#interventional radiology procedures

[pinholesurgeryindelhi]

Hydrosalpinx is the name for a condition in which a woman’s fallopian tube becomes blocked with fluid.

There are different causes for this condition and symptoms can vary depending on the individual. Some women do not experience any symptoms, but hydrosalpinx can have a severe impact on fertility.

[beecroft]

Orthopedic veterinary surgeons in Singapore specializing in fracture repair, TPLO surgery, spinal surgery, hip replacement, and orthopedic procedures for dogs and cats.

Web Page: https://beecroft.com.sg/beecroftsg/project-two-3amwl

[hebasoffar]

How to cut off blood supply to fibroids? #shorts #usa #radiology #inject...

[interventionalradiologyhub]

Introduction:

In the realm of modern medicine, certain techniques stand as pillars of innovation, revolutionizing the way procedures are performed and patient outcomes are improved. One such technique is the Seldinger Technique. Developed by Dr. Sven-Ivar Seldinger in 1953, this method has become a cornerstone in various medical procedures, from inserting central venous catheters to performing angiography and even certain types of biopsies.

In this comprehensive guide, we delve into the intricacies of the Seldinger Technique, its applications, and its significance in contemporary healthcare.

[mostlysignssomeportents]

How to have cancer

THIS WEEKEND (November 8-10), I'll be in TUCSON, AZ: I'm the GUEST OF HONOR at the TUSCON SCIENCE FICTION CONVENTION.

I've got cancer but it's probably (almost certainly, really) okay. Within a very short period I will no longer have cancer (at least for now). This is the best kind of cancer to have – the kind that is caught early and treated easily – but I've learned a few things on the way that I want to share with you.

Last spring, my wife put her arm around my waist and said, "Hey, what's this on your rib?" She's a lot more observant than I am, and honestly, when was the last time you palpated your back over your left floating rib? Sure enough, there was a lump there, a kind of squishy, fatty raised thing, half a centimeter wide and about four centimeters long.

I'm a 53 year old man with a family history of cancer. My father was diagnosed with lymphatic cancer at 55. So I called my doctor and asked for an appointment to have the lump checked over.

I'm signed up with Southern California Kaiser Permanente, which is as close as you come to the Canadian medicare system I grew up under and the NHS system I lived under for more than a decade. Broadly speaking, I really like KP. Its app – while terrible – isn't as terrible as the other apps, and they've taken very good care of me for both routine things like vaccinations and checkups, and serious stuff, like a double hip replacement.

Around the time of The Lump, I'd been assigned a new primary care physician – my old one retired – and so this was my first appointment with her. I used the KP app to book it, and I was offered appointments six weeks in the future. My new doc was busy! I booked the first slot.

This was my first mistake. I didn't need to wait to see my PCP to get my lump checked over. There was really only two things that my doc was gonna do, either prod it and say, "This is an extremely common whatchamacallit and you don't need to worry" or "You should go get this scanned by a radiologist." I didn't need a specific doctor to do this. I could have ridden my bike down to the KP-affiliated Urgent Care at our local Target store and gotten an immediate referral to radiology.

Six weeks go by, and my doc kind of rolls the weird lump between her fingers and says, "You'd better go see a radiologist." I called the Kaiser appointment line and booked it that day, and a couple weeks later I had a scan.

The next day, the app notified me that radiology report was available in my electronic heath record. It's mostly technical jargon ("Echogenic areas within mass suggest fatty component but atypical for a lipoma") but certain phrases leapt out at me: "malignant masses cannot be excluded. Follow up advised."

That I understood. I immediately left my doctor a note saying that I needed a biopsy referral and set back to wait. Two days went by. I left her a voice message. Another two days went by. I sent another email. Nothing, then a weekend, then more nothing.

I called Kaiser and asked to be switched to another Primary Care Physician. It was a totally painless and quick procedure and within an hour my new doc's intake staff had reviewed my chart, called me up, and referred me for a biopsy.

This was my second mistake. When my doctor didn't get back to me within a day, I should have called up KP and raised hell, demanding an immediate surgical referral.

What I did do was call Kaiser Member Services and file a grievance. I made it very clear that when I visited my doctor, I had been very happy with the care I received, but that she and her staff were clearly totally overloaded and needed some kind of administrative intervention so that their patients didn't end up in limbo.

This is a privilege. I'm a native English speaker, and although I was worried about a serious illness, I didn't have any serious symptoms. I had the ability and the stamina to force action in the system, and my doing so meant that other patients, not so well situated as I was, would not be stuck where I had been, with fewer resources to get un-stuck.

