{"id":1407,"date":"2013-10-11T07:11:45","date_gmt":"2013-10-11T07:11:45","guid":{"rendered":"http:\/\/jacobimed.org\/NS\/?page_id=1407"},"modified":"2013-10-11T07:11:45","modified_gmt":"2013-10-11T07:11:45","slug":"medical-consultation-overview","status":"publish","type":"page","link":"https:\/\/jacobimed.org\/old\/ambulatory\/mlove\/curriculumconsult-specialties\/introduction-to-consult\/medical-consultation-overview\/","title":{"rendered":"Medical Consultation: Overview"},"content":{"rendered":"

 <\/p>\n

\n

\n

MEDICAL CONSULTATION: OVERVIEW<\/span>\u00a0\u00a0\u00a0 <\/span><\/p>\n

Lori Lemberg M.D. Summer-Fall 2012<\/p>\n

\n

Dr. Lemberg’s Lecture Slides<\/a><\/h1>\n
\n

LEARNING OBJECTIVES<\/span><\/h1>\n

\u00a0<\/span><\/p>\n

Function of the Consultant<\/span><\/p>\n

Goldman\u2019s Ten Commandments<\/span><\/p>\n

Surgical Considerations<\/span><\/p>\n

Anesthetic Considerations<\/span><\/p>\n

History and Physical Exam<\/span><\/p>\n

Cardiac Risk Assessment<\/span><\/p>\n<\/div>\n

\n

\n

History to Include:<\/span><\/p>\n

Medical Problems<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Cardiovascular<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Pulmonary<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Hematologic<\/span>, Thromboembolic<\/span><\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Endocrine<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Renal<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Liver<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Rheumatologic<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Neurologic<\/span><\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Pregnancy<\/span><\/p>\n

Exercise Capacity<\/span><\/p>\n

Prior Surgery, any complications<\/span><\/p>\n

Medications (all)<\/span><\/p>\n

Allergies<\/span><\/p>\n

Habits\/Substance Use<\/span><\/p>\n

Family History (especially any difficulties with surgery or bleeding)<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Exam to Include:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Labs: <\/span><\/p>\n

Vitals\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>EKG<\/span><\/p>\n

General Exam\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Others<\/span> as relevant<\/span><\/p>\n

Mental Status<\/span><\/p>\n

\u00a0<\/span><\/p>\n

References:<\/span><\/p>\n

Kammerer<\/span><\/strong><\/span> and Gross\u2019 Medical Consultation: the Internist on Surgical, Obstetric and Psychiatric <\/span><\/strong><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Services, 3rd<\/sup><\/span><\/strong> ed., ed<\/span><\/span> Gross R, Caputo G. Baltimore: Williams and Wilkins, 1998
\n<\/span><\/p>\n

Auerbach<\/span><\/span> A, Goldman L.\u00a0 <\/span>Assessing and Reducing the Cardiac Risk in Noncardiac<\/span> Surgery<\/a>.\u00a0 <\/span>Circuluation<\/strong><\/span><\/span> <\/strong>2006.<\/span> 113:1361-76.<\/span><\/p>\n


\n<\/span>Eagle K, Berger P, Cakins<\/span> H et al. ACC\/AHA Guideline Update for <\/a>Perioperative<\/span> Cardiovascular Evaluation for <\/a><\/span><\/p>\n

Non Cardiac Surgery; a Report of the American College of Cardiology\/American Heart Association Task <\/span><\/a><\/p>\n

Force on Practice Guidelines<\/span><\/a>. Circulation<\/strong>.<\/span> 2002: 105:1257-1267. <\/span><\/p>\n

\u00a0<\/span><\/p>\n

Fleisher L, Eagle K. Lowering Cardiac Risk in Noncardiac<\/span> Surgery<\/a>.<\/span><\/span> NEJM<\/strong> 2001; 345: 1677-1682<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Gilbert K, Larocque<\/span> B, Patrick L. Prospective Evaluation of Cardiac Risk Indices for Patients Undergoing <\/a><\/span><\/p>\n

Noncardiac<\/span><\/span><\/span> Surgery<\/span><\/span><\/a>.<\/span><\/span> Ann Intern Med<\/strong> 2001; 133: 356-9.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Grayburn<\/span><\/span> P, Hillis<\/span> L. Cardiac Events in Patients Undergoing Noncardiac<\/span> Surgery: Shifting the Paradigm from <\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Noninvasive Risk Stratification to Therapy.<\/span> Ann Intern Med<\/strong> 2003; 138: 506 – 511.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Lee T et al. Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major <\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>Noncardiac<\/span><\/span> Surgery.<\/span> Circulation<\/strong> 1999; 100: 1043-1049.<\/span> <\/span><\/p>\n

