Misc Topics Flashcards
1
Q
What are the 3 main pharmacological modalities to treat shivering?
A
Meperidine
Clonidine
Precedex
2
Q
How much is O2 consumption reduced for every 1 degree C reduction in body temp?
A
5-7%
3
Q
What are considered core temperature measurements?
A
Literally all but skin
Esophagus, nasal, rectum, bladder, pa, and tympanic membrane
4
Q
Where is the ideal placement of an esophageal stethoscope?
A
Distal 1/3 -1/4 of esophagus
(Or 38-42 cm pst incisors)
5
Q
What are the 3 ingredients to a fire?
A
> Ignition source (cautery, laser)
Fuel (drapes, surgical supplies, ETT)
Oxidizer (oxygen, nitrous oxide)
6
Q
What are the steps when a fire is present? IN ORDER
A
- Stop ventilation and REMOVE ETT
- Stop the flow of all airway gases
- Remove other flammable material
- Pour water or saline into the airway
- If fire isn’t extinguished, use CO2 fire extinguisher
Following fire control:
> reestablish ventilation by mask
> check ETT for damage ~ fragments may remain in airway
> perform bronch to inspect for airway injury
7
Q
Should you squeeze the reservoir bag as you extubated during an airway fire?
A
NO!! It’s like a blow torch
8
Q
What is a laser an acronym for?
A
L: light
A: amplification
S: stimulated
E: emission
R: radiation
9
Q
How does laser light differ from ordinary light?
A
Monochromatic (one wavelength)
Coherent (light oscillates in the same phase)
Collimated (light exists as a narrow parallel beam)
10
Q
What are some facts about CO2 lasers?
A
Wavelength: 10,600 nm
Type of surgery: oropharyngeal/vocal cord
Structures damaged: cornea
Eye protection: Clear lenses
11
Q
What are some facts about Nd:YAG lasers?
A
Wavelength: 1064 nm
Type of surgery: tumor debunking/tracheal
Structures damaged: retina
Eye protection: Green goggles
12
Q
What are some facts about Ruby lasers?
A
Wavelength: 694 nm
Type of surgery: retinal
Structures damaged: retina
Eye protection: Red goggles
13
Q
What are some traits about Argon lasers?
A
Wavelength: 515
Type of surgery: vascular lesion
Structures damaged: retina
Eye protection: Amber goggles
14
Q
Are ETT flammable?
A
Yes! Most are flammable
***Laser reflective tape is no longer advised ~ use a laser resistant ETT.
15
Q
What is the most vulnerable part of the ETT?
A
The cuff!
16
Q
What is the rule of 9s?
A
Divides the body surface into areas that represent 9% or multiples of 9
17
Q
In the rule of 9s, what % is the head?
A
10%
18
Q
In the rule of 9s, what % is the trunk?
A
36%
19
Q
In the rule of 9s, what % is the arm?
A
9%
20
Q
In the rule of 9s, what % is the leg?
A
18%
21
Q
In the rule of 9s, what % is the perineum?
A
1%
22
Q
What is a 1st degree burn?
A
Epidermis only
> spontaneous healing
> stinging, tender, and sore (sun burn)
23
Q
What is a second degree burn (superficial)?
A
Dermis (this is specifically superficial ~ upper dermis)
> spontaneous healing
> painful (but not as painful as a deep 2nd degree)
24
Q
What is a second degree deep burn?
A
Dermis (both upper and lower dermis)
> needs a skin graft to heal
> very painful!!
25
What is a 3rd degree burn?
Epidermis, dermis, and subQ tissue
> full thickness
> will require a skin graft
> complete destruction of dermis and epidermis
> ***no sensation d/t nerve ending damage
26
What is a 4th degree burn?
Epidermis, dermis, subQ, and muscle
> full thickness
> will require skin graft
> extends to muscle and bone
> no sensation d/t nerve ending damage
27
When are fluid shifts and edema formation the greatest?
In the first 12 hours
**they begin to stabilize by 24 hours ~ hence why fluid requirements are greatest in the first 24
28
What should be avoided in the first 24 hours following a burn?
