This is blog 2 of 3 that explains the ins and outs of pre-admissions cardiac testing from my perspective. As an anesthesiologist, with over 30 years of experience, I’ve done everything from open heart and liver transplant to fast-paced ASCs and pain management. My goal is to provide a common-sense explanation that helps ASC preop nurses to better understand cardiac testing in the context of a preop evaluation for ambulatory surgery.
So here’s what I can tell you: If stranded on a deserted island (or is it a desert island!?) doing anesthesia on old folks and I could have only one cardiac test, the cardiac echo would be it. Hands down. Stop the show.
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 2021 - 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!
As we learned in Part 1 of this article, EF is one of the most, if not THE most important thing to know about any patient that you are preoping because of the profound implications of EF on a patient’s overall health as well as how the patient will respond to anesthesia.
Disclaimer: I LOVE cardiac physiology. I spent the first decade of my career doing hearts almost every day at the New England Deaconess Hospital. Lots of liver transplants too. With my engineering mindset, cardiac physiology just clicked. However, there are a lot of nurses (and doctors too!) who really don’t understand cardiac physiology. It's a real shame, because cardiac physiology is easy to understand if you’ve been taught “how” things work versus just being given a bunch of numbers to memorize.
In Part 1 of this 4-part series, I talked about what Ejection Fraction (EF) is. In Part 2, I talked about the classifications of normal and abnormal EF. In this 3rd blog article in the series, I’ll talk about Congestive Heart Failure - commonly known as just CHF.