Therapeutic & Diagnostic Procedures Flashcards
Understanding that the standards of anesthesia care and patient monitoring are the same regardless of _____
location***
Realize that remote locations have different safety concerns, such as radiation and powerful magnetic fields.
Sedation practices may result in ____ or _____ which must be rapidly recognized and managed to avoid risk of aspiration, hypoxic brain damage, cardiac arrest, or death.
cardiac or respiratory depression***
It is the responsibility of the anesthesia provider to ensure that the location meets the
ASA guidelines for safety
The ASA published guidelines, standards, & definitions of general anesthesia & levels of sedation.
Understanding the procedure, ______ , the anticipated level of stimulation, and patient position during the procedure are all important considerations.
the patient’s condition***
Procedures that might be anticipated to last _____ may best be performed with GA at the onset rather than _____ after failure of sedation.
Several hours
late conversion***
- Consider performing anticipated difficult intubations in the operating room.
- Once the airway is controlled, the patient can be transported to the site of the planned procedure.
JCAHO defines anesthesia care as the administration of IV, IM, or inhalation agents that may result in the ____
loss of protective reflexes***
JCAHO introduced standards requiring anesthesia services participate with non-anesthesiology departments in setting up a ______ for patients undergoing sedation in all parts of the hospital
uniform quality of care***
JCAHO - Patients that receive anesthesia or sedation at alternative sites should expect the same ____ that they would receive in the OR.
standard of care***
Anesthesia providers undertake most of their training in the OR surrounded by familiar ______ experienced in the care of anesthetized patients.
equipment & staff***
At the conclusion of the procedure, patients should ______ supervised by personnel who are trained to take care of unconscious patients & with appropriate monitoring & resuscitation equipment immediately at hand.
recover from anesthesia or sedation in a PACU or similar setting***
Who must be present the entire case?
Qualified anesthesia personnel must be present for the entire case.
Nurses and radiology techs are often less familiar with the management of anesthesia, therefore they are often unable to provide skilled assistance in an emergency unless they receive specific training.
What monitoring is required in out of OR anesthesia
Supplemental Oxygen Pulse oximetry End-tidal carbon dioxide detection and disconnect alarm. EKG & NIBP Temperature Patient positioning
After the case, patients must be ____
medically stable before transport***
Patient must be accompanied to the recovery area with what?
Provisions for O2 delivery and monitoring on the transport cart are required.
Emergency medications***
Office based anesthesia is usually used for what type of procedures?
ENT and dental
Office based anesthesia require what?
A full pre-op workup**
Who are not good candidates for office based anesthesia?
potentially difficult airways
What type of anesthesia is used in office based settings and what agents?
Procedures often involve local anesthesia plus IV sedation or light general anesthesia with a mask or LMA.
Agents of choice include: Propofol Sevo Des N2O
Office based anesthesia ASA and JCAHO guidelines
Employment of appropriately _____
Availability of properly maintained ____
Complete documentation of the ___ as required at other surgical sites.
Use of standard ___ & availability of ___
Provision of a ____ that is staffed by trained nursing personnel.
Establishment of a written plan for ____ of the patient to a comprehensive care center if a complication occurs.
trained and credentialed anesthesia personnel.
anesthesia equipment.
care provided
ASA monitoring; emergency equipment.
PACU
emergency transport
*** this whole slide
In US, CT, MRI, RFA, and neuro-coiling, there is a unique risk for
radiation exposure***
What are the risks of radiation exposure?
Leukemia and fetal abnormalities (abnormalities caused by damage to the gonadal cells or developing fetus).
Dosimeters are required for radiation exposure, what is the annual maximum exposure? Lifetime? Monthly for pregnant women?
Annual: maximum exposure 50 mSv
Lifetime: 10 mSv x age
Pregnant: 0.5 mSv
T/F: Fluoroscopy is significantly less exposure to everyone than taking single shot x-rays.
True
What can be done to limit radiation exposure
by wearing appropriate lead aprons and thyroid shields, using movable leaded glass screens, and using innovative techniques such as video monitoring and remote mirroring
Iodinated Contrast Media
Older ionized contrast media were hyper-osmolar and toxic.
Newer non-ionized contrast media have ___
lower osmolality and improved side-effects***
Predisposing factors to adverse reactions from contrast media include a history of: ___9___
bronchospasm allergy cardiac disease hypovolemia hematologic disease renal dysfunction extremes of age anxiety medications (beta-blockers, aspirin, and NSAIDs). ***
What is the pre-treatment for contrast media?
prednisone, 5O mg 12 hours before
diphenhydramine, 5O mg immediately before the procedure
What are the mild, severe and lifethreatening reactions to contrast media?
MILD: nausea, perception of warmth, headache, itchy rash, and mild hives.
SEVERE: vomiting, rigors, feeling faint, chest pain, severe hives, bronchospasm, dyspnea, arrythmias, and renal failure.
LIFE-THREATENING: glottic edema/bronchospasm, pulmonary edema, arrythmias, cardiac arrest, and seizures/unconsciousness.
***
What is the treatment for reactions to contrast media?
O2, bronchodilators, epi, corticosteroids, and antihistamines***
Renal dysfunction is well documented in association with contrast media, particularly in patients with preexisting renal dysfunction and most especially in patients with preexisting renal dysfunction related to ___
Most cases of new or worsened renal function related to contrast media are ___ and resolve within 2 weeks.
diabetes***
self-limited***
Recent studies have demonstrated a reduction in contrast media nephrotoxicity by the administration of ____
acetylcysteine***
Life-threatening _____ may develop in non-insulin-dependent diabetic patients who are receiving ____ and have preexisting renal dysfunction if their renal function declines further.
lactic acidosis***
metformin***
CT:
Two-dimensional, cross-sectional image.
Each cross-section requires a few seconds of ___
Pt immobility is required.
It is often noisy, warm, and claustrophobic.
CT can be used for diagnostic and therapeutic purposes.
Number one problem: ____
radiation exposure
inaccessibility to the patient***
MRI:
Able to obtain images in any plane & excellent soft tissue contrast.
Does not produce ___ is non-invasive, and does not produce biologically ____
Hearing protection is ____
Thermal injury has been reported at site of ___ and areas where skin ___
Most significant risk in the MRI suite is the effect of the magnet on ____.
ionizing radiation; deleterious effects
Hearing protection is mandatory (>90 dB)***
EKG electrodes; contacts the machine.
ferrous objects
Contraindications for MRI
Shrapnel, vascular clips and shunts, wire spiral ETT’s, pacemakers, ICDs, mechanical heart valves, recently placed sternal wire, implanted biological pumps, tattoo ink with high concentrations of iron-oxide (permanent eyeliner), and intraocular ferromagnetic foreign bodies ***
Why is tattoo ink a possible contraindication?
may contain high concentrations of iron oxide***
Burns at tattoo sites have been reported after exposure to MRI magnetic fields, but such incidents are very rare and the presence of, for example, permanent eyeliner