Albumin! (It will get lost in the intravascular space)
29
What does a rising hemoglobin in the first few days post burn suggest?
Inadequate volume resuscitation
30
When do you consider transfusion in a post burn?
Hct < 20 (healthy)
Hct < 30 (cards history)
31
What are the two fluid resuscitation formulas for burned patients?
Parkland
Brooke
32
What is the parkland formula for burns?
Remember ~ there are more parks than brooks (4 vs 2)
4 mL x %TBSA burn x kg
> 1/2 in first 8 hours
> 1/2 in next 16 hours
33
What is the Brooke resuscitation formula?
2 mL x %TBSA x kg
> 1/2 in first 8 hours
> 1/2 in next 16 hours
34
During volume resuscitation in a burn patient, what fluid do you give in the first 24? What about second 24?
First 24: LR
Second 24: D5W
35
What is an adequate UOP for burn resuscitation?
Adult: > 0.5 mL/kg/hr
Child: > 1 mL/kg/hr
High electrical injury: > 1-1.5 mL/kg/hr (this is because myoglobin is nephrotoxic)
36
What is an adequate BP following burn resuscitation?
Adult: MAP > 60 mmHg
Child: SBP > 60 mmHg
Infant: SBP 70 -90 + (2 x age in years)
37
What is an adequate HR following burn resuscitation?
80-140
38
What is an adequate base deficit following burn resuscitation?
< 2
39
What is an adequate oxygen delivery index following burn resuscitation?
600 mL O2/min/m2
40
What is an adequate mixed venous following burn resuscitation?
35-40 mmHg
41
What is abdominal compartment syndrome defined as?
> 20 mmHg
Happens a lot following aggressive fluid resuscitation
42
What is CO affinity to hemoglobin?
200x that of O2
43
What blood takes in a cherry appearance?
CO poisoning.
Also the pulse oximeter will not be accurate ~ it cannot distinguish b/t
Tx: hyperbaric oxygen
44
What is the gold standard for diagnosing airway injury?
Fiberoptic bronch
45
What is the safest method to controlling an airway of a burn patient?
EARLY awake fiberoptic.
46
Should a surgical airway be used in a burn patient?
Only as LAST resort. They increase the risk of sepsis and late pulmonary complications.
47
When does up regulation of extrajunctional receptors begin?
After 24 hours
(Sux is safe within first 24!)
48
What is a good choice of anesthesia med for burns? What is a bad one?
Good: ketamine
Bad: etomidate (they need their adrenal fx)
49
What is electroconvulsive therapy?
It’s a treatment of medication-resistant depression as well as mania, catatonia, suicidal ideation
50
What is the initial response in ECT?
Increased PNS activity during the tonic phase (last around 15 seconds)
(Bradycardia, decreased BP, increased oral secretions, increased gastric secretions)
51
What is the secondary response in ECT?
Increased SNS activity during the clonic phase (last several minutes)
(Increased HR, ^BP, ^intragastric pressure, ^cerebral blood flow, ^ICP, ^IOP)
52
What are ABSOLUTE CONTRAINDICATIONS for ECT therapy?
Recent MI (<4-6 mos)
Recent intracranial surgery (<3 mos)
Recent stroke (< 3 mos)
Brain tumor
Unstable cervical spine
Pheochromocytoma
53
What is the min recommended seizure length in ECT?
25 second. Efficacy is better the longer it is
54
What meds increase seizure duration?
Etomidate
Ketamine
Alfentanil
Aminophylline
Caffeine
55
what are some conditions that increase seizure duration?
Hyperventilation/hypocapnia
***less free ionize calcium (Ca increase seizure threshold and stabilize Na channels)
56
What are some conditions that decrease seizure duration?
Propofol
Midazolam
Lorazepam
Fent
Lidocaine
57
What are some conditions that decrease seizure duration?
Hypoventilation
Hypercarbia
Hypoxia
(More free ionized Ca to stabilize Na channels and increase seizure threshold)
58
What med is considered the gold standard for ECT therapy?
