#Liver resection | Explore Tumblr posts and blogs

traveler-at-heart · 4 months ago

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Hello there, how are you? I don't know if you take requests at the moment but i want to ask you if you could write something with Liho?

Maybe something like, Liho didn't like any partners Nat had before Yn, and since they got together Liho likes Yn, Nat thought that maybe more than the cat loves her.

And maybe Yn left some clothes in Nat's house and when Liho misses her, she went to i don't know, a jumper, and sleep on top of it. And when Nat found Liho, she send a picture to Yn, and went next to Liho like saying "i'm gonna marry her soon"

So, this isn't exaaactly the request, but it is where the story took me! In any case, I hope you enjoy it and thanks for the prompt :)

Natasha Romanoff x Fem!R

Natasha knew how to protect herself.

Don’t trust anyone, always look over your shoulder.

It’s what kept her alive for so long.

But it’s what made her lonely too.

The few people she dated took her dettachment as a challenge that they happily accepted but soon abandoned.

Others were disinterested in complicated affairs from the start, and so things didn’t move past a couple of dates.

Then, you.

Medical staff came and went around the Compound. Most of the team had enhanced capabilities to heal themselves; for her part, Natasha was too stubborn to go on her own.

That’s how she knew she was seriously injured.

“Agent Romanoff” you greeted, a wary smile on your lips as Natasha struggled to focus, the white lights hurting her eyes. “How are you feeling?”

“Confused”

“Yeah, that tracks” you nodded, turning away from the chart to look at her. “Do you remember anything?”

“An explosion…“

“And before that a bullet to your side. We were able to fix it by resecting a small portion of your liver and spleen, but you’ll need rest. For now, I’ll monitor you. Let’s think about discharging you in a couple of days”

“I can take care of myself” she objected, but struggled to sit up, pain invading her right side.

“That would be the feeling of cracked ribs” you nodded torwards her side. “I’m not asking if you want to stay, Agent. Your teammates are coming and going for missions or other engagements and you need to be monitored 24/7 for possible complications”

“What you’re saying is, I’m a prisoner here”

“Of course not” you closed the chart, smiling. “We don’t let the prisoners watch tv”

—

It had been mere hours, and Natasha was restless. There was nothing interesting in the tv, her phone was dead and it was ridiculous she was held captive here for “observation” when no one had checked on her for the last three hours.

“Sorry about that. Busy day here” you said with a smile, checking her blood pressure and the chart. “Any discomfort, pain?”

“No”

You nodded, asking for her permission to do a physical exam. Natasha scoffed but agreed with an eye roll.

“Bowel movement?” you asked, checking her pupils.

“No!”

“Ok, no need to get defensive” you placed your hands on each side of Natasha’s head. Your gentle touch made her squirm, and she was able to inspect you closer.

“You’re pretty” Natasha blurted out. You chuckled. “I am so sorry, I don’t know where that came from”

“No need to apologize” you smiled. “It’s the concussion”

“Right”

“Vitals are good, I’ll come back to check up on you in a bit” your pager went off. A large group of agents had just gotten back from a mission. “Squeeze the button if you need anything. Enjoy your stay with us, Agent Romanoff”

“When will I be able to go… home?” Natasha said, but you closed the door before she had a chance to finish her sentence.

—

Natasha hated being wrong. At midnight, the pain got bad and yet, you had to convince her she needed some medicine to ease the discomfort and rest.

But whatever you gave her worked wonders. When she openes her eyes, you were on the couch next to her bed, going through some charts and reports.

“Hey” she said. “I don’t know your name”

“Y/N” you looked up, smiling.

You sat next to her, checking her vitals as she drifted in and out of her sleep stupor. By the time she was fully awake, it was almost noon.

There you were again, munching on a cookie as you scribbled on a sheet.

“You don’t have to stay here all day”

“Oh, it’s no bother” you said, not looking up.

“No other patients right now?”

“No, it’s actually because every medic and nurse is afraid of you and they won’t bother me when I’m here”

“Glad I can be of service”

“Are you hungry? We can get you something very light to eat” you finally looked up, trying to hold back a yawn. It had been an intense night in the emergency medbay.

“What are my options?”

