leersnyder day 2 Flashcards
(149 cards)
0
Q
most reliable source of info about your patient
A
the patient
1
Q
three vanderbilt computer interfaces
A
vpims, vpimsweb, starpanel
2
Q
if a preop was templated and has the physical exam filled out, is it complete?
A
no
3
Q
What is the name of the diagnosis and procedure codes in the US?
A
icd9, icd10, CPT
Also the codes for the dx must match between anesthesia and surgery or no reimbursement.
4
Q
which of the following is NOT a redflag for preops?
- aicd/pacer
- OSA
- mild pulm htn
- new stents
A
- mild pulm HTN
5
Q
state risks associated with REGIONAL anesthesia and their incidence
A
prolonged numbness/weakness, post-dural headache, failure of technique
6
Q
state at risk populations
A
extremes of age, redheads, drugs and alcohol, chronic pain patients, enzyme induced patients, genetic variances (MH)
Watch out for the old drunk redhead who goes to the methadone clinic and has a genetic predisposition to malignant hyperthermia.
7
Q
state strategies to minimize risk
A
avoid full stomachs, emergency surgery, cardiac problems, emergency c-section (high risk of general anesthesia, high risk of loss of airway and aspiration), light anesthesia = recall (risk of PTSD, use a BIS), maintain anesthesia equipment and competency.
Don’t do an EMERGENT C-SECTION on the patient who just ate 14 KRYSTALS and has new onset A-FIB if your BIS monitor and anesthesia MACHINE aren’t working.
8
Q
sore throat
A
50%
9
Q
hoarseness
A
15-50%
10
Q
post op N/V
A
10-80%
11
Q
drowsiness/confusion - emergence delirium vs. POCD (postop cognitive dysfunction)
A
age dependent
12
Q
operative awareness
A
less than 1%
13
Q
neuromuscular blocker MOST OFTEN associated with anaphylactic reaction
A
succs
14
Q
states with HIGHEST INCIDENCE of malignant hyperthermia
A
Wisconsin, Nebraska, West Virginia, Michigan
Willy Nelson wears virgin Miche
15
Q
visual loss
A
less than 0.056%
1/20th of 1%
16
Q
aspiration incidence
A
highest in pregnancy
17
Q
drug reactions
A
1:13,000
18
Q
number 1 drug reaction in US
A
antibiotics
19
Q
death
A
1:10,000
20
Q
in surveys patients are most concerned about
A
post op pain, N/V, not waking up, drains and needles
21
Q
triple low phenomena
A
low MAC, low MAP, low BIS
4x greater mortality over 30 days
22
Q
infection incidence post regional
A
3:65,000
You have a 1:22,000 chance
23
Q
persistent numbness / weakness
A
1:4,343
24
seizures post regional
0.022%
| Like if you accidentally shot yourself in with a tenth of a .22 pistol, you wouldn't die you'd just have a seizure
25
overall cardiac arrest rate overall vs anesthesia related
3/100 vs 1/1,000
26
overall critical events vs anesthesia related
964/10,000 vs 64/10,000
| Minus 900 critical events
27
overall mortality rate vs anesthesia related
463/10,000 vs 4/10,000
| Minus 460 deaths
28
_____ was mainly responsible for CRITICAL EVENTS in patients with GOOD physical status, but _____ diseases were mainly responsible in those with POOR physical status
anesthetic management
| coexisting diseases
29
we kill the ASA __ and __, the __ and __ kill themselves
1, 2, 3, 4
30
____ fold increase in critical events for ASA 4's non-emergency vs. emergency surgery
four (148:10,000 compared to 592:10,000)
31
anesthesia related deaths due to ADVERSE EFFECTS OF ANESTHETICS
42.4%
32
WHO MOST COMMONLY DIES DURING SURGERY?
MALES (80%), age 25-54 (55%), lowest death rate (5-14 years), highest death rate (age 85 or older)
33
In the USA between 1999-2005, 1,030 people died of anesthesia related complications to what?
overdose of anesthetic
34
In Japan study emergency surgery for an ASA4 patient increases the risk of anesthesia complications by what factor?
four times the risk
35
In Japan what was the leading cause of CRITICAL EVENTS of people with good physical status?
anesthetic management
36
In Japan what was the leading cause of critical events in those with poor physical status?
coexisting diseases
37
HPI
history of present illness
38
In the US mortality due to anesthesia is higher in what gender?
males
39
percentage of deaths caused by adverse effects?
| percentage of deaths caused by anesthetic overdose?
42. 4% adverse effects
| 46. 5% anesthetic overdose
40
what are some red flags in preop?
