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General Hospital Care
Acute Inpatient Care
Preoperative Cardiac Evaluation
Perioperative Anticoagulation
Other Perioperative Considerations
100
This is the most common preventable cause of death in the hospitalized patient.
What is Venous Thromboembolism
100
Depending on the cause, possible treatment options for this general complaint include Maalox with Diphenhydramine, Oxygen with Nitroglycerine and/or Morphine, NSAIDS and anticoagulation
What is chest pain
100
Surgeries that include superficial procedures, cataract surgery, breast surgery and endoscopic procedures carry less than 1% risk of cardiac event and are categorized as this.
What is low risk surgery
100
Name 2/5 surgeries considered to carry a low risk for bleeding complications, therefore allowing patients to continue taking Coumadin prior to procedure.
Minor dental procedures, cataract surgery, endoscopy without biopsy, arthrocentesis, minor dermatologic procedures
100
A patient with either a pacemaker or ICD should have their device interrogated within how many months of any significant surgical procedure?
What is 3-6 months
200
These typically develop within 2 weeks of hospitalization and can develop within 2-6 hrs.
What is Pressure Ulcers
200
This general complaint is most commonly caused by cardiopulmonary abnormalities and should be promptly and carefully evaluated
What is Dyspnea
200
Name 3 of the 5 clinical cardiac risk factors that must be taken into account prior to surgery.
Preexisting/stable CAD, Compensated CHF, DM, Prior CVA/TIA, Renal Insufficiency
200
For a patient taking Coumadin, what is the typical INR value for which a patient can be deemed safe for surgery?
What is less than 1.5
200
Name 4/5 of the clinically significant pulmonary complications of surgery
-PNA, Respiratory Failure, Bronchospasm, Atelectasis, Exacerbation of underlying chronic lung dz
300
What are two medications and dosages used for VTE Prophylaxis
Unfractionated Heparin (5000units SC q8), Low Molecular Weight Heparin aka Lovenox (40mg SC daily), Fondaparinux aka Arixtra 2.5mg SC daily
300
A sudden onset of this in the hospitalized patient could be caused by volume overload, pain and withdrawal syndromes
What is Acute Hypertensive Episode
300
Name the 4 perioperative cardiac complications that risk stratification prior to surgery should recognize and prevent
Cardiac Death, MI, CHF, Clinically Significant Rhythm Disturbances
300
How many days prior to surgery should a patient hold their Coumadin if there INR goal is stable in the 2-3 target range?
What is 5 days
300
Majority of all deaths from postoperative anemia result from hemoglobin value less than this
What is 5
400
In regards to pressure ulcer staging, this stage refers to full thickness tissue loss in which subcutaneous fat may be visible but bone, tendon or muscle are not exposed.
What is Stage III
400
This is the initial drug of choice for acute management of agitation and psychosis in the hospitalized setting.
What is Haloperidol
400
Although controversial, a blood pressure less than this is generally considered acceptable and should not delay surgery
What is less than 180/110
400
DAILY DOUBLE!!!!!! How long after surgery can a patient resume their Coumadin if postoperative bleeding is controlled?
What is 24-48 hours
400
This is the best validated measure of perioperative risk in patients with cirrhosis
What is Child-Pugh Score
500
Prevention is the key to management of pressure ulcers as majority are preventable. Name 3 of the 4 measures for pressure ulcer prevention.
Risk Factor Assessment, Skin Care, Nutritional Supplements in patients at risk, Interventions aimed at relieving or redistributing pressure
500
This medication is particularly useful in hospitalized patients to treat insomnia and anxiety, especially in those with a history of drug dependence. Beware of possible side effects in the elderly!
What are antihistamines (Benadryl, Vistaril)
500
This type of valvular heart disease is associated with an approximate 30% incidence of cardiac morbidity and 10% mortality
What is severe aortic stenosis
500
Certain populations are recommended to receive bridging therapy with heparin or lovenox prior to surgery to prevent thromboembolic events. Name 4/7 populations
-Mechanical mitral valve -Older generation aortic or mitral mechanical valve -Any mechanical valve with hx cardioembolism within last 6 months -Nonvalvular a. fib with either hx embolism last 3 months or CHADS2 score greater 5 -Valvular a. fib -VTE last 3 months -Known thromboembolic state
500
Metformin should be held for how long prior to and post-operative for any planned surgical procedure?
What is 24hrs prior and 48 hrs post-op