“Oatmeal and that’s about it”

“No coffee?”

“Nu-uh”

Natasha shruged her shoulders and nodded. You smiled, walking out of the room. At least three interns were waiting for you, asking all kinds of very stupid questions. You turned to her, as if saying, “I told you so” and left.

—

For the rest of the day, Natasha was the perfect patient, which obviously made you suspicious.

You repeated your physical exam, asked the same questions, got the answers minus the hint of sarcasm. You were about to turn and leave when she asked again.

“Wait! I can go home now, right?”

“Your hemoglobin is still a bit low and I’d like to wait at least another day”

“I can’t wait another day” Natasha said, glaring.

“Agent Romanoff, you can’t even go on missions right now. Whatever it is you’re so eager to do, I’m sure it can wait” you insisted, trying to avoid an argument after a 48 hour shift.

“It can’t” she insisted, and the monitor began to signal the rise of her blood pressure.

“Calm down” you asked, walking back to her bed. “Please tell me how can I help”

“It’s complicated”

“I’ll tell you what’s complicated. Pulling out bullet fragments from your stomach while I try to keep you from bleeding out. I was in that OR for eight hours and would like to guarantee you recover fully”

Natasha looked at you, and you sighed, sitting by the edge of her bed.

“I have a… cat”

“Oh”

“I need to feed her”

“Can’t someone else do it? A neighbour? One of the other Avengers?”

“Liho doesn’t like anyone, but me. If she hears or smells a stranger, she’ll freak out and attack them or try to run away” Natasha explained. “It’s not ideal considering my profession”

“Yeah” you nodded, thinking about what to do. Moving Natasha was not an option right now. “Let me try”

“Try what?”

“Try feeding Liho, is that her name?”

“It’s dangerous” Natasha warned you, sure it would end in disaster.

“My shift is ending, I can go right now” you ignored her warning. “If I could discharge you right now, I would. Don’t want a cat starving on my watch”

Natasha nodded, and gave you her address. You were surprised she had moved out of the Compound, but then again, a chief surgeon wasn’t privy to the Avengers every move.

The spy made you swear you’d call her if anything went wrong. As you opened the door to her apartment with the spare key, you were expecting to find a giant, feral animal waiting to sink its claws in your flesh.

“Liho” you called a couple of times, making sure the door was closed so she couldn’t escape. “I’m a friend of your mama, she’ll be back in a couple of days”

You were looking around the living room, when a thud behind your back made you jump. And there she was, a black cat with beautiful green eyes -that strangely, reminded you of Natasha’s-. You stared at each other, waiting for someone to move.

Liho did.

She let out a meow and rubbed herself against your leg.

“You’re the cutest” you cooed her, relaxing as she purred in your arms. “Why would Natasha even say you’re scary?”

While the cat jumped around, you searched for her food, cleaned her water bowl and her sandbox. Once you were done, you called Natasha.

“You owe me an apology”

“Did she scratch your eye out like Fury?” she sighed.

“No… wait. Is that how Fury lost his eye?”

Liho jumped on the kitchen counter, purring and rubbing herself against your arm.

“Is that Liho?”

“Yes. She has been purring and following me ever since I got here, Nat. She’s the sweetest cat and you were calling her crazy! In fact, you don’t owe me an apology, you owe it to Liho. Come here, gorgeous”

The cat responded to your words and Natasha smiled.

“I’ll stop by again before I go back to the hospital. Anything else you need?”

You filled a tote bag with everything on her list. Once you were done, you said goodbye to Liho. Thinking it might be funny, you took a selfie with her, smiling as she snuggled on your chest.

You sent it to Natasha, not thinking much of it.

Natasha’s blood pressure increased as soon as she saw the picture. No nurse dared to comment when she turned off the monitor with a smack.

—

“Is this really necessary?” Natasha said, fidgeting on the wheelchair.

“Humor me, Agent” you asked, pushing her to the entrance of SHIELD’s medical facilities. “This is the last time you have to follow my medical advice”

Clint was waiting for Natasha, and he looked as you wheeled her his way, clearly amused.

“How did you manage to get her to sit?”

“I have my ways” you winked at the man. Agent Barton was a far better patient, if only because you had his wife on speed dial.