\u00a0<\/span><\/p>\n

Mangano<\/span><\/span><\/span> D. Assessment of the Patient with Cardiac Disease; an Anesthesiologist\u2019s Paradigm.<\/span><\/span> Anesthesiology<\/strong> <\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>1999; 91: 1521-6.<\/span> <\/span><\/p>\n

\u00a0<\/span><\/p>\n

Smetana G, Cohn S, and Lawrence V.<\/span><\/span>\u00a0 <\/span>Update in Perioperative<\/span> Medicine<\/a>. Ann Intern Med<\/strong>. 2004; 140: 452 – 61.<\/span> <\/span><\/p>\n

\u00a0<\/span><\/p>\n

\u00a0<\/span><\/strong><\/p>\n

FORMAT FOR MEDICAL PREOPERATIVE CONSULTATION<\/strong><\/span><\/p>\n

ID Data\/Relevant problems:<\/span><\/p>\n

Procedure, type of anesthesia if known<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Exercise tolerance: (__flight of stairs with groceries or run short distance or walk _ blocks briskly)<\/span><\/p>\n

Any history of angina, MI, CAD, angioplasty or CABG?<\/span><\/span><\/p>\n

Any history or symptoms of heart failure?<\/span><\/span><\/p>\n

Any history of arrhythmias?<\/span><\/span><\/p>\n

Any history of pulmonary disease?<\/span><\/span><\/p>\n

\u00a0<\/span><\/p>\n

Medical Problems<\/span><\/p>\n

Prior Surgery<\/span><\/p>\n

Allergies of any type<\/span><\/p>\n

Meds including supplements, vitamins<\/span><\/p>\n

Habits: Cigs\/EtOH<\/span>\/Drugs<\/span><\/p>\n

Women: LMP, any chance of being pregnant<\/span><\/p>\n

Bleeding History, family members with bleeding problems<\/span><\/p>\n

FH: any difficulties with surgery<\/span><\/p>\n

\u00a0<\/span><\/p>\n

PEX:\u00a0 <\/span>include: vitals<\/span><\/p>\n

HEENT: <\/span><\/p>\n

NECK: JVD?<\/span><\/p>\n

CHEST:\u00a0 <\/span>signs of pulmonary disease<\/span><\/p>\n

CV: murmurs? gallops<\/span><\/span><\/p>\n

ABD: <\/span><\/p>\n

EXT: pulses<\/span><\/p>\n

NEURO: esp<\/span><\/span> if any element dementia<\/span><\/p>\n

\u00a0<\/span><\/p>\n

LABS: EKG if over 40<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/p>\n

A\/P:<\/span><\/p>\n

1. CV RISK FORMULATION<\/span><\/p>\n

Medication Management<\/span><\/p>\n

HTN control<\/span><\/p>\n

\u00a0<\/span><\/p>\n

2.Other<\/span><\/span> issues if relevant, such as<\/span><\/p>\n

PULMONARY<\/span><\/p>\n

HEME <\/span><\/p>\n

ENDOCRINE\/DIABETES\/THYROID<\/span><\/p>\n

RENAL
\nDVT PROPHYLAXIS
\nANTIOBIOTIC PROPHYLAXIS<\/span><\/p>\n

SUBSTANCE USE\/MEDICATIONS<\/span><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

  MEDICAL CONSULTATION: OVERVIEW\u00a0\u00a0\u00a0 Lori Lemberg M.D. Summer-Fall 2012 Dr. Lemberg’s Lecture Slides LEARNING OBJECTIVES \u00a0 Function of the Consultant Goldman\u2019s Ten Commandments Surgical Considerations Anesthetic Considerations History and Physical Exam Cardiac Risk Assessment History to Include: Medical Problems \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cardiovascular \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pulmonary \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hematologic, Thromboembolic \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Endocrine \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Renal \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Liver \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Rheumatologic \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0….<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1405,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"class_list":["post-1407","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages\/1407","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/comments?post=1407"}],"version-history":[{"count":1,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages\/1407\/revisions"}],"predecessor-version":[{"id":1408,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages\/1407\/revisions\/1408"}],"up":[{"embeddable":true,"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/pages\/1405"}],"wp:attachment":[{"href":"https:\/\/jacobimed.org\/old\/wp-json\/wp\/v2\/media?parent=1407"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}