YKHC Low-Risk Endoscopy Criteria: Difference between revisions
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# Recent (<6mos) BNP <= 125 pg/mL (or YKHC laboratory’s current upper limit of normal) | # Recent (<6mos) BNP <= 125 pg/mL (or YKHC laboratory’s current upper limit of normal) | ||
# No loop diuretic use (chronic or acute) within the last 12 months | # No loop diuretic use (chronic or acute) within the last 12 months | ||
# No current or recent cardiac-like symptoms which have not been thoroughly investigated | |||
===CAD=== | ===CAD=== | ||
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# No use of anti-angina agents in the last 12 months | # No use of anti-angina agents in the last 12 months | ||
# Normal cardiac stress test within the last 12 months | # Normal cardiac stress test within the last 12 months | ||
# No current or recent cardiac-like symptoms which have not been thoroughly investigated | |||
===A-Fib=== | ===A-Fib=== | ||
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# No use of anti-arrythmic drugs within 12 months | # No use of anti-arrythmic drugs within 12 months | ||
# Meets all of the "CHF" criteria above | # Meets all of the "CHF" criteria above | ||
# No current or recent cardiac-like symptoms which have not been thoroughly investigated | |||
Revision as of 01:16, 25 April 2018
OVERVIEW
Because YKHC has no ICU, serious endoscopy complications require transfer to the Emergency Department and/or Medevac transfer. Prevention of this occurrence is a priority. Therefore endoscopy in Bethel is limited to low risk patients.
The intention of this page is to provide transparent criteria for the most common conditions which increase the risk of an endoscopy complication. This page is not all-inclusive.
These criteria are written with isolated diagnoses in mind. The presence of multiple comorbidities may yield a higher risk than either individually and this effect is not incorporated into these criteria.
The intention of these criteria is to risk stratify based on the functional status of a disease rather than its mere mention in a patient's chart.
GENERAL
BMI
- BMI < 45 (non-negotiable limit)
- - for BMI 40-45: anesthesia approval (for non-Bethel patients this should occur PRIOR to ordering)
CARDIAC
CHF
- Most recent LVEF >= 40%
- Recent (<6mos) BNP <= 125 pg/mL (or YKHC laboratory’s current upper limit of normal)
- No loop diuretic use (chronic or acute) within the last 12 months
- No current or recent cardiac-like symptoms which have not been thoroughly investigated
CAD
- No history of coronary revascularization (either surgical or endovascular)
- No use of anti-angina agents in the last 12 months
- Normal cardiac stress test within the last 12 months
- No current or recent cardiac-like symptoms which have not been thoroughly investigated
A-Fib
- Currently in sinus rythm
- No subjective or objective A-Fib occurrence within 12 months
- No use of anti-arrythmic drugs within 12 months
- Meets all of the "CHF" criteria above
- No current or recent cardiac-like symptoms which have not been thoroughly investigated
PULMONARY
Asthma
Prior to endoscopy (and preferably prior to the referral), asthma severity should be classified in accordance with the Guidelines for the Diagnosis and Management of Asthma (EPR-3). Alternatively, the associated Quick Reference is an excellent resource.
Endoscopy will only be performed upon asthma patients who meet these criteria:
- If treated, must meet criteria for Well Controlled asthma.
- If UNtreated, must meet criteria for Intermittent asthma.
The Asthma Control Test questionnaire can aid in rapidly and accurately classifing asthma severity.
COPD
- Post-bronchodilator FEV1 >= 60% of predicted
- - order as "PFT (Pre-&Post-Albuterol) Eval"
- - view results in Multimedial Manager —> EKG Folder
OSA
- Positive pressure ventilation has NOT been recommended/prescribed
- Anesthesia approval (for non-Bethel patients this should occur PRIOR to ordering)
MEDICATIONS
Antiplatelets
- _
Anticoagulants
- _
Opioid Replacement Therapy
- _