“Remember, rest. Take your meds and call me if anything feels off. And say hi to Liho for me” you helped Natasha to the car, closing the door as she settled in. You waved as they drove off.

“What was that about your cat?”

“Oh, Dr. Y/L/N went to my place twice a day to feed her”

“And she survived? She must be special” Clint chuckled.

Natasha had to agree with that.

—

Liho was happy to see her human again, roaring like an engine as she rubbed herself on Natasha’s legs. After she came back from the hospital, the cat would never leave Natasha’s side.

The Russian also noticed that you had kept her place clean, and left some groceries and food for the first few days of her home recovery.

It was a strange feeling, being taken care of. Not unpleasant, truthfully, when it came from you. As she stayed in the confines of her apartment, Natasha pondered if it meant something else or if it was just wishful thinking.

You checked on her via text message, and that was all you could really manage to do, as you had back to back shifts and emergency procedures throughout the week. Still, you made sure to send some food to Natasha through delivery apps.

By the time you finally had more free time, it was a chilly Thursday night. As you were leaving the hospital and walking to your car, your phone rang.

“Please, not another emergency” you sighed, surprised at the name on the screen. “Hey, Agent Romanoff. How are you feeling?”

“I’m doing ok… but I might need your help”

“Nat, what’s wrong?” you dropped all formalities, rushing to your car.

“I’m fine, it’s Liho. I left the window open and she climbed all the way up the emergency stairs. And I tried but can’t go out and reach her”

“What do you mean you tried? You should have called me right away! Anyway, doesn’t matter, I’ll be there. Don’t do anything stupid, those are doctor’s orders”

By the time you got to Natasha’s apartment, a storm was fast approaching.

“Hey, sorry for bothering you”

“It’s not… blood!”

“What?” Natasha looked down, at the place where you were pointing. Right on her stitches, there was a small stain of blood. “Oh, must have happened when I tried to reach for her”

“I knew I should have kept you for another week at the hospital” you grumbled, leading her to the couch. You found a gauze in your emergency kit and lifted her shirt, applying pressure. “Do not move. I’ll be right back”

“The stairs are slippery” she warned you as you stepped out the window. Natasha was surprised at how graceful your movements were.

You looked around, calling for Liho, but the clouds were covering the moon and the sky was dark, making it almost impossible to spot her.

“Ok, fine” you climbed up the steps, holding on to the rail. Taking a deep breath, you let out a high pitched call. “Kitty. Where’s my kitty?”

There small beads shone in the middle of the darkness, and you reached forward. Liho complained, clearly scared about the height. A thunder made her jump, climbing a lot higher.

“Liho, I take it back. You are crazy”

By the time you were able to reach her, it had begun pouring. You placed the cat inside your sweatshirt, to protect her from the rain and have both hands free to climb down.

“That was fun” you said, going inside soaking wet. You almost slipped and Natasha caught you by the waist. “Thanks” you said, feeling warm as her hand went around your back. You couldn’t help but look at her lips, and Natasha caught on, leaning forward.

In that moment, Liho peeked her head from the collar of your sweatshirt, protesting at the uncomfortable feeling of being drenched.

“Here, you need to dry” Natasha offered while you closed the window.

“Thanks, Nat”

She came back with a towel, yoga pants and a t-shirt. You tried not to swoon at the idea of wearing something of hers. Still, you said thanks and disappeared in the bathroom to get changed.

“Let me have a look” you asked when you came back, inspecting her abdomen. “Looks like it was just a small stitch on the edge of the wound. I’ll fix it if it’s alright with you?”

“Yeah, sure” Natasha nodded, and laid back as you prepared the sutures and wore gloves. You applied some local anesthesia and began to work.

“My technique is flawless. The scarring will be almost invisible” you promised.

“So, I can still wear bikinis?”

“Yeah” you nodded, trying to stay focused while the image of Natasha in a swimsuit floated around your head.

“I can’t thank you enough for taking care of Liho” Natasha said in a low voice, which almost made your hands tremble. “Too bad my doctor hasn’t officially discharged me, or I’d take you out to dinner”

“How about some take out instead?” you smiled, cleaning the wound and helping her up.

