PMHx:

CVD: CAD/MI Stents? CHF IrregHR Pacer/AICD AS/AI MS/MR RheumaticFvr HTN Lipid SOB/DOE TOB_______PYrs ETOH OSA COPD Asthma Bronchitis DM:I/II____cntrl? Liver Anemia GERD Adrenal Thyroid Spine TMJ OA/RA CA

Age___Ht____Wt___BMI/BSA______
MD: MDA:

Meds:Rigid Dose Schedules/INTERACTIONS?

CV drugs B-blocker taken: Y/N

Anes Start:___ : ___ Anes End: ___ : ___

Gtts to start?

Allergies:
Latex: Y/N?

Anticoags

MAOIs, TCA, lithium

Dx/Sx:

Antibiotic? Ancef____Gms? Vanco____Gms? Other:

Hypoglycemics: Oral/INJ

Workup:
___Ekg Rhythm: Q waves? LVH? RBBB/LBBB? ST-T abn? ___***Stress: Perfusion Abn? Fixed/Reversible EF: WMA?: CC: EF_____ LMain: LAD: Diag LCx: OM: RCA: Others: Dominance? ___Echo: calc LV EF______% AVA (<0.8 [nml=2.6-3.5]) LVH Mean Gradient (>40=severe) PHTN? TV PV MV AV

*NPH or Viagra (Cialis)

Steroids?

CC:

Resp Txt: PRN/ATC

Vol. Agent N2O/Iso/Sevo/Des Versed (0.02-0.03mg/kg) Fentanyl (3-5mcg/kg) Propofol (1.5-2.5mg/kg) Prop.Infus 50-200mcg/kg/min) Ketamine (50mg/ml 1-2mg/kg) Etomidate (0.2-0.6mg/kg) SCh (0.56-1.5mg/kg) Roc (0.6-1.2mg/kg) Vec (0.1mg/kg) Vec. Maint (0.02-0.05mg/kg Neostigmine (0.04-0.08mg/kg) Robinul (0.02mg/kg) Zofran (4-8mg) Albuterol (2-6puffs) Others:

MP:1 2 3 4 / ASA:12345E

Lines/Traps:
Times:
Leg incision Chest incision Sternotomy Heparin_______u IV Aorta cannulated OnCPB Aorta X on Rewarming Aorta X off OffCPB Protamine __mg slowIV post-neg test Ancef, last @ ____ Amicar Fluids Blood products: PRBC FFP SPP Cryo

ROS: NPOstatus:______
HEENT:Hx Difficult Airway? CROM: TMD: Neuro:
VENT:

ABG:

CV/F&E:edema:0/+1/+2/+3/+4
Murmur: Y/N

PP:0/+1/+2/+3

AnesHx:
Self/Family?
PSHx:
CABG Appy Tonsils Breast C/S D&C Hyster Catarct Chole CEA Back Prostate Roids

Bruit: Y/N: FxnlCapacity(METS): <4 / 4-7 / 7-10 ChstTbs:___

Labs: BNP____
NZ: Dig: Lipids: TG (<150)____ LDL (<100/<70)____ TSH/free_____ HDL (>50)____

UA:

Carotids: R_________/L__________

__PCXR: BGT____ LFTs: Blood Type:

Cardiomegaly____ Tumors____ Effusions____

Resp:

PFTs: FVC Avail?

FEV1 (<2L=high risk PPC) FEV1/FVC (<0.5=high risk) Flow/Vol Loop Abn?

__Other:

GI/GU/Endo/Metab:
O/NG______

Alb_____ PO4____

Musc/Integ:

Perioperative CVRisk Major: Unstable/ACS, Decompensated HF, Significant Arrhythmias, Severe Valve Dz. Intermediate: Mild Angina, History of MI, Pathologic Qs, Compensated/Prior CHF, Diabetes Mellitus, Renal Insuff. (CKD) Minor: Advanced age, Abnormal ECG, Rhythm other than sinus, Low fxnl capacity Hx stroke,Uncontrolled HTN

Consults:

Txfrd to Bed#?

