Preoperative - الأهلية

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Questions and Answers

What is the PRIMARY aim of preassessment clinics in the context of elective surgery?

  • To provide patients with a detailed overview of potential post-operative complications.
  • To immediately admit patients for surgery, bypassing the need for extensive evaluation.
  • To assess surgical patients 2-4 weeks before admission, allowing time to optimize their condition. (correct)
  • To conduct emergency surgeries without prior evaluation to save time and resources.

Why must preassessment be timed appropriately before surgery?

  • To avoid highlighting any potential problems and proceeding with surgery as quickly as possible.
  • To delay surgery as long as possible, minimizing potential complications.
  • To ensure that any identified problem receives a suitable response, while preventing new problems from arising. (correct)
  • To overwhelm the patient with medical information and reduce their anxiety.

Which of the following is NOT a component of the surgical history taken during preoperative assessment?

  • The patient's presenting complaint and its potential impact on anesthetic management.
  • Details of past medical conditions, surgical procedures, and bleeding tendencies.
  • A comprehensive review of each body system to identify any relevant issues.
  • The surgeon's personal preferences for surgical techniques and instruments. (correct)

Why is it essential to ask patients directly about their use of oral contraceptives and antiplatelet medications like aspirin before surgery?

<p>To determine if these medications need to be stopped preoperatively to reduce the risk of bleeding. (A)</p> Signup and view all the answers

Detailed descriptions of physical examination methods are BEST learned through which of the following?

<p>Observation and practice (A)</p> Signup and view all the answers

Why is it crucial to avoid relying solely on the examination findings of others during a preoperative assessment?

<p>Because surgical signs can change rapidly, and important pathologies can easily be missed. (C)</p> Signup and view all the answers

What key aspects should be ensured to provide appropriate care for patients during a physical examination?

<p>Treating them with respect and dignity, providing a clear explanation, and ensuring comfort. (A)</p> Signup and view all the answers

Considering the American Society of Anesthesiologists (ASA) classification, which patient would be classified as ASA III?

<p>A patient with poorly controlled diabetes and morbid obesity. (A)</p> Signup and view all the answers

What is the BEST course of action for a surgeon when deciding whether or not to operate?

<p>Base the decision on all available information, including history, examination, and investigations. (B)</p> Signup and view all the answers

Which of the following considerations is MOST important when obtaining informed consent from a patient?

<p>Presenting information at a time when the patient can best understand and retain it. (D)</p> Signup and view all the answers

What is the PRIMARY purpose of ensuring that all patients admitted to the hospital receive an identity wristband?

<p>To ensure accurate patient identification and prevent medical errors. (D)</p> Signup and view all the answers

Why is promoting adequate nutrition considered a key aspect of optimizing a patient's condition before elective surgery?

<p>To ensure the patient is strong enough to tolerate the stress of surgery and improve wound healing (B)</p> Signup and view all the answers

In managing an acutely ill surgical patient, what is the FIRST priority before theatre?

<p>Ensuring the patient is adequately resuscitated and stabilized. (C)</p> Signup and view all the answers

What is the initial step in the general principles of resuscitation for a surgical patient?

<p>Correct dehydration (B)</p> Signup and view all the answers

Why is the insertion of a urinary catheter considered vital in the initial resuscitation of a surgical patient?

<p>To monitor fluid balance carefully with hourly measurements. (B)</p> Signup and view all the answers

Which of the following statements BEST describes the role of prophylaxis in preoperative care?

<p>Reducing or preventing a known risk. (C)</p> Signup and view all the answers

Which of the following interventions is recommended to reduce the risk of deep vein thrombosis (DVT) in surgical patients?

<p>Administering heparin. (C)</p> Signup and view all the answers

Which of the following surgical wounds is MOST likely to be classified as "contaminated"?

<p>An appendectomy. (C)</p> Signup and view all the answers

What is the PRIMARY focus when considering preoperative management of coexisting cardiac disease?

<p>Identifying and managing known cardiac risk factors. (C)</p> Signup and view all the answers

Generally, for elective procedures, how long after a myocardial infarction (MI) is the risk of re-infarction considered to be at an acceptable minimum?

<p>After 6 months. (C)</p> Signup and view all the answers

What are the potential consequences of both hypoglycemia and hyperglycemia in a diabetic patient undergoing surgery?

<p>Both conditions increase the risk of infection, poor wound healing, and other complications. (B)</p> Signup and view all the answers

What is the rationale for placing diabetic patients first on the operating list?

