Miscellaneous Flashcards
(182 cards)
1
Q
What % of surgical patients have recall?
A
12%
*Greatest in trauma
2
Q
Where do the vertebral arteries arise from?
A
The subclavian arteries
3
Q
What 3 vessels can be most easily compressed during mediastinoscopy?
A
- Innominate (R carotid and R subclavian)
- R brachiocephalic
- R common carotid
4
Q
What are the top 3 complications of a mediastinoscopy?
A
- Hemorrhage - have blood available
- Pneumo (R. side)
- Recurrent laryngeal nerve injury (50% of cases are permanent)
5
Q
What 2 nerves are around the aortic arch and should be considered during a mediastinoscopy?
A
L recurrent laryngeal nerve
Phrenic nerve
6
Q
What is the proper position of the Aline, BP cuff, and pulse ox for a mediastinoscopy?
A
Aline - R radial artery
BP cuff - L arm
Pulse ox - R finger if no Aline, L finger if Aline
7
Q
Rheumatoid Arthritis
A
Symmetric polyarthropathy Significant systemic involvement Cervical vertebral involvement Consider cricoarytenoid involvement - hoarseness or stridor PFTs and ABGs - restrictive Tx: ASA, corticosteroids
8
Q
Osteoarthritis
A
Degenerative Articular cartilage Lack of inflammatory reaction Primarily - middle to lower cervical spine + lower lumbar area Tx: ASA, NO corticosteroids
9
Q
Pheochromocytoma
Tissue and location?
A
Tumor of the adrenal medullary or chromaffin tissue of the paravertebral sympathetic chain
Found in the abdominal cavity (95%)
Originates in the adrenal medulla (90%)
10
Q
Manifestations of a Pheochromocytoma
A
Paroxysmal HTN Sweating Tremulousness Tachycardia Headache Palpitations Orthostatic hypotension
11
Q
What is the diagnostic triad of a pheochromocytoma?
A
- Diaphoresis
- Tachycardia
- Headaches
12
Q
What will happen if a pheochromocytoma is left untreated?
A
Patient may die from CHF, MI, or intracerebral hemorrhage
13
Q
Describe the pre-op prep for a pheochromocytoma.
A
Alpha block - BP control
Phenoxybenzamine
Prazosin
Beta block - HR control
Correct fluid status
14
Q
Anesthesia Goals for a Pheochromocytoma
A
Continue pre-op therapy
Do NOT stimulate the SNS
Control hemodynamic swings
15
Q
What is the goal of OLV?
A
Optimize arterial oxygenation
16
Q
Explain the placement of the Robertshaw tube.
A
Concave cure of tube is anterior
After the tip of the tube passes the cords the tube is turned 90 deg to the LEFT and advanced until RESISTANCE is met
Inflate tracheal cuff
Confirm bilateral and equal breath sounds
17
Q
ASA Physical Status Classification
Class 2
A
MILD that only SLIGHTLY limits activity Heart disease Essential HTN DM Anemia Extremes of age Morbid obesity Chronic bronchitis
18
Q
ASA Physical Status Classification
Class 3
A
SEVERE that limits activity Heart disease Hx of prior MI and chest pain Poorly controlled HTN DM with complications Chronic pulmonary disease
19
Q
ASA Physical Status Classification
Class 4
A
Constant THREAT to life
CHF
Persistant chest pain
Any advanced kidney, liver, or pulmonary disease
20
Q
ASA Physical Status Classification
Class 5
A
Moribund patient - NOT expected to live 24 hours
PE
Cerebral trauma
Ruptured AAA
21
Q
ASA Physical Status Classification
Class 6
A
Brain-dead
Organ donation
22
Q
List examples of when to add “E” to the ASA class.
A
Appendicitis
D&C for bleeding
Non-elective basis
23
Q
List the one absolute contraindication for performing anesthesia for mediastinoscopy.
A
Previous mediastinoscopy
24
Q
A patient with a mediastinal mass is induced and intubated and BP falls dramatically. What should you do?
A
Change positions
25
What are the hallmark signs for a tension pnemo?
```
Hypotension
Hypoxemia
Tachycardia
Increased CVP
Increased PIP
Absence of breath sounds on the affected side
Tracheal shift
```
26
What is the treatment for a tension pneumo?
Chest decompression via a large bore needle through the chest wall in the 2nd ICS MCL
27
What accounts for nearly all cases of superior vena cava syndrome?
Cancer
| Mediastinal tumor that obstructs venous drainage in the upper thorax
28
What are the 4 absolute indications for OLV?
