NMS. Casos Clínicos

1 Chapter

Part I: Foundations

Preoperative Care Bruce E. Jarrell • Molly Buzdon • Eric D. Strauch

Cutting to the Chase Preoperative Care Principles • The overall goal of surgery is to make the patient’s life better by improving a clinical condition, making a diagnosis, and/or palliating pain and discomfort. • All procedures have a risk/benefit ratio; for a procedure to be appropriate and worthwhile, the benefit must outweigh the risk. • Risk is difficult to assess but certainly includes understanding: What does the surgery intend to correct? How invasive is the procedure? What common complications occur? What pre-existing, concurrent diseases exist in the patient? How is the disease being treated? • The most important assessment tool in medicine is the history and physical examination. A good history and physical examination will guide the clinician to what diagnostic laboratory, radiologic, and other interventions are necessary for patient care. • Every test that is ordered must be checked and evaluated and the result correlated with the patient’s clinical condition. Treat the patient, not the radiographs or laboratory tests. • For elective procedures, the patient should be in optimal condition—diabetes, hypertension, and heart disease under control; no active infectious processes; not smoking; stable renal function; and no new symptoms or processes. If not, surgery should be postponed until these issues are resolved. • For urgent or emergent procedures, managing existing problems to the extent possible is desired. SAMPLE

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