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Gwen - Anaesthetics > Pre-Assessment > Flashcards

Pre-Assessment Flashcards

(43 cards)

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1
Q

What’s the point in a pre-op assessment?

A
  • An opporunity toidentify co-morbidities that may lead to patient complcations during the anaethetic, surgical or post op period.
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2
Q

When do people get there pr-op assessment?

A

2-4 weeks

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3
Q

What is ECOG stage 0?

A

Fully active, able to carry on all pre-disease performance without restriction

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4
Q

What is ECOG grade 1?

A

Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work

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5
Q

What is ECOG grade 2?

A

Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours

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6
Q

What is ECOG grade 3?

A

Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours

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7
Q

What is ECOG grade 4?

A

Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair

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8
Q

What is ECOG grade 5?

A

Death

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9
Q

What is ASA score of 1?

A

Normal, healthy individual

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10
Q

What is an ASA score of 2?

A

Mild systemic disease - Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease

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11
Q

What is an ASA score of 3?

A

Severe systemic disease - Substantive functional limitations; One or more moderate to severe diseases. Examples include (but not limited to): poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA < 60 weeks, history (>3 months) of MI, CVA, TIA, or CAD/stents.

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12
Q

What is ASA score of 4?

A

A patient with severe systemic disease that is a constant threat to life - Examples include (but not limited to): recent ( < 3 months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis

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13
Q

What is an ASA score of 5?

A

A moribund patient who is not expected to survive without the operation - Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction

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14
Q

What is an ASA score of 6?

A

A declared brain-dead patient whose organs are being removed for donor purposes

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15
Q

What cardiovascular problems may you want to ask about in the pre-operative assessment?

A
  • IHD
  • HF
  • HTN
  • Valvular disease
  • Conduciton defects
  • Arrythmias
  • PVD/DVT
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16
Q

What are the main surgical grades used to determine the appropriate tests to do pre-operatively?

A
  • Minor
  • Intermediate
  • Major
  • Major plus surgery
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17
Q

What respiratory conditions would you want to screen for in pre-operative assessment?

A
  • COPD
  • Asthma
  • Infection
  • Restrictive lung disease
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18
Q

What criteria need to be met for patients to deemed low risk for surgery?

Study These Flashcards
A
  1. No coexisting medical problems
  2. Have coeisting medical problem that is well controlled and does not impair daily activity
  3. Do not require/require only baseline investigations
  4. Have no Hx of anaesthetic difficulties
  5. Require surgery with minimal complicaiton risk
19
Q

How would you assess exercise tolerance in pre-op assessment?

Study These Flashcards
A
  • Could you run for a bus?
  • How far uphill can you walk?
  • How far can you walk on flat?
  • Are you able to do shopping?
  • How many stairs?
  • Able to do housework/take care of yourself?
20
Q

What other considerations (besides CVS, Resp and exercise tolerance) might you want to investigate/ask about in the pre-op assessment?

Study These Flashcards
A
  • Indegestion/Reflux
  • RA
  • DM
  • Neuromuscular disorders
  • Chronic renal failure
  • Jaundice - liver dysfunciton
21
Q

When would you consider doing U+E’s in a patient as part of pre-op assessment?

Study These Flashcards
A
  • Taking drugs - digoxin, diuretics, steroids
  • Diabetes
  • Renal disease
  • Vomiting
  • Diarrhoea
22
Q

When would you consider doing LFT’s in someone for pre-op assessment?

Study These Flashcards
A
  • Hepatic disease
  • High alcohol intake
  • Metastatic disease
  • Evidence of malnutrition
23
Q

When would you consider doing blood sugars in someone as part of pre-op assessment?

Study These Flashcards
A
  • Diabetes
  • Severe PVD
  • Long term steroids
24
Q

When would you consider doing an ECG in someone as part of their pre-op assessment?

Study These Flashcards
A
  • Hypertensive
  • IHD
  • Cardiac arrythmia
  • Diabetes > 40 years old
25
When would you consider a CXR as part of your pre-op assessment?
* **Cardiac/respiratory disease** * **Known/suspected malignancy** * **Thoracic surgery planned** * **Suspected TB**
26
When would you consider doing pulmonary function tests in somoene as part of a pre-operative assessment?
* **Symptoms of dyspnoa on mild exertion** * **COPD** * **Asthma**
27
If a patient was found an pulmonary function tests to be dyspnoeic or cyanosed at rest, or FEV1 \< 60%, what additional investigation would you consider?
Arterial blood gas while breathing AIR
28
When might you consider a coagulation screen in someone for pre-op assessment?
* **Anticoagulant therapy** * **History of bleeding diathesis** * **History of liver disease/jaundice**
29
When might you consider doing a C-spine x-ray in someone as part of their pre-op assessment?
* **RA** * **Major trauma/surgery to the neck** * **Difficult intubation is predicted**
30
What systems would you want to assess pre-operatively in a diabetic patient?
* **CVS** - HTN, IHD, CVD, MI * **Renal** - Kidney disease * **Resp** - prone to infections * **Airway** - thicking of soft tissues * **GI** - delayed gastric empting = prone to reflux
31
What pre-operative investigations would you consider doing in a diabetic patient?
* **Examination** - any signs of complications * **HbA1c** - 20-48 mmol/mol * **U+E's** * **Blood sugar** * **ECG** * **CXR**
32
How would you manage a diabetic patient in the pre-operative setting?
* **Individualize diabetes management** * **Place patient first on list** * **Avoid overnight admission if possible** * **If Planned short starvation/miss meal** - variable-rate IV insulin infusion * Try to avoid short starvation
33
What investigaitons should you consider as part of your pre-operative assessment of someone with asthma?
* **How well it is managed** * **Document allergies/triggers** * **Therapy being used** * **PEFR** * **Spirometry** * **ABG** -severe asthma * **ECG** * **CXR**
34
What investigations might you consider doing in somoene with COPD as part of your pre-op assessment?
* **Spirometry** * **ABG** - moderate to severe COPD * **ECG** * **CXR**
35
How would you optimise COPD patient before surgery?
* **Stop smoking** - at least 8 weeks before is optimal * **Adjust LAMA/SAMA/LABA/SABA therapy** * **Preoperative chest physio** * **Pulmonary rehab**
36
How would you evaluate a hypertensive patient pre-operatively?
* **Assess whether primary of secondary** * **Assess severity** * **Asses end-organ involvement**
37
How would you manage hypertension pre-operatively?
* **Optimise hypertensive treatment** * **Consider deferal of surgery if severe**
38
How would you evaluate somoene with heart failure in pre-op assessment?
* **History and examination** * **Optimise treatment** - symptomatic arrythmias, diuretics etc. * **Consider appropriate investigaitons**
39
What investigations would you consider doing in someone with HF as part of you pre-op assessment?
* **Bloods** - FBC, U+E's, LFTs, TFTs, Fasting lipids, glucose * **ECG** * **CXR** * **TTE** - grade impairment * **Consider Cardiac catheterisaiton**
40
What investigations would you consider doing in someone with IHD as part of your pre-operative assessment?
* **Grading as per METS criteria** * **ECG** * **ETT** * **MRI perfusion scan**
41
How would you assess/grade exercise tolerance?
42
What is used to meausure to measure risk of major perioperative cardiav event? List the components
**Cardiac risk index** * **High risk surgery** * **History IHD** * **History CCF** * **Histor cerebrovascular disease** * **DM** * **Serum creatinine \>180 mEq/l**
43
Whats the 2-4-6 rule?
* 2 hours clear fluids/tea/coffee * 4 hours breast milk * 6 hours food

Gwen - Anaesthetics (16 decks)

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