CM final 5

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Author:
Anonymous
ID:
212073
Filename:
CM final 5
Updated:
2013-04-07 21:54:47
Tags:
aa emory clinical methods
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Description:
CM final - anesthesia consult
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  1. 2 reasons for anesthesia conuslt:
    • 1) reduce surgical and anesthetic morbidity/mortality
    • 2) return pt to desirable level of functionality asap
  2. Stress Response to surgery proportional to:
    • magnitude of injury
    • total operating time
    • amt of blood loss
    • degree of post op pain
  3. decreasing stress response to surgery and trauma is _______ to _________ outcome and lowering length of _______ and total cost of pt's care.
    • key
    • improving
    • hospital stay
  4. History should include all of the following: (8)
    • 1. Medical hx (past/current)
    • 2. Surgical Hx
    • 3. Family hx
    • 4. Social hx
    • 5. Allergies
    • 6. Drug therapy (recent/current)
    • 7. drug reactions, anesthesia complications
    • 8. family hx of anesthesia adverse rx
  5. a physical exam should build on the information gathered during the ______.
    history
  6. Describe focused pre-anethesia physical exam:
    • airway assesment
    • lungs and heart w/ documentation of vital signs
  7. unexpected abnormal findings on PE should be ________ before ________ surgery
    • investigated
    • elective
  8. what are the indication for getting an INR lab?
    • Anticoag therapy
    • bleeding diathesis
    • liver dz
  9. What are the indication for getting an complete blood count lab?
    • chronic cv, lung, renal, hepatic dz
    • malignancy
    • anemia, bleeding condition, myelosuppression
    • < 1 year of age
  10. What are the indication for getting a fasting glucose lab?
    DM (on day of surgery and prior to)
  11. What are the indication for getting an EKG before surgery?
    Heart dz, HTN, DM, cardiac dz, age, cranial hemorrhage, cerebrovascular accident, head trauma
  12. What are the indication for getting  a chest radiograph?
    • cardiac or pulmonary dz
    • malignancy
  13. Most drugs should be continued up to and the day of surgery.  what are the exceptions?
    • MAOIs
    • OCP
    • Herbal supplements
    • Aspirin
    • Thienopyridines
    • Oral anticoags
    • anti-HTN:diuretics, ACE inhibitors/ARBs
    • diabetic meds: oral and insulin
  14. how before surgery should a pt stop taking MAOIS?
    2-3 weeks
  15. how before surgery should a pt stop taking OCPs?
    6 weeks. risk of venous thrombosis
  16. how before surgery should a pt stop taking Aspirin?
    7-10 days
  17. how before surgery should a pt stop taking thienopyridines?
    2 weeks
  18. how before surgery should a pt stop taking oral anticoags? INR should be ____ prior to surgery.
    • 4-5 days
    • 1.5
  19. ASA 1
    normal, healthy
  20. ASA 2
    mild systemic dz
  21. ASA 3
    severe systemic dz
  22. ASA 4
    severe systemic dz that is a constant threat to life
  23. ASA 5
    moribund, not expected to survive without surgery
  24. ASA 6
    brain-dead, organ removal for donor purposes
  25. What are the MAJOR risk factors for perioperative complications?
    • Recent MI
    • unstable angina
    • CHF
    • significant arrhythmias
    • severe valvular dz
  26. What are the MINOR risk factors for perioperative complications?
    • advanced age
    • abnormal ECG (LVH, LBBB, ST-T-wave abnormalities)
    • Rhythm other than sinus
    • Poor functional capacity
    • hx of stroke
    • uncontrolled HTN ( d> 110)
  27. Pt's are high risk for ___ days after coronary revascularization.
    40
  28. What surgeries are considered low risk for cardiac complications?
    • breast
    • superficial
    • eye
    • endoscopic
    • plastic, reconstructive
    • ambulatory
  29. PPC's occur in ____% of pt's undergoing major, non thoracic surgery
    20-30
  30. Name the PPC's
    • pneumonia
    • atelectasis
    • bronchitis
    • bronchospasm
    • hypoxemia
    • resp failure with prlonged mechanical vent
    • exacerbation of underlying chronic dz
  31. risk factors for PPC's
    • proximity to diaphragm
    • length ( >3 hours)
    • emergency
    • chronic pulmoary problems
    • smoker
    • >60 years
    • obesity
    • Sleep apnea
    • poor exercise tolerance
  32. _____ have a higher incidence of death after an MI.
    DIABETICS
  33. Pt's with DM- consider giving what? why?
    • beta blockers
    • ischemia, silent MI
  34. It is important to control what with diabetic pt's?
    Glucose
  35. What procedures don't need to alter anticoag therapy?
    dental, arthrocentesis, biopsies, ophthalmic operations, endoscopy (diangnostic)
  36. regarding anticoag- invasive surgery generally safe if INR is ____.
    1.5
  37. it takes ___ days for INR to reach 2.0 once oral anticoag started postoperatively
    3

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