This document discusses preoperative evaluation and preparation of surgical patients. It begins with an introduction on the importance of preoperative preparation from initial patient contact through to surgery. Preoperative evaluation involves gathering a comprehensive history and physical exam, ordering appropriate investigations, assessing risks, communicating with the patient, and involving a multidisciplinary team. Key areas addressed include cardiovascular, respiratory, gastrointestinal, metabolic, coagulation disorders and ensuring medical optimization and documentation is complete prior to surgery. The goal is to minimize surgical risk and maximize postoperative outcomes.
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
its sometime difficult to decide in urgent clinical scenarios - Trauma,active bleeding, surgery: What ; when ; how and why to transfuse? answering some of these queries here is my presentation especially made for PG students (will help in answer writing)
* Fluid resuscitation is mandatory in shock from traumatic haemorrhage * Massive use of resuscitative fluids following injury is now being disputed * Adequate resuscitation is no longer judged by presence of normal vital signs * Normalcy of organ and tissue specific measured values are to be achieved * Search for a single endpoint that works for all trauma patients, is unrealistic * Resuscitate with appropriate fluid, in appropriate amount, at appropriate time
Perioperative management of patients on corticosteroidsTerry Shaneyfelt
In these annotated PowerPoints I discuss the evaluation and perioperative management of patient taking or who have taken steroids. I discuss how to determine if the adrenal axis is suppressed and how to provide supplemental glucocorticoids if needed. Remember to download these slides to see the annotations for each slide.
RSI is a method of intubating patients who have a gag reflex who would otherwise be difficult to intubate. Intubation is accomplished by sedating and paralyzing the patient, allowing for easier intubation.
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
its sometime difficult to decide in urgent clinical scenarios - Trauma,active bleeding, surgery: What ; when ; how and why to transfuse? answering some of these queries here is my presentation especially made for PG students (will help in answer writing)
* Fluid resuscitation is mandatory in shock from traumatic haemorrhage * Massive use of resuscitative fluids following injury is now being disputed * Adequate resuscitation is no longer judged by presence of normal vital signs * Normalcy of organ and tissue specific measured values are to be achieved * Search for a single endpoint that works for all trauma patients, is unrealistic * Resuscitate with appropriate fluid, in appropriate amount, at appropriate time
Perioperative management of patients on corticosteroidsTerry Shaneyfelt
In these annotated PowerPoints I discuss the evaluation and perioperative management of patient taking or who have taken steroids. I discuss how to determine if the adrenal axis is suppressed and how to provide supplemental glucocorticoids if needed. Remember to download these slides to see the annotations for each slide.
RSI is a method of intubating patients who have a gag reflex who would otherwise be difficult to intubate. Intubation is accomplished by sedating and paralyzing the patient, allowing for easier intubation.
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
Définir le moment optimal pour une génioplastie fonctionnelle en évaluant:
1-le patron du remodelage osseux au menton
2-le patron de stabilité post chirurgicale chez le patient adulte et celui en croissance.
Colonoscopy is one of the most common procedures in medicine today. This lectures covers the complications associated with colonoscopy, including the risk factors and management.
Objective: To understand the pathophysiology of the arthrosis that lead to condylar resorption. To understand systemic, local and occlusal factors that may lead to condylar resorption. To know the diagnostic test that are recommended. To know how to adapt the treatment plan (surgical or non surgical) to patients with condylar resorption.
Mr. AMF 62 years presented with central chest pain on exertion for last 4 monthsHypertension(BP-220/120 mmHg) for last 4 years, taking 4 anti hypertensives.Diabetes for last 5 years (HbA1c-9.3%).Smoking for 8 years.Dyslipedemic for 3 years. H/o 5 times hospital admissions due to heart failure in last 3 years.ECG-Anterior wall ischemiaEF-58%During careful clinical exam- renal bruit on left side.Coronary angiogram done and revealed DVD. Renal angiogram showed significant left renal artery stenosis. Coronary angioplasty and left renal artery angioplasty done.
Mr AMF now have no chest pain on exertion after 3 months of coronary angioplasty.
Now BP is controlled (130/85 mm Hg), taking B blockers and ARB due to intolerance of ACE inhibitors.
No hospital admission during this period.
Diabetes and serum lipids are controlled.
