A
- Severe systemic disease
- No immediate danger of death
- CHF, angina, MI
- Poorly controlled HTN, renal failure
- Obesity
4
Q
Risk assessment- ASA 4
A
- Severe systemic disease that is constant life threat
- Poorly controlled or at end stage
5
Q
Risk assessment- ASA 5
A
- Not expected to survive w/o operation, >24 hrs
- Imminent death
- Sepsis, hypothermia
6
Q
Risk assessment- ASA 6
A
Brain death, organ donor
7
Q
Risk factors- CV
A
- Ischemic heart disease
- CHF
- Cerebrovasc disease
- High risk operation
- Perioperative insulin
- serum creatinine >2
- Stress testing for high risk
- Continue beta blockers
8
Q
Risk factors- Pulm
A
- Advanced age
- Elevated ASA class
- CHF
- COPD
- Malnutrition, alcohol, AMS
- Smoking
- Sleep apnea
9
Q
Risk factors- VTE
A
- Fam hx
- Malignancy
- obstetric complications
- Known procoagulants
- Prolonged operation
- Give LMWH
10
Q
Risk factors- DM
A
- Hyperglycemia > 140- sugical site infections
- Manage postop glucose
- ## Antihyperglycemic meds
11
Q
Risk factors- SSI
A
- Glycemic control
- Abx 1 hr prior
12
Q
Informed consent
A
- Indications of operations and outcome
- alternatives
- Nat hx with no intervention
13
Q
H and P
A
- HPI
- Sx acute infection or tumor
- Surg hx
- Med hx
- VTE events
- Bleeding events
- Meds, dosage and schedule
- Steroids w/in 6 months
- Allergies
- Social hx
- CV, Pulm, neuro, status
- Baseline o2 sat, BMI
14
Q
Risk factors- Nutrition
A
- Wound healing and immune status
- Hypoalbiunemia risk factor for SSI
- Malnourished = gut feeding 1 week prior
- Imune modulating nutrition
- Obesity = mortality
15
Q
Pre-op meds
A
Pre-anesthesia
- Anxiolytic-Benzo
- Opiate
- Consider H2, PPI antacids to prevent pulm aspiration syndrome
