Exam 1 Need To Know Tables Flashcards
(137 cards)
1
Q
What is a nonreassuring finding for the length of upper incisors?
A
Relatively long
2
Q
What is a nonreassuring finding for maxillary/mandibular incisor relation (jaw closed)?
A
Prominent overbite
3
Q
What is a nonreassuring finding for incisor relationship during voluntary jaw protrusion?
A
Cannot bring mandible anterior to maxilla
4
Q
What is a nonreassuring finding for interincisor distance?
A
< 3 cm
5
Q
What is a nonreassuring finding for visibility of uvula?
A
Not visible with tongue protruded (Mallampati > II)
6
Q
What is a nonreassuring finding for the shape of the palate?
A
Highly arched or very narrow
7
Q
What is a nonreassuring finding for compliance of mandibular space?
A
Stiff, indurated, mass-occupied, or nonresilient
8
Q
What is a nonreassuring finding for thyromental distance?
A
< 3 fingerbreadths
9
Q
What is a nonreassuring finding for neck length?
A
Short
10
Q
What is a nonreassuring finding for neck thickness?
A
Thick
11
Q
What is a nonreassuring finding for head/neck range of motion?
A
Cannot touch chin to chest or extend neck
12
Q
ASA I
A
A normal healthy patient
Healthy, nonsmoking, no or minimal alcohol use.
13
Q
ASA II
A
A patient with mild systemic disease
Mild diseases only without substantive functional limitations. Examples include: current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease.
14
Q
ASA III
A
A patient with severe systemic disease
Substantive functional limitations; one or more moderate to severe diseases. Examples include: poorly controlled DM or HTN, COPD, morbid obesity (BMI >40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA <60 wk, history (>3 mo) of MI, CVA, TIA, or CAD/stents.
15
Q
ASA IV
A
A patient with severe systemic disease that is a constant threat to life
Examples include: recent (<3 mo) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD, or ESRD not undergoing regularly scheduled dialysis.
16
Q
ASA V
A
A moribund patient who is not expected to survive without the operation
Examples include: ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction.
17
Q
ASA VI
A
A declared brain-dead patient whose organs are being removed for donor purposes.
18
Q
What are potential injuries to the head, eyes, ears, nose, and throat?
A
Postoperative vision loss, Corneal abrasion, Facial edema, Vocal cord edema
19
Q
What are potential cardiovascular injuries?
A
Vascular occlusion, Deep vein thrombosis, Ischemic injuries
20
Q
What are potential respiratory injuries?
A
Atelectasis, Endobronchial intubation
21
Q
What are potential neurologic injuries?
A
Peripheral neuropathy, Quadriplegia, Decreased cerebral blood flow, Increased intracranial pressure
22
Q
What are potential genitourinary injuries?
A
Myoglobinuria, Acute renal failure
23
Q
What are potential musculoskeletal injuries?
A
Amputation, Backache, Compartment syndrome, Rhabdomyolysis
24
Q
What are potential integumentary injuries?
A
Abrasion, Alopecia, Decubiti
25
What nerve group is injured in (Supine, Trendelenburg, Lithotomy)
Brachial Plexus
## Footnote
Injuries can occur in positions such as Supine, Trendelenburg, and Lithotomy.
26
What are potential causes of Brachial Plexus injury (Supine, Trendelenburg, Lithotomy)?
- Arm abducted >90° on armboard
- Arm falls off table edge and is abducted and externally rotated
- Arm abduction and lateral flexion of the head to the opposite side
27
What are the positioning recommendations to prevent Brachial Plexus injury (Supine, Trendelenburg, Lithotomy) ?
- Do not abduct arm >90°
- Ensure arms are adequately secured
- Support head to maintain neutral alignment
28
What nerve group is injured from Trendelenburg?
Brachial Plexus
29
What is a potential cause of Brachial Plexus injury from Trendelenburg?
Shoulder braces placed too medial or lateral
30
What is the positioning recommendation for Brachial Plexus from Trendelenburg?
Place well-padded shoulder brace over the acromioclavicular joint
## Footnote
Avoid use if possible
31
What is a potential cause of Brachial Plexus injury via lateral positioning?
Thorax pressure exerted on dependent shoulder and axilla
32
What is the recommended positioning to prevent Brachial Plexus injury via lateral position?
Place roll caudad to the axilla supporting the upper part of the thorax
33
What is a potential cause of Brachial Plexus Injury when positioned prone?
Arms abducted >90°
34
What is the recommended positioning to prevent Brachial Plexus Injury when prone?
Abduct arms minimally
35
What are potential causes of ulnar nerve injury?
