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15 Cards in this Set
- Front
- Back
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What are the four main checks for pre-op assessment?
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adverse medication events
bleeding clotting heart attack |
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Name the main medications that might cause surgical/postsurgical bleeding.
(mnemonic) |
We Face GGG (great gushing gore)
warfarin effient / prasugrel fish oil aspirin, nsaids clopidogrel e -vitamin E garlic ginko balboa ginseng |
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What questions should you ask to assess bleeding risk for surgery?
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prior bleeding post trauma/surgery
(teeth, tonsils, fractures, mva) liver disease, vasculitis, platelet disorders leukemia, lymphoma family history: "does anyone in your family have a bleeding problem like hemophilia, Christmas disease, von Wilebrand's disease?" Do your gums bleed when you brush your teeth? |
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Are screening LFTs necessary for pre-op bleeding assessment?
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no, exam and history can find:
ascites bilirubin icterus spider angiomata encephalopathy albumin? INR? |
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Are screening coag studies necessary to assess surgical bleeding risk?
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no, they are not predictive or helpful
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When should we get INR/ PT as a presurgical screen for bleeding risk?
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only in the case of liver dz.
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Risk factors on presurgical H&P for clotting
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age over 40
immobility cancer, esp. adenocarcinoma obesity varicose veins edema (venous stasis) hemosiderin pigmentation (venous stasis) prior dx of PCV, COPD, HF, MI, IBD (protein losing enteropathy) elevated estrogen (pregnancy, OCP, meds) |
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What cancer is especially associated with clotting?
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adenocarcinoma
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What presurgical blood tests are obtained for bleeding risk?
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CBC if anemic
platelet count if pt will be on heparin (baseline to assess HIT) metabolic panel if >50, or has condition or med affecting renal function H1AC if obese or >L 50 |
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What are the 5 cardiac risk factors for cardiac complications with MAJOR noncardiac surgery?
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stroke
MI HF RF DM |
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What are the criteria for a presurgical stress test?
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3 OR MORE risk factors
no stress test in past 2 years or poor functional capacity (can't climb 2 flights or walk 4 blocks) |
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What drug should be given perioperatively to noncardiac surgery patients (moderate and high cardiac risk)?
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beta blocker
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What are the criteria for getting presurgical CABG or PTCA?
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unstable angina
LVEF < 20% Left main artery dz critical aortic stenosis |
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What should be done about antihypertensive meds before surgery?
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continue up to and including the morning of surgery, with enough water to wash them down.
If pt has poor renal function, consider holding ACE and ARB, because they reduce renal perfusion. |
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What should be done about diabetes medications prior to surgery?
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discontinue oral hypoglycemics as patient begins fasting for surgery.
insulin: use half of usual dose of long acting insulin )on day of surgery?) |