1. Presence of blood or infectious secretions in one lung
2. Bronchopulmonary lavage
3. Unilateral bullae
4. Bronchopleural fistula
29
Identify the 2 greatest risk factors predicting morbidity in the patient undergoing a carotid endarterectomy.
1. Cigarette smoking
| 2. HTN
30
Why should you avoid dextrose-containing fluids in a patient undergoing a carotid endarterectomy?
Moderate hyperglycemia worsens ischemic brain injury
| Hyperglycemia is least tolerated with carotid occlusion
31
What regional block is performed for a CEA?
Cervical plexus block
32
Where should you keep the PaCO2 during a CEA?
Normocarbia
| Avoid hypocapnia-induced vasoconstriction
33
What is the most reliable way to assess cerebral perfusion during a CEA?
An awake patient
34
What should you do if your patient develops symptomatic bradycardia with a labile BP during a CEA?
Have the surgeon anesthetize the baroreceptors with lidocaine
35
What is the incidence of post-op HTN following a CEA?
10-66%
36
What are the first and second most common cause of morbidity and mortality associated with a CEA?
1. MI
| 2. Stroke
37
What is the leading cause of perioperative mortality at the time of peripheral vascular surgery?
Coronary artery disease
38
What is reactive hyperemia?
4-7 fold increase in BF to tissues that had been deprived of flow
Metabolites cause vasodilation when flow is reestablished
39
When the abdominal aortic cross clamp is removed, would you increase or decrease MV?
Increase MV
| Hypocarbia - constrict vessels, divert flow to ischemic tissues = inverse/reverse steal, Robin Hood effect
40
Does renal blood flow increase, decrease, or remain unchanged after infrarenal placement of the cross-clamp?
Decrease
| To prevent renal failure - keep up with fluids*, mannitol prior to cross-clamping, lasix post cross-clamping
41
Aneurysm Classification System
DeBakey
Stanford
DeBakey
Type I - tear originates in the ascending aorta and the dissection is not confined
Type II - dissection is confined to ascending aorta
Type IIIa - dissection is confined to the descending thoracic aorta
Type IIIb - dissection extends into the abdominal aorta and iliac arteries
Standford
A - ascending aorta is involved
B - ascending aorta is NOT involved
42
What is the fluid of choice for a bowel obstruction?
Fluid supplemented with K
43
The surgeon is complaining of "active bowel." What should you do?
Give an antimuscarinic - atropine or glyco
44
What electrolyte disturbances are expected during a Whipple procedure?
Hypocalcemia
Hypomagnesemia
Hypokalemia
Hypochloremic metabolic alkalosis
45
During laparoscopic procedure the patient develops a gas embolus. What position should the patient be placed?
L lateral decubitus position
46
Laparoscopic tubal ligation...
HTN and bradycardia
Hypotension and tachycardia
HTN and bradycardia - gas insufflation 20-25 cmH2O increases CVP and CO
Hypotension and tachycardia - gas insufflation 30-40 cmH2O decreases CVP and CO
47
TURP Syndrome - Acute Hyponatremia S/S
```
Respiratory distress
HTN or hypotension
Widened QRS or increased ST segment
Dysrhythmias and bradycardia
Hemolysis
ARF
Hyponatremia, hypoosmolarity
Hyperglycinemia
Hyperammonemia
N/V
Confusion
Seizures
```
48
TURP Syndrome Treatment
```
Give O2
Provide circulatory support
Notify surgeon
Terminate procedure
Send labs
12-lead ECG
Fluid restriction and Lasix
Hypertonic saline (3%) - rarely necessary
```
49
What non-electrolytes are found in irrigating solutions used for TURP?
1. 5% glycine OR
| 2. 7% sorbitol and 0.54% mannitol
50
What are SE of TURP when glycine is used?
Hyperglycinemia...transient blindness, ammonia toxicity, N/V, headache, ECG changes
51
What causes coagulopathies during TURP?
Dilutional thrombocytopenia
52
The patient undergoing a TURP with a spinal block experiences shoulder pain. What are 2 possible causes?
1. Perforated bladder - irrigating fluid is entering the peritoneal cavity and irritating the diaphragm
2. MI - common cause of death in these patients
53
What level of regional anesthesia is needed for TURP?
T10
54
Sudden N/V and abdominal pain in the awake patient undergoing surgical resection of the prostate gland is most likely due to...
Urinary bladder perforation
| Incidence 1%
55
What happens if you rapidly treat hyponatremia?
Central pontine myelinolysis
56
Name 3 anesthetic concerns for strabismus surgery.
1. Oculocardiac reflex
2. PONV (50-80%)
3. MH - thought to reflect an underlyting myopathy
57
What nerves carry afferent and efferent action potentials for the oculocardiac reflex?
