Pre-Operative Evaluation (Exam I) Flashcards
(56 cards)
What is the (metric) formula for BMI?
BMI = weight (kg) / [height (m)]²
What is the (imperial) formula for BMI?
BMI= 703 · weight (lbs) / [height (inches)]²
What mnemonic guides an emergent physical examination?
AMPLE
- Allergies
- Medications
- Past medical history
- Last meal eaten
- Events leading up to the need for surgery/procedure
What factors are worth one point on the Revised Cardiac Risk Index (RCRI)?
- High risk surgery
- Ischemic heart disease
- Hx of CHF
- Hx of CVA
- DM w/ insulin dependence
- Creatinine > 2 mg/dL (176 umol/L)
What group of surgeries has the highest risk?
High (>5% mortality risk)
Vascular (Aortic, major, & peripheral)
What sort of risk would be seen on the Revised Cardiac Risk Index with a score of 0?
What about with a score of 3 or greater?
- RCRI score of 0 = 0.4% risk of major cardiac events
- RCRI score of 3 = 5.4% risk of major cardiac events
What are METs?
- Metabolic Equivalent of Tasks (measurement of rate of energy consumption).
What is one MET equal to?
- 1 MET = 3.5 mLO₂ /kg/min
How would one assess functional capacity?
- Through METs
What is the range of this assessment?
- MET of 1 = eating, working at computer,
- MET of 3 = walking 1 or 2 blocks on level ground
- MET of 8 = rapidly climbing stairs or jogging slowly
- MET of 12 = running rapidly for long distances
What are the three levels of urgency of surgery?
- Emergent - Life or limb threatened, sx needed within 6 hours, no cardiac pre-op necessary.
- Urgent - Life or limb threatened, sx needed in 6-24 hours.
- Time-sensitive - delays exceeding 1-6 weeks would adversely affect patients.
What is ASA Physical status (APA-PS)?
A commonly used method by anesthesiologists to assess the overall perioperative risk.
What ASA level would an otherwise healthy 22 year old who got in a car wreck with massive trauma necessitating emergent surgery have?
- ASA V (won’t live without sx)
What ASA level would a healthy non-smoking 27 year old with diabetes have coming in for an EGD?
- ASA II (healthy but has well-controlled DM)
What ASA level would a 56 year old male who had an MI 2 months ago have for his follow up TEE today?
- ASA IV (MI less than 3 months ago)
What ASA level would a 12 year old girl with no hx have coming in for a routine tonscillectomy?
- ASA I (no hx, healthy, routine sx)
What ASA level would a 42 year old male with COPD and poorly controlled DM have?
- ASA III (COPD, poorly controlled DM)
Define ASA I
A normal healthy patient
Examples of ASA I
healthy, non-smoking, no or minimal alcohol use
Define ASA II
A patient with mild systemic disease w/o substantive functional limitations
Examples of ASA II
Current smokers, social alcohol drinkers, pregnancy, obesity (BMI range of 30-40), mild lung disease, controlled DM/HTN
Define ASA III
A patient with severe systemic disease with substantive functional imitations. (one or more moderate to severe diseases)
Example of ASA III
poor controlled DM, HTN, COPD, BMI = or > 40, pacemaker, ESRD w/ dialysis
Define ASA IV
A patient with severe systemic disease that is a constant threat to life