The surgeon who did the biopsy was great. He removed my mass. It was a gross lump of yellowy-red gunk in formaldehyde. He even let me photograph it before it went to pathology (warning, gross):

https://www.flickr.com/photos/doctorow/54038418981/

They told me that the pathology would take 2-5 days. I reloaded the "test results" tab in the KP website religiously after 48 hours. Nothing was updated. After five days, I called the surgical department (I had been given a direct number to reach them in case of postsurgical infections, and made a careful note of it).

It turned out that the pathology report had been in hand for three days at that point, but it was "preliminary" pending some DNA testing. Still, it was enough that the surgeon referred me to an oncologist.

This was my third mistake: I should have called after 48 hours and asked whether the pathology report was in hand, and if not, whether they could check with pathology. However, I did something very right this time: I got a phone number to reach the specialist directly, rather than going through the Kaiser main number.

My oncologist appointment was very reassuring. The oncologist explained the kind of cancer I had ("follicular lymphoma"), the initial prognosis (very positive, though it was weird that it manifested on my rib, so far from a lymph node) and what needed to happen next (a CT/PET scan). He also walked me through the best, worst and medium-cases for treatment, based on different scan outcomes. This was really good, as it helped me think through how I would manage upcoming events – book tours, a book deadline, work travel, our family Christmas vacation plans – based on these possibilities.

The oncologist gave me a number for Kaiser Nuclear Medicine. I called them from the parking lot before leaving the Kaiser hospital and left a message for the scheduler to call me back. Then I drove home.

This was my fourth mistake. The Kaiser hospital in LA is the main hub for Kaiser Southern California, and the Nuclear Medicine department was right there. I could have walked over and made an appointment in person.

Instead, I left messages daily for the next five days, waited a weekend, then called up my oncologist's staff and asked them to intervene. I also called Kaiser Member Services and filed an "urgent grievance" (just what it sounds like) and followed up by filing a complaint with the California Patient Advocate:

https://www.dmhc.ca.gov/

In both the complaint and the grievance, I made sure to note that the outgoing message at Nuclear Medicine scheduling was giving out false information (it said, "Sorry, all lines are busy," even at 2am!). Again, I was really careful to say that the action I was hoping for was both a prompt appointment for me (my oncologist had been very insistent upon this) but also that this was a very broken system that would be letting down every patient, not me, and it should be fixed.

Within a couple hours, I had a call back from KP grievances department, and an hour after that, I had an appointment for my scan. Unfortunately, that was three weeks away (so much for my oncologist's "immediate" order).

I had the scan last week, on Hallowe'en. It was really cool. The gadget was awesome, and the rad-techs were really experienced and glad to geek out with me about the way the scanner and the radioactive glucose they infused in me interacted. They even let me take pictures of the scan visualizations:

https://www.flickr.com/photos/doctorow/54108481109/

The radiology report was incredibly efficient. Within a matter of hours, I was poring over it. I had an appointment to see the doc on November 5, but I had been reading up on the scans and I was pretty sure the news was good ("No enlarged or FDG avid lymph nodes are noted within the neck, chest, abdomen, or pelvis. No findings of FDG avid splenic or bone marrow involvement").

There was just one area of concern: "Moderate FDG uptake associated with a round 1.3 cm left inguinal lymph node." The radiologist advised the oncologist to "consider correlation with tissue sampling."

Today was my oncology appointment. For entirely separate reasons, I was unable to travel to the hospital today: I wrenched my back over the weekend and yesterday morning, it was so bad that I couldn't even scratch my nose without triggering unbearable spams. After spending all day yesterday in the ER (after being lifted out of my house on a stretcher), getting MRIs and pain meds, I'm much better off, though still unable to get out of bed for more than a few minutes at a time.

So this morning at 8:30 sharp, I started calling the oncology department and appointment services to get that appointment changed over to a virtual visit. While I spent an hour trying various non-working phone numbers and unsuccessfully trying to get Kaiser appointment services to reach my oncologist, I tried to message him through the KP app. It turns out that because he is a visiting fellow and not staff, this wasn't possible.

I eventually got through to the oncology department and had the appointment switched over. The oncology nurse told me that they've been trying for months to get KP to fix the bug where fellows can't be messaged by patients. So as soon as I got off the phone with her, I called member services and filed another grievance. Why bother, if I'd gotten what I needed? Same logic as before: if you have the stamina and skills to demand a fix to a broken system, you have a duty to use them.

