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Discussion

When is cardiac clearance needed?

Hi, looking for some help in establishing some guidelines for when cardiac clearance is needed on patients, and abnormal lab parameters in which the patient is still ok for surgery. I'm new to the role of OR Manager in a very small hospital with a gun hoe general surgeon that wants to take everyone back to surgery (mostly lap choles, Lap appys).

It it seems to be up to my pre-op/PACU nurses to make the surgeons aware of the patient's true condition prior to surgery. I find this a bit disturbing. Even when abnormal labs are presented, he tends to ignore them. This puts the CRNA in the position of standing up to the surgeon and refusing to proceed.

A set set of established guidelines for what needs to be in place before a patient goes to surgery would be helpful. Of course, I recognize patient's condition, urgency, and benefits outweigh risks all playba factor.

As always, any help is appreciated. Perhaps there are sources you use to refer to?

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    • Admin

    Here are the latest ACC/AHA Guidelines for cardiovascular evaluation and management of patients undergoing noncardiac surgery:

    http://www.onlinejacc.org/content/64/22/e77

    You might be able to find more online, based on these guidelines, that is a more palatable read.

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    • Author

    Thanks. Will check it out

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    I know there are certain diagnosis and medications that flag our pre-op nurses to order certain labs and or EKG.

    Any diuretic the patient has to have a K+ drawn.

    Anticoag's = PT, INR & PTT ( even the antico-ags that don't effect those labs)

    Any history of heart problems, or heart meds means an automatic EKG if one has not been done in the past 72 hours.

    There are others but I don't pre-op so I'm not sure what they all are...

    Then all this info is given to the surgeon before they go and talk to their pts pre-operatively. More then once I've seen the surgeon want to go forward and the anesthesiologist say no way... Ive also seen patients that really need the surgery now so the Anesthesiologist have placed an art line, drawn blood gases and pushed various meds to help keep the pt stable throughout surgery... always tricky, but they tend to work it out between the two of them. It maybe easier for for the MD anesthesia provider to do this then a CRNA.

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    On 1/24/2018 at 12:22 AM, HeySis said:

    I know there are certain diagnosis and medications that flag our pre-op nurses to order certain labs and or EKG.

    Any diuretic the patient has to have a K+ drawn.

    Anticoag's = PT, INR & PTT ( even the antico-ags that don't effect those labs)

    Any history of heart problems, or heart meds means an automatic EKG if one has not been done in the past 72 hours.

    There are others but I don't pre-op so I'm not sure what they all are...

    Then all this info is given to the surgeon before they go and talk to their pts pre-operatively. More then once I've seen the surgeon want to go forward and the anesthesiologist say no way... Ive also seen patients that really need the surgery now so the Anesthesiologist have placed an art line, drawn blood gases and pushed various meds to help keep the pt stable throughout surgery... always tricky, but they tend to work it out between the two of them. It maybe easier for for the MD anesthesia provider to do this then a CRNA.

    Why is it easier for the MD than the CRNA?

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    Postponing a procedure because of any impediment is on the CRNA (sounds like you are a small place with a single, solo CRNA). That's a big part of being a CRNA. The pre-op nurses can call the surgeon with abnormal lab values or EKG changes or fever or whatever, but the last word is with anesthesia. I only point that out because I'm left wondering what your CRNA has to say about the whole thing. I'm guessing a lot and I'd be pretty surprised if he was unaware of ACC/AHA guidelines as well as other well known risk stratification tools.

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