Pre-op eval

Question 1

Risk assessment- ASA 1

Answer 1

Normal, healthy patient

• Excludes very young and old
• No organic, psych, or physic disturbance`

Question 2

Risk assessment- ASA 2

Answer 2

• Mild systemic disease
• No fxn limits
• Well controlled one system disease
• No COPD, peripheral neuropathy
• Pregnancy

Question 3

Risk assessment- ASA 3

Answer 3

• Severe systemic disease
• No immediate danger of death
• CHF, angina, MI
• Poorly controlled HTN, renal failure
• Obesity

Question 4

Risk assessment- ASA 4

Answer 4

• Severe systemic disease that is constant life threat

- Poorly controlled or at end stage

Question 5

Risk assessment- ASA 5

Answer 5

• Not expected to survive w/o operation, >24 hrs
• Imminent death
• Sepsis, hypothermia

Question 6

Risk assessment- ASA 6

Answer 6

Brain death, organ donor

Question 7

Risk factors- CV

Answer 7

• Ischemic heart disease
• CHF
• Cerebrovasc disease
• High risk operation
• Perioperative insulin
• serum creatinine >2
• Stress testing for high risk
• Continue beta blockers

Question 8

Risk factors- Pulm

Answer 8

• Advanced age
• Elevated ASA class
• CHF
• COPD
• Malnutrition, alcohol, AMS
• Smoking
• Sleep apnea

Question 9

Risk factors- VTE

Answer 9

• Fam hx
• Malignancy
• obstetric complications
• Known procoagulants
• Prolonged operation
• Give LMWH

Question 10

Risk factors- DM

Answer 10

• Hyperglycemia > 140- sugical site infections
• Manage postop glucose
• ## Antihyperglycemic meds

Question 11

Risk factors- SSI

Answer 11

• Glycemic control

- Abx 1 hr prior

Question 12

Informed consent

Answer 12

• Indications of operations and outcome
• alternatives
• Nat hx with no intervention

Question 13

H and P

Answer 13

• HPI
• Sx acute infection or tumor
• Surg hx
• Med hx
• VTE events
• Bleeding events
• Meds, dosage and schedule
• Steroids w/in 6 months
• Allergies
• Social hx
• CV, Pulm, neuro, status
• Baseline o2 sat, BMI

Question 14

Risk factors- Nutrition

Answer 14

• Wound healing and immune status
• Hypoalbiunemia risk factor for SSI
• Malnourished = gut feeding 1 week prior
• Imune modulating nutrition
• Obesity = mortality

Question 15

Pre-op meds

Answer 15

Pre-anesthesia

• Anxiolytic-Benzo
• Opiate
• Consider H2, PPI antacids to prevent pulm aspiration syndrome

Question 16

Bowel prep

Answer 16

• Colorectal surgery
• Lg volume of polyethylene glycol
• Oral and IV abx prior to surg