[HSF] Pre op room air blood gases.

Sun Jun 24 08:07:39 EDT 2007

Micahel,
well said. This was exactly what I wanted to emphasize.Sometimes I see patients with %O2 between 85-90 in the preop setting.Postop sam evalues are enough for them but the same values are predictors of reintubation in otherwise normal patients.
erdinc> Date: Sat, 23 Jun 2007 11:02:24 -0400> From: msfirst at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Pre op room air blood gases.> CC: > > Actually, the real problem that we see is the opposite.> Patients get labeled as having COPD, bad lungs, etc as a function of their> smoking histories and so they get extubated (usually at the insistence of> the Fellows) with mariginal blood gases (i.e. some degree of hypoxia or> hypercarbia) and everyone then says: "oh, Sats in the mid 80's is fine,> they are smokers" - fine until they get obtunded, hypoxic/hypercarbic, and> need reintubation under sometimes less than idea clinical situations.> > -michael> > > On 6/23/07, Ani Anyanwu <anianyanwu at hotmail.com> wrote:> >> > Michael> >> > Surely you do not need an ABG to confirm, refute, or even elucidate> > severity of COPD? Also, in what way does a preop ABG help in getting you off> > the ventilator? What exactly are your criteria for extubating patients and> > where does the ABG come in the decision making? That a test is easy to get> > and easily accessible does not indicate its usage.> >> > Sounds like a real interesting population you have down there - are they> > just dumping the crap on the new guy or is it typical of your entire> > center's practice?> >> > Ani> >> >> >> > ----- Original Message -----> > From: Michael Firstenberg> > Sent: Saturday, June 23, 2007 10:38 AM> > To: OpenHeart-L at lists.hsforum.com> > Subject: Re: [HSF] Pre op room air blood gases.> >> > As this discussion hopefully continues.> > We have point of care ABGs - which means the RT on the floor can walk to> > the> > bedside, draw the gas, and walk to the lab 10 meters down the hall and get> > the results in 5 minutes.> >> > I advocate that many of our patients do have multiple risk factors -> > long smoking histories> > history of "COPD" - often never proven just assumed over the years.> > shortness of breath is often a major complaint> >> > large operations are planned - we do a lot of VADs (bridge, DT, salvage)> > and> > low EF's with valves.> > Even our simple CABGs these days have multiple medical problems> >> > In fact the healthiest patient I have operated on in the past couple of> > weeks was no medical problems other than bad multiple sclerosis for which> > she needed frequent interferon treatments (and now CAD and CHF due to her> > acute left main thrombosis)> >> > Many of our patients do not have cardiologists nor have the seen a doctor> > in> > years (if ever)> > Histories are unreliable -> > One patient I did, also for bad left main disease, already had a lung> > biopsy for IPF and still smoked, according to her 8 cigs/day - although> > the> > rest of her family (including her husband) all insisted it was more like 3> > packs a day! She did fine and when I saw her in follow-up and asked her> > about her smoking - she said she was down to 8 a day - her husband in the> > corner just rolled her eyes......> >> > I find that having a pre-op ABG is very helpful in it gives us some sense> > of> > what to shoot for in trying to get these patients off of the vent -> > particularly if they dont fly off right after surgery.> >> > In addition, granted not everyone needs them, but it is probably easier to> > have a pre-op protocol to get them in everyone rather than selectively> > pick> > and choose.> >> > -michael> >> >> >> > On 6/23/07, prasannasimha <prasannasimha at gmail.com> wrote:> > >> > > Something I wanted to ask too.> > > Prasanna> > >> > > Ani Anyanwu wrote:> > > > It is interesting as you move around different hospitals and speak to> > > different surgeons you get to realize how much of what you do is a waste> > of> > > time or unnecessary. I would actually go to the extreme of saying there> > is> > > no patient that NEEDS an ABG before elective heart surgery. It may be a> > > helpful guide in some patients but not a necessity. I trained in some> > > hospitals where we got PFTs, and sometimes room air ABG on every patient> > who> > > had ever smoked, was elderly or was high risk. However in my present> > > hospital, and we do much sicker patients and we have practically never> > got a> > > room air ABG and very rarely PFTs. The truth is somewhere in between but> > > either test is certainly not a necessity.> > > >> > > > What I would ask those who do or rely on these tests is to think back> > as> > > to how many times the results of this test has changed management and> > how?> > > >> > > > Ani> > > >> > > > ----- Original Message -----> > > > From: prasannasimha> > > > Sent: Saturday, June 23, 2007 7:46 AM> > > > To: OpenHeart-L at lists.hsforum.com> > > > Subject: Re: [HSF] Pre op room air blood gases.> > > >> > > > Michael , if the patient has an OK pulse oximetry value on room air he> > > > doesn't need a preop ABG. If he has an abnormal one he needs a PFT etc> > > > etc etcand not just an ABG.> > > > We do a preop ABG selectively.