Chapter 31: Risk + Risk Management Flashcards

1
Q

Define risk.

A

Danger or hazard; probability of suffering harm or other untoward outcome

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2
Q

Define complication.

A

A problem that makes a disease or condition worse or more difficult to treat

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3
Q

A problem that makes a disease or condition worse or more difficult to treat

A

Complication

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4
Q

Danger or hazard; probability of suffering harm or other untoward outcome.

A

Risk

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5
Q

Define side effect.

A

Consequence of an agent other than expected

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6
Q

Consequence of an agent other than expected

A

Side effect

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7
Q

Define adverse event.

A

Harmful, usually unexpected

occurrence; deviation from normal course or progression in recovery, health, or well-being

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8
Q

Harmful, usually unexpected

occurrence; deviation from normal course or progression in recovery, health, or well-being

A

Adverse event

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9
Q

Define acute.

A

Occurring during performance of a procedure, administration of a drug, etc.

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10
Q

Define intermediate.

A

Occurring during the existence of a drug or device in a patient

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11
Q

Define long-term.

A

Occurring after elimination of a

drug or removal of a device from a patient

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12
Q

ASA, Committee on Professional Liability:
Chair?
Location?
How many insurance companies participate?
Time period?
How many cases per year?
How many claims in database?

A
Chair: Frederick Cheney, Jr., MD (1985)
Location: University of Washington, Seattle
35 insurance companies participate
Time period: 1985 - present
Cases per year: 300
Claims in database: 7300
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13
Q

The goal of the American

Society of Anesthesiologists (ASA) Closed Claims Project is to:

A

identify major areas of loss in anesthesia, patterns of injury, and strategies for prevention.

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14
Q

3 parts of goal of ASA Closed Claims project:

A

1) ID major areas of loss in anesthesia
2) ID patterns of injury
3) ID strategies for prevention

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15
Q

Name five means for confirming success or failure of endotracheal intubation.

A

1) Chest rises and falls
2) Condensation appears and disappears
3) Compliance of bag (refills)
4) Capnography
5) Auscultation

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16
Q

Gold standard for confirming endotracheal intubation

A

Capnography: 3 repeating waveforms

17
Q

How many adverse respiratory event claims end in death or brain damage?

A

85%

18
Q

Of those adverse respiratory event claims that ended in death/brain damage, how many were due to esophageal intubation?

A

18%

19
Q

Of those adverse respiratory event claims that ended in death/brain damage, how many were due to difficult airway?

A

17%

20
Q

Of those adverse respiratory event claims that ended in death/brain damage, auscultation led to a misdiagnosis in what percentage of cases?

A

48%

21
Q

Proportion of anesthesia-related morbidity/mortality that are related to airway?

A

35% (Largest proportion compared to other reasons)

22
Q
Difficult airway, percentage occurrence in: 
Induction:
Intraop:
Extubation:
Recovery:

Of those, percentage that resulted in brain damage/death?

A

Induction: 67%, 48% in BD/D
Intraop: 15%, 69% in BD/D
Extubation: 12%, 92% in BD/D
Recovery: 5%, 58% in BD/D

23
Q

Of those difficult airway events, an event in which stage of care is most likely to result in brain damage or death?

A

Extubation/emergence

24
Q

Airway injury during procedure is more likely to be reported in which gender?

A

Female (69%)

25
Q

Airway injury during procedure is more likely to be reported in what age group?

A

Adult (96%)

26
Q

Airway injury during procedure is more likely to be reported in inpatient or outpaitent?

A

Inpatient (73%)

27
Q

Airway injury during procedure is more likely to be reported in what ASA statuses?

A

ASA I-II (73%)

28
Q

Difficult intubation reported in what percentage of airway injury cases?

A

39%

29
Q

Most likely site in body to be listed for airway injury?

A

Larynx (33%)

30
Q

Most likely site in body at which airway injury to would result in death?

A

Esophagus (19%)

31
Q

Leading cause of airway injury to larynx?

A

Vocal cord paralysis (34%)

32
Q

Leading cause of airway injury to pharynx?

A

Perforation (37%)

33
Q

Leading cause of airway injury to esophagus?

A

Perforation (90%)

34
Q

What factors make a patient more vulnerable to airway injury in the esophagus?

A

Female
>60 years old
Difficult intubation (62%)

35
Q

Early findings of perforation in the airway include:

A

Subcutaneous emphysema
Pneumothorax
CXR changes

36
Q

Late findings of perforation in the airway include:

A

Mediastinitis
Retropharyngeal abcess
Pneumonia

37
Q

Anesthesia-related obstetric mortality?

A

1:500,000

Overall obstetric mortality is 1:20,000.

38
Q

In relation to obstetric mortality, anesthesia ranks:

A

3rd or lower

39
Q

Leading cause of obstetric anesthetic mortality?

A

AIRWAY: failure to secure patient airway + aspiration are the two leading factors