ASA classification???????

[docsmriti]

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ASA classification its so confusing.Can anyone help with the foll. n suggest some reliable reference
1.trauma patient with stable hemodynamics and
2.another with unstable hemodynamics.
3 pt with goiter but euthyriod
4 pt with allergies to food or meds

 

[IlDestriero]

ASA classification its so confusing.Can anyone help with the foll. n suggest some reliable reference
1.trauma patient with stable hemodynamics and
2.another with unstable hemodynamics.
3 pt with goiter but euthyriod
4 pt with allergies to food or meds

😕
If you find ASA classification confusing, you may need to reconsider your career choice "Doc".
Open any comprehensive Anesthesiology book, read/reread the definition, think about it and answer your own questions. Your examples show a fundamental misunderstanding of the ASA classification.

 

[rsgillmd]

ASA classification its so confusing.Can anyone help with the foll. n suggest some reliable reference
1.trauma patient with stable hemodynamics and
2.another with unstable hemodynamics.
3 pt with goiter but euthyriod
4 pt with allergies to food or meds

It can be subjective, and not infrequently you'll see a debate between ASA 3 and ASA 4. Being that you are a resident, I'll assume you've read the standard descriptions in the textbooks.

1. Stable hemodynamics does not necessarily mean not an emergency. How critical is the surgery? What medical problems does the patient have, and how well controlled are they? Too little information to say.

2. Too vague again. Another argument would be to say trauma resulting in unstable hemodynamics is a severe disease that poses a constant threat to life and therefore label the patient as a 4E.

3. Assuming not emergency surgery, and no other medical problems, I would say ASA 2.

4. Allergies have nothing to do with this. Now that I read your post again, I hope I didn't waste my time replying to a troll.

I also tend to view smokers as minimum ASA 2s, and morbidly obese patients as minimum ASA 3s.

 

[Precedex]

In my experience, people are often disagreeing about these. 2 vs 3 particularly. Also, can anyone come up with a case that is an ASA V? I'm not sure I've ever seen one because they've always been emergent hence VE.

 

[rsgillmd]

In my experience, people are often disagreeing about these. 2 vs 3 particularly. Also, can anyone come up with a case that is an ASA V? I'm not sure I've ever seen one because they've always been emergent hence VE.

I asked some of my colleagues a little while ago the same thing about a 5, and one of them was able to give me some really strange but plausible scenario. I just forget what it was right now. I agree, if you are a 5 then you are a 5E.

 

[IN2B8R]

I asked some of my colleagues a little while ago the same thing about a 5, and one of them was able to give me some really strange but plausible scenario. I just forget what it was right now. I agree, if you are a 5 then you are a 5E.

A scheduled organ harvest. Does that qualify as a 5 and not a 5E?

 

[Spandex]

Organ harvest = 6.

 

[IN2B8R]

Organ harvest = 6.

great....that tells u how long it has been since I did one

 

[IlDestriero]

ASA 5 example. End stage cancer or multiorgan failure patient in the ICU on the usual drips, family wants the full court press, but they are currently moribund, for a PICC line placement in IR. They want the picc line for convenience and secure access, but don't need it placed immediately, therefore not a 5E. It could go now, later or tomorrow therefore no E, but still ASA 5. We do some procedures under GA for end stage cancer kids that are ASA 4(1/2)-5 with the palliative care team. It makes me want to go home and have a giant glass of scotch every time, heartbreaking.

 

[Spandex]

Only did one 6 ever. Was a ped. I wanted to cry. 🙁

 

[proman]

From the website itself

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

I once did a 30 day old 28-week preemie with Grade IV IVH, PDA s/p closure, neonatal respiratory disease on a high frequency oscillator. Got septic from NEC. Was severely acidotic on a dopamine and something-else drips. Posted as an emergency ex-lap. I thought that would be an ASA 5E, as I didn't think the kid would survive 24 hours without the ex-lap. Attending disagreed and say 4E. What say you?

 

[fakin' the funk]

4 pt with allergies to food or meds

I saw the following on an allergy list once:

Allergy: chili
Reaction: diarrhea

This could get you into ASA4 territory if you're not careful

 

[fakin' the funk]

A scheduled organ harvest. Does that qualify as a 5 and not a 5E?

Perhaps also showing the time since you've done one...it's also now referred to by the less-evocative, less-likely-to-make-the-family-$hit-themselves "organ procurement."

 

[Trisomy13]

I saw the following on an allergy list once:

Allergy: chili
Reaction: diarrhea

This could get you into ASA4 territory if you're not careful

Definitely gets a DSM-IV.

 

[IN2B8R]

Perhaps also showing the time since you've done one...it's also now referred to by the less-evocative, less-likely-to-make-the-family-$hit-themselves "organ procurement."

Been a long while since I did one, but they might as well call themselves "grave robbers.." Looked barbaric everytime I was involved in those cases. One thing I used to do, though, was always stick a BIS monitor on the head, when possible. It was for "academic curiosity" reasons.... Curiously, the number always hovered in the teens. Whatever that means....

 

[fakin' the funk]

Been a long while since I did one, but they might as well call themselves "grave robbers.." Looked barbaric everytime I was involved in those cases. One thing I used to do, though, was always stick a BIS monitor on the head, when possible. It was for "academic curiosity" reasons.... Curiously, the number always hovered in the teens. Whatever that means....

If a braindead person is still in the teens, that, to me, means the BIS can't possibly go lower than that. Right? I mean, these people have NO cerebral perfusion and no activity. 0-100 my a$s.

