Preoperative Evaluation of the Surgical Patient Flashcards
The number one
limiting factor prior to surgery is a history of
cardiovascular disease.
Ejection fraction below____: increased risk for
noncardiovascular surgery
35%
Qx patient ¿elective? + Recent myocardial infarction: What to do?
must defer the surgery 6 months and stress the patient at that interval
What to do w a qx pt +Congestive heart failure (JVD, lower extremity edema): ?
Medically optimize the patient with ACE inhibitors, beta blockers, and spironolactone to decrease mortality
The ____________ is a tool used to estimate a patient’s
risk of perioperative cardiac complications
Revised Cardiac Risk Index (RCRI)
Revised Cardiac Risk Index (RCRI) is based on the following risk factors
History of
- ischemic heart disease
- congestive heart failure
- cerebrovascular disease (stroke or transient ischemic attack)
- diabetes requiring preoperative insulin use
- Chronic kidney disease (creatinine > 2 mg/dL)
- Undergoing suprainguinal vascular, intraperitoneal, or intrathoracic surgery
RCRI scores greater than___ indicate increased risk for cardiac death, nonfatal
myocardial infarction, and nonfatal cardiac arrest.
2
The best next step in management for patients with scores equal to or greater than 2 on the RCRI is to
give perioperative beta blockade to reduce cardiac mortality.
Higher scores mean the patient requires preoperative medical optimization.
what is evaluated by ASA Physical Status Classification System
1.-Healthy person.
2.- Mild systemic disease.
3.- Severe systemic disease.
4.- Severe systemic disease that is a constant threat to life.
5.- A moribund person who is not expected to survive without the operation.
6.- A declared brain-dead person whose organs are being removed for donor
purposes.
ASA classification scores greater than 3 require
preoperative
assessment and testing for elective conditions and optimization before surgical
emergencies.
what test do you need If the patient is under the age of 35 and has no history of cardiac disease,
only EKG
A patient who has a history of cardiac disease,
regardless of age, must have
EKG
Stress testing to evaluate for ischemic coronary lesions
Echocardiogram for structural disease and to assess ejection fraction
being male age >__ is a
risk factor.
45
______ hypertension should be controlled prior to any elective surgery.
systolic
What to do w a qx pt + known lung disease or those who have a smoking history? test and management
pulmonary function testing is necessary to evaluate for vital capacities
Have the patient quit smoking for 6 to 8 weeks prior to surgery and use a nicotine patch in the meantime.
What to do w a qx pt + known renal disease?
must be kept adequately hydrated;
Give fluids before and during surgery.
What to do If the patient is on dialysis
, dialyze the patient 24 hours prior to surgery.
diabetes is deemed ____ equivalent
coronary disease
best way to maintain an airway in patients with no facial trauma is
Orotracheal tubes
Patients with facial trauma require
a cricothyroidotomy.
Patients with no facial trauma but cervical spine injury need
orotracheal tube intubation. This should be performed with flexible bronchoscopy to reduce risk of further cervical spine injury.
The routine goal in (trauma) management is to keep oxygen saturation above
90%
Systemic Inflammatory Response Syndrome SIRS criteria
- Body temperature <36 C (96.8 F) or >38 C (100.4 F)
- Heart rate >90 BPM
- Tachypnea >20 breaths per minute, or PCO2 <32 mm Hg
- WBC <4,000 cells/mm or >12,000 cells/mm
the presence of __ or more criteria indicates SIRS.
2
2 criteria + source of infection =
sepsis
2 criteria + source of infection + organ dysfunction =
severe sepsis
2 criteria + source of infection + organ dysfunction + hypotension =
septic shock
Kidney shock lbt signs
increased BUN/creatinine ratio
Liver shock lbt signs
elevated AST and ALT
Heart shock signs
chest pain and shortness of breath
how is lactic acid level during shock?
increased
Most common etiologic agents of septic shock
E. coli and S. aureus
The only kind of shock with increased LVEDP or Pulmonary capillary wedge pressure (PCWP)
Cardiogenic
HY!!!!!!
The only kind of shock with increased CVP
Cardiogenic
The only kind of shock with increased Cardiac Output
Septic
The SVR increases and decreases in:
IN: Hypovolemic, Cardiog
DC: Neuro, Septic
Anaphylactic shock has CO __ and PCWP ___
elevated
decreased
Cardiac output =
Stroke volume × Heart rate
Stroke volume =
End-diastolic volume – End-systolic volume
Total peripheral resistance =
Mean arterial pressure – Mean venous pressure
Blood pressure =
Cardiac output × Total peripheral resistance
