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Sp: Sim Lab 1 > Session 10: Pre-Op Interview & Physical Exam > Flashcards

Session 10: Pre-Op Interview & Physical Exam Flashcards

1
Q

Reasoning Qs

A

what issues do they currently have?
will they change our anesthetic?
what is the severity of the interference?

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2
Q

Complete Pre-Op Components (12)

A

Med/Surg History
Meds/Allergies
Social History
Anesthetic History
DNR
Airway/Physical exam
Lab/Pre-op test results
NPO status
Catch All
ASA Status
Anesthetic Plan
Informed Consent

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3
Q

Neurological Exam (8)

A

Seizure
Stroke
Neuromuscular disorders
Aneurysm
Asymptomatic bruit
Parkinsons
Psych disorders
MS

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4
Q

Alert and Oriented
(A&O status)

A

overall capacity of brain to know where they are

Alzheimer’s
dementia

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5
Q

A&Ox1

A

oriented to person

knows their name
recognizes significant others

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6
Q

A&Ox2

A

oriented to person and place

understands where they are

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7
Q

A&Ox3

A

Oriented to person, place, time

aware of date, day of week, season

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8
Q

A&Ox4

A

oriented to person, place, time, situation

understands/can explain why they are at healthcare facility

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9
Q

Respiratory Exam

A

Colds/cough
COPD
Restrictive PD
Asthma
Pulmonary hypertension

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10
Q

Pediatric URTI Algorithm

A

can we postpone surgery to minimize risk during upper respiratory infection

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11
Q

Cardiovascular Exam

(HHIMR)

A

Hypertension
Heart Failure
Ischemic Heart Disease (METs)
Murmurs/Valvular abnormalities
Rhythm disturbances

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12
Q

Metabolic Equivalents of Functional Capacity Test

A

METS
used to asses a pts functional level of exercise
determine risk of intraoperative cardiovascular event

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13
Q

severe risk of intraoperative cardiovascular event if MET

A

<4

1 - eating, working at comp
2 - walking down stairs
3 - waking 1-2 blocks
4 - raking leaves, gardening

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14
Q

Revised Cardiac Risk Index (RCRI)

A

High risk surgery
Diabetes
Ischemic heart diesease
Congestive heart failure (Hx)
Cerebrovascular disease (Hx)
Creatine >2.0 mg/dL

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15
Q

High risk surgeries

A

intraperitoneal (abdomen)
intrathoracic
supra-inguinal vascular

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16
Q

Very low risk

A

procedures that usually require min/mod sedation w/few physiological risks

  • eye surgery
  • GI endoscopy w/o stenting
  • dental
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17
Q

low risk

A

procedures associated w/min physiological effect

  • hernia repair
  • ENT
  • IR
  • GI endoscopy w/stent
  • cystoscopy
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18
Q

intermediate risk

A

procedures associated w/mod changes in hemodynamics, risk of blood loss

  • intracranial/spine
  • gyn/urologic
  • intra-abdominal w/o bowel resection
  • intra-thoracic w/o lung resection
  • cardiac cathertization
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19
Q

high risk

A

procedures w/possible significant effects on hemodynamics/blood loss

  • colorectal w/bowel resection
  • kidney transplant
  • maj joint replacement
  • open prostatectomy/
    cystectomy
  • maj oncologic surgery
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20
Q

very high risk

A

procedures w/maj impacts to hemodynamics, fluid shifts. possible maj blood loss

  • aortic/cardiac surgery
  • intra-thoracic lung resection
  • maj transplant (heart, liver, lung)
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21
Q

Endocrine Exam

A

Hypothalamic-Pituitary Disorder
Diabetes mellitus
Thyroid disease
Parathyroid disease
Pheochomocytoma

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22
Q

Hepatic Exam

A

Hepatitis
Obstructive Jaundice
Liver failure
Cirrhosis

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23
Q

Hepatic Disease State Classification

A

Child-Turcotte-Pugh

Model for End-Stage Liver Disease (MELD)

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24
Q

MELD score

A

higher value = worst state of liver disease

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25
Q

at what MELD score do you see rapid decline?

A

15+ MELD

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26
Q

Gastro-Intestinal Exam

A

Heartburn/GERD
Bowel obstruction
NPO guidelines

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27
Q

Clear liquids

A

2 hrs

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28
Q

breast milk

A

4 hrsi

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29
Q

infant formula

A

6 hrs

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30
Q

nonhuman milk

A

6 hrs

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31
Q

light meal

A

6 hrs

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32
Q

light meal includes

A

carb and clear liquid

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33
Q

heavy meal

A

8 hrs

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34
Q

heavy meal inclused

A

fat and protein

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35
Q

Renal Exam

A

Chronic Kidney disease
Chronic renal failure
Acute renal failure
Fistula/PD catheter/HD catheter
End Stage Renal Disease (ESRD)

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36
Q

Musculo-Skeletal Exam

A

Lupus
Anklosing spondylitis
Rheumatoid arthritis
Sclerosis (systemic)

Scoliosis
Marfans
Ehlers-Danlos

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37
Q

Hematological Exam

(STTAPHV)

A

Sickle Cell
Thrombocytopenia
Thrombocytosis
Anemia
Polycythemia
Hemophilias
Von Willebrands

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38
Q

Medication Interview

A

allergies
prescriptions
OTC
Herbal supps

39
Q

Prescrptions/OTC questions

A

how much?
last dose?

