Preop Evaluation (Lungs (Heart :<3: (Pt:
:warning:EF < 35%
- :warning:EF < 35%
- (decomp HF/vol overload = 75% risk of death)
- (wait 6mo); risk @ 3m = 40%; risk @ 6mo = 6%.
- No elective sx, except to improve :<3: sx.
(Pretest FM) contradiction!: < 6m since CABG is a risk factor
- electives: Defer elective sx until 6m (then proceed w/o screen if Asx)
- non-elective: Sx within 6m = echo/stress/cath
Goldman Index (LY)
- more points = worse off
- Compare CV risk to functional status
- JVD (EF <35%) :no_entry: sx
- recent MI :<3: :no_entry: sx
Dx: workup for sx
Persons w/ CABG or HF pt, get
- begin w/ ECG
- most don't require more than this; but…
- Echo (HF eval)
- Stress vs. Cath (left heart Cath)
(Pretest FM): exceptions... Asx &
- CABG < 5y ago
- angioplasty < 5y ago
- normal stress test < 2y ago
Tx: Stent or CABG
- wait 6mo then reevaluate
- CHF? max heart failure
- Rx BBlockers :trumpet: & ACEi :spades:
- Vol overload? Diuresis w/ loops :roller_coaster::curly_loop::curly_loop:
Path: Ventilation >> Oxygenation
- Doc can raise FiO2 to bring up SaO2
- Bad lungs = CO2 trapping = respiratory acidosis
Pt: Bad lungs
- OLD: COPD/asthma
- ILD: now called DPLD
(Pretest FM): :smoking: w/ Asx, no need to PFT/ABG. Need s/s
- (to measure if has ability to oxygenate/ventilate)
- :calendar:DAY OF: ABG
- (elevated CO2 or drop in O2 :warning:)
- give O2 for low O2
- control the underlying disease:
- Smoking cessation :no_smoking:
- always right answer
- :pencil2:Immediately after smoking, bronchiole secretions increase.
- Smoking should stop 8wks before sx.
- Use nicotine patch to help w/ cravings
- (day to day change: medicine/transplants)
- Childs-Pugh ( surgeons use):
- A[not that bad :+1::skin-tone-4:] - C[pretty bad :-1::skin-tone-4:]
Pt: Synthetic fn of the liver
- Clotting factors (↑PT, ↑PTT)
- ↑Total Bilirubin
- s/s of ascites, encephalopathy (spectrum of severity)
:pencil2:Any 1 of these derangements = 40% chance of death.
- All 5 = 100% chance of death: :skull_and_crossbones:
- short of a liver transplant, there is no management
- :pencil2:cirrhotics don't get elective sx, unless v. minimal/ emergent
DKA: check BG :candy: before day of sx. (esp. elective sx)
- Hi glucose? :warning: Will die if DKA & sx. :skull_and_crossbones:
- Will die w/ dehydration & sx. :skull_and_crossbones:
- Control BG :candy: prior to going to sx
- Want to find things that preclude someone from elective sx.
- Emergent sx required? They go. (else they die)
- Can still use these criteria to predict the risk of death and MI.
- Elective case: assess risk & reduce risk before they go through sx.
- Organ systems & prep evaluation procedure