Term
| 3 times more productive than physical exam |
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Definition
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Term
| 11 times more productive than labs |
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Definition
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Term
| 75-90% diagnostic when combined with physical exam |
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Definition
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Term
| Pre Operative Assessment contains: |
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Definition
History of the present illness (HPI)
Past medical history (MPH)
Physical exam (PE)
Laboratory tests
Electrocardiogram (EKG) all pts over 40
Chest X-ray (CXR)- >40y/o or thoracic/cardiac history
Consent |
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Term
| History of the present illness (HPI) |
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Definition
| Nature and urgency of the problem |
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Term
| Past medical history (PMH) |
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Definition
| General condition of the patient and uncover risk factors w/ROS |
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Term
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Definition
| Every patient gets a full exam |
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Term
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Definition
Complete Blood Count
Chemistry 7- Na, K, Cl, HCO3, BUN, Cr, and glucose
Chem 20- above +Ca, mag, phos, LFT, Amy, and lip
PT/PTT
UA
Type and screen/cross-match |
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Term
| Importance of the Preop Evaluation |
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Definition
Prepare the pt for surgery
Optimize physiologic status
Promotes pt safety (med review, NPO, T&S)
Minimizes surprises (coags/labs, EKG)
Prevent postoperative complications (UA, CXR, EKG, antibiotics) |
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Term
Differential DX
Understanding the different possible causes will allow for a better ___ |
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Definition
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Term
| Better H+P will narrow down the ___ or make the ___ |
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Definition
Differential dx
Diagnosis in most cases |
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Term
Differential DX
__ and __ are adjunct to a good history. . .unless your in the ER!!! |
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Definition
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Term
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Definition
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Term
Timing for surgery
Emergent |
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Definition
Tauma, hemorrhage, etc.
For life threatening conditions
Requires surgical intervention immediately
Bump less urgent cases
Often requires MD-MD contact |
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Term
Timing for Surgery
Urgent |
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Definition
Appendix, ortho, abscess, etc.
Condition making pt sick and will not improve without intervention
Need for surgery out ways risks |
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Term
Timing for Surgery
Routine |
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Definition
Often considered elective
Needs to be done prior to pt being discharged |
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Term
S3 gallop or JVD on PE
MI in the last 6 months
Rhythm other than sinus/PAC's on pre-op EKG |
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Definition
| Significant risk factors for postop cardiac events |
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Term
>5 PVC's/min pre-op
Intraperitoneal, intrathoracic, or aortic operations
Age > 70 years
Significant aortic stenosis (either audible bruits, physical symptoms, or arteriogram findings) |
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Definition
| Significant risk factors for postop cardiac events |
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Term
Emergency operation
"Poor medical condition": defined as PO2<60
PCO> 50
K<3
HCO3< 20
BUN > 50
Cr > 3
elevated AST/ALT (liver enzymes), signs of chronic liver disease, bedridden from non-cardiac disease |
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Definition
| Significant risk factors for postop cardiac events |
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Term
| Review of symstems: Dyspnea, exercise tolerance, paroxysmal nocturnal dyspnea, Orthopnea, peripheral edema, irregular heart beat ("fluttering in the chest" or "skipped beats"), chest pain |
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Definition
| Evaluation for preoperative cardiac risk |
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Term
| Past medical history: congenital heart disease, Rheumatic fever, atherosclerosis, pacemaker, angina, past MI, HTN, diabetes, previous cardiac surgery or angioplasty |
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Definition
| Evaluation for preoperative cardiac risk |
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Term
| Medications: Diuretics ("water pills"), Digoxin, antianginals (nitrates, paste), Antihypertensives, antiarrhythmics, anticoagulants |
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Definition
| Evaluation for preoperative cardiac risk |
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Term
| Physical Exam: Pulse, BP (take in both arms, and also while standing), cyanosis, clubbing of fingernails, distended neck veins (JVD), rales, wheezes, cardiac thrill or lift, cardiac murmurs, carotid, abdominal, and femoral bruits, hepatomegaly |
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Definition
| Evaluation for preoperative cardiac risk |
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Term
| Chest X-ray: cardiac enlargement, pulmonary vessel distention, lung infiltrates, tortuous aorta, and calcification of arteries and valves |
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Definition
| Evaluation for preoperative cardiac risk |
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Term
| EKG: arrhythmias, conduction defects, ischemia, previous MI, chamber englargement, hyperkalemia, digoxin toxicity |
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Definition
| Evaluation for preoperative cardiac risk |
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Term
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Definition
Surgical timing and need
Pre-op/intra-op/post-op beta blocker!!!
Improved cardiac perfusion
Fluid management
Clase cardiac monitoring
Post op care |
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Term
| Review of systems: dyspnea with or without exertion, wheezing, chest pain, cough, sputum production (quantity and quality), Hemoptysis |
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Definition
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Term
| Past medical history: tobacco use (ppd), occupational exposures, Tuberculosis, pneumonia, asthma, medications and steroids |
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Definition
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Term
| Physical exam: respiratory rate and effort, cyanosis, clubbing, rhonchi, wheezes, rubs, pain, tenderness, hyperresonance |
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Definition
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Term
| CXR: infiltrae, granuloma, atelectasis, hyperlucency, pneumothorax, vascular abnormalities, masses |
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Definition
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Term
Arterial blood (ABG)
Pulmonary function tests |
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Definition
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Term
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Definition
Types of Anesthesia
Type of surgery
Positioning
Pain control
Aggressive post-op care
Fluid managment |
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Term
| Review of systems: Frequency of urination, dysuria, poor stream, incontinence, hematuria, impotence/sexual dysfunction |
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Definition
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Term
| Past medical History: renal disease, calculi, HTN and diabetes, use of diuretics, exposure to nephrotoxins |
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Definition
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Term
| Physical exam: edema, state of hydration, friction rub (indicates pericardial effusion) |
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Definition
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Term
| Lab studies: urinalysis, BUN/Creatinine (Cr) |
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Definition
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Term
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Definition
Inform anesthesia!!
Fluids!!
Adjust meds
Type of surgery
Close urinary monitoring |
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Term
Communication is the key to good teamwork
Gather information and get assistance
Discuss risk with pt and family
Informed consent is the key to the safe practice of medicine!!!! |
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Definition
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