Methohexital ~ it produces rapid recovery and DOES NOT affect seizure duration
59
What is the antidote for neuroleptic malignant syndrome?
Bromocriptine
60
What is the antidote for serotonin syndrome?
Cyproheptadine
61
What is the antidote during anticholinergic syndrome?
Physostigmine
62
What is the equation to Intraocular perfusion pressure?
Intraocular perfusion pressure = MAP-IOP
63
What is normal IOP?
10-20
64
Where is the aqueous humor produced?
Ciliary process (in the posterior chamber)
65
Where is the aqueous humor reabsorbed?
The canal of Schlemm (in the anterior chamber)
66
What are some things that decrease IOP?
Hypocarbia
Decreased CVP
Decreased MAP
Volatile anesthetics
Nitrous oxide
NMB (non depolarizing)
Propofol
Benzos
Hypothermia
67
What are some things that increase IOP?
Hypercarbia
Hypoxemia
Increased CVP
Increased MAP
DL/intubation
Straining
Sux
Nitrous oxide (if bubble is in place)
Tberg
Prone
68
Is sux ok to use in an open globe injury?
Yes ~ but Roc is probably the more suitable option
69
What is glaucoma?
Chronically elevated IOP that leads to retinal artery compression
70
What is open angle glaucoma cause from?
Sclerosis of the trabecular mesh work
71
What is close-angle glaucoma caused from?
Closure of the anterior chamber; this creates a mechanical outflow obstruction
72
What is Echothiophate?
Cholinesterase inhibitor that promotes aqueous drainage humor via the canal of schlemm
**it can prolong duration of Sux
73
What are the two biggest anesthetic considerations during strabismus surgery?
Increased PONV
Increased risk of activating the Oculocardiac reflex
74
How long should you discontinue N2O prior to SF6 bubble placement? How long should should you avoid N2O?
Discontinue: 15 mins before
Avoid: 7-10 days
75
How long should you discontinue N2O prior to silicone oil bubble placement? How long should should you avoid N2O?
Avoid: 0
76
How long should you discontinue N2O prior to air bubble placement? How long should should you avoid N2O?
Avoid: 5 days
77
How long should you discontinue N2O prior to perfluoropropane bubble placement? How long should should you avoid N2O?
Avoid: 30 days
78
What type of procedures are best suited for TAP blocks?
General, GYN, and urologic that involve the T9-L1 distribution
79
What are the landmarks to the TAP block?
The Triangle of Petit
External oblique muscle
Latissimus dorsi muscle
Iliac crest
80
What are the two most common complications of a TAP block?
Liver hematoma
Peritoneal puncture
81
What is allodynia?
Pain due to a stimulus that does not normally produce pain
**fibromyalgia
82
What is algogenic?
A stimulus that is normally expected to produce pain
**surgical incision
83
What is analgesia?
No pain is senses in response to a stimulus that produces pain
**opioids
84
What is dysesthesia?
Abnormal and unpleasant sense of touch
**burning in DM patients
85
What is hyperanalgesia?
Exaggerated pain response to a pain stimulus
** remifentanil
86
What is neuralgia?
Pain localized to a dermatome
**herpes zoster
87
What is neuropathy?
Impaired nerve function
* silent MI r/t DM
88
What is paresthesia?
Abnormal sensation described as pins and needles
Nerve stimulation during block placement
89
What are the two types of complex regional pain syndrome?
Type 1: reflex sympathetic dystrophy
Type 2: causalgia
90
How is complex regional pain syndrome described?
Neuropathic pain with autonomic involvement
91
What are the main risk factors to complex regional pain syndrome?
Female gender
Previous trauma
Or previous surgery
92
What is the key difference b/t type 1 CRPS and Type 2 CRPS?
Type two is ALWAYS preceded by a nerve injury (type 1 is NOT)
93
What is considered a single shot, unilateral epidural block that provides analgesia for breast surgery, thoracomty and rib fractures?
