MEDICAL CONSULTATION: OVERVIEW   

Lori Lemberg M.D. Summer-Fall 2012

Dr. Lemberg’s Lecture Slides

History to Include:

Medical Problems

            Cardiovascular

            Pulmonary

            Hematologic, Thromboembolic

            Endocrine

            Renal

            Liver

            Rheumatologic

            Neurologic

            Pregnancy

Exercise Capacity

Prior Surgery, any complications

Medications (all)

Allergies

Habits/Substance Use

Family History (especially any difficulties with surgery or bleeding)

 

Exam to Include:                              Labs:

Vitals                                                      EKG

General Exam                                        Others as relevant

Mental Status

 

References:

Kammerer and Gross’ Medical Consultation: the Internist on Surgical, Obstetric and Psychiatric

        Services, 3^rd ed., ed Gross R, Caputo G. Baltimore: Williams and Wilkins, 1998

Auerbach A, Goldman L.  Assessing and Reducing the Cardiac Risk in Noncardiac Surgery.  Circuluation 2006. 113:1361-76.

Eagle K, Berger P, Cakins H et al. ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for

Non Cardiac Surgery; a Report of the American College of Cardiology/American Heart Association Task

Force on Practice Guidelines. Circulation. 2002: 105:1257-1267.

 

Fleisher L, Eagle K. Lowering Cardiac Risk in Noncardiac Surgery. NEJM 2001; 345: 1677-1682

 

Gilbert K, Larocque B, Patrick L. Prospective Evaluation of Cardiac Risk Indices for Patients Undergoing

Noncardiac Surgery. Ann Intern Med 2001; 133: 356-9.

 

Grayburn P, Hillis L. Cardiac Events in Patients Undergoing Noncardiac Surgery: Shifting the Paradigm from

        Noninvasive Risk Stratification to Therapy. Ann Intern Med 2003; 138: 506 – 511.

 

Lee T et al. Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major

        Noncardiac Surgery. Circulation 1999; 100: 1043-1049.

 

Mangano D. Assessment of the Patient with Cardiac Disease; an Anesthesiologist’s Paradigm. Anesthesiology

        1999; 91: 1521-6.

 

Smetana G, Cohn S, and Lawrence V.  Update in Perioperative Medicine. Ann Intern Med. 2004; 140: 452 – 61.

 

 

FORMAT FOR MEDICAL PREOPERATIVE CONSULTATION

ID Data/Relevant problems:

Procedure, type of anesthesia if known

 

Exercise tolerance: (__flight of stairs with groceries or run short distance or walk _ blocks briskly)

Any history of angina, MI, CAD, angioplasty or CABG?

Any history or symptoms of heart failure?

Any history of arrhythmias?

Any history of pulmonary disease?

 

Medical Problems

Prior Surgery

Allergies of any type

Meds including supplements, vitamins

Habits: Cigs/EtOH/Drugs

Women: LMP, any chance of being pregnant

Bleeding History, family members with bleeding problems

FH: any difficulties with surgery

 

PEX:  include: vitals

HEENT:

NECK: JVD?

CHEST:  signs of pulmonary disease

CV: murmurs? gallops

ABD:

EXT: pulses

NEURO: esp if any element dementia

 

LABS: EKG if over 40

           

A/P:

1. CV RISK FORMULATION

Medication Management

HTN control

 

2.Other issues if relevant, such as

PULMONARY

HEME

ENDOCRINE/DIABETES/THYROID

RENAL
DVT PROPHYLAXIS
ANTIOBIOTIC PROPHYLAXIS

SUBSTANCE USE/MEDICATIONS