40
Q

Social History Interview

A

Smoking
Drinking
Illicit drugs

41
Q

Smoking Qs?

A

do you smoke?
how much?
how many years?

42
Q

pack year

A

1.5 packs a day for 18 years
= 1.5 x 18
= 27 pack year smoker

43
Q

Drinking Qs?

A

do you drink?
how much?
what type?

(12oz beer = 1.5oz liquor = 5oz wine)

44
Q

Illicit Drugs

A

depressants
hallucinogens
stimulatns

45
Q

depressants

A

alcohol
benzodiazepines
cannibis
GHB
ketamine
opioids

46
Q

hallucinogens

A

cannabis
LSD
ketamine
psilocybin
PCP

47
Q

stimulant

A

amphetamines
caffeine
cocaine
ecstasy
nicotine

48
Q

inhalants

A

volatile solvents
aerosols
gases
nitrites

49
Q

performace enhancing drugs

A

anabolic steroids
peptides
hormones

50
Q

Past anesthetic history

A

unusual familial death w/anesthesia?
PONV
adverse outcomes

**keep open ended

51
Q

DNR wishes

A

most often DNR suspended for anesthesia

varying levels:
no compressions
no shocks
no intubation/sustained intubation

52
Q

Airway Exam

A

mallampati score
thyromental distance
mouth opening
neck mobility
dentition

53
Q

Dentition exam

A

loose
chipped
veneers
crowns
implants
grills

54
Q

heart auscultation

A

aortic area
pulmonic area
erbs pt
tricuspid area
mitral area

55
Q

aortic

A

right side of sternum
2nd intercostal space

56
Q

pulmonic

A

left side of sternum
2nd intercostal space

57
Q

tricuspid

A

left side of sternum
4th intercostal space

58
Q

mitral

A

left side of sternum
5th intercostal space

59
Q

erbs pt

A

left side of sternum
3rd intercostal space

60
Q

lung auscultation

A

bronchial
bronchovesicular
vesicular

61
Q

auscultation

A

technique perfomed to listen to internal sounds of the body
- heart lungs bowel

62
Q

bell

A

low-pitched sounds
(heart murmers)

63
Q

diaphragm

A

normal high-pitched sounds
abnromal sounds

64
Q

broncial

A

loud high pitched sounds
around the trachea

65
Q

bronchovesicular

A

medium pitched sounds
1st and 2nd intercostal space
by sternum

66
Q

vesicular

A

soft low pitched sounds
entirety of lung fields

67
Q

abnormal lung sounds

A

diminished lung sounds
adventitious breath sounds

68
Q

cracklets

A

abnormally closing airways during inspiration/expiration

CHF or excessive fluid on lungs

69
Q

wheezes

A

narrowing of airways leading to obstruction

manifestation of asthma exacerbation

70
Q

auscultation big picture

A

wheezes or crackles?
cardiac valvular sounds that cannot be explained by previous echo?

71
Q

manual bp measurement

A

korotkoff sounds
sound of the blood when the cuff occludes and partially occludes in an artery

72
Q

BP measurement

A

size cuff according

73
Q

too small cuff

A

overestimate systolic

74
Q

too large cuff

A

underestimate systolic

75
Q

cuff bladder

A

extend 50% round extremity

76
Q

cuff width

A

20-50% greater than the extremity diameter

77
Q

pulse check

A

access can be limited

to ensure we are adequately perfusing heart/brain

78
Q

PEA

A

pulses electrical activity of heart

79
Q

potential for blood loss
(labs)

A

CBC
Type and Screen +/- cross

80
Q

potential for electrolyte disturbances (labs)

A

BMP
specific assay

81
Q

coagulation ?
(labs)

A

coag screen
TEG
P2y12

82
Q

Pre-Op vitals

A

arrythmia
hypoxic
respiratory distress
vital signs

83
Q

1 kg

84
Q

1 lb

85
Q

Catch All Phrase

A

“is there anything else you see a physician/doctor for that we did not cover?”

last change to bring anything else to light

86
Q

ASA Status

A

determine overall phsyical aspects of Pt

87
Q

ASA1

A

healthy pt
no systemic issues

88
Q

ASA2

A

mild to moderate systemic
cause by surgica need or pathological process
well controlled by meds

89
Q

ASA3

A

severe disease
limits activity

90
Q

ASA4

A

severe disease
constant threat to life

91
Q

ASA5

A

moribund pt
will not survive w/o surgery
w/in 12 hrs

92
Q

ASA 6

A

brain dead
organ donation

93
Q

ASA E modifier

A

added to any classification to denote emergency status

Sp: Sim Lab 1 (23 decks)

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