Arm pronated on armboard; Arms folded across abdomen or chest with elbows flexed >90°; Arms secured at side with inadequate elbow padding; Arms inadequately secured, elbows extend over table edge
36
What are the positioning recommendations to prevent ulnar nerve injury?
Supinate forearm on padded armboard; Do not flex elbows >90°; Place sufficient padding around elbow; Draw sheet should extend above the elbow and be tucked between patient and mattress
37
What is a potential cause of Radial or Circumflex Nerve Injury?
Arm pressed against vertical positioning aid, retractor post, or screen pole
38
What is a recommended positioning practice to prevent Radial or Circumflex Nerve Injury?
Place adequate padding between or ensure the arm is not pressing against vertical posts or pole
39
What is a potential cause of Suprascapular Nerve Injury?
In lateral position, patient rolls semiprone onto dependent arm with shoulder circumduction.
40
What is the recommendation for positioning to prevent Suprascapular Nerve Injury?
Stabilize patient in lateral position.
41
What is a potential cause of Sciatic Nerve injury?
Malnourished/emaciated patient supine or sitting on inadequately padded table- Legs straight in sitting position
42
What is the positioning recommendation to prevent Sciatic Nerve injury?
Generous soft padding under buttock- Flex table at knees
43
What is a potential cause of Sciatic Nerve injury via Lithotomy?
Legs externally rotated with knees extended
44
What is the recommended positioning to prevent Sciatic Nerve injury via Lithotomy?
Minimal external rotation of legs; knees should be flexed
45
What is a common cause of Peroneal Nerve injury during lithotomy?
Fibular neck rests against vertical bar of lithotomy stirrup with legs extended and externally rotated.
46
What is a recommended positioning to prevent Common Peroneal Nerve injury in lithotomy?
Adequate padding between leg and stirrup with knees flexed and minimal external rotation.
47
What is a potential cause of Common Peroneal Nerve injury?
Undue pressure on the downside leg
48
What is a recommended positioning to prevent Common Peroneal Nerve injury?
Padding under the fibular head
49
What is a potential cause of Posterior Tibial Nerve injury during lithotomy?
Knee crutch stirrups supporting the posterior aspect of knees.
50
What is a recommended positioning to prevent Posterior Tibial Nerve injury in lithotomy?
Generous padding under knees.
## Footnote
Avoid use of knee crutch stirrups for prolonged procedures.
51
What is a potential cause of Saphenous Nerve injury during Lithotomy?
Foot suspended outside vertical bar; leg rests on bar. Excessive pressure on medial leg from 'knee crutch' stirrups.
52
What is a recommended positioning to prevent Saphenous Nerve injury during Lithotomy?
Sufficient padding between legs and vertical bar. Sufficient padding between stirrup and leg.
53
What is a potential cause of Obturator Nerve injury during Lithotomy?
Excessive flexion of the thigh at the hip
54
What is the recommended positioning to prevent Obturator Nerve injury during Lithotomy?
Minimal hip flexion
55
What is a potential cause of Pudendal Nerve injury?
Traction of legs against perineal post or orthopedic fracture table
56
What is a positioning recommendation to prevent Pudendal Nerve injury?
Generous padding between perineum and post
57
Echinacea (purple coneflower root) - Effect
Activation of cell-mediated immunity
58
Echinacea (purple coneflower root) - Perioperative Concerns
Allergic reactions, Decreased effectiveness of immunosuppressive drugs (e.g., corticosteroids, cyclosporine), Potential hepatotoxicity with long-term use
59
Ephedra (ma huang) - Effect
Increased heart rate and blood pressure via direct/indirect sympathomimetic effects
60
Ephedra (ma huang) - Perioperative Concerns
Risk of MI or stroke from tachycardia/hypertension, Depletes catecholamines → hypotension under anesthesia, Can interact with volatile anesthetics & vasopressors
61
Ephedra (ma huang) - Preoperative Discontinuation
At least 24 hours before surgery
62
Ginger (Zingiber officinale) - Effect
Flavoring, GI effects (anti-nausea, antiemetic), Antiplatelet properties
63
Ginger (Zingiber officinale) - Perioperative Concerns
Increased risk of bleeding
64
Ginger (Zingiber officinale) - Preoperative Discontinuation
At least 7 days before surgery
65
Garlic (Allium sativum) - Effect
