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Preop Evaluation (Lungs (Heart :<3: (Pt: :warning:EF < 35% …

- - - - 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
        
        begin w/ ECG
        
        most don't require more than this; but…
        
        Persons w/ CABG or HF pt, get
        
        Echo (HF eval)
        
        Stress vs. Cath (left heart Cath)
        
        (Pretest FM): exceptions... Asx &
        
        CABG < 5y ago
        
        angioplasty < 5y ago
        
        normal stress test < 2y ago
        
        ~~Echo, stress, cath~~
        
        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:
  - - - Dx: workup
        
        PFT
        
        (to measure if has ability to oxygenate/ventilate)
        
        :calendar:DAY OF: ABG
        
        (elevated CO2 or drop in O2 :warning:)
        
        Tx:
        
        give O2 for low O2
        
        control the underlying disease:
        
        inhalers
        
        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
- - - - :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
  - - - Pt: @ risk :warning: for malnutrition:
        
        those w/ -20% body weight within 3 mo
        
        Albumin < 3
        
        (ensure its malnutrition, not liver disease)
        
        fail a Skin Anergy Test
        
        Dx: get prealbumin & CRP
        (these are other proteins in body)
        
        if ↓ albumin & ↓prealbumin/CRP
        
        body is ↓protein state
        
        ↓albumin : ↑prealbumin
        
        = liver disease
        
        :pencil2:Prealbumin changes before albumin
        
        Prealbumin doesn't become albumin, its just a product that precedes albumin on electrophoresis.
        
        Skin Anergy testing
        
        do you have enough Ig (proteins) to form an allergic rxn? Tuberculin skin test
        
        failure (no rxn), not enough protein, :no_entry:sx.
        
        Tx: Replace food :hamburger: (PO>IV)
        
        :warning:Give 10d replacement > 5d (wait it out)
        
        longer feeds are better than shorter
    - - 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
        
        Tx: IV fluids :ocean: & IV insulin (just like normal management)