MI within last 6 mo's, chest pain, stents, new EKG changes
41
what is the fastest growing surgical specialty?
interventional radiology for neuro
42
a basic neuro exam should include...
oriented x4, deficits do not impair communication or comprehension, eyesight, pupils, visual fields, motor or sensory impairment
43
what is the NIHSS stroke score
42 point scale to identify deficits, 0 = no deficit, 42 = worst deficit, score defines 30 day mortality rate
44
what is hunt and hess scoring?
grading scale for subarachnoid hemorrhage
grade 1 - minimal headache
grade 2 - mod to severe HA, nuchal rigidity, cranial nerve palsy
grade 3 - drowsy
grade 4 - stuporous, mod to severe hemiparesis
grade 5 - deep coma, decerebrate rigidity
45
three interventional radiology treatments for a clot
penumbra, solitaire, trevo pro
46
three interventional radiology treatments for an aneurysm
glue, coil, clip
47
fourth leading cause of death and first leading cause of disability
stroke
48
three drugs that dissolve a clot
integrillin, TPA, reopro
49
EBUS stands for __
endobronchial ultrasound
50
american cancer society rates lung cancer the ____ cancer in the US
#2
51
two possible airway effects of the asthmatic in the OR
bronchospasm, laryngospasm
52
best anesthetic gas for reactive airway?
sevo
53
s3 murmur
heart failure
54
most feared respiratory complication in anesthesia?
aspiration pneumonia
55
what is the PCI goal for STEMI
90 minutes
56
6 p's of arterial insufficiency
pain, pallor, pulselessness, parasthesia, paralysis, perishing cold
57
what percentage of non cardiac surgical patients suffer a cardiac morbidity
1-5%
58
what does the first heart sound represent
closure of mitral and tricuspid valve
59
Most common cause of acute liver failure
tylenol OD
60
what is the gold standard test for cardiac function
treadmill stress test
61
most common complication of cirrhosis?
fatigue
62
most common drug induced hepatitis?
tylenol
63
liver disease is reflected by what labs
increased total bili, increased ast, alt, decreased albumin, increased PT
64
major cause of m and m in the pt with cirrhosis
bleeding from esophageal varices
65
what two labs best evaluate liver dz
serum albumin and PT
66
surgical risk is greater in a patient with the following 5 factors
high bili (>3g/dL), severe ascites, coma, poor nutritions, low albumin <3g/dL
67
concerns with morbidly obese patients
iv access, airway obstruction, metabolization of drugs, solubility of drugs
68
a low albumin (half life 20 days) reflects acute or chronic liver dz?
chronic
69
what is your primary concern with a tooth abscess?
airway
70
which class of drugs should you avoid in a patient with a history of ulcers?
nsaids
71
what should you check in a patient with GI symptoms?
frequency, recent EGD, how many pillows, treatment and efficacy, hemoptysis
72
what is a whipple?
resection of antrum of stomach, duodenum, gall bladder, and head of pancreas
73
name four issues with morbid obesity?
IV access, drug metabolism, difficult airway, use insoluble gas (des), loss of functional reserve capacity
74
what is a major risk factor of a patient with a bowel obstruction?
vomiting
75
leading cause of kidney disease in the US?
diabetes
76
how much kidney function can you lose before symptoms begin
you can lose 80%
77
which of the following electrolytes are affected by CRF?
hyperK, hyperMAG, hyperPHOS, hypoCALC
78
why are chronic renal patients anemic?
healthy kidneys secrete erythropoetin, anephric patients do not,
also reduced iron intake from dialysis diet leads to ironn-deficiency anemia
79
in order to differentiate pre renal (decreased renal perfusion) from acute renal failure (tubular damage) what test might you order?
fractional excretion of filtered sodium, if 1% = obstructive renal failure (ATN)
80
coagulopathy in CRF leads to what four sites of bleeding?
GI ulcers, epistaxis (nose bleeds), subdural hematoma, hemorrhagic pericarditis
81
Features of a child's airway vs. adults are
funnel-shaped larynx
82
number one cancer in kids
leukemia
83
t/f it is important to discuss risks of anesthesia in front of children?
false
84
Most common cancer in children
leukemia
85
recent studies have shown that infants have___ (more/less) sensitivity to pain
increased sensitivity to pain
86
oxygen consumption of an infant is ___ that of an adult?
twice
87
what is the fastest growing endocrine disease in the US?
diabetes
88
almost all pediatric codes are due to
respiratory distress
89
what needs replaced after a parathyroidectomy?
calcium
90
what does MEN syndrome stand for?