Inhibits platelet aggregation, Increases fibrinolysis
66
Garlic (Allium sativum) - Perioperative Concerns
Increased risk of bleeding, especially with other antiplatelet agents
67
Garlic (Allium sativum) - Preoperative Discontinuation
At least 7 days before surgery
68
Ginkgo (Ginkgo biloba) - Effect
Inhibits platelet-activating factor
69
Ginkgo (Ginkgo biloba) - Perioperative Concerns
Increased risk of bleeding, especially with anticoagulants
70
Ginkgo (Ginkgo biloba) - Preoperative Discontinuation
At least 36 hours before surgery
71
Ginseng (American, Asian, Chinese, Korean) - Effect
Lowers blood glucose, Irreversible platelet inhibition, Inhibits PTT/PT in animals
72
Ginseng (American, Asian, Chinese, Korean) - Perioperative Concerns
Hypoglycemia, Increased bleeding, Potential to interfere with warfarin
73
Ginseng (American, Asian, Chinese, Korean) - Preoperative Discontinuation
At least 7 days before surgery
74
Kava (kava-kava, pepper root) - Effect
Sedation, anxiolysis
75
Kava (kava-kava, pepper root) - Perioperative Concerns
Increased sedative effects of anesthesia, Potential liver toxicity
76
Kava (kava-kava, pepper root) - Preoperative Discontinuation
At least 24 hours before surgery
77
St. John’s Wort (Hypericum perforatum) - Effect
Antidepressant, Serotonin reuptake inhibitor, CYP450 inducer
78
St. John’s Wort (Hypericum perforatum) - Perioperative Concerns
Alters metabolism of anesthetics, opioids, warfarin, etc., Risk of serotonin syndrome
79
St. John’s Wort (Hypericum perforatum) - Preoperative Discontinuation
At least 5 days before surgery
80
Valerian (all heal, garden heliotrope) - Effect
Sedation
81
Valerian (all heal, garden heliotrope) - Perioperative Concerns
Increased sedative effects of anesthesia, Risk of withdrawal symptoms
82
Valerian (all heal, garden heliotrope) - Preoperative Discontinuation
No clear recommendation (taper suggested)
83
BOX 43.1 Special Considerations for ENT Procedures
• Increased risk of unanticipated difficult airways
• Cannot intubate, cannot ventilate situation
• Use of specialized ventilation techniques
• Insufflation
• Intermittent apnea
• Apneic oxygenation
• Prevention of endotracheal tube fire
• Shared airway
• Surgical field avoidance
• Restricted use of nitrous oxide
• Restricted use of muscle relaxants
• Use of specialized equipment
• Use of laser for ablation
• High-frequency jet ventilation
• Transnasal humidified rapid-insufflation ventilatory exchange (or THRIVE)
• Potentially undiagnosed obstructive sleep apnea
• Potential for bleeding
84
TABLE 43.1 Paired Cartilages of the Larynx
Arytenoid
Corniculate
Cuneiform
85
TABLE 43.1 Unpaired Cartilages of the Larynx
Thyroid
Cricoid
Epiglottis
86
Sensory Nerves = Superior laryngeal n. internal branch (vagus) innervates
Laryngeal mucosa above vocal cords
(inferior epiglottis)
87
Recurrent laryngeal innervates
= Laryngeal mucosa below vocal cords
88
Glossopharyngeal innervates
= Superior aspect of epiglottis and base
of tongue
89
Motor Nerves = Recurrent laryngeal innervates =
All intrinsic muscles except cricothyroid
90
Superior laryngeal n. external branch innervates
= Cricothyroid muscles
91
What is Lidocaine available in?
2% and 4% solution; 2% viscous solution; 10% aerosol; 2.5% and 5% ointment.
92
What is Benzocaine available in?
10%, 15%, 20% cream.
93
What does Cetacaine contain?
14% benzocaine, 2% butamben, and 2% tetracaine.
94
What is the recommended dosage of Lidocaine?
4 mg/kg plain; 7 mg/kg with epinephrine.
95
What is the typical dosage of epinephrine used with Lidocaine?
250-300 mg.
96
What is the onset and duration of action for Lidocaine?
Rapid onset, suitable for all areas of the tracheobronchial tree; short duration of action (10 min).
97
What adverse effect can Lidocaine produce?
Can produce methemoglobinemia.
98
Sodium nitroprusside dosage for young adults and children
Young adults: 1-5 mcg/kg/min; children: 6-8 mcg/kg/min
## Footnote
Potent, reliable, rapid onset and recovery, cardiac output well preserved.
99
Dexmedetomidine dosage
1 mcg/kg over 10 min then 0.2-0.7 mcg/kg/hr
## Footnote
Dose-dependent sedation and analgesia with associated hypotension, decreases intravenous/inhalational anesthetic requirements, smooth emergence.
100
Esmolol dosage for mean arterial pressure reduction
200 mcg/kg/min to achieve 15% reduction of mean arterial pressure
## Footnote
Preserves myocardial blood flow, reduces preload, preserves tissue oxygenation.