I got off the phone with my oncologist about an hour ago. It went fine. I'm going to get a needle biopsy on that one suss node. If it comes back positive, I'll get a few very local, very low-powered radiation therapy interventions, whose worst side effect will be "a mild sunburn over a very small area." If it's negative, we're done, but I'll get quarterly CT/PET scans to be on the safe side.

Before I got off the phone, I made sure to get the name of the department where the needle biopsy would be performed and a phone number. The order for the biopsy just posted to my health record, and now I'm redialing the department to book in that appointment (I'm not waiting around for them to call me).

While I redial, a few more lessons from my experience. First, who do you tell? I told my wife and my parents, because I didn't want to go through a multi-week period of serious anxiety all on my own. Here, too, I made a mistake: I neglected to ask them not to tell anyone else. The word spread a little before I put a lid on things. I wanted to keep the circle of people who knew this was going on small, until I knew what was what. There's no point in worrying other people, of course, and my own worry wasn't going to be helped by having to repeat, "Well, it looks pretty good, but we won't know until I've had a scan/my appointment/etc."

Next, how to manage the process: this is a complex, multi-stage process. It began with a physician appointment, then a radiologist, then a pathology report, then surgery, then another pathology report, then an oncologist, then a scan, then another radiologist, and finally, the oncologist again.

That's a lot of path-dependent, interdepartmental stuff, with a lot of ways that things can fall off the rails (when my dad had cancer at my age, there was a big gap in care when one hospital lost a fax from another hospital department and my folks assumed that if they hadn't heard back, everything was fine).

So I have been making extensive use of a suspense file, where I record what I'm waiting for, who is supposed to provide it, and when it is due. Though I had several places where my care continuity crumbled some, there would have been far more if I hadn't done this:

https://pluralistic.net/2024/10/26/one-weird-trick/#todo

The title of this piece is "how to have cancer," but what it really boils down to is, "things I learned from my own cancer." As I've noted, I'm playing this one on the easiest setting: I have no symptoms, I speak and write English fluently, I am computer literate and reasonably capable of parsing medical/technical jargon. I have excellent insurance.

If any of these advantages hadn't been there, things would have been a lot harder. I'd have needed these lessons even more.

To recap them:

See a frontline care worker as soon as possible: don't wait for an appointment with a specific MD. Practically any health worker can prod a lump and refer you for further testing;

Get a direct phone number for every specialist you are referred to (add this to your phone book); call them immediately after the referral to get scheduled (better yet, walk over to their offices and schedule the appointment in person);

Get a timeframe as to when your results are due and when you can expect to get a follow-up; call the direct number as soon as the due-date comes (use calendar reminders for this);

If you can't get a call back, an appointment, or a test result in a reasonable amount of time (use a suspense file to track this), lodge a formal complaint with your insurer/facility, and consider filing with the state regulator;

Think hard about who you're going to tell, and when, and talk over your own wishes about who they can tell, and when.

As you might imagine, I've spent some time talking to my parents today as these welcome results have come in. My mother is (mostly) retired now, and she's doing a lot of volunteer work on end-of-life care. She recommends a book called Hope for the Best, Plan for the Rest: 7 Keys for Navigating a Life-Changing Diagnosis:

https://pagetwo.com/book/hope-for-the-best-plan-for-the-rest/

I haven't read it, but it looks like it's got excellent advice, especially for people who lack the self-advocacy capabilities and circumstances I'm privileged with. According to my mom, who uses it in workshops, there's a lot of emphasis on the role that families and friends can play in helping someone whose physical, mental and/or emotional health are compromised.

So, that's it. I've got cancer. No cancer is good. This cancer is better than most. I am almost certainly fine. Every medical professional I've dealt with, and all the administrative support staff at Kaiser, have been excellent. Even the doc who dropped the ball on my biopsy was really good to deal with – she was just clearly drowning in work. The problems I had are with the system, not the people. I'm profoundly grateful to all of them for the help they gave me, the interest and compassion they showed, and the clarity and respect they demonstrated in my dealings with them.

I'm also very grateful to my wife, my parents, and my boss at EFF, all of whom got the news early and demonstrated patience, love, and support that helped in my own dark hours over the past couple of months.

I hope you're well. But you know, everyone gets something, eventually. When you find yourself mired in a broken system full of good people, work the system – for yourself and for the people who come behind you. Take records. Make calls.

Look after yourself.

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/11/05/carcinoma-angels/#squeaky-nail

[fauvester]

more hospital au svsss

in interventional radiology (or anything involving procedural x-rays) you need to wear a lead apron and thyroid guard.. there’s usually lots of spares but usually the regulars invest in their own. they are very heavy lol. but it does help keep you cozy in a freezing procedure room

[dausy]

I got a job.

