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DPD > Preop assessment > Flashcards

Preop assessment Flashcards

1
Q

Why do you do pre-op assessment?

A 
Identify risk to airway, anaesthetic and post op risks
Modify risks
Make decisions on medication
Give advice on fasting
Make decisions on post-op care
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2
Q

When do you do the pre-op?

A

2-4 weeks before surgery so it’s long enough to arrange any further investigations, but soon enough to avoid any interim medical problems

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3
Q

History

A 
What is the procedure? 
PMH
Previous surgery/anaesthetics + any problems 
Systems review
Medication
Allergies
SH 
FH
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4
Q

What problems might you ask about when asking about previous surgery?

A

Airway/intubation problems
Reaction to drugs
N/V post op

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5
Q

What systems will you review?

A

Respiratory
Cardiac
Renal
Endocrine

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6
Q

What will you ask about socially?

A

Smoking
Alcohol - are they at risk of withdrawal?
Recreational drugs
Support at home/work

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7
Q

What would you be looking out for in FH?

A

Malignant hyperpyrexia

Myasthenia gravis

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8
Q

What is the problem with malignant hyperpyrexia?

A

Pt becomes dangerously hyperthermic when administered with certain volatile agents

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9
Q

What score is calculated?

A

American society anestheisa

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10
Q

What are the stages of ASA and what do they stand for?

A

1 - healthy patient, uncompromised
2 - minor disease
3 - severe systemic disease
4 - severe systemic disease with a constant threat to life

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11
Q

What counts as minor surgery?

A

Skin lesions

Breast abscess

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12
Q

Intermediate surgery

A

Varicose veins
Knee arthroscopy
Inguinal hernias (primary)

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13
Q

Major

A

Thyroidectomy
Colonic resection
Joint replacement
Adrenalectomy

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14
Q

Major plus

A

Cardiac surgery

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15
Q

What do you do after taking a history?

A 
Obs 
Airway atm 
CV assessment
Resp
Abdo potentially
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16
Q

What counts as obs?

A

HR
BP
Temp
O2 sats at rest

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17
Q

What counts as airway assessment?

A

Neck extension/flexion
Mouth opening
Mallapati
Jaw protrusion

18
Q

What questions are you going to ask them for the airway assessment?

A

Can you touch your chin to your chest?
How far can you open your mouth?
Can you get your bottom teeth in front of your top teeth?

19
Q

What grading score is used to assess how easy it will be to put an endotracheal tube into the mouth?

A

Mallampati grading

20
Q

Mallamapti score 1

A

Hard palate
Soft palate
Uvula
All pillars

21
Q

Mallamapti score 2

A

hard palate
Soft palate
Uvula

22
Q

Mallamapti score 3

A

Hard palate and soft palate

23
Q

Mallamapti score 4

A

Hard palate only seen

24
Q

What do you do after this scoring?

A

Special routine tests e.g. FBC, clotting, renal function, lung function, ABGs, ecg, kidney function tests

25
Q

What is the age cut of after which you’d definitely arrange an ECG?

A

65

26
Q

If someone is taking BP meds, what tests do you need to do?

A

U and E

27
Q

If someone is taking antiplatelet meds, what tests do you need to do?

A

FBC

28
Q

If someone is taking anticoagulants meds, what tests do you need to do?

A

FBC and coagulation

29
Q

If someone is taking diabetes meds, what tests do you need to do?

A

HbA1c

30
Q

If someone is taking thyroid meds, what tests do you need to do?

A

TFTs

31
Q

If someone is taking anaemia meds, what tests do you need to do?

A

FBC

32
Q

When do you do a pregnany test?

A

If pt agrees to ad could be pregnant

33
Q

When do you do a HbA1c test?

A

Only if known diabetic and you don’t have a result in the last three months

34
Q

When do you do a sickle test?

A

only if there is FH

35
Q

What meds might need modification during surgery?

A

Blood thinners
Diabetic meds
Antihypertensives

36
Q

Which antihypertensives need to be stopped?

A

Omit ACEi

37
Q

What is the general fasting advice?

A

Nil by mouth for 2 hours

Except for 30ls water with tablets

38
Q

Clear fluids

A

up to 2 hours before

39
Q

Solid food including milk

A

up to 6 hours

40
Q

What is the exception to this??

A

Delayed gastric emptying

emergency surgery

41
Q

If a diabetic patient has emergency surgery, what insulin do you give them?

A

variable rate insulin e.g. Actrapid??

42
Q

??

A

Look up the other things about diabetes and surgery

DPD (38 decks)

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