Term
| Emergency History (acronym) |
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Definition
| (AMPLE) Allergies, Meds, PMH, Last meal, Events leading up to emergency |
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Term
| T/F Preoperative consults are used to "clear" a patient for surgery. |
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Definition
| False - Preoperative consults are used to provide additional information, risk stratification and recommendations to maximize pt's status /fitness for operation. |
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Term
| When (for whom) is the following lab ordered: Hemoglobin (7) |
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Definition
| hx of anemia, malignancy, renal insuff, cardiac dx, DM, pregnancy, or any surgery with expected blood loss. |
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Term
| When (for whom) is the following lab ordered: Electrolytes (9) |
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Definition
| chronic dz, DM, HTN, CV dz, renal or hepatic dz, pt with potential fluid loss, dehydration, vomiting, elderly |
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Term
| When (for whom) is the following lab ordered: Urinalysis (3) |
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Definition
| urinary symptoms, chronic dz, urinary procedure |
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Term
| When (for whom) is the following imaging ordered: CXR (2) |
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Definition
| intrathoracic procedure or active pulmonary dz |
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Term
| When (for whom) is the following lab ordered: ECG (6) |
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Definition
| men>40, women>50, symptomatic CV dz, HTN, DM, any thoracic, intraperitoneal, aortic or emergency surgery |
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Term
| T/F Pts who have labs within previous 4-6 months need not repeat them if there have been no clinical changes. |
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Definition
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Term
| What are the preop instructions for pts taking: Insulin |
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Definition
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Term
| What are the preop instructions for pts taking: aspirin |
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Definition
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Term
| What are the preop instructions for pts taking: Clopidogrel (antiplatelet) |
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Definition
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Term
| What are the preop instructions for pts taking: Warfarin |
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Definition
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Term
| What surgical complications can be caused by Garlic, Ginseng and Ginko? |
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Definition
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Term
| To what complications do medications predispose the surgical patient? |
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Definition
| Acute respiratory failure and bleeding. |
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Term
| What are the preop instructions for pts taking: Beta blockers and antiphypertensives |
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Definition
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Term
| What role does heparin have for surgical pts? |
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Definition
| Give to pt's with history of PE, hypercoagulable and valve replacement |
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Term
| Name 4 Risk stratification /assessment tools |
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Definition
1. Dripps-ASA classification
2. ASA classification
3. Goldman Scale
4. ACC-AHA |
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Term
| Describe Dripps-ASA classification |
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Definition
Class I-V
I=healthy patient, limited procedure
II=mild-moderate
III=severe
IV=life threatening
V=not expected to survive with or without surgery |
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Term
| Describe ASA classification |
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Definition
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Term
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Definition
| 9 factors that indicate risk for postoperative MI and death are assigned points. Number of points indicates risk. Classes I-IV; I=0-5 II=6-12 III=13-25 IV=>26 |
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Term
| Name some examples of Goldman Scale factors with points |
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Definition
S3 /JVD = 11 points
MI in last 6 mos = 10 pts
Rhythm other than sinus = 7
> 5 PVC's /min = 7
Age>70 = 5
Emergeny = 4
Aortic /abdominal /thoracic procedure=3 |
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Term
| Describe ACC-AHA Task force assessment |
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Definition
| List of Major Clinical predictors, Intermediate Clinical predictors and Minor clinical predictors |
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Term
| ACC-AHA Major Clinical Predictors |
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Definition
Unstable coronary syndrome
Decompensated CHF
Significant arrhythmis, vascular disease |
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Term
| ACC-AHA Intermediate clinical predictors |
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Definition
Mild angina
Compensated or prior CHF
DM |
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Term
| ACC_AHA Minor clinical predictors |
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Definition
advanced age
abnormal ECG
rhythm other than sinus
low functional capacity
hx of CVA
uncontrolled HTN |
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Term
| Eval & testing for high risk clinical predictors |
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Definition
| Non invasive testing and invasive testing (coronary angiography) |
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Term
| Eval & test for Intermediate risk predictors with poor functional capacity or high risk procedures |
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Definition
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Term
| Eval & testing for low risk predictors with poor functional capacity AND high risk procedures |
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Definition
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Term
| Non invasive testing includes: |
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Definition
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Term
| Invasive testing includes |
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Definition
| Cardiac Cath /angiography |
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Term
| How long after an MI should pt's wait to have elective surgery? |
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Definition
| 6 months (5% risk vs 30% risk at 3 mos) |
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Term
| What is the most common cause of postoperative morbidity? |
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Definition
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Term
| When should a surgical pt get specialized evaluation? |
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Definition
Only those with significant underlying risk factors,
undergoing procedures with high risk of pulmonary complications |
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Term
| T/F Medication for lung disease should be continued throughout perioperative period. |
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Definition
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Term
| Name some Pulmonary risk factors. |
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Definition
| Tobacco use, asthma, neuromusculare Dz, obesity, nutritional depletion, acidosis, COPD, prolonged OP time, decreased albumin, extended preop stay, chronic bronchitis, occupational lung dz, coma, tracheal intubation, hypotension, hypoxemia, azotemia, >60 yo, thoracoabdominal OP. |
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Term
| For nonpulmonary procedures; who gets PFT's? |
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Definition
Pt's with hx of occupational exposure /irritants;
problems with ADL's ie walking stairs;
smoking, wheezing, DOE;
Obesity, clubbing cyanosis;
prolonged expiration |
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Term
| How many flight of stairs to tolerate pneumonectomy? Lobectomy? |
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Definition
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Term
| ACP recommends PFT'f for: |
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Definition
Smokers /DOE undergoing CABG, upper abd OP;
Those with susp lung dz undergoing lower abd OP;
All lung resections |
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Term
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Definition
| Smoker /DOE undergoing CABG, upper abd. surgery and All resections. |
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Term
| When is surgery safest for pregnant women? |
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Definition
2nd trimester
(1st trimester - teratogenesis, SAB
3rd trimester - premature labor) |
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Term
| What are the most common procedures done in pregnant women? |
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Definition
| Appendicitis and biliary tract dz |
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Term
| When should mastectomy and chemotherapy take place in pregnant women? |
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Definition
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Term
| When should radiation therapy begin in pregnant women? |
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Definition
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Term
| When should pregnant women have resection for Rectal CA? |
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Definition
| During 1st half of pregnancy. If found during 2nd half, then wait until after delivery |
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Term
| % of fetal loss in trauma with sever injuries? |
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Definition
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Term
| What issues are common to pregnant women with trauma? |
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Definition
| Placental abruption, DIC, Rh-sensitization (Rh-neg should be considered for Rhogam) |
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