Pre-Operative Evaluation (Exam I) Flashcards
what is vancomycin used for
- distal ilium, colon and appendix surgeries
what is clindamycin alternative for?
- when allergic to cefazolin
-gram positive and negative bacteria - for surgeries located in the abdomen
What does cefazolin cover
most aerobic gram positive bacteria that cause SSI
what is the most common antibiotic for surgery
Cefazolin
What is the formula for BMI?
BMI = kg / m²
What mnemonic guides an emergent physical examination?
AMPLE
- Allergies
- Medications
- Past medical history
- Last meal
- Events leading up to need for surgery
What factors are worth one point on the Revised Cardiac Risk Index?
- High risk surgery
- Ischemic heart disease
- Hx of CHF
- Hx of CVA
- DM w/ insulin
- Creatinine > 2 mg/dL
What group of surgeries has the highest risk?
Vascular (Aortic, major, & peripheral vascular) > 5%
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%
- 3 = 5.4%
What are METs?
What is one MET equal to?
- Metabolic Equivalent of Tasks (measurement of rate of energy consumption).
- 1 MET = 3.5 mLO₂ /kg/min
How would one assess functional capacity? What is the range of this assessment?
- Through METs
- 1 MET = eating, working at computer, etc
- 12 MET = running rapidly for long distances
What are the three levels of urgency of surgery?
- Emergent - Life or limb threatened, sx needed within 6 hours, no cardiac pre-op necessary.
- Urgent - Life or limb threatened, sx needed in 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)
What ASA level would a healthy non-smoking 27 year old with diabetes have coming in for an EGD?
- ASA II (healthy but has well-controlled DM)
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 (MI less than 3 months ago)
What ASA level would a 12 year old girl with no hx have coming in for a routine tonscillectomy?
- 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 (COPD, poorly controlled DM)
What is the most common anaphylactic drug allergy?
What other two drugs have really common allergies?
- NMBs
- Antibiotics & chlorhexidine
What condition makes one more prone to latex allergy?
- Spina Bifida
What three things discussed in lecture would prompt you to order coagulation studies?
- Known or suspected coagulopathy
- Known bleeding disorder, hepatic disease, or anticoagulant use.
- ASA 3-4; undergoing moderate - major surgery
Is Lidocaine and amide or an ester?
How can you tell?
- Lidocaine = Amide
- Two “i’s” would indicate and amide (ex. bupivicaine)
What cross-reactivity allergies are possible for someone who has a known neuromuscular blocking agent allergy?
- Neostigmine & Morphine
What medications need to be discontinued for surgery?
- Aspirin & P2Y12 Inhibitors (Clopidogrel, ticagrelor dc 5-7 days, prasugrel & ticlopidine dc 7-10)
- Topical Medications (day of)
- Diuretics (day of, except Thiazide)
- Sildenafil dc 24 hr prior (unless for CHF, then continue)
- NSAIDs dc 48 hrs prior
- Warfarin dc 5 days prior
- Hormone Replacement Therapy (dc 4 weeks prior)
- Non-insulin DM meds (dc day of)
What insulin should a type 1 diabetic take (or not take) the day of their surgery?
- DC short-acting
- Continue basal rate if using a pump
- Take 1/3 of normal long-acting if no pump.
