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Flashcards in Pre-op eval Deck (16):
1

Risk assessment- ASA 1

Normal, healthy patient
- Excludes very young and old
- No organic, psych, or physic disturbance`

2

Risk assessment- ASA 2

- Mild systemic disease
- No fxn limits
- Well controlled one system disease
- No COPD, peripheral neuropathy
- Pregnancy

3

Risk assessment- ASA 3

- Severe systemic disease
- No immediate danger of death
- CHF, angina, MI
- Poorly controlled HTN, renal failure
- Obesity

4

Risk assessment- ASA 4

- Severe systemic disease that is constant life threat
- Poorly controlled or at end stage

5

Risk assessment- ASA 5

- Not expected to survive w/o operation, >24 hrs
- Imminent death
- Sepsis, hypothermia

6

Risk assessment- ASA 6

Brain death, organ donor

7

Risk factors- CV

- Ischemic heart disease
- CHF
- Cerebrovasc disease
- High risk operation
- Perioperative insulin
- serum creatinine >2
- Stress testing for high risk
- Continue beta blockers

8

Risk factors- Pulm

- Advanced age
- Elevated ASA class
- CHF
- COPD
- Malnutrition, alcohol, AMS
- Smoking
- Sleep apnea

9

Risk factors- VTE

- Fam hx
- Malignancy
- obstetric complications
- Known procoagulants
- Prolonged operation
- Give LMWH

10

Risk factors- DM

- Hyperglycemia > 140- sugical site infections
- Manage postop glucose
- Antihyperglycemic meds
-

11

Risk factors- SSI

- Glycemic control
- Abx 1 hr prior

12

Informed consent

- Indications of operations and outcome
- alternatives
- Nat hx with no intervention

13

H and P

- HPI
- Sx acute infection or tumor
- Surg hx
- Med hx
- VTE events
- Bleeding events
- Meds, dosage and schedule
- Steroids w/in 6 months
- Allergies
- Social hx
- CV, Pulm, neuro, status
- Baseline o2 sat, BMI

14

Risk factors- Nutrition

- Wound healing and immune status
- Hypoalbiunemia risk factor for SSI
- Malnourished = gut feeding 1 week prior
- Imune modulating nutrition
- Obesity = mortality

15

Pre-op meds

Pre-anesthesia
- Anxiolytic-Benzo
- Opiate
- Consider H2, PPI antacids to prevent pulm aspiration syndrome

16

Bowel prep

- Colorectal surgery
- Lg volume of polyethylene glycol
- Oral and IV abx prior to surg