20 years ago, most ASCs typically cared for ASA 1 and 2 patients: young, relatively healthy patients having simple, relatively non-invasive surgery. Fast forward to 2019 - as advances in anesthesia techniques, surgical techniques, and an overall better understanding of minimizing risk for ambulatory surgical patients has evolved, most ambulatory surgery center preop surgical nurses today will routinely care for at least some ASA 3 patients.
As an ambulatory surgical nurse, you know what that means: older, sicker patients with more cardiac problems. Frequently, these patients come with either (1) a slew of pre-admissions documentation that you have to weed through or (2) nothing at all. It seems like there’s never just the right amount!
It’s easy to lose one’s bearing with a patient’s ambulatory surgery center pre-admissions cardiac testing. Getting back to the basics, just remember, the heart is a pump. Nothing more, nothing less. All of your cardiac testing should be aimed at figuring out how well that pump is working, and is it likely to keep working well during the perioperative period . That’s it.
So here is the first of “The Big 3” of cardiac testing for ambulatory surgery center preop nurses:
This is the most frequent cardiac study you’ll see. That’s because it’s the cheapest and most readily available. By the way, an electrocardiogram which contains no “K” is called an EKG because the technology was invented by a Dutch doctor named Einthoven and in Dutch it’s “elektrocardiogram”. Now go impress your colleagues with that bit of trivia!
- What it does – An EKG records the electrical activity of the heart
- What it can tell you for sure – heart rate and heart rhythm
- What it can maybe tell you – presence of ischemia, an acute MI, an old MI, structural heart changes like hypertrophy
- What it can’t tell you – pump function (ejection fraction), valve function or what happens when the patient engages in physical activity. Remember, it is taken at a single point in time, so it can’t tell you whether the patient was ischemic climbing the stairs 30 minutes ago or will become ischemic 30 minutes from now on the walk out to the parking lot.
- What to look for – normal sinus rhythm, normal ST segments and T waves and no change from a prior EKG
As an ambulatory surgery center preop nurse, if the patient’s EKG is NSR (normal sinus rhythm) with no other abnormalities noted, you’re all set. However, don’t be fooled. Remember that an EKG just tells you what the electrical activity of a patient’s heart was at the point in time the EKG was taken. It doesn’t rule out the possibility that the patient goes in and out of afib, SVT or other rhythms, nor does it exclude the possibility that the patient does have ischemia (insufficient blood flow to an area of the heart), just not at the time the EKG was taken.
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Go to An Ambulatory Surgery Center PreOp Nurse’s Guide to the “Big 3” of Pre-admissions Cardiac Testing – Part 2 The Echocardiogram
About the Author: Stephen Punzak, MD is a practicing Anesthesiologist as well as the CEO of One Medical Passport. He founded One Medical Passport because he has always had a vision of how healthcare could run more efficiently using technology. He frequently writes on medical topics, workflow efficient measures and ASC industry trends.