 

[rsgillmd]

If a braindead person is still in the teens, that, to me, means the BIS can't possibly go lower than that. Right? I mean, these people have NO cerebral perfusion and no activity. 0-100 my a$s.

I take it you haven't used a BIS on a circ arrest case yet. I've seen it go to 0. But you'll rewarm faster than the BIS will rise. It takes a while to come back up.

I've never seen a BIS higher than 98.

Also remember that the BIS picks up muscle activity also -- it is both a processed EEG and a processed EMG. I've seen the numbers come up a little as muscle relaxant wears off, and go back down after I've dosed more. So I would not necessarily be surprised by numbers in the teens.

 

[periopdoc]

This BIS is constantly looking for something to interpret as EEG activity. The weaker the true EEG activity is, the more likely the BIS will interpret some other signal (EMG, electrical interference etc) as EEG activity and give you a falsely elevated number. You can usually pick this up by looking at the EEG tracing itself and see if it looks like an EEG or noise. You likely had electrical interference of some sort. EMG is possible, but it usually gives you a higher number than teens.

Hell I put the BIS on myself a couple of times and got a reading of >90, and we ALL know that I don't have that much brain activity.

- pod

 

[Narcotized]

I wouldn't get too caught up in this. This ranks in priority around the same level as when the nurse interrupts your intubation to harass you about the in-room time. I simplify it and find this efficient:

1- Healthy
2- Diseases
3- The diseases are causing problems
4- They're really f'ed up
5- They're basically dead

 

[jetproppilot]

😕
If you find ASA classification confusing, you may need to reconsider your career choice "Doc".
Open any comprehensive Anesthesiology book, read/reread the definition, think about it and answer your own questions. Your examples show a fundamental misunderstanding of the ASA classification.

Your observation is untrue.

ASA classification is open to interpretation.

For example, I make anyone having a CABG a 4, figuring if their disease is bad enough to warrant heart surgery, it is certainly a constant threat to their life. My actions reflect my time in residency spent at The Texas Heart Institute.

Some of my partners make pts I classify as a 4, a 3.

Conversely, I have partners who make the AV graft revision patients who stereotypically all have the same problems, a 4, where I see them as a 3.

It is not an exact science.

 

[IlDestriero]

Your observation is untrue.

ASA classification is open to interpretation.

It is not an exact science.

My observation is actually quite CORRECT. His/her examples, with incomplete clinical information, show a complete lack of understanding of the ASA classification system. The kind of lack of understanding that comes from never actually looking up the classification system at all. He's not asking if a CABG pt is ASA 3 or 4, or if it matters if he has unstable angina or not. He's asking what role food allergies play. So weak I'm suprised that I responded at all.👎
I never suggested that it is an exact science, or not open to interpretation, which of course it is.
I have a low tolerance threshold for people asking questions that have not done any basic research themselves first.

Proman- As described, I would have called that kid a 5E. He's got bad multiorgan disease and has a high risk of mortality with or without the operation. That's a 5er. Jet would probably call him a 4!

 

[jetproppilot]

I have a low tolerance threshold for people asking questions that have not done any basic research themselves first.

I understand that point.

 

[Licoricestick]

From the website itself

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

Love that the website says "There is no additional information that will help you further define these categories."

 

[tucker27705]

What do you guys typically put for a healthy uncomplicated laboring pt to get an epidural, or going to C/S?

I have seen most people put 1 or 2. I used to put 1, I now assign a 2. They really aren't normal, but I feel funny calling pregnancy a systemic disease. Any thoughts?

Tuck

 

[Laryngophed]

I give them a 2, not for the physiologic changes of pregnancy but for their relentless psychiatric issues.

Do they have to be pregnant to suffer the relentless psychiatric issues?

 

[doctor712]

I take it you haven't used a BIS on a circ arrest case yet. I've seen it go to 0. But you'll rewarm faster than the BIS will rise. It takes a while to come back up.

I've never seen a BIS higher than 98. Also remember that the BIS picks up muscle activity also -- it is both a processed EEG and a processed EMG. I've seen the numbers come up a little as muscle relaxant wears off, and go back down after I've dosed more. So I would not necessarily be surprised by numbers in the teens.

I was observing an Anesthesiologist for a week once and he was explaining the BIS to me, asked me if I knew what it was about, and I gave an "awareness" explanation as best I could, being the point to the BIS. Anyway, I'm not sure the next question that I asked him, but he promptly turned the volatile "way" up to demonstrate and the BIS dived to about 5 over the next minute or three. (heart case). Then did some more explaining, then turned volatile down so it returned to normal. I felt JUST A LITTLE uneasy until that number climbed back to 50s. As in, what if something happened at the time the BIS was at 7...😱 AND after my question prompted said dial turning no less.

Anyway, his partner came back into the room and immediately asked, (upon seeing BIS tracing), "Did the patient die a little?"

Reminds me of the first time I learned people were paralyzed during these cases, academic dude looked right into my shocked eyes and said, after I asked him, "what if you cannot reverse the drug..." and he said, "Then you cannot go into anesthesiology - if you're worried about that." ; ) He was an AMAZING guy, Eric Skolnick at P&S. Came up to me later and tried to soften the reply, "You mean, if you don't reverse before the patient becomes aware, sure, that's a big concern..." But no, that was my day one observing anesthesia, and I really thought reversing was hit or miss. You know, 50/50 crapshoot. (and I know someone will highlight that sentence and say it IS). 😀

D712