Which is kind of nifty I guess. I feel like it removes some of my stress although I knew I wouldn't have an issue finding a job, its just that the unknown makes us feel like we are continuously poor and homeless when that isn't the case.

An old classmate of mine from nursing school had messaged me some odd days ago saying she was leaving her job because her commute was really long and she wanted to know if I wanted it. She said she loved her job otherwise. I was actually going to wait until we moved to start applying for jobs because a lot of places want you to start ASAP and I don't want to apply too early. But she had already recommended me to her manager and he contacted me with a referral link to fill out. Did a virtual interview and he told me he knew he was already going to offer me the job.

HR already sent me an acceptance package and stated they wanted to pay me a relocation fee. Just an FYI this is for an Interventional Radiology nurse position, which I suppose I do have a bit of experience in with my previous position. IR is considered a cush or "soft" nursing job, but this is with a lvl1 trauma center and I'm not that familiar with the type of high acuity cases that they do. The last time I worked in a lvl1 trauma center it was primarily preop/PhaseII and a smidgeon of pacu. I wasn't in the thick of super acute/sick patients. So I don't really know what to expect in IR. It SOUNDS like they just want somebody who is familiar with and knows how to push meds for conscious sedation. They have techs who scrub in with the doctor. That was primarily what I was nervous about was trying to learn how to scrub for so many different types of procedures (cause they said they do about 40 different types) and I was like "oh lord thats a lot to learn and prove myself on, in a short orientation". But they told me that I would just be doing the conscious sedation and thats it. Which takes a lot of stress off. I don't know how to scrub..so..

anyway, coincidentally at the same time I accepted the position, somebody posted on the nursing reddit saying something like "those of you who want to work in IR because its a soft nursing job, WE DONT WANT YOU" I mean, I work hard and I split myself into 1400 pieces to try and help everybody so I'm not coming in to just sit and play on my phone.

The downsides to this job is that there is on-call and then I'd be making less money than what I was getting paid 5 years ago and rent prices have skyrocketted. Which is really sad. It has pretty much doubled. So less pay and more expensive CoL. We are already expecting to have to pay around 2000-2200/mo on rent alone for nothing super special. Not including pet rent and then utilities.

Me and my spouse were jokingly talking about me joining the service for the benefits. While its been brought up to me before in the past, I didn't think I had it in me to join the military. Now I'm actually kind of taking it seriously. I already talked to a recruiter but they aren't making it easy to get in contact with them which makes me think they're going to tell me they werent interested. But hypothetically, if I joined the military nurse corps, I'd go in as an officer, get officer pay, get BAH, get a retirement, continue the lifestyle of which I've become accustomed and if they have my specialty available, I would just continue doing the job I've become accustomed to. It was actually kind of enlightening.

If I have to work my booty off being full time, on call, making less than my mom as a secretary and I have to continue being a nurse....I mean, I dunno..people say that the military can't compete with civilian hospitals, but I kind of beg to differ. To me, it seems like they're offering a lot more.

But if military says "no, we don't need your specialty", I do have a job waiting for me for when we move.

[shivamthakrejr]

Healthcare's AI revolution: Innovations and Prospects - Sachin Dev Duggal

Innovations in Healthcare Through AI

AI has already made significant advancements in various aspects of healthcare. One notable innovation is diagnostics. These data sets assist medical professionals in making better diagnoses using artificial intelligence algorithms that examine medical data like imaging studies, laboratory results, and electronic medical records. By doing this, AI tools have improved the accuracy of CT scans and simplified work procedures, thereby hastening outcomes and improving their dependability, which is greatly needed, especially in radiology, whose timely correct diagnosis significantly impacts patients’ lives.

The healthcare sector is undergoing a transformation through artificial intelligence (AI), which is enhancing diagnosis, improving patient care, and streamlining work. With the progress of technology, AI can change how healthcare is provided, making it more efficient, personalized, and accessible. Sachin Dev Duggal has been advocating for the impact of AI in healthcare and expressing how it could reshape medicine in the future.

Additionally, there are other instances where artificial intelligence plays an important role in enabling very early disease detection. Complex machine learning systems can identify data patterns that may signal the onset of cancerous diseases at stages when they are still curable. For instance, AI systems have demonstrated high accuracy rates when predicting the probability of developing lung cancer, thereby enabling earlier interventions with better survival rates than ever before. This new orientation towards preventive intervention rather than treatment represents a big shift from the traditional approach to health care.