PMHx:
CVD: CAD/MI Stents? CHF IrregHR Pacer/AICD AS/AI MS/MR RheumaticFvr HTN Lipid SOB/DOE TOB_______PYrs ETOH OSA COPD Asthma Bronchitis DM:I/II____cntrl? Liver Anemia GERD Adrenal Thyroid Spine TMJ OA/RA CA

Age___Ht____Wt___BMI/BSA______
MD: MDA:

Meds:Rigid Dose Schedules/INTERACTIONS?

CV drugs B-blocker taken: Y/N

Anes Start:___ : ___ Anes End: ___ : ___

Gtts to start?

Allergies:
Latex: Y/N?

Anticoags

MAOIs, TCA, lithium

Dx/Sx:

Antibiotic? Ancef____Gms? Vanco____Gms? Other:

Hypoglycemics: Oral/INJ

Workup:
___Ekg Rhythm: Q waves? LVH? RBBB/LBBB? ST-T abn? ___***Stress: Perfusion Abn? Fixed/Reversible EF: WMA?: CC: EF_____ LMain: LAD: Diag LCx: OM: RCA: Others: Dominance? ___Echo: calc LV EF______% AVA (<0.8 [nml=2.6-3.5]) LVH Mean Gradient (>40=severe) PHTN? TV PV MV AV

*NPH or Viagra (Cialis)

Steroids?

CC:

Resp Txt: PRN/ATC

Vol. Agent N2O/Iso/Sevo/Des Versed (0.02-0.03mg/kg) Fentanyl (3-5mcg/kg) Propofol (1.5-2.5mg/kg) Prop.Infus 50-200mcg/kg/min) Ketamine (50mg/ml 1-2mg/kg) Etomidate (0.2-0.6mg/kg) SCh (0.56-1.5mg/kg) Roc (0.6-1.2mg/kg) Vec (0.1mg/kg) Vec. Maint (0.02-0.05mg/kg Neostigmine (0.04-0.08mg/kg) Robinul (0.02mg/kg) Zofran (4-8mg) Albuterol (2-6puffs) Others:

MP:1 2 3 4 / ASA:12345E

Lines/Traps:
Times:
Leg incision Chest incision Sternotomy Heparin_______u IV Aorta cannulated OnCPB Aorta X on Rewarming Aorta X off OffCPB Protamine __mg slowIV post-neg test Ancef, last @ ____ Amicar Fluids Blood products: PRBC FFP SPP Cryo

ROS: NPOstatus:______
HEENT:Hx Difficult Airway? CROM: TMD: Neuro:
VENT:
ABG:

CV/F&E:edema:0/+1/+2/+3/+4
Murmur: Y/N

PP:0/+1/+2/+3

AnesHx:
Self/Family?
PSHx:
CABG Appy Tonsils Breast C/S D&C Hyster Catarct Chole CEA Back Prostate Roids

Bruit: Y/N: FxnlCapacity(METS): <4 / 4-7 / 7-10 ChstTbs:___

Labs: BNP____
NZ: Dig: Lipids: TG (<150)____ LDL (<100/<70)____ TSH/free_____ HDL (>50)____

UA:

Carotids: R_________/L__________

__PCXR: BGT____
Cardiomegaly____ Tumors____ Effusions____

Resp:

LFTs: Blood Type:

PFTs: FVC Avail?

FEV1 (<2L=high risk PPC) FEV1/FVC (<0.5=high risk) Flow/Vol Loop Abn?

__Other:

GI/GU/Endo/Metab:
O/NG______

Alb_____ PO4____

Musc/Integ:

Perioperative CVRisk Major: Unstable/ACS, Decompensated HF, Significant Arrhythmias, Severe Valve Dz. Intermediate: Mild Angina, History of MI, Pathologic Qs, Compensated/Prior CHF, Diabetes Mellitus, Renal Insuff. (CKD) Minor: Advanced age, Abnormal ECG, Rhythm other than sinus, Low fxnl capacity Hx stroke,Uncontrolled HTN

Consults:

Txfrd to Bed#?