“That can be done for sure”

You had pizza with beer, sitting on Natasha’s living room while Liho jumped from your lap to hers. It was the best date you ever had.

Pretty soon, the alcohol and exhaustion caught up to you and when Natasha came back from the kitchen, you were fast asleep in her couch, Liho snuggled up in your chest.

Natasha smiled, covering you with a blanket. Liho purred, and your hand went up to scratch behind her ear on pure insctinct.

“I like her too, Liho” Natasha said with a smile. “She’s definitely a keeper”

#natasha romanoff x reader #natasha romanoff x you #natasha romanoff x y/n

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2boldlyqueer · 2 years ago

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lil surgery

#Lil liver resection to remove an atypical growth #Lmao

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feminist-space · 3 months ago

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"The Bryan family’s attorney, Joe Zarzaur in Pensacola, says general surgeon, Dr. Thomas Shaknovsky, and the hospital’s chief medical officer, Dr. Christopher Bacani, persuaded the Bryans not to return home for the surgery, but to have it in Florida, even though they were reluctant.

...

According to medical records, the surgeon apparently did not realize his mistake at the time of the surgery and proceeded with labeling the removed liver specimen as a “spleen.” After the procedure, Shaknovsky told Beverly Bryan that the “spleen” was so diseased that it was four times bigger than usual and had “migrated” to the other side of Mr. Bryan’s body.

...

As Zarzaur’s legal team began looking into Bryan’s death they also discovered this was not the first time Dr. Shaknovsky had mistakenly operated on the wrong part of a person’s body. In a previous wrong-site surgery in 2023, Zarzaur said the surgeon mistakenly removed a portion of a patient’s pancreas instead of performing the intended adrenal gland resection at the same hospital. That case was settled in confidence, and Dr. Shaknovsky remained a surgeon at Ascension Sacred Heart Emerald Coast Hospital as recently as August 2024. He said it’s uncertain whether he continues to have privileges at Ascension Sacred Heart Emerald Coast Hospital or other area facilities."

#medical malpractice #death by surgeon #surgery malpractice #death tw

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thepurplebacon · 6 months ago

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this is the first thing that came to mind when you said Elisk has no liver 😭😭😭

The medical robot that performing liver resection surgery on Elisk at that time belike:

#tpb ask #mortis cycle elisk #mortis cycle #OMG THIS IS SO LORE ACCURATE

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blatantescapism · 1 year ago

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I get a very small liver resection done tomorrow. Should be minor

I was planning to bring my finger-woven belt WIP with me as entertainment for the hospital stay, but my lovely spouse pointed out that attempting a complicated pattern while on the Strong Painkillers was perhaps unwise.

All of my WIPs have complicated patterns, though..,

Contemplating whether it’s worth starting a very boring scarf, just to have something to do.

#medical #medical tw #hospital #hospital tw #liver health #minor surgery

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thessalian · 1 year ago

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Thess vs the Human Digestive System

VENT BREAK.

So New Girl is back today, and back to the usual tricks. She was blatant enough about it today for me to spot the pattern.

See, I was typing away, we'd got down to 260-odd, things were about as good as they get even with the really obvious cherry-picking of bits of dictation ... and then suddenly, I pop out of what was for once a fairly simple bit of dictation to find that the queue has forty more items in it than when I last looked, many of them timestamped for before the one I just finished typing. They're not even all that long, so I wonder, what the fuck is the problem?

I start in on the first one of these - a gallbladder, fairly short and straightforward, especially if you've been doing them for years. Come out of that one a couple of minutes later, and the queue is suddenly down by twenty, and I see by the timestamps that more cherry-picking has been done later in the day. So I look at this and go, "Okay, most of the ones that got thrown back were the same couple of doctors, and their accents aren't that bad, and they're not that long, so again I ask what the fuck?" But it's no good asking questions of these people, so back to the typing.

Another gallbladder.

And another.

Half a dozen of them, all told.

So I think what New Girl is doing is picking them up, listening just long enough to figure out what they are, and then just ... not doing the ones she doesn't want to do. Maybe she's not comfortable with them - but if so, the only way for her to gain comfort with them is to do them. Maybe she just doesn't want to do them. Maybe all she really wants to do is the really simple ones, like spot biopsies of various parts of the colon and oesophagus, which are honestly the easiest ones to do.