<p>To reduce the period of starvation and risk of hypoglycemia. (D)</p> Signup and view all the answers

Why is it essential to recognize the side effects of steroid therapy in the perioperative period?

<p>Steroids can mask signs of sepsis/peritonitis and impair wound healing. (C)</p> Signup and view all the answers

A patient on long-term steroid therapy is undergoing a major surgery. Glucocorticoid deficiency in the perioperative period may manifest as which of the following?

<p>Addisonian crisis with vomiting and cardiovascular colapse (C)</p> Signup and view all the answers

What is the recommended approach for managing patients on steroid therapy undergoing surgery?

<p>Administer stress-dose steroids based on the nature of the surgery and the level of previous steroid use. (A)</p> Signup and view all the answers

Which factor is LEAST likely to influence the urgency of a surgical procedure as dictated in the presenting complaint?

<p>Patient's preferred timing (D)</p> Signup and view all the answers

What is the MOST critical consideration when assessing each body system during the systemic assessment phase of preoperative preparation?

<p>Ruling out potential involvement in the presenting complaint. (D)</p> Signup and view all the answers

Why is it MOST important to specifically ask patients about their use of oral contraceptives and antiplatelet medications before surgery?

<p>To determine potential bleeding risks that may necessitate preoperative cessation. (C)</p> Signup and view all the answers

What is the MOST relevant aspect of a patient's social history in the context of preoperative assessment?

<p>Assessment of recreational drug use and alcohol intake. (A)</p> Signup and view all the answers

Why is it crucial to treat patients with respect and dignity during a physical examination?

<p>To adhere to ethical guidelines and facilitate accurate diagnosis. (C)</p> Signup and view all the answers

What is the MOST important role of a chaperone during intimate examinations?

<p>To ensure patient comfort and allay potential discomfort or anxiety. (B)</p> Signup and view all the answers

When is preoperative laboratory testing LEAST likely to be performed?

<p>When surgical intervention is deemed inappropriate. (A)</p> Signup and view all the answers

Which patient demographic would be LEAST likely to require a preoperative ECG as part of their workup?

<p>A 30-year-old female with no known cardiac history undergoing elective laparoscopic cholecystectomy. (A)</p> Signup and view all the answers

According to the American Society of Anesthesiologists (ASA) classification, which patient would be categorized as ASA IV?

<p>A patient with severe systemic disease that is a constant threat to life. (B)</p> Signup and view all the answers

What is the PRIMARY reason for using up-to-date written material, visual and other aids when presenting information to patients before surgery?

<p>To ensure the information is current and to explain complex aspects of surgery effectively. (A)</p> Signup and view all the answers

What information is LEAST essential on a patient's identity wristband upon admission to the hospital?

<p>The patient's insurance details. (B)</p> Signup and view all the answers

In what way does inadequate resuscitation BEFORE theatre MOST negatively impact patient outcomes?

<p>It compromises the patient's physiological reserve and increases the risk of complications. (D)</p> Signup and view all the answers

What is the rationale for using intravenous (IV) fluids in the initial resuscitation of an acutely ill surgical patient?

<p>To correct dehydration and restore electrolyte balance. (D)</p> Signup and view all the answers

Why is pain control considered a crucial element in the resuscitation of a surgical patient?

<p>To minimize adrenaline release, thereby reducing tachycardia and hypertension. (A)</p> Signup and view all the answers

When should antibiotics be administered to a surgical patient with suspected sepsis?

<p>Empirically, as early as possible, pending culture results. (D)</p> Signup and view all the answers

What is the MOST important reason to decompress the stomach with a nasogastric (NG) tube in a surgical patient?

<p>To reduce the risk of aspiration on anesthetic induction. (C)</p> Signup and view all the answers

In the context of preoperative care, what does 'prophylaxis' refer to?

<p>The reduction or prevention of a known risk. (B)</p> Signup and view all the answers

If a patient is a smoker and requires surgery, why is it important for the patient to stop smoking preoperatively, even if only for 24 hours?

<p>To improve respiratory function before anesthesia. (D)</p> Signup and view all the answers

Which type of surgical wound is MOST likely to require therapeutic antibiotics based on its classification?

<p>Dirty wound. (D)</p> Signup and view all the answers

Why is it important to identify all known cardiac risk factors in the history?

<p>To allow for tailored risk-reduction strategies during the perioperative period. (B)</p> Signup and view all the answers

What is the PRIMARY concern regarding patients with diabetes mellitus undergoing surgery?

