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Flashcards in Emergence & PACU/ICU Transport Deck (50):
1

complications associated with emergence

Airway obstruction
Agitation
Delirium
Pain
Nausea/vomiting
Hypothermia
Shivering
Autonomic lability

2

when do you start planning emergence?

as soon as the patient is asleep

3

what are 5 main factors to consider when emerging a patient

reversed?
breathing spontaneously?
comfortable?
are they gonna vomit?
can they be safely extubated?

4

what are 3 factors that directly influence emergence time?

Agent Solubility (directly)
Agent Concentration (directly)
Duration of Anesthesia (directly)

5

Emergence of inhalational anesthesia depends chiefly on what?

pulmonary elimination

6

____________ blunt the ventilatory responses to both hypercarbia and hypoxemia.

IV or inhalational anesthetics

7

PaCO2 where spontaneous ventilation is initiated

Apneic threshold

8

Maintain FiO2 >_____ during hypoventilation

>0.85

9

how long do most non-depolarizing blockers work?

15-45 mins

10

a condition where too much CO2 becomes an anesthetic

Hypercarbic narcosis

11

succinylcholine depolarizes the end-plate _______ receptor

nicotinic

12

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

13

which NMB can cause sinus bradycardia?

Succ

14

how to non-depolarizing NMB work?

Competitively inhibit end plate nicotinic cholinergic receptor

15

name 4 possible locations for the nerve stimulator

Ulnar nerve
Facial nerve
Posterior tibial nerve
External peroneal nerve

16

which twitch monitor location most closely reflects blockade at diaphragm?

facial nerve

17

TOF = 4 stimulations @ ___ Hz

2

18

Tetany = __-___ Hz for 5 sec

50-100

19

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%

20

what class of drug do you reverse NMB with?

anticholinesterase

21

side effects of anticholinesterase

BLUDS

22

what class of drug is used to counter-act the BLUDS?

anti-muscarinic

23

max dose of neostigmine?
peak onset?

0.07mg/kg
5-10 mins

24

how do you assess the adequacy of ventilation during emergence?

-ETCO2
-SpO2 (>90%)
-Tidal Volume (>250ml)

25

3 major candidates for a NAW or OAW

Obesity
OSA
Hx snoring

26

what is the major factor in arousal of OSA patients?

hypoxia

27

Factors that increase incidence of PONV

Hx* including motion sickness
Female gender
Hypotension
Non-smoker
Postoperative pain/narcotic use
Type of Surgery: (Eye, ENT, Abdominal, GI/GU)
Anesthetic Rx
Gastric distention
Swallowed heme

28

Surgical sites that have increased risk of PONV.

Intra-abdominal
Laparoscopic
Orthopedic
Gynecological
ENT
Breast
Plastic
Neurosurgical

29

what class of drug is Zofran?

Serotonin 5-HT3 receptor antagonist

30

30mg Toradol = ___mg Morphine

10

31

what class of drug is toradol?

NSAID

32

Dilaudid = ____ relative potency morphine
How long does it last?

8x
4-8 hrs

33

Fentanyl = _____ relative potency to morphine
Duration _____hour(s)

100x
0.5-1 hrs

34

Titrate narcotics to RR _____ BPM

Titrate to RR 10-16 BPM

35

factors for extubation

Airway protective reflexes intact
Clinical stability
Intact neurological function
Adequate pulmonary function
Normal body temp (T 35-37 C)
Normal neuromuscular function
Normal coagulation

36

what is a major contraindication for droperidol?

parkinson's

37

at what stage(s) is it safe to extubate?

1. awake
3. surgical
(NOT 2. excitatory or 4. depression)

38

what are some immediate hazards of extubation?

laryngospasm
vomiting
bronchospasm

39

purpose of deep extubation

Minimize tracheal stimulation
Minimize coughing/bucking

40

Contraindications of deep extubation

Difficult mask airway
Difficult intubation
Aspiration risk
Airway edema

41

criteria for deep extubation

MAC 1.3
NMB completely reversed
Spont ventilation at regular rate/rhythm
No airway reflexes
100% O2
Lidocaine (0.5 mg/kg)

42

NEVER extubate a patient deep without _______ in place

an oral airway

43

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.

44

ASA Standard 1 PACU

All patients who have received general, regional, or monitored anesthesia care shall receive appropriate post-anesthesia management

45

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

46

What must be continually evaluated during pt transport?

Ventilation
Oxygenation
Circulation

47

all pts must be transported with what?

O2

48

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
Medication

49

what must be continuously monitored for ICU patients?

EKG
SpO2

50

what is included in the PACU report

Pt name, Allergies, preop vitals
ASA class, Medical Hx
Procedure, Surgeon, Anesthesia
Type Anesthesia
Pre-meds, narcotics, paralytics, Rx
Fluids, lines
Orders