Heparin-Induced Thrombocytopenia
Early Within the first 1–2 days of starting heparin Seen in patients with prior exposure to heparin (usually in the preceding 3 months) and hence prior antibodies Usual Within 5–10…
Disorders of Hemostasis
Risk Type of procedure Examples Low Non-vital organs involved, exposed surgical site, limited dissection Lymph node biopsy, dental extraction, cataract extraction, most cutaneous surgery, laparoscopic procedures, coronary angiography Moderate Vital…
Thrombocytopenia
Etiology Description Consumption Seen in larger blood loss surgeries Occurs immediately after surgery Returns toward normal within 2–3 days Thrombocytopenia due to infection Associated with both viral and bacterial infections…
Inflammatory Bowel Disease
Drug Recommendation for practice Evidence levelb Glucocorticoids Continue; administer stress dose 5-ASA Discontinue on day of surgery and resume 3 days after surgery if normal renal function C Azathioprine, 6-MP…
Thyroid Disease
Degree of thyroid dysfunction Laboratory findings Elective Urgent/emergent Treatment Subclinical ■ Increased TSH ■ Normal free T4 ■ Proceed ■ Proceed ■ None Mild–moderate ■ Increased TSH ■ Low free…
Perioperative Beta-Blockers
© Springer International Publishing Switzerland 2015Molly Blackley Jackson, Somnath Mookherjee and Nason P. Hamlin (eds.)The Perioperative Medicine Consult Handbook10.1007/978-3-319-09366-6_8 8. Perioperative Beta-Blockers Paul B. Cornia1 and Kay M. Johnson1 (1) Division of General Internal Medicine, Department of Medicine, University of…
The Preoperative Evaluation
Requesting physician Usually the surgeon, sometimes a PCP or specialist, or anesthesiologist Consult for Specific reason for or question for consultation Chief complaint Include the intended surgical procedure Date of…
Perioperative Medication Management
Drugs to hold for at least 2 weeks preoperatively Aspirin: Hold for a minimum of 1 week; consider 2 weeks for neuro/spine surgery Warning: Must evaluate whether patient has received…
Atrial Fibrillation
Rate control If NPO Individualize desired rate control target, depending on the patient’s baseline rate control goals, the presence of ischemic heart disease, and the patient’s post-op blood pressure. In…
Stress-Dose Steroids
HPA axis status Glucocorticoid (GC) exposure Management NOT suppressed <3 weeks Every-other-day therapy AM dose of <5 mg prednisone or equivalenta Take usual AM dose of GC MAY be suppressed…
