ASA Physical Status Classification MCQ — NEET PG Practice Question | NEETPGAI
ASA Physical Status Classification
hard
syringe Anesthesia
A 72-year-old woman with a history of acute myocardial infarction 3 months ago, currently on dual antiplatelet therapy and a beta-blocker, presents for emergency repair of a ruptured abdominal aortic aneurysm. She is hemodynamically unstable (BP 95/60 mmHg, HR 110 bpm), in severe pain, and has signs of hypovolemic shock. Recent echocardiography showed an ejection fraction of 40% with apical akinesis. What is her ASA Physical Status classification?
A. ASA III
B. ASA V
C. ASA IVE
D. ASA IV
Explanation
ASA Classification in Emergency Settings
Key Point
The suffix E (Emergency) is added to the base ASA class when surgery is performed on an emergent or urgent basis. It is NOT a separate class but a modifier.
Understanding the "E" Suffix
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The E suffix indicates urgency, not severity of disease.
A patient who is ASA IV and requires emergency surgery is classified as ASA IVE, not ASA V.
ASA V is reserved for moribund patients expected to die within 24 hours regardless of surgery.
Analysis of This Patient
Base ASA Class (Without Emergency Modifier)
1.
Recent MI (3 months ago): Significantly increased perioperative cardiac risk.
2.
Reduced Ejection Fraction (40%): Indicates moderate left ventricular dysfunction.
3.
Hemodynamic Instability: BP 95/60 mmHg, HR 110 bpm—signs of shock.
4.
Severe Systemic Disease: Post-MI state with LV dysfunction is a constant threat to life.
→ Base classification: ASA IV (severe systemic disease that is a constant threat to life)
Hemodynamic Shock: Patient is unstable and deteriorating.
→ Final classification: ASA IVE
ASA Classification Hierarchy with Emergency Modifier
Table
Class
Definition
Emergency Modifier
I
Healthy
ASA IE (rare)
II
Mild systemic disease
ASA IIE
III
Severe systemic disease, no functional threat
ASA IIIE
IV
Severe systemic disease, constant threat to life
ASA IVE ← This patient
V
Moribund, expected to die within 24 hrs
ASA VE (rarely used)
Clinical Pearl
The presence of hemodynamic instability, shock, or life-threatening pathology (ruptured AAA) does NOT automatically make a patient ASA V. ASA V is reserved for patients who are expected to die within 24 hours regardless of whether surgery is performed. This patient may survive with emergency repair, so she is not ASA V.
Mnemonic
E = Emergency/Urgent. Always add E to the base class when surgery is unplanned or emergent. The base class reflects the patient's medical status; the E reflects the timing of surgery.
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