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A lot of my patients have risk factors for cardiac events after non cardiac surgery based on RCRI and I am sure I am not alone since patients in this country are very sick.
DM on insulin is very prevalent, so is CAD. With those 2 factors alone, the estimated risk is already 6.6%, which is 1 in 15 people. 3 Risk factors and it's 10% or 1 in 10.
For those who cover patients in the PACU, do you check troponins on these patients? A lot of cardiac events can present without chest pain so that isn't reliable. EKG changes can be hard to spot especially in the early stages.
For example, a 75 year old man with several medical problems including IDDM, CAD (no stents), HTN gets lipoma excision under sedation. No major problems in surgery and patient goes to PACU. Would you immediately order troponins? What if the patient had a couple episodes of hypotension that responded well to phenylephrine boluses and has since had stable vitals with no support?
DM on insulin is very prevalent, so is CAD. With those 2 factors alone, the estimated risk is already 6.6%, which is 1 in 15 people. 3 Risk factors and it's 10% or 1 in 10.
For those who cover patients in the PACU, do you check troponins on these patients? A lot of cardiac events can present without chest pain so that isn't reliable. EKG changes can be hard to spot especially in the early stages.
For example, a 75 year old man with several medical problems including IDDM, CAD (no stents), HTN gets lipoma excision under sedation. No major problems in surgery and patient goes to PACU. Would you immediately order troponins? What if the patient had a couple episodes of hypotension that responded well to phenylephrine boluses and has since had stable vitals with no support?