Paravertebral block
This block targets the ventral ramus of the spinal nerve
94
What is a celiac plexus block useful for?
Cancer pain of upper abd organs (distal esophagus, liver, pancreas, small intestine, and parts of the colon.)
95
What is a superior hypo gastric block useful for?
Cancer pain of pelvic organs (uterus, ovaries, prostate, and descending colon)
96
What is a sphenopalatine block used for?
Relieve postural puncture headache.
97
What is a complication of a retrobulbar block?
The optic nerve is PART OF THE CNS. You can cause a subarachnoid block in the optic sheath. If local anesthetic is injected into optic sheath, it can migrate over and affect CN 2 and 3 ~ this results in contralateral Amaurosis (blindness)
***it’s essential to assess contralateral pupil
***in addition, if local anesthetic reaches the brainstem, it can cause apnea
98
What are examples and risks r/t beta-lactam abx?
examples: PCN, cephalosporins
Risks: allergic reaction
99
What are examples and risks r/t aminoglycosides?
examples: gentamycin, streptomycin
Risks:ototoxicity, nephrotoxicity, skeletal muscle weakness (they may potentiate NMB)
100
What are examples and risks r/t tetracyclines?
examples: doxycycline
Risks: hepatotoxicity, nephrotoxicity
101
What are examples and risks r/t fluoroquinolones!
examples: ciprofloxacin, Levofloxacin, moxifloxacin
Risks: GI intolerance and tendinitis and tendon rupture
102
What are examples and risks r/t macrolides?
examples: erythromycin
Risks: p450 inhibition
103
What are examples and risks r/t clindamycin?
Risks: skeletal muscle weakness (caution with NMB) ; allergy
104
What are examples and risks r/t vancomycin?
Risks: hypotension with rapid infusion (d/t histamine), red man syndrome, Steven-Johnson syndrome
105
What are examples and risks r/t metronidazole?
Risks: peripheral neuropathy and alcohol intolerance
106
If a patient has a PCN allergy, when can they receive a cephalosporin?
Was not IgE mediated (anaphylaxis)
Did not produce exfoliative dermatitis (Steven Johnson syndrome)
107
What is the most common SE of antibiotics?
Pseudomembranous colitis
108
How do cephalosporin and Vanco act?
They disrupt bacterial cell wall synthesis (in a different way)
109
How often should ancef be re-doses?
Q 4 hours
110
What antibiotics can impact fetal development?
Tetracyclines
Fluoroquinolones
Erythromycin
Chloramphenicol
111
What is the abx of choice for a MRSA infection?
Vanco
112
What is the MOST important method of infection prevention?
Hand washing
113
What is the MOsT common source of blood stream infection in the hospital?
Central line
114
What are the 7 SCIP protocols?
> Abx within 60 mins
> abx is determined by site of surgery
> abx discontinued within 24 hours
> BBG < 200 for cardiac surgery
> surgical patient get hair removal
> colorectal patients are normothermic > 36
> post op wound drainage is diagnosed during initial hospitalization
115
What is the most common cause of HIV occupational exposure?
Needle stick
Percutaneous injury (needle): 0.3%
Mucous membrane: 0.09%
116
What is a classic example of a prion disease?
Creutzfeldt- Jakob disease
(Mad cow disease)
**it can lead to encephalopathy and dementia
117
What are the most common S&S of tuberculosis?
Productive cough, hemoptysis, weight loss, fever, night sweats, anorexia and malaise
118
What is the most common test for TB?
Mantoux test
119
What is a + Mantoux test?
Site of induration > 10mm (> 5 mm in the immunocompromised)
***a positive skin test necessitates a chest X-RAY
120
What is the first-lien agent for TB?
Isonaizid (but it causes neuropathy and hepatotoxicity)
Rifampin may also be used (causes thrombocytopenia, leukopenia, anemia, kidney failure; AND sweat, urine, and tears turn orange)
121
What is associated with the highest risk of skin test conversion in the health care professional?
number 1: Bronchoscope
Then ETT intubation
122
What WBCs are considered granulocytes?