Well, tough shit, no pun intended. Why should she get the easy spot biopsies when I'm typing up all the resections (which is when you actually take out a whole segment of bowel, usually because there's a tumour or perforation in there)? I get the whole bowel resections. I get the kidneys. The testes. The hysterectomy specimens and ovaries and fallopian tubes. The placentas. The breasts (well, the mastectomies and major excisions, anyway; they're fine doing the little core biopsies). Any skin biopsy that's not a straight-up punch. The livers and gallbladders. In short, all the complicated stuff. And New Girl not only cherry-picks the short ones, but also cherry-picks the short ones that are even remotely more than "number of specimens, measurements of specimens, done".

I cannot express enough how absolutely sick to the back teeth I am of bowel resection specimens. Don't even get me started on placentas and the fucking pancreas.

So it's still going to be an overtime night and after this one anterior resection that I don't want to do but am now stuck with, I'm stuck with a fifteen minute monstrosity of multiple skin excision biopsies.

I mean, I feel really bad for the patients whose bodies used to contain these pieces of tissue, and the doctors are just doing their jobs, and I feel bad about kvetching. However ... my colleagues need to share the fucking load, and they don't, and I'm tired and in a lot of pain and just so FED THE FUCK UP.

I'd say, "Hey, at least it's the weekend", but guess who's going to have to do overtime on Saturday too, because we're only into dictations from about 1pm on Thursday (again, because I've had all the 5-10 minute ones all day and the other two are fucking dawdling, and have been since Scruffmen went on his half-day annual leave). I want this bullshit cleared out as much as possible so maybe I won't have to do this shit next week too.

Right. VENT BREAK over. I will stuff an apple into my face and keep going.

#Thess has a day job

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livingwithaweirdliver · 1 year ago

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what are hepatic adenomas? what are they up to in there?

hepatic adenomas are a (usually benign) tumour on the liver. they are solitary tumours, meaning they usually just pop up alone. i however have four.

they very rarely turn into cancer but do tend to rupture, meaning they burst and kind of just bleed everywhere and that's not ideal for a human being wanting to live. i essentially have four time bombs chilling on a very valuable organ right now!

why do i worry about them rupturing? the bigger they are the more likely they are to rupture, oestrogen is known to grow them. i am a woman. the dots are connecting...

how are they treated? in my case, they aren't. mine are not large enough to be considered for a resection and even if they were, it would be a very risky surgery for me as i have multiple hanging out in different areas. i get a fun MRI scan every year and a few ultrasounds here and there so that's something!

how do i keep myself safe? i don't play contact sports and generally avoid getting punched in the liver (a task when working in childcare) i also carry various forms of medical ID and train everyone around me on the "what to do if i start dying very suddenly"

i have checked the tags on here and it seems i am a rare bird on every website, i'm writing so much because i simply don't want another person like me, struggling to find any personal information or comfort to spend hours scrolling through decade old forums or wishing there were another like them somewhere... so if that's you message me RIGHT NOW.

#chronic illness #gallstones #medicine #hepatic adenoma

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honeysuckle-venom · 10 months ago

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Warning: weight loss mention (no in depth discussion about feelings yet)

So. Those of you who keep up to date with my personal posts will know that on Monday I saw a new hepatologist to discuss my many (non-cancerous) liver tumors and what to do about them.

The answers I got were more or less what I expected. Thankfully, I don't need any scary procedures any time soon, and possibly won't ever need surgery, which would be fantastic. As I suspected, I'm not a good candidate for resection anyway. Since I'm largely asymptomatic we don't need to look into something like trans arterial embolization right now, let alone transplant. Yay! Also, they said I can safely eat moderate amounts of soy, which is great, because I like soy based foods. That's the good news.

There were a few pieces of bad news. The first was that while I knew I couldn't be on estrogen based birth control, they said it wouldn't be safe for me to risk progesterone based birth control either. I have to stay off entirely. So that kind of sucks, I hate just getting my period naturally every month, the pmdd symptoms are so much worse that way. But I'll take horrible cramps and mental health struggles over tumor growth.

