Misc

Question 1

Primary risk factors for heart failure in the US are…

Answer 1

CAD, smoking, HTN, DM, Obesity

Question 2

H&P findings that raise likelihood of CHF

Answer 2

Myocardial Infarction
Crepitations (crackles in lungs)
Edema

Question 3

Peri-op drugs in CHF

Answer 3

if well-tuned, continue all of them

Question 4

1. What is the WHO definition of anemia for men and women? At altitude? For smokers?

Answer 4

men - 13
women - 12
altitude - correction ranges from adding up 0.2 g/dL to the cutoff for people living at 1000 m to 4.5 g/dL for those living at ≥4500 m
smokers - smoke up to 1 ppd -0.3
smoke 1-2 ppd -0.5
some more than 2 ppd -0.7

Question 5

2. What proportion of preoperative patients are likely to have anemia? What proportion of these will be iron-deficient?

Answer 5

34%

75%

Question 6

3. With what adverse postoperative outcomes is preoperative anemia associated?

Answer 6

bood transfusion, mortality, prolonged LOS, morbidity

Question 7

4. But certainly mild preop anemia is no big deal?

Answer 7

preop anemia, even to a mild degree, is independently associated with an increased risk of 30-day morbidity and mortality in patients undergoing major non-cardiac surgery.

Question 8

5. The international consensus statement recommends screening anemia in surgical cases with what level anticipated blood loss?

Answer 8

500ml+

Question 9

6. What is ferritin?

Answer 9

Ferritin is a blood cell protein that contains iron. A ferritin test helps your doctor understand how much iron your body is storing.

Question 10

7. What is transferrin?

Answer 10

a protein of the beta globulin group which binds and transports iron in blood serum.

Question 11

8. How can iron deficiency anemia be diagnosed?

Answer 11

Serum ferritin level < 30 lg.l!1 is the most sensitive and specific test used for the identification of absolute iron deficiency. However, in the presence of inflammation (C-reactive protein > 5 mg.l!1) and/or transferrin saturation < 20%, a serum ferritin level < 100 lg.l!1 is indicative of iron deficiency.

Question 12

10 (there is no 9). What are the benefits of treating preoperative anemia?

Answer 12

reduced morbidity, mortality, transfusions