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FINALS OSCE > Pre-operative Patient in Clinic > Flashcards

Pre-operative Patient in Clinic Flashcards

1
Q

Core details

A

Patient details
Operation
Anaesthesia required
Background

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2
Q

Patients current health

A

Recent illness
Smoking
Alcohol

Medical conditions:
HTN
Diabetes - first on list
Asthma
COPD
CVS disease - pacemaker?
IHD
Liver disease

Drug history
ALLERGIES

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3
Q

Anaesthetic history

A

Any previous anaesthetic
Any reactions
Family history of reaction to anaesthetics

Anaesthetist will see you for a full anaesthetics assessment of you airway

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4
Q

Risks of surgery

A

TWAS

Trauma
Haemorrhage
Infection
Scarring

Wound dehiscence
Anaesthetic risk and side effects PONV
VTE
Pain
Dehydration
Anastamotic leak
Constipation
Incisional hernia
Post-op ileus
Adhesions
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5
Q

Risks of surgery

A

TWAS

Trauma to nearby structures/organs/NV injury
Haemorrhage/bleeding/haematoma
Infection - local/systemic
Scarring

Wound dehiscence
Anaesthetic risk and side effects PONV
VTE
Pain
Dehydration - low BP
Anastamotic leak
Constipation
Incisional hernia
Post-op ileus
Adhesions
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6
Q

What preparation for op should you consider

A 
Correct investigation abnormalities:
 INR
 Hb
 Platelets
 Electrolytes

Medications
IV fluids
New meds
Regular meds - stopping/changing

Forms
VTE Proforma
Consent form

Fasting and Admission

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7
Q

How do you correct INR for a day 1 pre-op assessment?

A

IF > 1.4
Aggressive regime (if on warfarin for AF):
5-10mg IV vitamin K, then repeat INR in 6 hours
If still high, discuss with haematology regarding giving prothrombin complex concentrate pre-op

Cautious regime (if on warfarin for artificial heart valve/ recent PE):
Discuss with seniors and haematology - will usually require reversal fo warfarin and UFH infusion cover, which will be stopped 4 hours pre-op and restarted after

Raised du to liver disease: 10mg IV vitamin K, then repeat INR in 6 hours - if still high, discuss with haematology who may advise FFP/cryoprecipitate

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8
Q

When should you give blood transfusion

A

Hb> 9g/dL or < 10g/dL if elderly/CVS/resp disease

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9
Q

When should you consider platelet pool

A

Platelets < 50

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10
Q

How do you correct INR for early pre-op assessment (>1 week pre-op)

A

INR corrected by stopping warfarin

Anaemia should be investigated and cause treated

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11
Q

When should you prescribe IV fluids overnight when NBM?

A

Instructed by consultant
Patient need VRII
Dehydrated

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12
Q

What new medication prescribed

A

Operation prepration: e.g. bowel prep for colorectal
VTE prophylaxis: prophylactic LMWH nigh before oepration but omit any doses when operation will start in < 12h
TED stockings
Anti-emetics PRN
Analgesia PRN

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13
Q

What medications to stop/change pre-op and when?

A

COCP - 4 weeks
Clopidogrel/aspirin/dipyradimol 7 days
Heparin LMWH therapeutic 48 hours
Oral hypoglycaemics - avoid on day of operation
Warfarin - 5 days
Diuretics/ACE inhibitors - avoid on day of operation
Insulin - avoid morning dose - VRII with surgical fluid
Steroids - change to higher dose IV hydrocortisone

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14
Q

Warfarin

A

5 days

Therapeutic dose LMWH prescribed in interim but stopped 48 hours before op

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15
Q

Oral anticoagulant (DOAC)

A

24h for minor surgery

48 hours for major surgery

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16
Q

UFH infusion

A

4 hours

Restart post-op

17
Q

Antiplatelets

A

7 days

Liase with cardiology if stent recently

18
Q

Antiplatelets

A

7 days for clopidorgel

For others may consider stopping if renal impairment

Liase with cardiology if stent recently

19
Q

ORal hypoglycaemics

A

Avoid on the day of operation
VRII
Avoid metformin for 2 days after operation (lactic acidosis risk)

20
Q

Diuretics/ ACE inhibitors

A

Avoid on day of operation

21
Q

COCP

A

4 weeks

Restart 2 weeks after

22
Q

What forms prior to surgery

A

VTE prophylaxis

Consent form

23
Q

Fasting instructions

A

2-6 rule

Clear fluids 6h pre-op
NBM for 2h pre-op

IF unsure of time prepare patient for 8am

Only need to stay overnight before if diabetic and require VRII from midnight

24
Q

Fasting instructions

Admission instructions

A

2-6 rule

Clear fluids 6h pre-op
NBM for 2h pre-op

IF unsure of time prepare patient for 8am

Only need to stay overnight before if diabetic and require VRII from midnight

25
Q

Post-op

A 
Pain control IV, PCA, Oral
Limitations of food/drink post-op
VTE prophylaxis - LMWH, compression stockings
Physiotherapy 
OT

FINALS OSCE (15 decks)

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