Pre-op Testing Flashcards
T/F, routine tests often lead to false positive results, extra cost, possible delay of surgery, and medico-legal liability.
True. Do not perform tests unless there is a clear clinical indication.
When test are felt to be necessary it is reasonable to use test results that were performed and were normal within the past 4 months, unless there has been a change in clinical status.
In Healthy patients each of the following are indicated when?
- Hgb and HCT
- Serum creatinine
- Pregnancy test
- CXR and PFTs
- CBC
- electrolytes
Hgb and HCT: not indicated unless major surgery if greater than 65YO or in younger pts if significant blood loss is expected.
Creatinine: if over 50YO with intermediate or high risk surgery OR younger with anticipated hypotension or nephrotoxic drugs
All women of reproductive age should have pregnancy test
CXR and PFT not needed unless greater than 50YO with upper abd or thoracic surgery. or unless you suspect cardiopulmonary dz
PFT a must for pts undergoing lung resection
CBC: anyone over 65YO having major surgery
Electrolytes: not routinely recommended unless on diuretics, ACEI, ARB or has known renal dz
When is blood glucose recommended for surgery?
What should INR be for normal person?
Blood glucose: check if DM, otherwise 25% of pts over 60 have abnormal values.
INR = 1.0
each of the following are indicated when?
- LFT
- PT/INR, PTT, Platelet count
- U/A
- ECG
LFT: not routinely recommended
PT/INR, PTT, platelet: not routinely recommended but are required in those who are on anticoags or having neurosurgery
UA: not recommended. if positive UA they are treated with abx and proceed with surgery w/o delay.
ECG: not routinely recommended but required in pts with CAD, CHF, arrhythmias, structural heart dz, PAD, cerebrovascular dz, DM
T/F, pts with obstructive sleep apnea have increased risk of surgical complications?
Surgical consequences of smoking.
True.
Smoking:
- less likely to heal fusions and skin grafts
- -test for abstinence; serum continine levels
