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Pre Operative tests in Cardiothoracic Surgery

Pre Operative tests in Cardiothoracic Surgery. 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. U & E. Na

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Pre Operative tests in Cardiothoracic Surgery

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  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 ExaminationDON’T UNDERESTIMATE THE IMPORTANCE OF THIS

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