ASA Classification

Good question, Cam.

In my book, if the dude PRESENTS to me in critical condition, regardless of his previous healthy condition, he's a 4-E.

 

sound reasoning to me

 

Agree. If you don't do anything, he is dead therefore, ASA 4
Emergency, cause its got to go now.

But it doesn't really matter cause insurance (if I remember right) will only pay for one or the other (ASA3 or >, or emergency case) not both. So for us its an emergency.

 

The ASA classification doesn't really apply to trauma if you read the definition.

 

agreed. the ASA classification is almost completely worthless, imho, especially in trauma. in general, there is a lot of interevaluator AND intraevaluator variability (and studies have repeatedly demonstrated this).

ASA classification has to do solely with the patient's background and underlying physical status and pre-morbid condition. for example, an otherwise healthy 25-year-old with a huge isolated tumor in their belly coming in for removal is still an ASA 1 if they do not have any other functional limitations based upon their physiology. if they are, otoh, a 25-year-old with DM1, HTN, severe CHF, and severe persistent asthma coming in for a bunionectomy under regional and MAC, they'd be an ASA 4 in my book.

the ASA classification is intended to provide a predictive value in the likelihood that a patient will suffer morbidity/mortality secondary to the anesthetic. nothing more. and, imho, it is so woefully misunderstood and misused by ancillary staff, and even many anesthesia attendings, that it is of little value. i mean, what's the real difference between an ASA 2 with an acute exacerbation and a stable ASA 3? as near as i can tell, no study has been able to answer that question either.

 

I agree philosophically, but someone who comes in with a transected aorta gets a 5E - let the friggin insurance company figure it out. And what about ASA 6? We have plenty of perfectly healthy individuals who are organ donors following their head trauma.

 

ASA 5 in my opinion is someone who will die from the injury in some recent time frame, like 24 hrs.
I have had 2 transected aorta survive. They were on the same day (new years) and both were uner circ arrest. Therefore, I make them a ASA 4 until I am sure that they are going to die. Just my thoughts on the subject. I think it is a poor system overall.

 

P1 A normal healthy patient

P2 A patient with mild systemic disease

P3 A patient with severe systemic disease

P4 A patient with severe systemic disease that is a constant threat to life

P5 A moribund patient who is not expected to survive without the operation

P6 A declared brain-dead patient whose organs are being removed for donor purposes

A transected aorta gets a 5 in my book as you really can't expect them to survive without the operation.