Afferent - Trigeminal CN 5
| Efferent - Vagus CN 10
58
Which muscle when pulled during strabismus surgery would most likely trigger the oculocardiac reflex?
Medial rectus
59
What are 3 ECG manifestations of the oculocardiac reflex?
1. Bradycardia
2. Junctional rhythm
3. PVCs
60
Are antimuscarinics effective in suppressing the oculocardiac reflex? Retrobulbar block?
NO and NO
61
List the 3 desired effects of a retrobulbar block.
1. Akinesia
2. Anesthesia
3. Abolishment of oculocardiac reflex
62
What is the mechanism by which a patient can receive a total spinal after retrobulbar block?
Perforation of the meningeal sheaths that surround the optic nerve
*Suspect if patient has difficult swallowing and becomes apneic
63
What is the most frequent complication of a retrobulbar block?
Hemorrhage
64
What IOP is considered normal? Abnormal?
Normal IOP: 10-22
Abnormal IOP: >25
*Determined by the rate of aqueous humor formation and the rate of outflow
65
List 3 parameters that determine the rate of aqueous humor formation.
1. CVP - direct *(most profound effect)
2. BP - direct
3. PaCO2 - direct
66
What is sulfur hexafluoride?
Inert gas that is less soluble in blood than nitrogen and much less soluble than nitrous oxide
Injected into the posterior chamber of the eye during vitreous surgery
Bubble size doubles from nitrogen moving into bubble
Flattens a detached retina and allows correct healing
*Fick's law of diffusion
*AVOID nitrous oxide for 10 DAYS after
67
What do you need to avoid in the intoxicated patient with an open-globe injury?
Gagging, coughing, straining
Avoid Sux if possible (increases IOP 6-8 mmHg within 1-4 min)
RSI w/o Sux would be the best
68
Respiratory obstruction after thyroid surgery is most likely due to what?
Tracheomalacia
69
What does PTU and iodine do prior to thyroid surgery?
PTU - inhibits thyroid hormone synthesis, reduces gland vascularity
Iodine - reduce gland vascularity
70
What is your most important concern for the patient undergoing thyroidectomy?
Maintain body temp
71
What intubation technique is contraindicated in a patient with a LeFort III fracture?
Nasotracheal intubation
| *Place patient in lateral position and pull mandible or maxilla forward to secure the airway
72
How long does it take for the tract from stoma to trachea to establish?
5 days
| *Do NOT change or remove a trach tube w/in 5 days
73
During radical neck dissection, the QT interval may become prolonged. Explain.
Trauma to the R stellate ganglion and cervical autonomic NS
| Lowers the threshold to V.Fib
74
What is the best way to prevent hypotension during radical neck dissection?
Block the carotid sinus nerve with lidocaine
75
What is the major anesthetic consideration for the patient undergoing surgery for breast augmentation?
Avoid MR so that nerve function can be assessed
76
Which causes greater stimulation, surgical incision or intubation?
Intubation!
| 25% will exhibit severe HTN
77
How many total seizure seconds of ECT are generally needed to see a good therapeutic effect?
400-700 seconds
| 30-60 sec each session
78
List 6 absolute contraindications to ECT.
1. Pheo
2. MI < 6 weeks ago
3. CVA < 3 mo ago
4. Intracranial surgery < 3 mo ago
5. Intracranial mass lesion
6. Unstable cervical spine
Relative: CHF, PM, major bone fracture, pregnancy
79
What are the autonomic s/s of ECT?
Immediate parasympathetic NS stimulation followed by late SNS stimulation
80
Can ECT cause memory loss?
YES, retrograde memory loss lasting 2-3 weeks
81
What is the chief cause of blood loss during spinal instrumentation and fusion procedures?
Bone decortication/bone manipulation
82
What are the strongest predictors of an increased risk for perioperative MI and increased risk of post-op death?
Ischemic heart disease (prior MI or angina)
| CHF
83
List 4 most common causes of hypertension.
1. Pain
2. Hypercapnia
3. Hypoxia
4. Fluid overload
84
Define hypertensive crisis.
DBP > 130 mmHg
85
Your patient is hypotensive. What ventilation changes can you make to help?
Decrease PEEP
Switch to CPAP
Do NOT increase the I:E ratio (this creates auto-PEEP)
86
List causes of unilateral decrease in breath sounds during GA.
1. Migration of ETT into one of two main bronchi
2. Pneumo
3. Mucous plug
4. Atelectasis
87
Ischemia of the tracheal mucosa is likely to occur when the pressure in the cuff of the ETT exceeds what level?
32 mmHg
| *This is capillary hydrostatic pressure
88
What is the most frequent cause of upper airway obstruction in the unconscious patient?
