Pre-op Testing Flashcards Preview

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Flashcards in Pre-op Testing Deck (25):
1

Goals of a Preoperative Evaluation

Define co-morbidities
Evaluate severity & stability of co-morbidities
Identify unrecognized comorbid disease
Identify risk factors for medical complications of surgery
Optimize all medical conditions
Recommend perioperative measures to reduce risk

2

What tests should be ordered?

Hospital requirements
Patient history & risk of procedure

3

When can you use past lab tests for surgery?

Normal within past 4 months unless there has been a change in clinical status

4

When is an H&H indicated?

Major surgery if >65
Younger patients if significant blood loss is expected

5

When is a creatinine indicated?

50+ with intermediate or high risk surgery
Younger with anticipated hypotension or nephrotoxic drugs

6

When is a pregnancy test indicated?

All women of reproductive age

7

When should a CXR & PFTs needed?

50+ with upper abdominal or thoracic surgery

8

When is a CBC warranted?

Age 65+ having major surgery
H&H where major blood loss expected

9

At what level of a serum creatinine is there an increased cardiac risk?

>2 mg/dL

10

When is a creatinine indicated?

50+ with:
Moderate surgery risk
Anticipated hypotension
Possible use of nephrotoxic drugs

11

When is a CMP recommended?

Patient on:
Diuretics
ACEI
ARB
Known renal disease

12

What type of diabetes is at greater risk of cardiac complications?

Insulin-dependent DM

13

Which patients have a greater morbidity & mortality in regards to LFTs?

Cirrhosis
Acute liver failure

14

When are bleeding tests required?

Anti coagulated patients
Neurosurgery

15

When is a UA indicated?

Never

16

When is a pregnancy test indicated?

Women of reproductive age

17

A patient with what conditions require an EKG?

CAD
CHF
Arrhythmias
Structural HD
PAD or cerebrovascular disease
DM

18

Lee Index

High risk surgery
History of ischemic HD
HF
Cerebrovascular disease
Insulin dependent DM
Creatinine >2

19

Recommend a CXR for Patients with

Known/suspected
cardiopulmonary disease
50+ undergoing AAA or upper abdominal/thoracic surgery

20

Consider a CXR for Patients

AP & lateral for the morbidly obese (BMI >40)
70+ without risk factors

21

When are PFT's recommended?

Lung resection
Unexplained dyspnea or exercise intolerance
COPD or asthma

22

Pulmonary Complications with Surgery

COPD
CHF
OSA
Pulmonary HTN
50+

23

Which patients need a sleep study prior to surgery?

Patients with persistent symptoms, don't follow treatment plan, & have had weight changes

24

Smoking & Surgery

Less likely to heal fusions & skin grafts
Check serum continine levels: normal after 2 weeks of abstinence

25

Immunocompromised Patients & Surgery

Less likely to heal
More likely to develop an infection