Pre Operative tests in Cardiothoracic Surgery - PowerPoint PPT Presentation

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Pre Operative tests in Cardiothoracic Surgery

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Confusion in old grannies. K. Arrthymias. Urea. GI bleed. Diuretic use. Dehydration. Creatinine ... Monitor heparin and warfarin therapy and reversal ... – PowerPoint PPT presentation

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Title: Pre Operative tests in Cardiothoracic Surgery


1
Pre Operative tests in Cardiothoracic Surgery
2
FBC
  • HB
  • Anaemia ? Why
  • Anticoagulation type of valve
  • WCC
  • neutrophilia
  • neutropaenia
  • Prosthetic valve endocarditis has 50 mortality
  • PLT
  • Thrombocytosis
  • Thrombocytopaenia
  • Aspirin and clopidogrel have no effect

3
U E
  • Na
  • Paraneoplastic in Ca lung
  • Confusion in old grannies
  • K
  • Arrthymias
  • Urea
  • GI bleed
  • Diuretic use
  • Dehydration
  • Creatinine
  • Major risk factor for dying post cardiac surgery

4
LFTs and calcium
  • Alcoholics major risk factor
  • Metastasis in lung cancer

5
Clotting
  • Pro coagulant
  • Lupus anticoagulant
  • Block the grafts
  • Bleed
  • Monitor heparin and warfarin therapy and reversal
  • VonWillibrands
  • Haemophilia A
  • Christmas disease (Haemophilia B)

6
Glucose
  • Diabetes is major risk factor for dying
  • Poorly controlled means metabolic problems post
    operatively
  • Newly diagnosed in CABG patients

7
ECG
  • Normal or not
  • Rate eg brady
  • PR interval
  • LV hypertrophy
  • Bundle branch block
  • ST levels in CABG
  • Pacemaker

8
PFTs
  • Epidural use
  • Nebulsiers use
  • Risk of thoracotomy
  • Valve patients different to CABG patients
  • Thoracic surgery
  • Rule of 19 for predicting post operative FEV1

9
CXR
  • Size heart
  • Risk
  • Cardioplegia
  • Trauma
  • Aortic calcification CVA risk eg Cannulation ?
    Off pump
  • Lung cancer as most are ex or current smokers
  • ribs ? sternum in past
  • Wires from previous sternotomy

10
Angiogram
  • ?needs CABG
  • LMS length
  • Circ size in mitral surgery
  • Aortic calcification
  • Amount aortic regurgitation
  • LV function
  • Aortic valve calcification ? CVA risk

11
CT
  • Redo surgery ? RV and sternum separation
  • Aortic sizes ? Need root or arch
  • Thoracic surgery
  • Tumour
  • Mediastinal LNs
  • Metastatic spread

12
Echo
  • All murmurs need evaluating
  • Always check supposedly normal valves
  • Pulmonary and tricuspid valves rarely commented
    on with mitral valve patients
  • PA pressure MAJOR risk factor
  • LV and RV function

13
Weight
  • Tamponade
  • Leg wound healing
  • Breathless patients ? Need diuretics

14
BP
  • Left and right arm for LIMA
  • Level that kidneys and brain expect

15
Swabs
  • Sternal wound and valve infection

16
Carotid scans
  • Type of operation
  • Blood pressure on bypass
  • Risk of stroke
  • ? Combined procedure

17
Clinical ExaminationDONT UNDERESTIMATE THE
IMPORTANCE OF THIS
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