SA Pre-Operative Patient Assessment & Preparation (20) Flashcards
Dr. Thompson
What ways do we assess a patient preoperatively?
- patient history
- physical exam
- laboratory data
- associated underlying disease
- patient stabilization
What are the “Big 4” or “Quats” that young, healthy animals undergoing elective surgery get?
- PCV (hematocrit)
- total protein (TP)
- blood glucose
- BUN
What should an animal older than 5 to 7 years get before surgery - laboratory data?
“Minimum Data Base”
- CBC and differential
- serum biochemical profile
- urinalysis
How should you assess neoplasia in a dog?
evaluate for metastasis - see if in multiple places
- thoracic imaging
- abdominal ultrasound
- lymph node aspiration
How do you evaluate cardiac disease before surgery?
- thoracic radiographs
- cardiac ultrasound scan
- electrocardiogram
How should you assess trauma patients before surgery?
- diaphragm
- pleural space
- lungs
What is ASA I?
healthy with no discernible disease - elective procedure
What is ASA II?
healthy with localized disease or mild systemic disease
patellar luxation, skin tumor, cleft palate without aspiration pneumonia
What is ASA III?
severe systemic disease
pneumonia, fever, dehydration, heart murmur, anemia
What is ASA IV?
severe systemic disease that is life-threatening
heart failure, renal failure, hepatic failure, severe hypovolemia, severe hemorrhage
What is ASA V?
patient not expected to live longer than 24 hours with or without surgery
endotoxic shock, multi organ failure, severe trauma
What is E in ASA?
emergency
A skin tumor is ASA ___
II
A heart murmur is ASA ___
III
A declaw is ASA ___
I
Hepatic failure is ASA ___
IV
Severe trauma is ASA ___
V
Endotoxic shock is ASA __
V
How should you determine surgical risk?
consider history, physical examination, and laboratory tests
risk of the surgical procedure may outweigh its potential benefits
What is a “Fair” prognosis of surgical risk?
serious complications are possible, but uncommon
recovery may be prolonged
animal may not return to its pre surgical function
What is a “Poor” prognosis of surgical risk?
underlying disease or surgical procedure is associated with many or severe complications
recovery is expected to be prolonged
likelihood of death during or after the procedure is high
unlikely to return to pre surgical function
What is a “Excellent” prognosis of surgical risk?
potential for complications is minimal
high probability that the patient will return to normal
What is a “Good” prognosis of surgical risk?
some potential for complications
high probability of a good outcome
What is a “Guarded” prognosis of surgical risk?
when the outcome is highly variable or unknown
What should owners be informed of before surgery?
- diagnosis
- surgical and nonsurgical options
- potential complications
- postoperative care
- prognosis
- cost
What is indicated for all animals undergoing general anesthesia, including healthy animals having elective procedures?
intravenous fluids
What are the dietary restrictions for adult animals?
food intake: restrict 6 to 12 hours before induction of anesthesia
- helps avoid intraoperative or postoperative emesis and aspiration pneumonia
Food prior to surgery should not be withheld from ______ for longer than ______ because hypoglycemia may occur
young animals
4 to 6 hours
What is a SSI?
includes infection that directly results from surgical procedures that involve other areas of the body as well, such as organs or internal spaces that are manipulated during the operation
What are the most common sources of SSIs?**
staphylococcus aureus
streptococcus spp.
What are the classifications of SSIs?
incisional
- superficial
- deep
organ/space
What is an incisional SSI?
inflection of the actual site of the surgical incision
What is a superficial incisional SSI?
involving the skin and SQ tissue at the surgical incision
What is a deep incisional SSI?
involving the deep soft tissue layers such as incisional fascia and muscle at the surgical incision
What is an organ/space SSI?
infection of an anatomical part that was manipulated during the operation
When is something considered an SSI?
- occur within 30 days of the surgical procedure
- occur within 1 year if it is associated with a surgical implant and the infection appears to be related to the operation
What are resident flora on the skin?
- staphylococcus epidermidis
- corynebacterium spp.
- pityrosporum spp.
What are transient pathogens in SSIs?
- staphylococcus aureus
- staphylococcus intermedius
- e. coli
- streptococcus spp.
- enterobacter spp
- clostridium spp
What is antisepsis?
the prevention of sepsis ban preventing or inhibiting the growth of resident and transient microbes
What is antiseptic?
product with antimicrobial activity that formerly may have been referred to as an antimicrobial agent
an agent capable of producing antisepsis
[Chlorohexidine/Povidone Iodine] is superior for preoperative antisepsis for patients
chlorohexidine
How can you prevent SSIs?
- administration og antimicrobial prophylaxis - intraoperative antibiotics
- proper utilization of skin antiseptic agents for the surgical team and patient
T/F: You can shave the site night before a surgery
FALSE - associated with a significant increase in superficial skin infection rates
T/F: In a male dog, you should clip the prepuce
TRUE
What does this show?
flushing the prepuce of male dogs with antiseptic solution before performing the sterile preparation
How do you prepare for a limb procedure that does not include the paw?
place a latex glove over the distal extremity and securing it to the limb with tape
wrap the glove with tape or vetwrap
What does this image show?
hanging leg preparation
- limb is circumferentially clipped and then hung from and IV pole
place field drapes around the limb and secure them with towel clamps
Sterile preparation begins [before/after] positioning of the animal
after
How do you sterilely prep?
dominant hand: handles sterile
non dominant hand: non sterile
How do you clamp the prepuce for an abdominal incision?
with a sterile towel clamp - clamp prepuce opposite surgeon
What instrument do you use to drape a patient?
Backhaus towel clamps
What should you NOT do when performing surgery regarding instruments and other materials the surgeon may use during surgery?
- soiled sponges will not be placed back on the instrument table
- patient is not a table to place instruments, soiled sponges, etc on
