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Justin Lyle Cards > HEENT Part I > Flashcards

HEENT Part I Flashcards

1
Q

what anesthetic technique should be used with ENT surgery?

A

TIVA, may be difficult to maintain inhalational anesthesia

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2
Q

use of NMB with ENT surgeries?

A

must ask the surgeon first, they might be monitoring something and NMB may be c/i

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3
Q

with neck surgery, if retractors are used it can put pressure on the _______________ –> _________________

A

carotid; bardycardia

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4
Q

positioning considerations with ENT surgery

A
  1. head is prepped and completely draped or wrapped in towels 2. the ETT if often positioned and taped/padded to forehead 3. nasal and oral RAE common for long surgeries - watch for pressure on nares and lips 4. table may be turned 90 - 180 degrees (disconnect circuit when turning) 5. arms are tucked to ensure no IV kinking
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5
Q

when would you monitor auditory evoked potentials?

A
  1. acoustic neuroma 2. trigeminal neuralgia 3. facial nerve decompression
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6
Q

with neuromuscular junction monitoring, you are monitoring the ________________ nerve

A

facial

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7
Q

surgeries that utilize facial nerve monitoring

A
  1. thyroid 2. neck flap 3. dissections for cancer, nerve issues 4. parotid surgeries 5. mastoid surgeries
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8
Q

NIMS tube procedure uses what neurological monitoring

A

EMG

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9
Q

different ventilation techniques that can be used with ENT surgery

A
  1. spontaneous ventilation 2. apneic ventilation 3. jet ventilation
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10
Q

if the ETT is too deep and you are utilizing jet ventilation, what is the risk ?

A

gastric insuffulation

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11
Q

hypoventilation with jet ventilation can cause

A

air trapping and barotrauma

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12
Q

if using jet ventilation with ENT surgery, you are using _____________ tidal volumes and ______________ pressures

A

small; high

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13
Q

what situations would an elective tracheostomy be performed?

A
  1. prolonged ventilation in the ICU 2. chronic aspiration risk 3. super morbid obesity 4. free flap or other airway surgery requiring good visualization
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14
Q

T/F: tracheostomy procedures can be done awake, sedated, or under general anesthesia

A

TRUE

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15
Q

what is a MLT tube

A

microlaryngoscopy tube it is longer, but smaller diameter

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16
Q

sizes MLT tubes are available in?

A

4, 5, 6,

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17
Q

what ETT is the best for vocal cord surgery or pt with tracheal stenosis

A

MLT tube

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18
Q

when is a MLT tube an appropriate choice of airway securing device?

A
  1. vocal cord surgery 2. tracheal stenosis 3. tracheal malasia 4. tracheal strictures
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19
Q

what is the disadvantage to MLT tubes

A

smaller diameter thus increased resistance ventilation

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20
Q

if using a laser for ENT surgery, FiO2 must be less than ___________

A

30%

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21
Q

T/F: N2O is the gas of choice with laser ENT surgery

A

false; N2O is contraindicated

22
Q

what is the fire triad

A
  1. oxidizer 2. ignition source 3. fuel
23
Q

what are examples of oxidizers in the fire triad

A
  1. O2 2. N2O
24
Q

what are examples of ignitions sources in the fire triad

A
  1. cable connections 2. fiber optic lights 3. electrocautery 4. electrosurgical laser
25
Q

what are examples of fuel, in the fire triad

A
  1. linens 2. supplies 3. patient 4. alcohol prep solutions 5. surgical drapes
26
Q

how do you manage airway fire?

A
  1. D/C laser 2. remove airway device, turn off gas, remove any flammable material, and pour saline in airway 3. put burning ETT/LMA in saline 4. ventilate pt with air 5. once fire extinguished ventilate with 100% FiO2 6. examine airway with bronchoscopy 7. if damage is minimal - humbidifed O2 via mask 8. reintubate if needed (with smaller ETT) 9. ABG, carboxyhgb, and CXR 10. if airway burn present/suspected –> 40-60% FiO2 + humdity 11. consdier steroids 12. consider trach 13. secure ICU bed for min of 24 hours
27
Q

leforte I fracture

A

Maxillary separation from mid face, maxilla is mobile

28
Q

leforte II fracture

A

Nasomaxillary fracture

29
Q

leforte III fracture

A

Cranial base-facial separation

30
Q

nasal intubation or NG tube placement is contraindicated with what classifications of leforte fractures

A

II and III

31
Q

what is the primary concern with pharyngeal abscess?

A

airway

32
Q

what can be used to decrease the risk of renal failure with the administration of contrast media?

A
  1. ensure well hydration 2. IV with NaHCO3 3. add N-acetyl-cysteine 4. you can also hydrate + vitamin C
33
Q

how does N-acetyl cysteine decrease risk of renal failure with contrast media?

A

binds up the electrons

34
Q

if pt has an allergy to shellfish and is going to get contrast, how should you pre-tx to decrease risk of reaction

A
  1. H1 or H2 blocker (like benadryl) 2. steroids (methylprednisolone)
35
Q

how should you tx an allergic reaction to contrast media

A
  1. supportive care 2. bronchodialators 3. vasopressors
36
Q

what is the maximum recommended occupational exposure to radiation?

A

5000 mrem/year

37
Q

how can occupational radiation exposure be kept to a minimum (ALARA)

A
  1. reduce exposure time 2. reduce exposure dose 3. shielding all body parts as much as practical 4. being aware that rapidly replaced cells are at higher risk
38
Q

if hemorrhagic neurocatastrophic event occurs in the radiology suite, what are the appropriate steps to prevent further complications

A
  1. secure the airway 2. support CV system 3. DC heparin 4. administer protamine sulfate
39
Q

when you administer protamine sulfate you administer ___ mg / 100 units of total heparin adminstered

A

1

40
Q

what medications can be given to increase the quality/duration of seizure during ECT

A
  1. alfenanil with propofol 2. aminophylline 3. caffeine 4. clozapine 5. etomidate 6. ketamine
41
Q

when would external beam radiation therapy be utilized?

A
  1. children with malignant tumors that cannot be resected by surgery (ex: neuroblastoma)
42
Q

what is external beam radiation therapy

A

high energy beams from a machine that target tumor from the outside of the body.

43
Q

why is a cardiac echocardiogram performed prior to DC cardioversion

A

to ensure patient is not going to throw a clot

44
Q

why is glucagon give during ERCP

A
  1. relaxes sphicter of oddi 2. spasmolytic, decreases gastric motility
45
Q

CV response to ECT

A
  1. brady + asystole followed by HTN and tachycardia 2. can lead to increases in myocardial O2 demand 3. can cause arrhythmias 4. can cause transient ischemic changes
46
Q

why is succinylcholine given to patients having ECT

A
  1. rapid onset, short duration, and independent reversibility 2. attenuates the potentially dangerous skM contractions produced with seizure activity
47
Q

what is the 3rd leading cause of hospital acquired acute renal failure

A

MRI contrast

48
Q

who is at increased risk of renal failure d/t contrast media

A
  1. DM 2. CKD 3. dehydrated pt
49
Q

mild rxn to contrast media

A
  1. uriticaria 2. fever 3. chills 4. facial flushing 5. N/V
50
Q

with ENT surgery, shared airway is common, therefore _______________ is key!!

A

effective communication

Justin Lyle Cards (27 decks)

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