And speaking of mental health struggles being preferable to tumor growth, the other thing that was made very clear to me was that I absolutely must lose weight. Estrogen production increases with large amounts of fatty tissue, and the doctor said that's the main reason these tumors are worsened by weight gain. She thinks that the amount of tumor growth they found was within the margin of error, so it's possible it didn't grow, but if it did grow it's likely because I gained some weight in the past year. (They're going to look at all my MRIs during rounds next week with a radiologist to see if it really grew or not). It was made very clear to me that the only way to get them to shrink is to lose weight, and that if I don't or if I gain weight I'm at serious risk of them growing.

So. Weight loss. Apparently not super optional. I mean, I know I have bodily autonomy, I could decide not to lost weight technically, but yeah the consequences here are serious and not worth messing around with. Which means for the first time since I was an anorexic teenager I will be trying to lose weight.

I have...a lot of conflicting feelings about that, but this post is already long and I feel like those feelings should go in their own post so I can adequately explain and trigger warn. So. I'll stop here for now.

#text post #my post #the liver saga #is a tag i should've made ages ago #medical cw #weight loss mention

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cancer-researcher · 25 days ago

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youtube

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drdhaivat · 3 months ago

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Liver Surgery Doctor Ahmedabad: Expert Care for Complex Cases

Seeking a skilled Senior Liver Surgery Doctor in Ahmedabad? Senior Liver Surgeon Doctor in Ahmedabad – Dr. Dhaivat Vaishnav at Gastro Surgeon Gujarat offers world-class care for complex liver conditions, including liver transplantation and resection surgeries.

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mcatmemoranda · 2 years ago

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Patient is a [ ] yo male/female presenting to the clinic for a preoperative evaluation.

Procedure [ ]

Scheduled date of procedure [ ]

Surgeon performing procedure requesting consultation for preop is [ ] and can be contacted at [ ]

This patient is/is not medically optimized for the planned surgery, see below for details.

EKG collected in office, interpreted personally and under the direct supervision of attending physician as follows- sinus rate and rhythm, no evidence of ischemia or ST abnormalities, no blocks, normal QTc interval.

The following labs are to be completed prior to surgery, and will be evaluated upon completion. Procedure is to be performed as scheduled barring any extraordinary laboratory derangements of concern.

Current medication list has been thoroughly reviewed and should not interfere with surgery as written.

Patient has no prior history of adverse reactions to anesthesia, problems with airway management, difficult IV access, prolonged emergence, or postoperative nausea/vomiting.

Airway Mallampati score: This patient is a Grade based on the criteria listed below

-Grade I Tonsillar pillars, soft palate, entire uvula

-Grade II Tonsillar pillars, soft palate, part of uvula

-Grade III Soft palate, base of uvula

-Grade IV Hard palate only, no uvula visualized

Patient is a low/medium/high risk for this low/medium/high risk surgical procedure.

Will send documentation of this preoperative visit to surgeon [ ].

**** ADDITIONAL INFORMATION****

Patient Risk for Elective Surgical Procedure as Determined with the Criteria Below:

1- Very Low Risk

No known medical problems

2- Low Risk

Hypertension

Hyperlipidemia

Asthma

Other chronic, stable medical condition without significant functional impairment

3- Intermediate Risk

Age 70 or older

Non-insulin dependent diabetes

History of treated, stable CAD

Morbid obesity (BMI > 30)

Anemia (hemoglobin < 10)

Mild renal insufficiency

4- High Risk

-Chronic CHF

-Insulin-dependent diabetes mellitus

-Renal insufficiency: creatinine > 2

-Moderate COPD: FEV1 50% to 70%

-Obstructive sleep apnea

-History of stroke or TIA

-Known diagnosis of dementia

-Chronic pain syndrome

5- Very High Risk

-Unstable or severe cardiac disease

-Severe COPD: FEV1 < 50% predicted

-Use of home oxygen

-Pulmonary hypertension

-Severe liver disease

-Severe frailty; physical incapacitation

Surgical Risk Score Determined as Below:

1- Very Low Risk

Procedures that usually require only minimal or moderate sedation and have few physiologic effects

