Oral Flashcards
(18 cards)
Lab values for postponing a case
Hard cutoffs
Na< 125 mEq/L
K<2.5 or >6 mEq/L
Hct>60% or <25%
BG>300-400 mg/dL or < 50
Considerations for postponing surgery
How big is operation
How sick is patient? Comorbidities
How will operation impact current conditions (hyponatremia)
Is the patient symptomatic?
3 components of informed consent
Benefits
Material risks
Alternatives
What does material risk mean?
A risk is material when, “a reasonable person…would likely attach significance to the risk or cluster of risks in deciding whether or not to forego the proposed therapy.”
Broad criteria for extubation
• Normothermia
• Complete reversal of NMB
• Hemodynamic stability
• Adequate oxygenation
• Adequate ventilation [TV > 6 ml/kg]
• Ability to protect airway
Fasting guidelines
Clears 2 hrs
Breast milk 4 hrs
Infant formula 6 hrs
Non human milk 6 hours
Light meal 6hrs
Fried/fatty foods 8hrs
Who requires an RSI?
Full stomach- trauma, pregnancy >16 wks, emergent or unknown NPO status
Gastroparesis
-pregnant, DM, SBO, Ozempic
Why order a test?
It will change your management
When would you order an EKG?
• Reasonable for ANY known CAD/IHD/arrhythmia/PAD/CVD, etc. for a
medium-high risk surgery (Class 2a)
• May be considered for healthy patients having moderate-high risk surgery
(2b)
• Not useful for asymptomatic patients having low-risk surgery (Class 3)
Recommendation for preop echo in setting of valvular disease
• Recommended for any patients with ≥moderate valve disease with either:
o No echo within 1 year, or
o A significant change in clinical status
(Class I)
When do you order pharmacological stress testing?
Elevated risk ANDDDDD unknown functional capacity
And:
-results of test could impact perioperative care
-results impact patients decision to perform surgery
Not useful in low risk surgery**
Why get an ABG?
Baseline PaCO2
Meds (severe acidosis may prompt bicarbonate)
Ventilation goals
Reason to get pulmonary function test
Pre-op lung resection
Myasthenia gravis to correlate with post op ventilation
Indications for an artline
• Beat-to-beat BP determinations especially w/potentially unstable patient
or vasoactive infusions
• Frequent ABG/Lab Draws
Barry: rarely a need to have post-induction arterial lines (prefers pre-induction
-if you’re thinking about it just fucking place it
Allen test
Poor sensitivity and specificity
Limited clinical utility mostly medical/legal test
What is NOT a good reason to place a CVC
The need to infuse large volumes of fluid/blood is a poor reason to put in a
CVC, as peripheral IVs can accomplish this
Contraindications to CVP
Coagulopathy
Anatomic distortion of site
Contaminated site
Vascular injury proximal to site
Best indicator of LV preload
TEE
