Preoperative workup
- History and Examination - a full history and physical examination should be recorded in the notes - this should include a full cardiovascular history and risk factor assessment
- Ensure that there is a recent duplex of carotids (within 4 weeks or after any recent tia or stroke) and that the result has been printed and is in the chart.
- Occasionally patients require MRA or CT angiography but this should only be arranged after consultation with a senior team member or neurology/stroke team
- ECG and Chest x-ray
- A recent CT or MRI Brain (usually within 4 weeks or after any recurrent symptoms) is usually required
- Bloods
- FBC,
- U&E,
- coag screen,
- T/S.
- Fasting risk factors.
- Cardiac evaluation: Where the patient has normal exercise tolerance and no significant cardiac history, no further investigation may be required. Where there is limited exercise tolerance, peripheral vascular disease or any hisotry of cardiac disease, an ECHO is usually performed. Further cardiac evaluation is also required in those with a suspected cardioembolic source (Holter and/or TOE) or those with previous CABG/PCI or unstable angina - usually this requires a full cardiology assessment.
- Ensure that the patient understands the procedure (information leaflet has been given and recorded), that informed consent is recorded in the chart. Record the consent process in the chart incluidng the most senior team member who spoke to the patient, and note when the patient has been informed of the risk of peroperative stroke, nreve injury and myocardial infract etc. (up to 5%).
- Check the side - document it on the chart and consent form. Mark and initial the side.
Carotid stent angioplasty
- These patient will always be discussed at the MDM preoperatively
- They will need to be fully preloaded with Clopidogrel (usually 300mg in divided doses according to the clinical circumstances)
- Consent must be obtained and documented in full in the notes.
Multidisciplinary vascular/stroke/neurology conference.
- Most patient will be discussed at this conference preoperatively.
- The names and MRNs need to communicated to Dr. McCabe's team before midday on Wednesday.
- Bring the charts to the meeting and have an up to date summary ready to present.
- Record the outcome of the discussion in the notes for future reference.
Last Updated ( Tuesday, 31 March 2009 15:24 )