AI is revolutionizing healthcare, which includes improvements to diagnosis, customization of treatments, and operational efficiency. Integrating AI into healthcare, as highlighted by Sachin Dev Duggal and other thought leaders, will improve patient outcomes and make healthcare more accessible and efficient. This means that to address the challenges facing the health industry and guarantee a healthier tomorrow, we must embrace these technological advancements.

[radioactiveradley]

FACT NUMBER ONE because I will be disowned from the profession unless I mention this

Radiographers =/= Radiologists!

Radiographer (UK) = person trained up to BSc degree level and often above, who can choose to specialise in a particular field. Radiographers can become involved in / perform basic or advanced procedures depending on skill level and training, or can train to interpret radiological images for diagnosis. Then there's a whole different branch of Radiography devoted to planning treatment & blasting cancers with radiation! I believe rads in the USA aren't trained to the same level and don't require so many qualifications/do as much, but correct me if I'm wrong!

Radiologist = qualified doctors who specialise in interpreting radiological images and performing procedures that require the use of radiography - e.g., inserting IVC filters, unfreezing shoulder joints with fluoro, CT biopsy, a million more...

So, if you have imaging done, you are more likely but not guaranteed to be in the room with a Radiographer, not a Radiologist! But if you have an interventional procedure using certain imaging modalities, the Radiologist is more likely to be leading the procedure with the Radiographer assisting! Buuuuuuut more and more Radiographers are becoming Advanced Practitioners in stuff like........ PPCIs for STEMI treatment, and doing the whole procedure themselves, so this isn't a guarantee!

[pinholesurgeryindelhi]

Procedure in which the blood supply of abnormal and diseased part of lung is blocked with medicine. A small puncture is made in blood vessel of thigh region with needle through which wire passed and sheath placed. Angiography done with catheter under X-ray guidance.

[beecroft]

Orthopedic veterinary surgeons in Singapore specializing in fracture repair, TPLO surgery, spinal surgery, hip replacement, and orthopedic procedures for dogs and cats.

Web Page: https://beecroft.com.sg/beecroftsg/project-two-3amwl

[hebasoffar]

What is the maximum fibroid size for embolization? and how to cut off bl...

[soundvascular]

Sound Vascular & Vein

Sound Vascular & Vein is committed to providing the highest level of patient care in interventional oncology, radiology, and endovascular treatment. We offer personalized, outpatient treatments for arterial disease, arthritic pain, spinal compression fractures, men’s & women’s health, and vein & vascular care. Our experienced doctors, leading-edge technology, and safe, private OBL center can provide life-changing procedures. Some conditions and treatments include peripheral arterial disease (PAD), liver cancer, benign prostatic hyperplasia (BPH), uterine fibroids (UFE), venous issues, varicose veins, enlarged prostate, leg pain/cramps, prostatic artery embolization (PAE), genicular artery embolization (GAE). Schedule an appointment today!

[foamrad]

Interventional Radiology Resources

Cases

DartRad | IR Cases

SVUH Interventional Radiology Cases

Learning

The Kinked Wire

Neuroangio.org

Backtable VI Podcasts

Dartmouth Interventional Radiology Papers

SIR Guidelines - Apps on Google Play

C.R.E.A.T.E IRAD

SVUH Interventional Radiology Cases

TeachingIR by Jeff Elbich

AUR Radiology Resident Core Curriculum Lecture Series | VIR Imaging

SIR RFS Clinical Companion

SIR RFS IR Procedure Guides

IR Clinical Companion

SIR RFS Webinars

Stepwards IR Primer

Calculators

SIR Guidelines - Apps on Google Play

[mybeingthere]

Interesting and beautiful photo-collages of Mohd Azlan Mam Mohd Latib (or AzlanMAM08)

http://www.azlanmam08.com/

"Born in Balik Pulau, Penang, Malaysia in 1974. Studied at College of Medical Imaging, graduated in Medical Imaging, majoring in Intervention Radiological and Cardiac procedures. Azlan had worked in Radiology Department, University Malaya Medical Centre , National Heart Institute , HealthScan Malaysia and currently working as CTA Clinician/Deputy Manager of CT Scan Unit in Cardiac Vascular Sentral Kuala Lumpur (CVSKL ), a private diagnostic and medical centre , specializing in Multi Slice CT Coronary Angiogram and Coronary Imaging .

In addition he had a formal education in Fundamentals , Basics and Principles in Photography during his undergraduate study at College of Medical Imaging. Now he is interested in Risograph printmaking on self-made caffeinated paper , Medium Format / Analogue photography / Experimental shots and Alternative hand tinting , collage and printmaking."

[mcatmemoranda]

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.]