If a patient exhibits a classic "aortic stenosis" murmur and carotid bruit pre-operatively, what should be ordered first?

Ordering an echocardiogram first for a patient exhibiting classic signs of aortic stenosis and a carotid bruit is the most appropriate action. An echocardiogram plays a crucial role in assessing the severity of aortic stenosis by providing information on the heart’s structure and function, particularly the aortic valve. It can help determine the degree of obstruction and evaluate for associated conditions such as left ventricular hypertrophy, which is often present in patients with aortic stenosis.

Additionally, it allows the healthcare provider to gather essential information regarding the patient's hemodynamic status, which is critical before proceeding with any surgical interventions. The results of the echocardiogram can guide further management and decision-making regarding the need for surgical intervention or other treatments.

While a carotid ultrasound might be useful in assessing vascular health, particularly if there are suspicions of carotid artery disease contributing to the bruit, it would not address the immediate concerns posed by the aortic valve pathology. Consulting cardiology might also be necessary, but it is more effective after obtaining specific echocardiographic data. Cancelling surgery may be warranted based on results but determining the heart’s function and aortic stenosis severity is a priority before taking such measures.