Neutrophils, basophils, and eosinophils
123
What WBCs are considered agranulocytes?
Monocytes and lymphocytes
124
What is the most abundant WBC?
Neutrophil ~ immune defense
60% of all WBCs
125
What are Basophils?
Essential to allergic reactions
Release histamine, cytokines, and prostaglandins
126
What are eosinophils?
Defend against parasites
127
What are monocytes?
Fight bacterial, viral, and fungal infections
Release cytokines
Present piece of pathogens to T-lymphocytes
128
What are lymphocytes?
B-humoral immunity (produce antibodies)
T- cell mediated immunity (do NOT produce antibodies)
Natural killer cells: limit the spread of tumor and microbial cells
Function is reduced by opioids
129
What is a classic example of a type 1 hypersensitivity?
Anaphylaxis
130
What is a classic example of a type 2 hypersensitivity?
ABO incompatibility
131
What is a classic example of a type 3 hypersensitivity?
Serum sickness after a snake bite
132
What is a classic example of a type 4 hypersensitivity?
Graft vs host
133
What is the main different b/t anaphylaxis and anaphylactiod?
Anaphylaxis requires previous sensitization or cross-sensitivity
134
What does the H1 receptor do?
Vasodilation
Increased vascular permeability
Smooth muscle contraction (not vascular)
135
What does the H 2 receptor do?
Increase gastric secretion
Cardiac stimulation (tachycardia)
136
What do leukotrienes and prostaglandins do?
Bronchoconstriction and vasodilation
137
What is a type 1 sensitivity?
Antigen + antibody interaction in a patient with a previous sensitization
IgE mediated
**anaphylaxis
138
What is the best lab to determine if an allergic response has occurred?
Tryptase ~ released from mast cells
139
What is a type 2 sensitivity?
IgG and IgM antibodies bind to cell surfaces or extracellular regions
Activates a complement cascade
**HIT, ABO incompatibility
140
What is a type 3 hypersensitivity?
An immune complex is formed and deposited into the patient’s tissue
Activates the complement cascade
**snake bite
141
What is a type 4 hypersensitivity?
Allergic reaction is delayed at lease 12 hours
**contact dermatitis, graft vs host, tissue rejection
142
What is the treatment for intraoperative anaphylaxis?
>Discontinue agent
> increase FiO2 and provide airway support
> epi
> iv hydration 10-20 mL/kg
>H1 receptor antagonist (benadry)
>H2 receptor antagonist (ranitidine)
> hydrocortisone
> albuterol
> vaso
143
In what three ways does epi treat anaphylaxis?
Prevents degranulation
Provides CV support
And dilates the airway
144
What are the MOST common cause of allergic reactions?!
Neuromuscular blocks
(Sux is the worst)
145
What are the 3 most common culprits for an intraoperative allergic reaction?
NMB (most)
Latex
Abx
146
What is doxorubin’s main side effect?
Cardiac toxicity
“The D kind of looks allied a heart”
147
What is bleomycin’s main side effect?
Pulmonary toxicity
***Bleo and Blebs!! Also it’s affects right where the boobs are!
148
What is Cisplatin’s main side effect?
Renal toxicity
(Remember the chemo man ~ ears and beans) ~ both are shaped like a C!
149
What is Methotrexate’s main side effect?
Bone marrow suppression
(That’s why we use it in Lupus and RA)
150
What is Vincristine and Vinblastine’s main side effects? Chemo man!
Peripheral neuropathy (the limbs look like vs)
151
What are some traits about gastrin?
Site of production: G cells in stomach
Stimulus: food in the stomach
Function: ^ gastric acid/Pepsinogen secretion
152
What are some traits about secretin?
Site of production: S cells ~ small intestine
Stimulus: acid in duodenum
Function: increase pancreatic bicarb; decrease gastric
153
What are some traits about cholecystokinin?
Site of production: I cells ~small intestine
Stimulus: food in duodenum
Function: gallbladder contraction, ^ pancreatic enzyme release, decrease gastric emptying
154
What are some traits about gastric inhibitory peptide?