MEN- multiple endocrine neoplasm
91
nerve damage / paralysis post regional
0.2 - 0.4 %
92
Box 19-12 surg risk estimates
| HIGH >5% cardiac risk
Aortic
Major vascular
Peripheral vascular
93
Box 19-11 active cardiac conditions that require further eval before non-cardiac surgery
```
Unstable or severe angina
MI within 30 days
High grade block
Symptomatic ventricular arrhythmia
SVT >100 bpm
Symptomatic bradycardia
New v-tach
Aortic stenosis (pressure >40, area 2mg/dl
```
94
Box 19-12 surg risk estimates
| LOW <1% cardiac risk
Breast Dental Endo Endo Superficial Cataracts Gyn Reconstructive MinOrtho MinUro
95
Box 19-12 surg risk estimates
| INTERMEDIATE 1-5% cardiac risk
```
Intra peritoneal / thoracic
Transplant
Carotid
Peripheral arterial angioplasty
Endovasc aneurysm repair
Head and neck
Major neuro / ortho / uro
```
96
S/s cocaine and amphetamines
Tachycardia, labile BP, HTN, MI, arrhythmia, pulm edema, excitement, delirium, hallucination, psychosis, euphoria, hyperreflexia, tremors, convulsions, mydriasis, sweat, fever, exhaustion, coma
97
S/s of marijuana
Tachycardia, labile BP, headache, euphoric, dysphoric, depressed, poor memory and decreased motivation, rare anxiety panic or psychosis.
98
S/s of opiod abuse
Resp depression, hypotension, bradycardia, constipation, euphoria, pinpoint pupils, coma.
99
S/s hallucinogens: LSD, PCP
Sympathomimetic, weak analgesia, altered perception and judgement, dissociative anesthesia with increasing doses.
100
Most common female adult cancer
Skin, breast is second
101
Most common male adult cancer
Skin, Prostate is 2nd
102
Leading cause of cancer DEATH in both male and female
Lung
103
what gland is often removed in pediatric congenital heart surgery?
thymus
104
what are the symptoms of thyroid storm?
increased heart rate, temp, and basal metabolic rate
105
Patients with cancer have a __ fold increase in VTE, but __ if treated with chemo
4 fold cancer alone, 7 fold if treated with chemo
106
Cancer is the __ most common cause of death in US
2nd
107
Japanese study- leading causes of mortality in patients with GOOD physical status
Procedures and massive hemorrhage
108
Japanese study- mortality attributed to anesthesia
7/10,000
109
Five major differences between peds and adults
```
Larynx more cephaladad
Relatively large tongue
Angled vocal cords
Long stiff U shaped epiglottis
Funnel shaped larynx narrowest at cricoid cartilage
```
110
Oxygen consumption of infant is __ that of an adult per kg/min
Twice
111
OB- leading cause of maternal mortality in US
Thromboembolic events / PE
112
OB- RSI only after __ weeks
12
113
What is a normal change of pregnancy
Increase in cardiac output
114
In the US how many pregnant women have surgery not related to delivery?
1 in 50
115
What is a red flag related to pregnancy?
Proteinuria and elevated LFTs
116
According to the AANA guidelines the primary responsibility of the CRNA is to the NEONATE post delivery?
False
117
How many people for a log roll
4
118
most common heart murmur
mitral regurge
119
most serious heart murmur
aortic stenosis
120
s3 murmur indicative of
heart failure
121
which is not a redflag for preops
mild pulm hypertension
122
murmur best heart in the 2nd right intercostal space with transmission into the neck
aortic stenosis
123
critical aortic stenosis
less than 0.6 cm squared
124
sudden death in young athletes
hypertrophic cardiomyopathy
125
diagnostic gold standard for pulmonary HTN
right heart cath
126
treatment for pulm hypertension
flolan
127
gold standard for coronary artery disease
coronary angiography
128
bare metal stents recommendation for elective surgery
6 weeks
129
drug eluting stents recommendation for elective surgery
one year
130
how long after MI before having non-cardiac elective surgery
6 months
131
What drug killed Michael Jackson
Jackson Juice
132
most common cancer in US males after skin cancer
prostate
133
most common cancer US females after skin cancer
breast
134
chemo agent associated with pulmonary fibrosis
bleomycin
135
chemo increases risk of PE by __ fold
7 fold
136
ABCDE
```
airway and c spine
breathing and ventilation
circulation and hemorrhage control
disability and neuro assessment
exposure and environment
```
137
goal of surgeon during level one operation
get in, get out
138
how to perform a log roll
4 people
139
HELLP
hemolysis, elevated liver 'zymes, low platelets
140
first stage of labor, pain neurons enter cord at level
T10-L1
141
second stage of labor, pain through neurons enter cord at level
pudendal nerve, S2-S4
142
most common cause of maternal morbidity
thromboembolic events / PE
143
INR >2
cancel surgery
144
what does a pheochromocytoma secrete?
catecholamines
145
what gland is resected through the nose?
pituitary
146
beck's triad associated with cardiac tamponade
low BP, JVD, muffled heart sounds
147
pulsus paradoxus
associated with cardiac tamponade
148
Mendelson syndrome
chemical pneumonitis caused by aspiration during anaesthesia, especially during pregnancy.
