Pre-op H&P Flashcards Preview

Surgery > Pre-op H&P > Flashcards

Flashcards in Pre-op H&P Deck (33):
1

What is the goal of a pre-op H&P?

Reduce complications
Health care costs

2

Role of Medical Consultant Prior to Surgery

Define co-morbidities
Evaluate severity of co-morbidities
Optimize all medical conditions
Provide surgical risk assessment
Recommend peri-op measures to reduce risk

3

Surgical Physiology

Peripheral dilation
Reduced myocardial contractility
Decrease in tidal volume
Epi & norepi elevated
Cortisol elevated
ADH elevated

4

Complete ROS with Special Attention to

Undiagnosed or inadequately controlled chronic disease
Cardiac & pulmonary
Bleeding disorders
Hx of DVT

5

What all needs to be included in the medication history of a pre-operative patient?

Anticoagulants
Aspirin
NSAIDs
Echinacea
Ginsent
Garlic
Gingko
St. John's Work
Kava

6

Effects of Echinacea Important for Surgery

Hepatotoxicity

7

Effects of Ginseng Important for Surgery

Platelet inhibitor
Hypoglycemia

8

Effects of Garlic Important for Surgery

Platelet inhibitor
Preload reduction

9

Effects of Gingko Important for Surgery

Platelet inhibitor
Alters vasoregulation

10

Effects of St. John's Wort Important for Surgery

Up-regulates P450
Drug-drug reactions

11

Effects of Kava Important for Surgery

Potentiates sedation
Drug-drug reactions

12

Important Factors of Functional Status

Exercise tolerance
Activity level

13

Lee Index Risk Factors for Major Cardiac Complications

High-risk surgery
Hx of ischemic HD
Hx of congestive HF
Hx of stroke/TIA
Insulin-dependent DM
Serum Cr >2 mg/dL

14

Major Cardiac Complications with Lee Index

MI
Pulmonary edema
V-fib
Primary cardiac arrest
Complete heart block

15

When is noninvasive cardiac testing performed?

Intermediate clinical predictor
Poor functional capacity
High risk surgery

16

Examples of Intermediate Clinical Predictors

Class 1 or 2 angina
Prior MI or pathologic Q waves
Compensated or prior HF
DM

17

Management of Low Risk Patient with CAD

4-5% risk of major cardiac complication
Considered for prophylactic revascularization if indications for revascularization exist independent of non cardiac surgery
Preoperative anti-anginal meds should be continued
Prophylactic IV nitro may reduce ischemia

18

Evaluation of High Risk Patient with CAD

Surgery delayed until CAD is treated
Delay surgery 3-6 months of recent MI

19

What do you need to know with a CHF patient for surgery?

Ejection fraction

20

How is decompensated CHF indicated?

Elevated JVP
Audible 3rd heart sound
Evidence of pulmonary edema on exam or CXR

21

Pre-op Necessities with CHF Patients

Pre-op control of CHF
Electrolytes & digoxin levels
Anesthesiologist & surgeon aware of severity of CHF

22

Valvular HD & Pre-op Evaluation

Echo to determine nature & severity of disease
Severe systemic aortic stenosis are high risk for complications

23

Arrhythmias & Pre-op Evaluation

Determine any arrhythmias
A-fib: control with Lovenox window
Symptomatic SVT & VT should be controlled
Indications for pacemaker: placed prior to surgery

24

HTN & Surgery

Should be controlled prior to surgery

25

Pulmonary Evaluation & Surgery

Highest risk in cardiac, thoracic, & upper abdominal surgery
Patient specific factors associated with increased risk
Highest risk: FEV1 less than 500 mL or arterial pCO2 >45 mmHg
Well controlled asthma?

26

Pulmonary Evaluation: Patient Specific Factors Associated with Increased Risk

Chronic lung disease
Morbid obesity
Tobacco use

27

Peri-operative Management of Patients with Lung Disease

DVT prophylaxis
Antibiotics

28

Bleeding Risk Assessment

History
Hx unavailable: PT, PTT, platelet count, & bleeding time

29

2 Most Common Serious Neurologic Problems After Surgery

Acute delirium
Stroke

30

DM & Surgery

Increased risk of infection & MI
Regulation of blood sugar
CMP measured & corrected prior to surgery

31

Hypothyroidism & Surgery

Severe symptomatic should be corrected
Mild or asymptomatic generally okay

32

Risk of Renal Disease & Surgery

Peri-operative complications: hyperkalemia, pneumonia, & fluid overload
Dialysis 24 hours prior to surgery
Monitor volume status closely

33

Medication Recommendations & Surgery

Most Rx meds continued morning of surgery
ACEI & diuretics withheld day of surgery
DM: No oral hypoglycemics day of surgery
Discontinue herbals 2 weeks prior
Refrain from ASA, NSAIDs, & Plavix 2 weeks prior
Warfarin: use lovenox window
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