The Perioperative Medicine Consult Handbook PDF
Preview The Perioperative Medicine Consult Handbook
The Perioperative Medicine Consult Handbook The Perioperative Medicine Consult Handbook Christopher J. W ong, MD Department of Medicine, Division of General Internal Medicine, University of Washington Medical Center, Seattle, Washington, USA Nason P. H amlin, MD, FACP Department of Medicine, Division of General Internal Medicine, University of Washington Medical Center, Seattle, Washington, USA Editors Christopher J. W ong, MD Department of Medicine Division of General Internal Medicine University of Washington Medical Center Seattle, W A, USA Nason P. H amlin, MD, FACP Department of Medicine, Division of General Internal Medicine University of Washington Medical Center Seattle, WA, USA ISBN 978-1-4614-3219-7 ISBN 978-1-4614-3220-3 (eBook) DOI 10.1007/978-1-4614-3220-3 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2012950321 © Springer Science+Business Media New York 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, b roadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic a daptation, computer software, or by similar or dissimilar m ethodology now known or hereafter developed. Exempted from this legal r eservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and e xecuted on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, s ervice marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the e ditors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Dedication We dedicate this book to Dominic F. “Dom” Reilly, MD and Diane Doerner, MD and to our patients. Preface Perioperative medical consultation is an exciting and evolving fi eld of medicine. At the University of Washington Medical Center, medicine consultation as a separate endeavor began in the late 1980s with gen- eral medicine attendings taking medicine consultation calls in addi- tion to their primary care practices. In the early 1990s, a formal Medicine Consult Service was developed, with early pioneers includ- ing Dominic Reilly, MD, and Diane Doerner, MD. Patients were seen on the inpatient wards and in the surgical clinics. By 1995, however, the Medicine Consult Service began its own small clinic in a shared space. Over the ensuing years, the Medicine Consult Service has expanded in number of staff, patients seen, and clinic size. Our focus has been on the evaluation of medically complex patients undergoing noncardiac surgery. Collaboration and continuity have been hallmarks of the service: ■ In November of 2003 the Medicine Consult Clinic moved into the Surgical Pavilion, in close proximity to the Pre-Anesthesia Clinic and the Surgical clinics. This location fosters close con- tact with the perioperative team. ■ A unique feature of this service has been its continuity—the same provider who performs the preoperative evaluation also sees the patient postoperatively (see Chap 2, Styles of Medical Consultation). In the current hospitalist era, it is a way in which a general internist can still practice inpatient and outpatient medicine at the same time. The Medicine Consult Service has always maintained its teaching mis- sion, with housestaff and medical students rotating through the ser- vice. In addition, in the course of performing clinical consultation, we also serve as educators for the surgical residents, holding the belief that a surgeon who knows more medicine will provide better overall care. The fi rst edition of The Medicine Consult Handbook was published in 2006 as a resource for residents and junior faculty regarding the vii viii PREFACE science and art of perioperative medicine. As the evidence base for perioperative practice has expanded, so too has this handbook. We have attempted to provide a balanced presentation that includes edu- cation, evidence, common situations, guideline-based care, and pearls of wisdom, while not emphasizing practices that may be unique to our own institution. For the sake of point-of-care use, we have favored brevity and included references to a subset of the perioperative medi- cine literature, rather than creating comprehensive chapters better suited to a traditional textbook. How to use this book: For those just starting in perioperative medi- cine, we recommend reading Chap 3: The Preoperative Evaluation, Chap 4: Perioperative Medication Management, Chap 6: Cardiovascular Risk Stratifi cation, and Chap 13: Pulmonary Risk Assessment and Management as a general overview. Other topics may be reviewed as needed depending on one’s practice setting and the types of patients seen. Even with the increasing guidelines and evidence, perioperative medicine remains an art and, as always, there may be local practices that are different from those presented in this book. We fully expect the practice of perioperative medicine to continue to change and welcome your comments and feedback. Christopher J. Wong, MD Seattle, W A, USA Nason P. Hamlin, MD, FACP March 2012 Acknowledgments Perioperative Management of the Patient with Rheumatologic Disease Gregory C. Gardner, MD , P rofessor, Rheumatology , University of Washington Valvular Heart Disease Philip A. Vedovatti, MD Implantable Cardiac Devices Philip A. Vedovatti, MD Perioperative Diabetes Management Irl B. Hirsch, MD , Professor of Medicine , University of Washington Anthony DeSantis, MD , Clinical Assistant Professor of Medicine , University of Washington Janet Kelly, PharmD , Clinical Professor, Dept. of Pharmacy, School of Pharmacy, University of Washington Cindy Sayre, ARNP , D irector/Assistant Administrator, Patient Care Services , University of Washington Ischemic Heart Disease Steven L. Goldberg, MD, Clinical Associate Professor of Medicine, Division of Cardiology, University of Washington Laurie A. Soine, PhD, ARNP, Teaching Associate in the Department of Radiology and Department of Medicine, Division of Cardiology, University of Washington Surgical Procedures Overview John L. Gore, MD , Assistant Professor, Department of Urology , University of Washington Daniel W. Lin, MD , Associate Professor, Department of Urology , University of Washington ix
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