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Questions and Answers
What is the PRIMARY aim of preassessment clinics in the context of elective surgery?
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?
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?
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?
Why is it essential to ask patients directly about their use of oral contraceptives and antiplatelet medications like aspirin before surgery?
Detailed descriptions of physical examination methods are BEST learned through which of the following?
Detailed descriptions of physical examination methods are BEST learned through which of the following?
Why is it crucial to avoid relying solely on the examination findings of others during a preoperative assessment?
Why is it crucial to avoid relying solely on the examination findings of others during a preoperative assessment?
What key aspects should be ensured to provide appropriate care for patients during a physical examination?
What key aspects should be ensured to provide appropriate care for patients during a physical examination?
Considering the American Society of Anesthesiologists (ASA) classification, which patient would be classified as ASA III?
Considering the American Society of Anesthesiologists (ASA) classification, which patient would be classified as ASA III?
What is the BEST course of action for a surgeon when deciding whether or not to operate?
What is the BEST course of action for a surgeon when deciding whether or not to operate?
Which of the following considerations is MOST important when obtaining informed consent from a patient?
Which of the following considerations is MOST important when obtaining informed consent from a patient?
What is the PRIMARY purpose of ensuring that all patients admitted to the hospital receive an identity wristband?
What is the PRIMARY purpose of ensuring that all patients admitted to the hospital receive an identity wristband?
Why is promoting adequate nutrition considered a key aspect of optimizing a patient's condition before elective surgery?
Why is promoting adequate nutrition considered a key aspect of optimizing a patient's condition before elective surgery?
In managing an acutely ill surgical patient, what is the FIRST priority before theatre?
In managing an acutely ill surgical patient, what is the FIRST priority before theatre?
What is the initial step in the general principles of resuscitation for a surgical patient?
What is the initial step in the general principles of resuscitation for a surgical patient?
Why is the insertion of a urinary catheter considered vital in the initial resuscitation of a surgical patient?
Why is the insertion of a urinary catheter considered vital in the initial resuscitation of a surgical patient?
Which of the following statements BEST describes the role of prophylaxis in preoperative care?
Which of the following statements BEST describes the role of prophylaxis in preoperative care?
Which of the following interventions is recommended to reduce the risk of deep vein thrombosis (DVT) in surgical patients?
Which of the following interventions is recommended to reduce the risk of deep vein thrombosis (DVT) in surgical patients?
Which of the following surgical wounds is MOST likely to be classified as "contaminated"?
Which of the following surgical wounds is MOST likely to be classified as "contaminated"?
What is the PRIMARY focus when considering preoperative management of coexisting cardiac disease?
What is the PRIMARY focus when considering preoperative management of coexisting cardiac disease?
Generally, for elective procedures, how long after a myocardial infarction (MI) is the risk of re-infarction considered to be at an acceptable minimum?
Generally, for elective procedures, how long after a myocardial infarction (MI) is the risk of re-infarction considered to be at an acceptable minimum?
What are the potential consequences of both hypoglycemia and hyperglycemia in a diabetic patient undergoing surgery?
What are the potential consequences of both hypoglycemia and hyperglycemia in a diabetic patient undergoing surgery?
What is the rationale for placing diabetic patients first on the operating list?
What is the rationale for placing diabetic patients first on the operating list?
Why is it essential to recognize the side effects of steroid therapy in the perioperative period?
Why is it essential to recognize the side effects of steroid therapy in the perioperative period?
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?
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?
What is the recommended approach for managing patients on steroid therapy undergoing surgery?
What is the recommended approach for managing patients on steroid therapy undergoing surgery?
Which factor is LEAST likely to influence the urgency of a surgical procedure as dictated in the presenting complaint?
Which factor is LEAST likely to influence the urgency of a surgical procedure as dictated in the presenting complaint?
What is the MOST critical consideration when assessing each body system during the systemic assessment phase of preoperative preparation?
What is the MOST critical consideration when assessing each body system during the systemic assessment phase of preoperative preparation?
Why is it MOST important to specifically ask patients about their use of oral contraceptives and antiplatelet medications before surgery?
Why is it MOST important to specifically ask patients about their use of oral contraceptives and antiplatelet medications before surgery?
What is the MOST relevant aspect of a patient's social history in the context of preoperative assessment?
What is the MOST relevant aspect of a patient's social history in the context of preoperative assessment?
Why is it crucial to treat patients with respect and dignity during a physical examination?
Why is it crucial to treat patients with respect and dignity during a physical examination?
What is the MOST important role of a chaperone during intimate examinations?
What is the MOST important role of a chaperone during intimate examinations?
When is preoperative laboratory testing LEAST likely to be performed?
When is preoperative laboratory testing LEAST likely to be performed?
Which patient demographic would be LEAST likely to require a preoperative ECG as part of their workup?
Which patient demographic would be LEAST likely to require a preoperative ECG as part of their workup?
According to the American Society of Anesthesiologists (ASA) classification, which patient would be categorized as ASA IV?