101
Nitroglycerin dosage for adults and children
Adults: 125-500 mcg/kg/min; children: 10 mcg/kg/min
## Footnote
Ca** channel blocker.
102
Nicardipine dosage
5 mcg/kg/min
## Footnote
Preserves cerebral blood flow.
103
Remifentanil and Propofol dosages
Remifentanil: 1 mcg/kg IV then continuous infusion 0.25-0.5 mcg/kg/min; Propofol: 2.5 mg/kg IV, then infusion of 50-100 mcg/kg/min
## Footnote
Remifentanil reduces middle ear blood flow, creating a dry surgical field for tympanoplasty; Propofol may help reduce PONV.
104
Disadvantages of Sodium nitroprusside
Reflex tachycardia, rebound hypertension, pulmonary shunting, cyanide toxicity possible.
105
Disadvantages of Dexmedetomidine
Bradycardia and hypotension most often seen with bolus, heart block.
106
Disadvantages of Esmolol
Potential for significant cardiac depression.
107
Disadvantages of Nitroglycerin
Increases intracranial pressure, highly variable dosage requirements.
108
Disadvantages of Remifentanil
No analgesic effect once remifentanil infusion discontinued, postoperative secondary hyperanalgesia.
109
BOX 43.2 General Safety Protocol for Surgical Lasers
• Post warning signs outside any operating area: "WARNING: LASER IN USE."
• Patient's eyes should be protected with appropriate colored glasses and/or wet gauze.
• Matte-finish (black) surgical instruments reduce beam reflection and dispersion.
• Use the lowest concentration of oxygen possible (≥ 30%).
• Avoid using nitrous oxide because it supports combustion.
• Lasers should be placed in STANDBY mode when not in use.
• Use an endotracheal tube specifically prepared for use with lasers.
• Inflate cuff of laser tube with methylene blue-dyed saline so that a cuff
perforation is easily detected.
• All adjacent tissues should be shielded by wet gauze to prevent damage by
reflected beams.
• Plume should be suctioned and evacuated from the surgical field.
110
What is the innervation of the Cricothyroid muscle?
Superior laryngeal nerve
111
What is the function of the Cricothyroid muscle?
Tension and elongates vocal cords
112
What is the innervation of the Thyroarytenoid muscle?
Recurrent laryngeal nerve
113
What is the function of the Thyroarytenoid muscle?
Relaxes vocal cords
114
What is the innervation of the Vocalis muscle?
Recurrent laryngeal nerve
115
What is the function of the Vocalis muscle?
Relaxes vocal cords
116
What is the innervation of the Posterior cricoarytenoid muscle?
Recurrent laryngeal nerve
117
What is the function of the Posterior cricoarytenoid muscle?
Abducts vocal cords
118
What is the innervation of the Lateral cricoarytenoid muscle?
Recurrent laryngeal nerve
119
What is the function of the Lateral cricoarytenoid muscle?
Adducts vocal cords
120
What is the innervation of the Transverse arytenoid muscle?
Recurrent laryngeal nerve
121
What is the function of the Transverse arytenoid muscle?
Adducts vocal cords
122
What is the innervation of the Aryepiglottic muscle?
Recurrent laryngeal nerve
123
What is the function of the Aryepiglottic muscle?
Closes glottis
124
What is the innervation of the Oblique arytenoid muscle?
Recurrent laryngeal nerve
125
What is the function of the Oblique arytenoid muscle?
Closes glottis; approximates folds
126
What is the innervation of the Sternohyoid muscle?
Cervical plexus; C1, C2, C3
127
What is the function of the Sternohyoid muscle?
Draws hyoid bone inferiorly
128
What is the innervation of the Sternothyroid muscle?
Cervical plexus; C1, C2, C3
129
What is the function of the Sternothyroid muscle?
Draws thyroid cartilage caudad
130
What is the innervation of the Thyrohyoid muscle?
Cervical plexus; hypoglossal nerve; C1 and C2
131
What is the function of the Thyrohyoid muscle?
Pulls hyoid bone inferiorly
132
What is the innervation of the Thyroepiglottic muscle?
Recurrent laryngeal nerve
133
What is the function of the Thyroepiglottic muscle?
Inversion of aryepiglottic fold
134
What is the innervation of the Stylopharyngeus muscle?
Glossopharyngeal
135
What is the function of the Stylopharyngeus muscle?
Aids swallowing
136
What is the innervation of the Inferior pharyngeal constrictor muscle?
Pharyngeal plexus; vagus
137
What is the function of the Inferior pharyngeal constrictor muscle?
Folds thyroid cartilage
