HEENT Part I

Question 1

what anesthetic technique should be used with ENT surgery?

Answer 1

TIVA, may be difficult to maintain inhalational anesthesia

Question 2

use of NMB with ENT surgeries?

Answer 2

must ask the surgeon first, they might be monitoring something and NMB may be c/i

Question 3

with neck surgery, if retractors are used it can put pressure on the _______________ –> _________________

Answer 3

carotid; bardycardia

Question 4

positioning considerations with ENT surgery

Answer 4

1. head is prepped and completely draped or wrapped in towels 2. the ETT if often positioned and taped/padded to forehead 3. nasal and oral RAE common for long surgeries - watch for pressure on nares and lips 4. table may be turned 90 - 180 degrees (disconnect circuit when turning) 5. arms are tucked to ensure no IV kinking

Question 5

when would you monitor auditory evoked potentials?

Answer 5

1. acoustic neuroma 2. trigeminal neuralgia 3. facial nerve decompression

Question 6

with neuromuscular junction monitoring, you are monitoring the ________________ nerve

Answer 6

facial

Question 7

surgeries that utilize facial nerve monitoring

Answer 7

1. thyroid 2. neck flap 3. dissections for cancer, nerve issues 4. parotid surgeries 5. mastoid surgeries

Question 8

NIMS tube procedure uses what neurological monitoring

Answer 8

EMG

Question 9

different ventilation techniques that can be used with ENT surgery

Answer 9

1. spontaneous ventilation 2. apneic ventilation 3. jet ventilation

Question 10

if the ETT is too deep and you are utilizing jet ventilation, what is the risk ?

Answer 10

gastric insuffulation

Question 11

hypoventilation with jet ventilation can cause

Answer 11

air trapping and barotrauma

Question 12

if using jet ventilation with ENT surgery, you are using _____________ tidal volumes and ______________ pressures

Answer 12

small; high

Question 13

what situations would an elective tracheostomy be performed?

Answer 13

1. prolonged ventilation in the ICU 2. chronic aspiration risk 3. super morbid obesity 4. free flap or other airway surgery requiring good visualization

Question 14

T/F: tracheostomy procedures can be done awake, sedated, or under general anesthesia

Answer 14

TRUE

Question 15

what is a MLT tube

Answer 15

microlaryngoscopy tube it is longer, but smaller diameter

Question 16

sizes MLT tubes are available in?

Answer 16

4, 5, 6,

Question 17

what ETT is the best for vocal cord surgery or pt with tracheal stenosis

Answer 17

MLT tube

Question 18

when is a MLT tube an appropriate choice of airway securing device?

Answer 18

1. vocal cord surgery 2. tracheal stenosis 3. tracheal malasia 4. tracheal strictures

Question 19

what is the disadvantage to MLT tubes

Answer 19

smaller diameter thus increased resistance ventilation

Question 20

if using a laser for ENT surgery, FiO2 must be less than ___________

Answer 20

30%

Question 21

T/F: N2O is the gas of choice with laser ENT surgery

Answer 21

false; N2O is contraindicated

Question 22

what is the fire triad

Answer 22

1. oxidizer 2. ignition source 3. fuel

Question 23

what are examples of oxidizers in the fire triad

Answer 23

1. O2 2. N2O

Question 24

what are examples of ignitions sources in the fire triad

Answer 24

1. cable connections 2. fiber optic lights 3. electrocautery 4. electrosurgical laser

Question 25

what are examples of fuel, in the fire triad

Answer 25

1. linens 2. supplies 3. patient 4. alcohol prep solutions 5. surgical drapes

Question 26

how do you manage airway fire?

Answer 26

1. D/C laser 2. remove airway device, turn off gas, remove any flammable material, and pour saline in airway 3. put burning ETT/LMA in saline 4. ventilate pt with air 5. once fire extinguished ventilate with 100% FiO2 6. examine airway with bronchoscopy 7. if damage is minimal - humbidifed O2 via mask 8. reintubate if needed (with smaller ETT) 9. ABG, carboxyhgb, and CXR 10. if airway burn present/suspected --> 40-60% FiO2 + humdity 11. consdier steroids 12. consider trach 13. secure ICU bed for min of 24 hours

Question 27

leforte I fracture

Answer 27

Maxillary separation from mid face, maxilla is mobile

Question 28

leforte II fracture

Answer 28

Nasomaxillary fracture

Question 29

leforte III fracture

Answer 29

Cranial base-facial separation

Question 30

nasal intubation or NG tube placement is contraindicated with what classifications of leforte fractures

Answer 30

II and III

Question 31

what is the primary concern with pharyngeal abscess?

Answer 31

airway

Question 32

what can be used to decrease the risk of renal failure with the administration of contrast media?

Answer 32

1. ensure well hydration 2. IV with NaHCO3 3. add N-acetyl-cysteine 4. you can also hydrate + vitamin C

Question 33

how does N-acetyl cysteine decrease risk of renal failure with contrast media?

Answer 33

binds up the electrons

Question 34

if pt has an allergy to shellfish and is going to get contrast, how should you pre-tx to decrease risk of reaction

Answer 34

1. H1 or H2 blocker (like benadryl) 2. steroids (methylprednisolone)

Question 35

how should you tx an allergic reaction to contrast media

Answer 35

1. supportive care 2. bronchodialators 3. vasopressors

Question 36

what is the maximum recommended occupational exposure to radiation?

Answer 36

5000 mrem/year

Question 37

how can occupational radiation exposure be kept to a minimum (ALARA)

Answer 37

1. reduce exposure time 2. reduce exposure dose 3. shielding all body parts as much as practical 4. being aware that rapidly replaced cells are at higher risk

Question 38

if hemorrhagic neurocatastrophic event occurs in the radiology suite, what are the appropriate steps to prevent further complications

Answer 38

1. secure the airway 2. support CV system 3. DC heparin 4. administer protamine sulfate

Question 39

when you administer protamine sulfate you administer ___ mg / 100 units of total heparin adminstered

Answer 39

1

Question 40

what medications can be given to increase the quality/duration of seizure during ECT

Answer 40

1. alfenanil with propofol 2. aminophylline 3. caffeine 4. clozapine 5. etomidate 6. ketamine

Question 41

when would external beam radiation therapy be utilized?

Answer 41

1. children with malignant tumors that cannot be resected by surgery (ex: neuroblastoma)

Question 42

what is external beam radiation therapy

Answer 42

high energy beams from a machine that target tumor from the outside of the body.

Question 43

why is a cardiac echocardiogram performed prior to DC cardioversion

Answer 43

to ensure patient is not going to throw a clot

Question 44

why is glucagon give during ERCP

Answer 44

1. relaxes sphicter of oddi 2. spasmolytic, decreases gastric motility

Question 45

CV response to ECT

Answer 45

1. brady + asystole followed by HTN and tachycardia 2. can lead to increases in myocardial O2 demand 3. can cause arrhythmias 4. can cause transient ischemic changes

Question 46

why is succinylcholine given to patients having ECT

Answer 46

1. rapid onset, short duration, and independent reversibility 2. attenuates the potentially dangerous skM contractions produced with seizure activity

Question 47

what is the 3rd leading cause of hospital acquired acute renal failure

Answer 47

MRI contrast

Question 48

who is at increased risk of renal failure d/t contrast media

Answer 48

1. DM 2. CKD 3. dehydrated pt

Question 49

mild rxn to contrast media

Answer 49

1. uriticaria 2. fever 3. chills 4. facial flushing 5. N/V

Question 50

with ENT surgery, shared airway is common, therefore _______________ is key!!

Answer 50

effective communication