Preanesthetic evaluation of patients in oral and maxillofacial surgeryPunam Nagargoje
The word is derived from the Greek words an, which means “without” and aithesia which means “feeling”
The use of medical anesthesia was first reported in 1846
The development of anesthesia has made today’s modern surgical techniques possible
• Basic Principles of Anesthesia
• “Triad of General Anesthesia”
need for unconsciousness
need for analgesia
need for muscle relaxation and loss of reflexes
• Preoperative Evaluation
• The preanesthetic evaluation has specific objectives including:
- Establishing a doctor-patient relationship,
- Becoming familiar with the surgical illness and
- coexisting medical conditions,
- Anticipating potential complication
Developing a management strategy for perioperative anesthetic care,
- Obtaining informed consent for the anesthetic plan.
The overall goals of the preoperative assessment are to reduce perioperative morbidity and mortality and to allay patient anxiety.
• Pre-operative
This applied both in evaluation & investigations
• General
This include the following:
1-General condition of the patient.
2-Psychological condition. ( Specially in major operations).
• Specific
This include the following:
1-Related to anaesthesia.
2-Related to the surgery.
• Medical History
1. Review the chart
2. Review previous records
3. Interview the patient
• Demographic Data
Height / weight
Vital signs
Diagnosis
History and Physical Exam
Note any abnormalities
Don’t assume that all problems are listed
• Steps of the preoperative visit :
• Preoperative testing should be performed on a selective basis for purposes of guiding or optimizing perioperative management.
• Pre-op Testing Schema Example
• Preoperative Laboratory Testing:
• only if indicated from the preoperative history and physical examination.
• "Routine or standing" pre operative tests should be discouraged
• -CBC anticipated significant blood loss, suspected hematological disorder (eg.anemia, thalassemia, SCD), or recent chemotherapy.
• -Electrolytes diuretics, chemotherapy, renal or adrenal disorders
• -ECG age >50 yrs ,history of cardiac disease, hypertension, peripheral vascular disease, DM, renal, thyroid or metabolic disease.
• -Chest X-rays prior cardiothoracic procedures ,COPD, asthma, a change in respiratory symptoms in the past six months.
• -Urine analysis DM, renal disease or recent UTI.
• -tests for different systems according to history and examination
• Disease-based indications
Alcohol abuse
CBC, ECG, lytes, LFTs, PT
Anemia
CBC
Bleeding disorder
CBC, LFTs, PT, PTT
Cardiovascular
CBC, creatinine, CXR, ECG, lytes
• Disease-based indications
Cerebrovascular disease
Creatinine, glucose, ECG
Diabetes
Creatinine, electrolytes, glucose, ECG
Hepatic disease
CBC, creatinine, lytes, LFTs, PT
• Disease-based indications
Pregnancy (controversial)
Serum B-hCG- 7 days, Upreg 3 days
Pulmonary disease
CBC, ECG, CXR
Renal disease
CBC, Cr, lytes, ECG
RA
CBC, ECG, CX
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Introduction
• Preoperative preparation is the preparation of
a patient requiring surgery to optimize
postoperative outcomes
• Begins from the time of contact of the patient
with the surgeon and ends on the day of
surgery
• The approach is multidisciplinary
3. Preoperative patient preparation
1. Gathering and recording: History,
examination, investigation, conclusion and
treatment plan
2. Planning to minimize risk and maximize
benefit for the patient
3. Being prepared for adverse events and plan
to how to deal with them
4. Communicating with patient and all other
members of the team
7. • Explaining to the patient: discussing the
proposed management plan
8. Investigations
• Commonly needed investigations are
1. Full blood count : clinical diagnosis, anaemia,
blood loss
2. Urea and electrolyte:
>65 yrs, h/o of CVS, Pulmonary or renal
problems
10. • Hepatic risk:
• Predictors of mortality: Bilirubin (>2mg/dl),
Serum albumin (<3gm/dl), PT (>16secs),
Encephalopathy
• 40% mortality : if either of these present
• 80-85% mortality if 3 or more are present or if
bilirubin alone >4, albumin alone<2gm/dl, or
ammonia concentration > 150mg/dl
11. Investigations Contd.
4. Clotting screen: Anti coagulant therapy,
Abnormal LFT, bleeding disorder
5. Arterial blood gases: Acid- base abnormality
suspected or respiratory conditions
6. EKG: > 65 years, Past h/o of CVS, pulmonary
or anesthetic problems
7. Chest radiography: CVS and Pulmonary
problems
12. • Cardiac risk:
• Ejection fraction: <35% = incidence of MI 75-85%
and mortality 55-90%
• Goldman’s index: 11 points to raised JVP,
• 7 points to Premature ventricular contraction,
• 4 points to emergency surgery
• 3 points each to: Aortic valve stenosis, poor
medical condition, surgery within chest or
abdomen
13. • Interpretation of Goldman index and cardiac
complication
• <5 – 1%
• <12 – 5%
• <25 – 11%
• >25 – 22%
14. 8. Urinalysis: detects infections,
glycosuria, osmolarity, Haematuria
9. Beta- Human chorionic gonadotrophin:
in all female patients of childbearing age with
abdominal pain
or if she is unconscious
16. NICE guidelines
• Guideline help guide appropriate routine
preoperative investigations
• Based on ASA grading and Surgery Grading
17. ASA Grading
• ASA Grade 1: Normal healthy patient
• ASA Grade 2 : A patient with mild systemic
disease
• ASA Grade 3 :A patient with severe systemic
disease
• ASA Grade 4 :A patient with severe systemic
disease that is a constant threat to life
18. • Grade 1 (minor): Excision of lesion of skin
• Grade 2 (Intermediate): Primary repair of
inguinal hernia
• Grade 3 (Major): Endoscopic resection of
prostate
• Grade 4 (Major +): Colonic resection;
19. SPECIFIC PREOPERATIVE PROBLEMS
1. Cardiovascular:
• Hypertension: BP: >160/95 mmHg: elective
surgery should be deferred
• Ischaemic heart diseases: recent MI is stong
contraindication,
significant mortality rate from anaesthesia if
within 3 months
elective surgery can be delayed upto 6
months
20. • Dysrhythmias: AF to be controlled, Heart
block: preoperative pacing, bipolar diathermy
should be used when possible
• Cardiac failure: Oxygenation and fluid balance
• Anaemia and blood transfusion: transfusion if
Hb < 8gm/dl
21. 2. Respiratory Problems:
• Infection: LRTI should be controlled before
surgery
• Asthma: Inhalers to be continued
• Chronic obstructive pulmonary disease:
regional anesthesia
22. 3. Gastrointestinal system.
BMI CLASSIFICATION
• <16 Severe malnutrition
• 16–16.99 Moderate malnutrition
• 17–18.49 Mild malnutrition
• 18.5–24.9 Normal
• 25–29.9 Overweight
• 30–34.9 Obese class 1
• 35–39.9 Obese class 2
• ≥40 Obese class 3
24. MUST (Malnutrition Universal Screening) Tool:
BMI , Weight loss and Acute disease effect
Total: 6
0: low risk of undernutrition: routine clinical
care
1: Medium risk: Observe
2 or more : Treat: dietician or local policies, later
food fortification
25. • Obesity: BMI > 30
Advice to lose weight for elective procedure
26. • Regurgitation risk: in Hiatus hernia, bowel
obstruction, Paralytic ileus
decresed by Nil per oral: solid food 6 hours
and 2 hours for liquids
and also by: H2 receptor blockers and
Nasogastic tube insertion
27. • Jaundice: increased secondary complications:
Impaired clotting: Vitamin K
Renal failure: patient kept well hydration
Increased infection: prophylactic antibiotics
28. 3. Metabolic Disorder:
• Diabetes Mellitus: Are at high risk for
Complications,
• Improving Diabetic control
• Lipid lowering drugs
• Treating significant vascular stenosis
• For minor surgery: omiting morning dose, and
in insulin dependents: IV insulin given
30. 4. Coagulation disorder:
INR to be < 1.5:
Warfarin: stopped 3-4 days earlier in Atrial
Fibrillation.
Is replaced with heparin where thrombosis is
significant, eg. Mechanical heart valve.
Asprin and Clopidogrel to be stopped before 1
week of surgery.
31. • Disseminated intravascular coagulation and
haemophilia to be treated accordingly.
• Prophylaxis against thrombosis:
• Mechnical: Early mobilisation, stockings, calf
and foot pumps.
• Pharmacological: Heparin and low molecular
weight heparin, Warfarin, Asprin
32. 5. Neurological and psychiatric disorder:
Anticonvulsant: to be continued
Psychiatrically disturbed: may require general
rather than regional
Tricyclic antidepressents and Monoamine
oxidase inhibitor to be discontinued: may have
unwanted interaction
33. 6. Locomotor disorder:
Most catastrophic being unstable cervical spine.
Disease modifying drugs may be continued in
Rheumatoid Arthritis
34. 7. Remote site infection:
from teeth or toe, to be treated preoperatively
or given appropriate antibiotic prophylaxis
36. Consent to be obtained, from person fully
conversent on planned surgery, alternative
and complication
37. Multiprofesional team Members
• For Theatre:
• Ward staff
• List organiser and circulator
• Theatre nursing staff
• Anaesthetic staff
• Radiology department
• Pathology department
38. • For Postoperative recovery:
• Rehabilitation staff
• Social care worker
• ITU/ High dependency unit staff
• Specialist nurse counsellor (stoma/
amputation)