According to the American Society of Anesthesiologists (ASA) classification, which patient would be categorized as ASA IV?
What is the PRIMARY reason for using up-to-date written material, visual and other aids when presenting information to patients before surgery?
What is the PRIMARY reason for using up-to-date written material, visual and other aids when presenting information to patients before surgery?
What information is LEAST essential on a patient's identity wristband upon admission to the hospital?
What information is LEAST essential on a patient's identity wristband upon admission to the hospital?
In what way does inadequate resuscitation BEFORE theatre MOST negatively impact patient outcomes?
In what way does inadequate resuscitation BEFORE theatre MOST negatively impact patient outcomes?
What is the rationale for using intravenous (IV) fluids in the initial resuscitation of an acutely ill surgical patient?
What is the rationale for using intravenous (IV) fluids in the initial resuscitation of an acutely ill surgical patient?
Why is pain control considered a crucial element in the resuscitation of a surgical patient?
Why is pain control considered a crucial element in the resuscitation of a surgical patient?
When should antibiotics be administered to a surgical patient with suspected sepsis?
When should antibiotics be administered to a surgical patient with suspected sepsis?
What is the MOST important reason to decompress the stomach with a nasogastric (NG) tube in a surgical patient?
What is the MOST important reason to decompress the stomach with a nasogastric (NG) tube in a surgical patient?
In the context of preoperative care, what does 'prophylaxis' refer to?
In the context of preoperative care, what does 'prophylaxis' refer to?
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?
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?
Which type of surgical wound is MOST likely to require therapeutic antibiotics based on its classification?
Which type of surgical wound is MOST likely to require therapeutic antibiotics based on its classification?
Why is it important to identify all known cardiac risk factors in the history?
Why is it important to identify all known cardiac risk factors in the history?
What is the PRIMARY concern regarding patients with diabetes mellitus undergoing surgery?
What is the PRIMARY concern regarding patients with diabetes mellitus undergoing surgery?
Which of the following is the GREATEST concern regarding a patient with diabetes postoperatively?
Which of the following is the GREATEST concern regarding a patient with diabetes postoperatively?
What is the MOST likely presentation of Glucocorticoid deficiency in the perioperative period?
What is the MOST likely presentation of Glucocorticoid deficiency in the perioperative period?
What is the rationale for recommending a standardized approach to stress-dose steroids during surgery for patients on chronic steroid therapy?
What is the rationale for recommending a standardized approach to stress-dose steroids during surgery for patients on chronic steroid therapy?
Which is the MOST appropriate steroid intervention, for a patient on long term steroid therapy, undergoing a minor surgery?
Which is the MOST appropriate steroid intervention, for a patient on long term steroid therapy, undergoing a minor surgery?
Flashcards
Pre-op preparation rationale
Pre-op preparation rationale
Evaluating a patient's overall health to ensure they are fit to undergo a surgical procedure.
Elective Surgery
Elective Surgery
Surgery scheduled at a time convenient for both the patient and the surgical team.
Scheduled (or Semi-Elective) Surgery
Scheduled (or Semi-Elective) Surgery
Surgery needed promptly within a specific timeframe, like 3 weeks for malignancy
Urgent Surgery
Urgent Surgery
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Emergency Surgery
Emergency Surgery
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Preassessment Clinics
Preassessment Clinics
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Presenting Complaint
Presenting Complaint
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Systemic Assessment
Systemic Assessment
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Past Medical and Surgical History
Past Medical and Surgical History
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Drug History and Allergies
Drug History and Allergies
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Social History
Social History
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Family History
Family History
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Physical Examination Principles
Physical Examination Principles
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Physical Examination Items
Physical Examination Items
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Preoperative Lab Testing Goals
Preoperative Lab Testing Goals
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ASA System
ASA System
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Deciding to Operate
Deciding to Operate
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Patient should be
Patient should be
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Obtaining consent
Obtaining consent
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Patient identification
Patient identification
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Do not forget
Do not forget
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General Principles of Resuscitation
General Principles of Resuscitation
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Pain leads to
Pain leads to
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Role of Prophylaxis
Role of Prophylaxis
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Thromboembolic Prophylaxis
Thromboembolic Prophylaxis
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Preoperative Preparation
Preoperative Preparation
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Timing of preassessment
Timing of preassessment
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Impact of Presenting Complaint
Impact of Presenting Complaint
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Treat Pain Early
Treat Pain Early
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Methods of Thromboembolic Prophylaxis
Methods of Thromboembolic Prophylaxis
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Early Antibiotics in Sepsis
Early Antibiotics in Sepsis
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Contaminated Wound
Contaminated Wound
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Dirty Wound
Dirty Wound
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Recent Myocardial Infarction (MI)
Recent Myocardial Infarction (MI)
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DM: Good Glycemic Control
DM: Good Glycemic Control
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Steroid Therapy Side Effects
Steroid Therapy Side Effects
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Preoperative Decision Basis
Preoperative Decision Basis
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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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