Addressograph

1. Addressograph Abdominal Aortic Aneurysm NVD Proforma To be completed by surgical team Emergency Open L18.4 Elective Open L19.4 EVAR L27.1 Date of Admission______________ Elective / Emergency Medical Hx DM IHD CCF Smoker Renal Dialysis EVAR Discussed at MDT Y / N Type Bifurcated / AUI Aneurysm symptomatic Y / N Max. Diameter ________cm Detected by screening programme Y / N Incidental finding Y / N Suitable for EVAR Y / N ECG Normal AF Fast AF Ectopics >5 ST changes Antiplatelet ___________ β-Blocker ___________ Statin ____________ IV contrast in last 3 days Y / N ACEI given pre-op Y / N Angiotensein II Blocker Y / N Loop diuretic given pre-op Y / N NSAIDs Y / N Pre-op lowest systolic BP ____mmHg Highest pulse ____bpm Pre-op lowest diastolic BP ____mmHg eGFR ____ Bloods Hb WCC Urea Creat Na K Alb MRSA +ve Y / N INR Date of Admission______________ ASA grade _____ Procedure start time______________ Finish time______________ Previous aortic surgery Y / N Graft type Tube / Trouser GA / Spinal Aortic findings Inflammatory Infective Ruptured Standard Intra-operative blood loss ____mls Vol. of salvaged blood transfused ____mls Other open wounds Y / N Intra-op Lowest systolic BP ____mmHg Highest pulse ____bpm Clamp position Infrarenal / Suprarenal Clamp-time ____mins Left renal vein ligated Y / N

2. To be completed by anaesthetic team Intra-operative fluids Vol. of saline ____mls Vol. of other crystalloid ____mls Vol. of colloid ____mls Vol. of blood ____mls FFP ____units Vol. of salvaged blood ____mls Urine O/P ____mls Arterial line Y / N CVP line Y / N Inotropes Y / N specify __________________________________ Mannitol Y / N Furosemide Y / N Pre-op assessment IHD MI Angina CCF HTN CVA COPD ETT < 4 mins > 4mins ECHO findings ______________________________________________________________________ Other cardiac Ix findings ______________________________________________________________ CPX findings ________________________________________________________________________ Anaesthetic Volatile Y / N N2O Y / N TIVA Y / N Opiates Y / N (if yes specify)_______________________________ Post-op Epidural Y / N Infusion Y / N PCA Y / N NSAIDs Y / N Paracetamol Y / N Core Temp. at start ____ºC Core Temp. at end ____ºC Extubated Y / N where __________________________ Return completed to vascular lab by 5pm on day of surgery