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Preparing Patients for the Operating Room

Preparing Patients for the Operating Room. Emily Cantrell June 23, 2014. When does it start?. As soon as you meet the patient! Remember we are surgeons so every patient is a potential surgical candidate. Why is it important?.

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Preparing Patients for the Operating Room

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  1. Preparing Patients for the Operating Room Emily Cantrell June 23, 2014

  2. When does it start? • As soon as you meet the patient! • Remember we are surgeons so every patient is a potential surgical candidate

  3. Why is it important? • Identifies patients who might require a more extensive preoperative evaluation • Predicts post operative complications and morbidity/ mortality

  4. Top patient risk factors most predictive of post operative mortality

  5. ASA Classification • I -- Normal healthy patient • II -- Patient with mild systemic disease • III -- Patient with severe systemic disease that limits activity but is not incapacitating • IV -- Patient who has incapacitating disease that is a constant threat to life • V -- Moribound patient is not expected to survive 24 hours with or without an operation

  6. Key components • Chief Complaint and History • Past medical and surgical history • Allergies • Medications • Review of Systems • Physical Exam • Appropriate Labs and Studies

  7. Key Component: History • Self explanatory- just get the details and summarize pertinent data • Patients often “forget” about prior operations or think they aren’t important.

  8. Key Component: Allergies • Again, self explanatory but necessary to determine preoperative antibiotic prophylaxis • Don’t forget the 10% cross reactivity between penicillins and cephalosporins • Contrast allergy

  9. Key Component: Medications • Again, self explanatory • Don’t forget: • Herbal supplements • Anticoagulation • Anti-platelet therapies

  10. Key Component: Review of Systems • Constitutional/ General • Eyes • Ear, Nose, Mouth, Throat • Cardiovascular • Respiratory • Gastrointestinal • Genitourinary • Musculoskeletal • Integumentary • Neurological • Psychiatric • Endocrine • Hematologic/ lymphatic • Allergic/ immunology

  11. Informed consent • Blood • Pre printed forms that detail the risks of blood transfusion. • Operative/ Invasive • Generic forms • Procedure specific forms • Must list the risks associated with the procedure and generalized risks as well as benefits

  12. Pre-op Orders/ Considerations • CXR • EKG • Labs • Type and screen/cross • Diet- NPO after midnight versus Hold tube feeds on call to OR. • Maintenance IVF while NPO • Special orders- bowel preps, ostomy site marking etc.

  13. Pre-op Note • PRE-OP DIAGNOSIS: • PROCEDURE: planned surgery. • LABS: CBC, chemistries, PT/INR, urinalysis, etc. • CHEST X-RAY: note findings. • EKG: note findings. • ADDITIONAL STUDIES: echo, imaging, etc. • BLOOD: not needed, type/screen or type/cross 2 units packed RBCs, etc. • ORDERS: NPO, preoperative antibiotics, skin or colon preps, etc. • CONSENT: signed and on chart / CSOC.

  14. Prior to going to the OR, all patients need… • Full H&P within 30 days of the operation • Unless they are an inpatient • H&P update (if coming in the morning of surgery) • Consent for the operation/blood • Type and screen • Pre-op orders • NPO • MIVF • Antibiotics on call to OR (if needed) • Appropriate labs

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