VALORACION PREANESTESICA

NOMBRE DEL PACIENTE: _________________________________________________________________________________________________________________

EDAD: ______________ SEXO: __________________________ SERVICIO: _______________________________________ CAMA: ______________________

No DE EXPEDIENTE: _____________ CIRUGIA: PROGRAMADA ( ) URGENCIA:( ) FECHA: _________________________ HORA____________________

CIRUGIA PROGRAMADA: _________________________________________________________________________________________________________________

DIAGNOSTICO PREANESTESICO: __________________________________________________________________________________________________________

ANTECEDENTES

ESTADO NEUROLOGICO: ______________________________________________ HEPATICO: _______________________________________________________

ALERGICOS: _________________________________________________________ TRANSFUSIONALES: ______________________________________________

QUIRURGICOS: _______________________________________________________ ANESTESICOS: ___________________________________________________

DIABETES: ___________________________________________________________ HIPERTENSION ARTERIAL: ________________________________________

OBESIDAD: ___________________________________________________________ CARDIOPATIAS: __________________________________________________

OTRAS ENFERMEDADES:
EXPLORACION FISICA
PESO: ____________________ TALLA: _______________ FC: _________________ FR: _________________TA: __________________ Temp.: __________________

CABEZA: _________________________________________________________________________________________________________________________________

BOCA: ___________________________________ DENTADURA: ______________________________ CLASIF. MALLAMPATI: _____________________________

CUELLO: _________________________________ CLASIF. BELHOUSE – DORE: _________________CLASIF. PATIL – ALDRETE: __________________________

APARATO RESPIRATORIO: ________________________________________________________________________________________________________________

APARATO CARDIOVASCULAR: ____________________________________________________________________________________________________________

ABDOMEN: _______________________________________________________________________________________________________________________________

COLUMNA VERTEBRAL: __________________________________________________________________________________________________________________

EXTREMIDADES:
LABORATORIO Y GABINETE
Hb: _____ Hto: ______ PQL: _____ Tp: _____ Tpt: ____ INR: _____ EGO: ________ GLUSOSA: _____ NU: _____ CREAT: _____

GRUPO: _________ Rh: ____________ OTRO: ________________________________________________________________________________________________

ECG: ____________________________________________________________________________________________________________________________________

Rx DE TORAX: ___________________________________________________________________________________________________________________________

VALORACION DE M.I.: ____________________________________________________________________________________________________________________

GOLDMAN: _____ ASA: _____ RIESGO TROMBOEMBOLICO: ___________________________________

PLAN ANESTESICO: _______________________________________________________________________________________________________________________

OBSERVACIONES

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ANESTESIOLOGO CED. PROF. DE ESPECIALIDAD
FECHA Y HORA NOTA POST–ANESTESICA

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ANESTESIOLOGO CED. PROF. DE ESPECIALIDAD