> > > > Incidentally PFT's ABG's etc etc will all have a confounding value if> > > > the patients lungs are full of water eg MS or MR. or even an ASD.> > > > Prasanna> > > > Michael Firstenberg wrote:> > > >> > > >> We are in the midst of a heated discussion. I agrue that like basic> > > labs and chest xray a room air abg is needed before heart surgery. My> > > partners advocae that it is a waste of money unless clearly> > indicated. But> > > no one gives indications.> > > >>> > > >> Thoughts?> > > >> Practice patterns?> > > >> Bob - i am sure you wrote a few papers on this.> > > >>> > > >>> > > >> Michael Firstenberg <msfirst at gmail.com>> > > >>> > > >> -----Original Message-----> > > >> From: "John Schor" <johnschor at mac.com>> > > >> To: OpenHeart-L at lists.hsforum.com> > > >> Sent: 6/22/2007 9:00 PM> > > >> Subject: Re: [HSF] CABG in Patient with HIT Antibodies> > > >>> > > >> Hal:> > > >> One dose of heparin for CPB is usually OK....believe it or not. The> > > >> prolonged administration of heparin, ie the flush in an Arterial> > > >> line, is much worse.> > > >> John> > > >>> > > >> John Schor, MD> > > >> PO Box 4445> > > >> Cottonwood, AZ 86326> > > >>> > > >>> > > >> On Jun 22, 2007, at 4:50 PM, Hgrmd at aol.com wrote:> > > >>> > > >>> > > >>> > > >>> Dear Members,> > > >>> I need a little advice. My group was consulted on a 53 yo man> > > >>> with SEMI> > > >>> who was found to have 3VD with an EF of 25%. His past history is> > > >>> significant> > > >>> for severe thrombocytopenia after a PCI in '02. During this> > > >>> admission, he> > > >>> received Lovenox. Angiomax was used during the cath. He has HIT> > > >>> antibodies.> > > >>> I suggested an OPCAB with Angiomax to my partner. Supposedly, it> > > >>> has the> > > >>> shortest half life and is hepatically excreted. Does anybody have> > > >>> a specific> > > >>> protocol for Angiomax and CABG? Are other agents better?> > > >>> Claudia, where are> > > >>> you?> > > >>> Hal> > > >>>> > > >>>> > > >>>> > > >>> ************************************** See what's free at http://> > > >>> www.aol.com.> > > >>> _______________________________________________> > > >>> OpenHeart-L mailing list> > > >>>> > > >>> Send postings to:> > > >>> OpenHeart-L at lists.hsforum.com> > > >>>> > > >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > >>> http://mmp.cjp.com/mailman/listinfo/openheart-l> > > >>>> > > >>> All messages transmitted by the OpenHeart-L are subject to the> > > >>> policies and> > > >>> disclaimers posted at:> > > >>> http://www.hsforum.com/listdisclaim> > > >>> -----------------------------------------> > > >>>> > > >>>> > > >> _______________________________________________> > > >> OpenHeart-L mailing list> > > >>> > > >> Send postings to:> > > >> OpenHeart-L at lists.hsforum.com> > > >>> > > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > >> http://mmp.cjp.com/mailman/listinfo/openheart-l> > > >>> > > >> All messages transmitted by the OpenHeart-L are subject to the> > policies> > > and> > > >> disclaimers posted at:> > > >> http://www.hsforum.com/listdisclaim> > > >> -----------------------------------------> > > >>> > > >> _______________________________________________> > > >> OpenHeart-L mailing list> > > >>> > > >> Send postings to:> > > >> OpenHeart-L at lists.hsforum.com> > > >>> > > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > >> http://mmp.cjp.com/mailman/listinfo/openheart-l> > > >>> > > >> All messages transmitted by the OpenHeart-L are subject to the> > policies> > > and> > > >> disclaimers posted at:> > > >> http://www.hsforum.com/listdisclaim> > > >> -----------------------------------------> > > >>> > > >>> > > >>> > > >>> > > >> > > > _______________________________________________> > > > OpenHeart-L mailing list> > > >> > > > Send postings to:> > > > OpenHeart-L at lists.hsforum.com> > > >> > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > > http://mmp.cjp.com/mailman/listinfo/openheart-l> > > >> > > > All messages transmitted by the OpenHeart-L are subject to the> > policies> > > and> > > > disclaimers posted at:> > > > http://www.hsforum.com/listdisclaim> > > > -----------------------------------------> > > > _______________________________________________> > > > OpenHeart-L mailing list> > > >> > > > Send postings to:> > > > OpenHeart-L at lists.hsforum.com> > > >> > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > > http://mmp.cjp.com/mailman/listinfo/openheart-l> > > >> > > > All messages transmitted by the OpenHeart-L are subject to the> > policies> > > and> > > > disclaimers posted at:> > > > http://www.hsforum.com/listdisclaim> > > > -----------------------------------------> > > >> > > >> > > _______________________________________________> > > OpenHeart-L mailing list> > >> > > Send postings to:> > > OpenHeart-L at lists.hsforum.com> > >> > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > http://mmp.cjp.com/mailman/listinfo/openheart-l> > >> > > All messages transmitted by the OpenHeart-L are subject to the policies> > > and> > > disclaimers posted at:> > > http://www.hsforum.com/listdisclaim> > > -----------------------------------------> > >> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the policies> > and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the policies> > and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------