Cardiovascular Introduction and H&P

Rania Abbasi, MD

6 Cardiovascular Introduction and H&P

Rania Abbasi, MD

Goals and Objectives

Fellows will gain appropriate knowledge of the pediatric cardiovascular system and develop a systematic comprehension of the various forms of congenital heart disease. Skills for the preoperative evaluation of patients presenting for cardiac surgery, including exposure to echocardiography, will be developed. Mastery of the essentials of patient monitoring and of appropriate pre-bypass, bypass, and post-bypass anesthetic management will be emphasized.

Basic Duties

Perform preoperative evaluations of patients presenting for cardiovascular surgery and report findings to the attending staff
Develop an intraoperative anesthetic plan for each patient and discuss this with attending staff
Provide appropriate pre-bypass, bypass, and post-bypass anesthetic management
Provide appropriate anesthetic management for closed-heart surgical procedures

Conferences – CVICU conference room – when schedule allows

ECHO conference – every Monday 7:30am
Cath conference – every Friday 7:00am
CV M&M – one Tuesday per month 4pm
Remind CCAT attending the night before

Day to Day Routine

Night before case – Preop H&P

See patient if INPT
Formulate anesthetic plan, discuss with CCAT attending
Order drips in Cerner – discuss which ones with CCAT attending

Day of case

Arrive 6am to set up room – see case checklist
See patient early, write for premedication by 6:30am
If INPT, get preop handoff from CVICU attending between 6:45-7am

Past Medical History

Cardiac most important
Type of CHD – at birth and currently
Past surgeries
h/o ECMO, arrests, dysrhythmias, other complications
Exercise tolerance
Baseline sats
O2 use
Home meds/anticoagulation
h/o vessel thromboses
Current overall status
All other system pertinent findings – especially pulm/neuro/heme

Past Surgical History

Include date, location
If shunt present, note which side

Past Anesthetic History

Prior need for premedication?
Mask airway
Intubation grade, ETT size
Complications

Lines and Access

Type and location
What is going through each lumen? Which lumen is available for use?
Are the lines functional? Can you draw back?
How long has it been in place?

Medications and Allergies

Inotropes, including dose
Cardiac medications
Sedation and analgesics
Antibiotics – indication? Next dose due?
TPN

Studies

ECHO – date, findings
Cath report – date, findings
CXR
EKG
Labs
Other