-Eye surgery

-GI endoscopy (without stents)

-Dental procedures

2- Low Risk

Procedures associated with minimal physiologic effect

-Hernia repair

-ENT procedures without planned flap or neck dissection

-Diagnostic cardiac catheterization

-Interventional radiology

-GI endoscopy with stent placement

-Cystoscopy

3- Intermediate Risk

Procedures associated with moderate changes in hemodynamics, risk of blood loss

-Intracranial and spine surgery

-Gynecologic and urologic surgery

-Intra-abdominal surgery without bowel resection

-Intra-thoracic surgery without lung resection

-Cardiac catheterization procedures including electrophysiology studies, ablations, AICD, pacemaker

4- High Risk

Procedures with possible significant effect on hemodynamics, blood loss

-Colorectal surgery with bowel resection

-Kidney transplant

-Major joint replacement (shoulder, knee, and hip)

-Open radical prostatectomy, cystectomy

-Major oncologic general surgery or gynecologic surgery

-Major oncologic head and neck surgery

5- Very High Risk

Procedures with major impact on hemodynamics, fluid shifts, possible major blood loss:

-Aortic surgery

-Cardiac surgery

-Intra-thoracic procedures with lung resection

-Major transplant surgery (heart, lung, liver)

High risk surgery: yes/no

Hx of ischemic heart disease: y/n

Hx of CHF: y/n

Hx of CVA/TIA: y/n

Pre-op tx with insulin: y/n

DM/how are blood sugars?

Pre-op Cr >2mg: y/n

OTHER EVALUATIONS BASED OFF PATIENT HISTORY SEE BELOW:

1. CARDIAC EVALUATION

A. Ischemic Cardiac Risk- Describe any history of cardiovascular disease and list the cardiologist/electrophysiologist. For CAD, report the results of the most recent stress test or cardiac cath, type of procedures or type of stents, date of MI, and recommendations for perioperative management. Include antiplatelet management. Continue baby aspirin for patients with cardiac stents - unless having neurosurgery, then coordinate with surgeon.

B. Ventricular function - include most recent echocardiogram evaluation ideally performed within the past 2 years

C. Valvular heart disease- include most recent echocardiogram, type of prosthetic valve

D. Arrhythmias - include any implanted devices and recent interrogation report, contact electrophysiology about device management during the surgery and include recommendations provided. For A-Fib, include CHA2DS2-VASc score

E. Beta blockade - All patients on chronic beta blockers should have these medications continue throughout the perioperative period unless there is a specifically documented contraindication.

F. Hypertension - Other than for cataract surgery, ACEI inhibitors and ARBs should be held for 24hours prior to surgery and diuretics should be held the morning of surgery

G. Vascular disease - include antiplatelet management and dates of strokes

2. PULMONARY EVALUATION

A. COPD/Asthma - include any recent exacerbations, intubations, chronic O2 use, amount of rescue inhaler use

B. OSA risk - STOPBANG score - address severity of sleep apnea and CPAP use

3. HEMATOLOGIC EVALUATION

A. Bleeding Risk - assess the bleeding risk and history for every patient

B. VTE Prophylaxis/Thrombotic risk - estimate risk and provide recommendations

C. Anticoagulation management - include pre-op and post-op medication instructions

D. Anemia - pre-op treatment plan

D. Oncology - history and treatments

4. ENDOCRINE EVALUATION

A. Diabetes mellitus - include type, medication use, recent A1c, pre-op and post-op management instructions

B. Adrenal insufficiency risk - assess for prolonged steroid use in the last year

5. RENAL EVALUATION

A. CKD - include stage, baseline labs

B. ESRD - include dialysis schedule, type, access, dry weight, location of dialysis. Generally, surgery should not be scheduled on a dialysis day.

C. Electrolyte abnormalities

6. GI EVALUATION

A. Liver disease - including MELD score and Child-Pugh classification

7. OTHER relevant comorbidities or anesthesia considerations

[substance abuse, chronic pain, delirium risk, PONV (post-operative nausea and vomiting) risk, psych disorders, neurologic disorders, infectious disease, etc.]

#Preop eval #Preop clearance #preoperative eval #Preop

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