Site of production: K cells ~ small intestine
Stimulus: food in duodenum
Function: increased insulin release; decreased gastric acid secretion and reduced gastric motility
155
What are some traits about somatostatin?
Site of production: D cell in the pancreas
Stimulus: food in gut/Gastrin/CCK
Function: decrease all GI function
(Off switch!)
156
What is increased in a patient with Zollinger-Ellison syndrome?
Gastrin
157
What is used for treatment of carcinoid tumors?
Somatostatin
158
What are some things that Decrease lower sphincter tone?
Anticholinergics
Cricoid pressure
Pregnancy
159
What are some things that increase lower sphincter tone?
Reglan!
160
Where does the vomiting center reside?
Nucleus tractus solitarius (medulla)
161
What 3 areas does sensory input to the vomiting center come from?
Chemoreceptor trigger zone
GI tract
Vestibular apparatus
162
What are some traits about 5-HT3 antagonists?
Receptor target: 5-HT3
Ligand: serotonin
Example: ondansetron
Dose: 4-8 mg
163
What are some traits about Neurokinin-1 antagonists?
Receptor target: NK-1
Ligand: substance P
Example: aprepitant
Dose: 40
164
What are some traits about dopamine antagonists?
Receptor target: D2
Ligand: dopamine
Example: droperidol (0.625 mg), Haloperidol (0.5 mg) , metoclopramide (10 mg)
165
What are some traits about antihistamines
Receptor target: H1 and M1
Ligand: histamine and acetylcholine
Example: Benadryl (25) and promethazine (12.5 mg)
166
What are some traits about anticholinergics?
Receptor target: M1
Ligand: acetylcholine
Example: scopolamine
Dose: 1.5 mg
167
What are some traits about steroids?
Receptor target: intracellular receptors
Ligand: steroid
Example: decadron
Dose: 4-10 mg
168
What patient risk factors increase the risk of PONV?
Female
Non-smoker
Young
History of motion sickness
History of PONV
169
What are surgery risk factors to PONV?
Long surgery
GYN
Laparoscopic
breast
plastics
peds
170
What are some anesthetic risk factors to PONV?
Anesthetic gas
Nitrous oxide > 50%
Opioids
Etomidate
Neostigmine
171
What is the most common SE of Zofran?
HA and diarrhea
172
Which antiemetics prolong the QT?
5-HT3 and butyrophenones
173
Which drugs are contraindicated in a patient with Parkinson’s?
Dopamine antagonists/ butyrophenones
174
What should patients undergoing ear surgery receive as an antiemetic?
Agents that target the vestibular system (scopolamine and Benadryl)
175
When is scopolamine best applied?
> 4 hours before anesthesia
176
What is the non pharmacological method of reducing PONV?
The P6 acupressure point
177
What are the complications (symptoms) r/t bone cement implantation syndrome?
Bradycardia
Dysrhythmias
Hypotension
Pulmonary HTN
Hypoxia
Cardiac arrest
178
Which surgery has the highest risk of bone centenary implantation syndrome?
Hip arthroplasty
179
What are the first signs of bone cement implantation syndrome in an AWAKE patient? What about in the asleep patient?
Awake: Dyspnea and altered mental state
Asleep: decreased EtCO2
180
What is the triad of Fat embolism syndrome?
Resp insufficiency (hypoxemia, ARDs)
Neurological involvement (confusion/coma)
Petechial rash
181
What procedure is associated with the highest risk of bone cement implantation syndrome?
Hip arthroplasty
182
What is the max inflation time?
2 hours
183
What is the tourniquet inflation pressure for the upper extremity?
70-90 mmHg above the SNP
184
What is the inflation pressure in the lower extremity?
2x the SBP
185
What is the inflation pressure in a bier block?
250 mmHg or 100 mmHg over the SBP
186
What is the inflation pressure in the lower extremity?
350-400 mmHg
187
What does releasing the tourniquet produce?
