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CA-1 > PreOp Eval > Flashcards

PreOp Eval Flashcards

1
Q

Components of an anesthesia HPI

A

Pts
- age
- gender
- surgical diagnosis of …
- pertinent pmhx of …. controlled with …..(meds)
- scheduled for procedure …..
- with Dr.
- on date …..
- at … (facility)

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2
Q

What are the components of anesthesia social hx

A

Should include risk factors for disease
- tobacco use
- alcohol use
- substance use
All with qualifiers including
- frequency
- duration of use
- last use

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3
Q

What are social determinants of health

A
  • Non medical factors that influence health outcomes
    Including
  • housing
  • transportation
  • employment
  • access to care
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4
Q

What are the components of anesthesia fam hx

A
  • hx malignant hyperthermia
  • atypical plasma pseudocholinesterase
    Anything that will affect anesthesia care
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5
Q

What are METS

A

Metabolic equivalents of physical activity. Gives an indication of a pts ability to tolerate surgery given their baseline exercise/ activity tolerance

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6
Q

ASA I

A

Normal healthy patient
For adults
- healthy, non smoking, minimal etoh
For peds
- healthy, normal BMI percentile for age

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7
Q

ASA II

A

Mild systemic disease with no functional limitations
- well controlled diabetes
- well controlled HTN
- pregnancy
- BMI >30 but <40
- mild lung disease
- current smoker , social alcohol

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8
Q

ASA II Peds

A
  • asymptomatic congenital cardiac disease
  • well controlled dysrhythmias
  • asthma without exacerbation
  • well controlled epilepsy
  • non insulin dependent DM
  • mild OSA
  • oncologic state in remission
  • autism with only mild limitations
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9
Q

ASA II obstetric

A
  • normal pregnancy
  • well controlled gestational HTN
  • controlled preeclampsia without severe features
  • diet controlled gestational diabetes
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10
Q

ASA III

A

Severe systemic disease + functional limitation
- one or more systemic diseases like
- poorly controlled DM or HTN
- COPD
- morbid obesity BMI >40
- Active hepatitis
- implanted pace maker
- etoh dependency or abuse
- moderately low EF
- ESRD on dialysis
- 3 months of mor hx of MI, CVA, TIA CAD with stents

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11
Q

ASA III peds

A
  • uncorrected stable congenital cardiac disease
  • asthma with exacerbation
  • poorly controlled epilepsy
  • insulin dependent diabetes
  • morbid obesity, malnutrition
  • severe OSA
  • CF
  • Muscular dystrophy
  • hx of organ transplant
  • spinal cord malformation
  • sever autism
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12
Q

ASA III obstetrics

A
  • preeclampsia with sever features
  • gestational diabetes with complications or high insulin requirements
  • thromboembolic disease requiring anticoagulation
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13
Q

ASA IV

A

Severe systemic disease that is a constant threat to life
- recent MI CVA TIA CAD w/ stents < 3 mos
- ongoing cardiac ischemia
- severe valve dysfunction
- low EF
- shock
- sepsis
- ESRD not undergoing frequent dialysis
-

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14
Q

ASA IV peds

A
  • symptomatic congenital cardiac abnormalities
  • congestive heart failure
  • active sequelae of prematurity
  • DIC, sepsis, shock
    -ventilator dependence
  • endocrinopathy
  • advanced oncologic state
  • severe respiratory distress
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15
Q

ASA IV obstetrics

A
  • preeclampsia with severe features complicated by HELLP
  • peripartum cardiomyopathy with EF <40
  • decompensated heart failure
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16
Q

ASA V

A

Moribund will not survive without surgery
- ruptured AAA
- massive trauma
- intracranial bleed with mass effect
- ischemic bowel + cardiac pathology or multi organ system failure

17
Q

ASA V peds

A
  • massive trauma
  • intracranial hemorrhage with mass effect
    -pt requiring ECMO
  • respiratory failure or arrest
  • malignant hyperthermia
  • ischemic bowel
  • multi organ system failure
18
Q

ASA V obstetrics

A
  • uterine rupture
19
Q

ASA VI

A

Brain dead whose organs are being harvested for donation

20
Q

Preoperative fasting - 8 hrs or more

A

Fried foods , fatty foods, meat, normal meal essentially

21
Q

Preoperative fasting - 6 hrs

A
  • non human milk
  • infant formula
  • light meals : toast and clear liquids ( water coffee black tea juice without pulp)
22
Q

Preoperative fasting - 4 hrs

A
  • breast milt
23
Q

Preoperative fasting - 2 hrs

A
  • clear liquids : black tea, black coffee, water , fruit juices without pulp, carbonated beverages
24
Q

Components of anesthesia informed consent

A

Disclosure of information that a “reasonable person” would want in order to make a decision
Routine anesthetic
- pts medical condition. - procedures that will be performed. - risks
- consequences of care. - post op pain management : including options
-

25
Q

What factors influence choice of anesthesia type

A
  • surgical procedure
  • duration of procedure
  • pts coexisting diseases
  • pts preference of care
    Final decision rests on anesthesiologist
26
Q

Components of anesthesia

A
  • amnesia
  • analgesia
  • unconsciousness
  • muscle relaxation
27
Q

RSI

A

Rapid sequence intubation
Goal
- minimize time between onset of unconsciousness and tracheal intubation
- reduce risk of regurgitation

28
Q

Indications for RSI

A
  • increased risk of aspiration of gastric contents
  • pts with full stomachs : any emergency procedures
  • pregnancy. > 20 wks gestation
  • pts with increased abdominal pressure : abdominal mass ascites morbid obesity
  • certain GI pathology :esophageal stricture, SBO, gastric outlet obstruction
  • certain it’s with GERD : Active reflux, hiatal hernia
29
Q

Is routine heartburn only to spicy and acidic foods an indication for RSI

A

No

CA-1 (8 decks)

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