<p>Preventing both hypoglycemia and hyperglycemia to optimize wound healing and reduce infection risk. (A)</p> Signup and view all the answers

Which of the following is the GREATEST concern regarding a patient with diabetes postoperatively?

<p>Increased risk of infection (D)</p> Signup and view all the answers

What is the MOST likely presentation of Glucocorticoid deficiency in the perioperative period?

<p>Increasing cardiac failure which is unresponsive to catecholamines. (D)</p> Signup and view all the answers

What is the rationale for recommending a standardized approach to stress-dose steroids during surgery for patients on chronic steroid therapy?

<p>To prevent adrenal crisis and promote cardiovascular stability. (D)</p> Signup and view all the answers

Which is the MOST appropriate steroid intervention, for a patient on long term steroid therapy, undergoing a minor surgery?

<p>Administer 50mg hydrocortisone IM/IV preoperatively. (B)</p> Signup and view all the answers

Flashcards

Pre-op preparation rationale

Evaluating a patient's overall health to ensure they are fit to undergo a surgical procedure.

Elective Surgery

Surgery scheduled at a time convenient for both the patient and the surgical team.

Scheduled (or Semi-Elective) Surgery

Surgery needed promptly within a specific timeframe, like 3 weeks for malignancy

Urgent Surgery

Surgery performed as quickly as possible, usually within 24 hours, after adequate initial stabilization.

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Emergency Surgery

Immediate surgery performed alongside resuscitation efforts to save a life or limb.

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Preassessment Clinics

Clinics that evaluate surgical patients 2-4 weeks before elective surgery to assess their suitability for the procedure.

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Presenting Complaint

Gathering information on the current ailment prompting the patient to seek medical attention.

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Systemic Assessment

Thorough evaluation of each body system to identify any underlying issues.

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Past Medical and Surgical History

Details of surgical procedures, bleeding tendencies and hospital admissions.

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Drug History and Allergies

Comprehensive details of all medications, dosages, timing and allergies.

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Social History

Smoking/drinking habits, recreational drug use, living situation and support system.

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Family History

Focuses on bleeding disorders and malignant hyperthermia.

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Physical Examination Principles

Detailed examination via observation and practice.

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Physical Examination Items

Including general appearance, vital signs, cardiac, respiratory and abdominal.

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Preoperative Lab Testing Goals

To confirm a diagnosis, exclude a differential diagnosis, readiness for surgery and assess fitness.

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ASA System

Risks of surgery based on overall health status.

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Deciding to Operate

Thorough medical history, physical examination, and investigative tests guide decision-making.

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Patient should be

Respect, clear explanations, and kept comfortable.

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Obtaining consent

Provide enough info to make a descision.

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Patient identification

Clear wristband stating allergies.

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Do not forget

Nutrition.

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General Principles of Resuscitation

Fluid balance, electrolytes, urinary catheter insertion.

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Pain leads to

Tachycardia and hypertension.

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Role of Prophylaxis

Stopping medication, smoking, prescribing drugs.

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Thromboembolic Prophylaxis

elastic compression stocking and intermittent pneumatic calf compression.

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Preoperative Preparation

Prioritizes patient well-being by identifying and addressing health risks before surgery.

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Timing of preassessment

The interval should allow enough time to address potential issues but be brief enough to prevent new ones from arising.

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Impact of Presenting Complaint

Anesthetics can be affected by the patient's current condition and it can impact the presenting pathology during surgery

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Treat Pain Early

Treat pain early to minimize adrenaline release, which can cause tachycardia and hypertension.

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Methods of Thromboembolic Prophylaxis

Involves graded elastic compression stockings, intermittent pneumatic compression, early ambulation, and heparin prophylaxis.

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Early Antibiotics in Sepsis

Administer antibiotics early, ideally guided by blood and pus cultures

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Contaminated Wound

With opening of the abdominal cavity where there is major spillage of the contents

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Dirty Wound

Where the patient has a traumatic wound that is older than 4 hours, gangrenous wound, or pus

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Recent Myocardial Infarction (MI)

Dramatically increases the risk of re-infarction, necessitating careful risk assessment.

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DM: Good Glycemic Control

In a patient with DM, good glycemic control helps avoid Hypo/Hyperglycemia during operation.

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Steroid Therapy Side Effects

If the patient suffers from wound healing, the steroid therapy in the perioperative period increased the effect.