Increased EtCO2
Decreased core body temp
Decreased BP
Decreased SvO2
Metabolic acidosis
188
When does tourniquet pain begin?
45-60 mins after inflation
**Usually do to tissue ischemia
**also this type of pain is unresponsive to opioids
189
What is Samter’s triad?
Combo of asthma, nasal polyps, and allergic rhinitis
**these patients can develop life threatening bronchospasm following asa admin
190
Why have most COX 2 inhibitors been removed off the market?
Cardiovascular side effects
191
What is ephedra?
Diet aid/ athletic enhancer
> can cause serotonin syndrome with MAOs
> catecholamine depletion
192
What is garlic?
Anti platelets, hypertension, and HLD
> increased bleeding risk
> decreased serum glucose
193
What is ginger?
Nausea
> increased bleeding risk
194
What is ginkgo Biloba?
Anti-aging, and poor circulation
> increased bleeding risk
195
What is ginseng?
Antioxidant
> increased bleeding risk
> enhances SNS effects if sympathomimetics
> may cause hypoglycemia
196
What is Kava-Kava?
Anxiety
> decreased MAC (^ GABA)
> may prolong duration if anesthetic agents
197
What is licorice?
Gastric and duodenal ulcers
> mimics aldosterone
> Na and H2O retention ~ decreased K
> Conn’s syndrome
198
What is saw palmetto?
BPH
> increased bleeding risk
199
What is St. John’s wort?
Depression
> induction of CYP 3A4
> decreased serum of warfarin/ dig
> may prolong duration of anesthetic agents
> can cause serotonin syndrome with MAOIs
200
What is Valerian?
Anxiety med
> decreases MAC
> may prolong anesthetic agents
> abrupt discontinue can cause withdrawal
201
Why are the 4 G’s that affect bleeding?
Garlic
Ginkgo
ginseng
Ginger
202
What is the number 1 cause of anesthetic mortality?
Human error
203
What is the rate of death in an ASA 1?
.04 deaths per 10,000
204
What is the rate of death in an ASA 2?
0.5 deaths per 10,000
205
What is the rate of death in an ASA 3?
2.7 deaths per 10,000
206
What is the rate of death for an ASA 4?
5.5 deaths per 10,000
207
What is the most common cause of injury that results in a closed claim?
Regional anesthesia
208
What are the most common causes of injury that result in a closed claim? In order
Regional > resp events > cardiac events > equipment failure
209
What MUST be performed before every patient?
> good suction
> function of monitors and alarms
> check vaporizers ~ filled with caps tight
> check carbon absorbent
> perform a high pressure leak test
> assess unilateraldirectional valves
> document you completed procedures
210
How often must the ventilator be calibrated?
Once a day
211
What are the 4 zones of the MRI suite?
> Zone 1: public access and requires no supervision (hallway outside MRI suite)
> zone 2: public access + min supervision (entrance to MRI suite)
> zone 3: limited access and strict supervision (MRI control room)
> zone 4: very limited access + very strict supervision (MRI scanner room)
212
What must a patient not have prior to going to the MRI?
pacemaker/ICD
Aneurysm clip
Metal implant
Implantable pump
Shrapnel
213
What 5 areas does the modified Alfred’s score address?
Activity
Respiration
Circulation
Consciousness
Oxygen saturation
214
What adhere score suggests readiness for discharge from PACU?
9
215
What is the aldrete score for activity?
2: moves all extremities voluntarily
1: moves 2 extremities voluntarily or on command
0: cannot move extremities or head
216
What is the aldrete score for resp?
2: breathes normally and can cough
1: dyspneic or shallow
0: apneic
217
What is the aldrete score for a circulation?
2: BP within 20 mmHg of preanesthetic value (min SBP of 90)
1: BP within 20-50 of preanesthetic value
0: BP > 50 mmHg of preanesthetic value
218
What is the aldrete score for consciousness?
2: fully awake
1: arousable
0: unresponsive to voice
219
What is the aldrete score for oxygen saturation?
2: > 92% on RA
1: > 90%, but need O2
0: < 90 with O2
