Table 1.
Comorbidity Cards for “Bag O’Badness” in Simulation Roulette
| Neurological - Cerebrovascular | |
|---|---|
| ASA 1 | Headaches |
| ASA 2 | Seizure disorder, controlled on meds |
| ASA 3 | History of CVA |
| ASA 4 | Subarachnoid hemorrhage and vasospasm |
| Neurological – Central Nervous System | |
| ASA 1 | History of migraines |
| ASA 2 | s/p Ventriculo-peritoneal shunt |
| ASA 3 | Brain tumor |
| ASA 4 | Increased intracranial pressure, altered mental status |
| Neurological – Peripheral Nervous System | |
| ASA 1 | Carpal tunnel syndrome |
| ASA 2 | Neurofibromatosis Type 1 |
| ASA 3 | Multiple sclerosis |
| ASA 4 | Acute Guillan-Barre syndrome |
| Cardiac - Valves | |
| ASA 1 | Mitral valve prolapse (has murmur, but asymptomatic) |
| ASA 2 | Bicuspid aortic valve with mild aortic stenosis |
| ASA 3 | Moderate mitral stenosis |
| ASA 4 | Critical aortic stenosis |
| Cardiac – Ischemic | |
| ASA 1 | Emergency room visit for “chest pain”; turned out to be heartburn |
| ASA 2 | On medications for hypertension and hyperlipidemia |
| ASA 3 | History of 4-vessel CABG; Q waves on ECG |
| ASA 4 | s/p non-ST elevation MI one week ago |
| Cardiac – Congestive heart failure | |
| ASA 1 | Couch potato – “shortness of breath” with exertion but no known cardiac history |
| ASA 2 | EF 50%, “adequate” exercise tolerance |
| ASA 3 | EF 40%, on diuretics, compensated heart failure with symptoms only with moderate exertion |
| ASA 4 | EF 15%, symptoms at rest. Roll 20-sided die: 20 = LVAD |
| Cardiac - Arrhythmias | |
| ASA 1 | PVCs that disappear with exercise |
| ASA 2 | Pacemaker for isolated sinus node dysfunction |
| ASA 3 | Atrial fibrillation, on coumadin |
| ASA 4 | AICD in place for EF<30% and history of VT |
| Pulmonary - Miscellaneous | |
| ASA 1 | Snores loudly |
| ASA 2 | Smokes something illegal. Roll 6-sided die: 1 = bananas; 2 = crack; 3= marijuana; 4–6= acutely high on cocaine |
| ASA 3 | Obstructive sleep apnea, supposed to use CPAP |
| ASA 4 | Pulmonary hypertension on continuous prostaglandin infusion |
| Pulmonary - Tobacco | |
| ASA 1 | Only smokes when drinking |
| ASA 2 | < 20 pack-years |
| ASA 3 | > 30 pack-years and/or has had multiple episodes of bronchitis |
| ASA 4 | Severe COPD on continuous O2 |
| Pulmonary Asthma | |
| ASA 1 | Seasonal allergies |
| ASA 2 | Mild intermittent asthma |
| ASA 3 | Moderate/Persistent asthma |
| ASA 4 | Status asthmaticus |
| Gastrointestinal - intestines | |
| ASA 1 | Irritable bowel syndrome |
| ASA 2 | Constipation from chronic methadone treatment; takes Colace |
| ASA 3 | History of small bowel resection from gunshot wound; on TPN |
| ASA 4 | Acute small bowel obstruction – actively vomiting, +/− hypotension |
| Gastrointestinal - stomach | |
| ASA 1 | History of motion sickness |
| ASA 2 | GERD, controlled on over-the-counter medications |
| ASA 3 | Active GERD despite maximal medical therapy, occasionally wakes up vomiting |
| ASA 4 | s/p esophagectomy for Stage 4 esophageal cancer |
| Hepatic | |
| ASA 1 | 1–2 drinks/day |
| ASA 2 | Gallstones |
| ASA 3 | s/p liver transplant 6 months ago |
| ASA 4 | On liver transplant list for Hepatitis C cirrhosis |
| Renal | |
| ASA 1 | Normal creatinine |
| ASA 2 | Mild renal insufficiency, creatinine 1.4 |
| ASA 3 | Chronic renal insufficiency, creatinine 2.5 |
| ASA 4 | End-stage renal disease |
| Genitourinary | |
| ASA 1 | Male: Benign prostatic hypertrophy; Female: Frequent urinary tract infections |
| ASA 2 | Recurrent nephrolithiasis |
| ASA 3 | Recurrent bladder cancer, s/p chemotherapy and radiation |
| ASA 4 | Acute ureteral obstruction from abdominal or pelvic tumor, with rising creatinine |
| Endocrine - Diabetes | |
| ASA 1 | Eats a lot of sugar; has bad dental caries |
| ASA 2 | DM2, oral agents only, well-controlled |
| ASA 3 | DM1 or 2: Insulin therapy, somewhat erratic control |
| ASA 4 | DM1: “Brittle diabetic” with history of diabetic ketoacidosis and hypoglycemic episodes |
| Endocrine | |
| ASA 1 | Hydrocortisone cream for eczema |
| ASA 2 | Hypothyroid, on synthroid |
| ASA 3 | Chronic steroid use for ulcerative colitis |
| ASA 4 | Thyrotoxicosis |
| Musculoskeletal | |
| ASA 1 | Broken foot from extreme skateboarding |
| ASA 2 | Osteoarthritis |
| ASA 3 | Scoliosis with restrictive lung disease |
| ASA 4 | Severe rheumatoid arthritis |
| Hematologic | |
| ASA 1 | HbSS trait (heterozygote) |
| ASA 2 | Mild anemia, Hct = 30 |
| ASA 3 | Sickle cell disease (HbSS homozygote) |
| ASA 4 | s/p bone marrow transplant for recurrent AML, platelets < 10,000 K |
| Infectious diseases | |
| ASA 1 | History of positive PPD |
| ASA 2 | History of MRSA skin infections |
| ASA 3 | Pneumonia last week, still on antibiotics |
| ASA 4 | Sepsis |
| Wild Card | |
| ASA 1 | Only speaks Russian |
| ASA 2 | Jehovah’s Witness |
| ASA 3 | Family history suspicious for pseudocholinesterase deficiency |
| ASA 4 | Pheochromocytoma |
| Lab abnormalities | |
| ASA 1 | Hypomagnesemia |
| ASA 2 | Hypokalemia |
| ASA 3 | Hypercalcemia |
| ASA 4 | Hyponatremia |