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ASA Classification

Discussion in 'Anesthesiology' started by camkiss, Dec 14, 2005.

  1. camkiss

    camkiss Junior Member
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    How do you guys rate ASA classification in trauma patients?

    If a totally healthy 21 year old comes in with a ruptured spleen, IVC tear, etc. etc. from a MVC, is he a I-E or a IV-E?

    Outside of trauma, the classification makes sense to me.

    Thanks,
    camkiss
    CA-1
     
  2. jetproppilot

    jetproppilot Turboprop Driver
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    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.
     
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  3. mountaindew2006

    mountaindew2006 Senior Member
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    sound reasoning to me :thumbup:
     
  4. Noyac

    Verified Expert 10+ Year Member

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    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. :thumbdown: So for us its an emergency.
     
  5. militarymd

    militarymd SDN Angel
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    The ASA classification doesn't really apply to trauma if you read the definition.
     
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  6. VolatileAgent

    VolatileAgent Livin' the dream
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    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.
     
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  7. jwk

    jwk CAA, ASA-PAC Contributor
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    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.
     
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  8. Noyac

    Verified Expert 10+ Year Member

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    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.
     
  9. bubalus

    bubalus Member
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    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.
     

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