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Preoperative Decision Basis

The decision to undertake surgery based on history, examination, and investigative tests.

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Study Notes

Preoperative Preparation Rationale

  • Determines patient fitness for surgery
  • Allows for advanced preparation and organization of facilities and equipment
  • Enhances patient safety and minimizes chance of errors
  • Alleviates patient fear and anxiety
  • Intended to reduce morbidity and mortality

Classification of Surgery

  • Elective surgery happens with mutually convenient timing
  • Scheduled/semi-elective surgery occurs early with time limits, such as 3 weeks for malignancy
  • Urgent surgery happens as soon as possible after adequate resuscitation and within 24 hours
  • Emergency surgery happens with resuscitation concomitant with immediate operative intervention

Preassessment Clinics

  • Aims to assess surgical patients 2-4 weeks before their elective surgery admittance
  • Timing is important to ensure any issues are addressed and resolved, but also that new issues don't arise before surgery

Preoperative Assessment Includes

  • Gathering a history
  • Physical examination
  • Investigations as indicated
  • Consent and counseling

Surgical History Includes

  • Presenting complaint which dictates the urgency and influences anesthetic management
  • Systemic assessment to rule out involvement of any other body systems
  • Past medical and surgical history in order to note any diseases, operations, bleeding tendencies or hospital admissions
  • Drug history and allergies including dosages and times taken for all drugs
    • This includes related to sudden withdrawal, drugs continued over the perioperative period, allergies and the nature of reactions, asking about oral contraceptives, and antiplatelet medications like Aspirin and clopidogrel, which may need to be stopped preoperatively
  • Social history including smoking/drinking (how much and for how long), recreational drug abuse, and who lives at home with the patient, and who cares for them
  • Family history including bleeding disorders and malignant hyperthermia

Physical Examination

  • Gain detailed descriptions of physical examination methods through observation and practice
  • Avoid relying on the examination of others, as surgical signs may change and important pathologies may be missed
  • Treat with respect and dignity
  • Give a clear explanation of the examination
  • Keep patients as comfortable as possible
  • A chaperone should be present, especially for intimate examinations
    • This may be part of a local guideline or policy

Physical Examination Items

  • General examination including vital signs
  • Cardiac examination, including JVP and heart sounds
  • Respiratory examination: tracheal position, accessory muscles or respiration
  • Abdominal examination
  • CNS
  • Musculoskeletal system
  • Peripheral vascular
  • Local examination
  • Body orifices

Preoperative Laboratory Testing and Imaging

  • Performed when wishing to confirm a diagnosis, exclude a differential diagnosis, assess the appropriateness of surgical intervention, and assess fitness for surgery

Tests to Use

  • CBC: Major surgery, neonates, males older than 70 years, females older than 45 years, chronic renal/liver/lung disease, anemia, malignancy, poor nutritional states, vascular aneurysms
  • Serum Creatinine & Electrolytes: Kidney disease, hypertension, diabetes, stroke, poor nutritional states, medication (digoxin, diuretics, steroids), chemotherapy
  • Glucose: Diabetes, family history of diabetes, obese, stroke, poor nutritional states, steroid use, cushing, Addison
  • ECG: Cardiac disease, hypertension, chronic lung disease, thyroid disease, diabetes, morbid obesity, digoxin therapy, males older than 45 years, females older than 55 years
  • X-ray Chest: Heavy smoker, aortic aneurysm, chronic lung disease, radiation therapy, cardiomegaly
  • Coagulation Studies: Liver disease, renal dysfunction, family history of bleeding disorder, on anticoagulant drug

ASA Classification (American Society of Anesthesiologists)

  • Used to assess the risk of surgery
  • ASA I: Normal healthy patient is healthy, non-smoking, and has no or minimal alcohol use
  • ASA II: Patient with mild systemic disease
    • Mild diseases only without substantive functional limitations
    • Current smoker or social alcohol drinker
    • Pregnancy or obesity (303 months of MI
  • ASA IV: Patient with severe systemic disease that is a constant threat to life
    • Recent (40), active hepatitis
    • Alcohol dependence or abuse
    • Implanted pacemaker or moderate reduction of ejection fraction
    • ESRD undergoing regularly scheduled dialysis
    • History of MI, CVA, TIA, or CAD/stents
  • ASA V: Moribund patient who is not expected to survive without the operation
    • Ruptured abdominal/thoracic aneurysm
    • Massive trauma
    • Intracranial bleed with mass effect
    • Ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction.

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