Medical care of the surgical patient

Medical care of the surgical patient - Perioperative...

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Unformatted text preview: Perioperative Medical Care of the Surgical Patient Darrell L. Hunt, MD Department of Surgery University of Florida 413-0331 dlhunt@ufl.edu Introduction A chance to cut is a chance to cure Nothing heals like cold, hard steel Surgery = stress and insults Physiology of surgery Maximize pre-operative condition of patient Preoperative evaluation: H&P Perioperative care: think of what can kill first... Perioperative medical care: Surgical emergency Cardiac disease Pulmonary disease Renal dysfunction Liver dysfunction Diabetics Bleeding disorders Malnourished Perioperative medical care: Surgical emergency Trauma Cardiac disease Pulmonary disease Renal dysfunction Liver dysfunction Diabetics Bleeding disorders Malnourished Surgical Emergency 76 yo WM coded in front of dental bldg; ACLS followed x 20 min with intermittent pulse return; intubated, IVs placed, brought to ER; SBP 60 with HR return MICU team called to eval; pt started on Neo-synephrine for bp Surgery called when Hct returned 14.2 Surgical Emergency What do you want to do? HISTORY & PHYSICAL History? (tailor to situation) VS 70/20 135 16 (IMV) 36.4 Pt is unconscious, intubated, not moving- abdomen is very distended, quiet BS Keep DDx in mind during H&P Why cant he keep a bp? What do you want to do about it? Risk of doing something vs. risk of doing nothing ? What do you need to do before surgery? Surgical Emergency AMPLE history A M P L E llergies edications ast medical history ast meal vents preceding the surgery 44 yo WF who presented to ER today with RUQ three days ago. RUQ U/S showed gallstones. CT scan of the abdomen/pelvis showed gallstones. Pre-op this patient History and physical Informed consent for operation and blood Type and screen or type and cross CXR (age greater than 20) 12-lead ECG (age greater than 40) BMP, M/P, CBC, PT, PTT, INR NPO after MN (IV Fluids) Pre-op Note Pre-op Orders (hep 5000 units SQ, Abx, beta blocker) ?Bowel Prep Perioperative medical care: Surgical emergency Cardiac disease CHF HTN CAD Pulmonary disease Renal dysfunction Liver dysfunction Diabetics Bleeding disorders Malnourished Chest Pain Work Up History of event Physical exam 12-Lead ECG CXR ABG Cardiac Panel BMP, M/P, CBC, PT, PTT, INR Chart Review Tachycardia Delivery O2=1.34 hgb X O2 sat X SV X HR Hypovolemia (Think Bleeding) Anemia Hypoxemia MI Arrhythmia PE Pain anxiety Cardiac disease in peri-op period CAD can cause any of these Risks for CAD: age, sex, HTN, XOL, DM, tobacco Modify those risk factors you can......
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Medical care of the surgical patient - Perioperative...

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