Flashcards in Emergence & PACU/ICU Transport Deck (50):
complications associated with emergence
when do you start planning emergence?
as soon as the patient is asleep
what are 5 main factors to consider when emerging a patient
are they gonna vomit?
can they be safely extubated?
what are 3 factors that directly influence emergence time?
Agent Solubility (directly)
Agent Concentration (directly)
Duration of Anesthesia (directly)
Emergence of inhalational anesthesia depends chiefly on what?
____________ blunt the ventilatory responses to both hypercarbia and hypoxemia.
IV or inhalational anesthetics
PaCO2 where spontaneous ventilation is initiated
Maintain FiO2 >_____ during hypoventilation
how long do most non-depolarizing blockers work?
a condition where too much CO2 becomes an anesthetic
succinylcholine depolarizes the end-plate _______ receptor
why does succ have a short duration?
short duration due to pseudocholinesterase metabolism of Succs. It works to depolarize the motor end-plate and then diffuses away and is metabolized
which NMB can cause sinus bradycardia?
how to non-depolarizing NMB work?
Competitively inhibit end plate nicotinic cholinergic receptor
name 4 possible locations for the nerve stimulator
Posterior tibial nerve
External peroneal nerve
which twitch monitor location most closely reflects blockade at diaphragm?
TOF = 4 stimulations @ ___ Hz
Tetany = __-___ Hz for 5 sec
4/4 = __%
3/4 = __%
2/4 = __%
1/4 = __%
0/4 = __%
4/4 = 75%
3/4 = 85%
2/4 = 90%
1/4 = 95%
0/4 = 99%
what class of drug do you reverse NMB with?
side effects of anticholinesterase
what class of drug is used to counter-act the BLUDS?
max dose of neostigmine?
how do you assess the adequacy of ventilation during emergence?
-Tidal Volume (>250ml)
3 major candidates for a NAW or OAW
what is the major factor in arousal of OSA patients?
Factors that increase incidence of PONV
Hx* including motion sickness
Postoperative pain/narcotic use
Type of Surgery: (Eye, ENT, Abdominal, GI/GU)
Surgical sites that have increased risk of PONV.
what class of drug is Zofran?
Serotonin 5-HT3 receptor antagonist
30mg Toradol = ___mg Morphine
what class of drug is toradol?
Dilaudid = ____ relative potency morphine
How long does it last?
Fentanyl = _____ relative potency to morphine
Titrate narcotics to RR _____ BPM
Titrate to RR 10-16 BPM
factors for extubation
Airway protective reflexes intact
Intact neurological function
Adequate pulmonary function
Normal body temp (T 35-37 C)
Normal neuromuscular function
what is a major contraindication for droperidol?
at what stage(s) is it safe to extubate?
(NOT 2. excitatory or 4. depression)
what are some immediate hazards of extubation?
purpose of deep extubation
Minimize tracheal stimulation
Contraindications of deep extubation
Difficult mask airway
criteria for deep extubation
NMB completely reversed
Spont ventilation at regular rate/rhythm
No airway reflexes
Lidocaine (0.5 mg/kg)
NEVER extubate a patient deep without _______ in place
an oral airway
what do you do immediately following extubation?
Suction the pharynx one more time
Place mask on the patient
Keep your right hand on the bag
Test for airway patency
Help them breathe for a while if they are not doing an adequate job on their own.
ASA Standard 1 PACU
All patients who have received general, regional, or monitored anesthesia care shall receive appropriate post-anesthesia management
ASA Standard 2 PACU
A patient transported to the PACU shall be accompanied by a member of the anesthesia care team who is knowledgeable about the patient’s condition.
The patient shall be continually evaluated and treated during transport with monitoring and support appropriate to the patient’s condition
What must be continually evaluated during pt transport?
all pts must be transported with what?
what equipment must you have when transporting an ICU patient?
Cardiac Monitor or defibrillator
Airway management equipment
Oxygen Source with 30 minute reserve
Standard Resuscitation drugs
what must be continuously monitored for ICU patients?