Emergency surgery for a patient with severe systemic disease that is a constant threat to life. Which designation applies?

• A. ASA IV
• B. ASA IV E
• C. ASA III
• D. ASA III E

Answer: (B)

Understand that ASA physical status uses a number to describe the level of systemic disease, and an E suffix to mark an emergency procedure. Severe systemic disease that is a constant threat to life is the highest risk category. When the surgery is urgent or emergent, you append the emergency modifier to that category. So for a patient with a severe systemic illness posing a constant threat to life who needs immediate surgery, the appropriate designation is the high-risk category with the emergency modifier. This combination reflects both the gravity of the disease and the urgency of the operation.