Tongue and other soft tissue structures falling back against the posterior pharyngeal wall
89
What is the leading cause of death in patients undergoing total joint replacement?
PE
90
Fat Embolism Syndrome has been associated with what?
```
Acute pancreatitis
Cardiopulmonary bypass
Parental infusion of lipids
Liposuction
*Syndrome usually occurs 12-72 hours after insult
```
91
What triad of s/s should arouse suspicion of fat embolus syndrome?
1. Hypoxemia
2. Mental confusion
3. Petechiae
92
What agent may be administered prophylactically for patients at risk for fat embolism syndrome?
Corticosteroids
| Limit endothelial damage
93
What ECG change is seen in the hyperparathyroid patient?
Shortened QT interval
| Hypercalcemia can also cause bradycardia
94
When do s/s of hypocalcemia after thyroidectomy develop?
24-72 hrs post-op
| May manifest 1-2 hrs after surgery
95
What are 2 causes of stridor following thyroidectomy?
1. Hypocalcemia
| 2. Bilateral damage to recurrent laryngeal nerves
96
What is the most common nerve injury associated with thyroid surgery?
Unilateral recurrent laryngeal nerve damage
| Hoarseness
97
What is the first suggestion that surgically induced hypoparthyroidism and hypocalcemia is present?
Inspiratory stridor progressing to laryngospasm
98
With stress, which 6 endocrine organs respond?
1. Hypothalamus
2. Anterior pituitary
3. Posterior pituitary
4. Adrenal cortex
5. Adrenal medulla
6. Pancreas
99
What fluid should be selected in the trauma patient?
NS or LR
| AVOID dextrose-containing fluids
100
What is "walk & drop" associated with?
Loss of consciousness - awakened - then loss of consciousness
Epidural hematoma - skull fracture
101
Evidence of a basal skull fracture is a contraindication to...
Nasal intubation
Evidence includes: CSF rhinorrhea, otorrhea, LeFort III, blood behind ear drug
102
What agents should be avoided in the patient with a head injury?
Ketamine
Sux
N2O
103
What type of blood should be used in the trauma patient who has not been typed and crossmatched?
Type O Neg
104
How does fluid shift in the 1st 24 hours (early) in the burn patient?
Increased microvascular/capillary permeability
Shift of fluid from the intravascular space to the interstitial fluid compartment
*Fluid and protein shifts are greatest during the first 6-8 hours
105
What happens to RBCs and Hct early in the burn patient?
RBC are destroyed
| Hct increases d/t rapid loss of plasma volume
106
When does capillary integrity return and colloids remain in the intravascular compartment in the burn patient?
24-48 hours after a burn
*After the first 48 hours, fluid shifts from the interstitial compartment back to the intravascular compartment
107
What is the IV fluid of choice for burn patients?
Crystalloid, LR
| Colloid
108
Careful monitoring of what may guide fluid management following thermal injury?
Hct
109
By what route is most heat lost in the burn patient?
Evaporation
110
Describe the pharmacokinetic and pharmacodynamic changes seen in the burn patient.
Changes in Vd
Changes in extracellular volume - decreased plasma concentration
Changes in protein binding - decreased albumin, increased alpha 1- acid glycoprotein
111
The administration of Sux to a patient with a new burn injury, paraplegia, or upper motor neuron injury should be avoided for what period of time?
B/t the first 24 hours and 24 months after injury
112
Why are patients with 3rd deg burns resistant to the actions of non-depolarizing agents?
of cholinergic nicotinic receptors has greater increased
113
Rule of Nines
```
Head - 9%
UE - 9% each
Anterior trunk - 18%
Posterior trunk - 18%
LE - 18% each
Perineum - 1%
```
114
Hemoglobin saturation by carbon monoxide of more than ___% is toxic.
15%
115
Which 2 organs are most commonly transplanted?
1. Kidney
2. Liver
* 70% of all transplanted organs
116
What is the most predominant cause of death in patient with ESRD? What is the leading cause of death after renal transplantation?
Cardiovascular disease
117
List the 3 states of liver transplantation.
1. Preanheaptic (dissection)
2. Anhepatic
3. Reperfusion (neohepatic)
118
What are the 2 most common indications for pacemakers?
1. SSS
| 2. CHB
119
What are the 3 letter identification cods for pacemaker classification?
1. Paced
2. Sensed
3. Response to sensing
120
What is VOO pacing?
Fixed rate asynchronous pacing
121
What should be done first if the patient's pacemaker fails intra-op?
Increase the inspired O2 to 100%
122
What antidysrhythmics can cause pacemaker failure?
Verapamil or a beta blocker can decrease the excitability of the cardiac cell so the cardiac cell does not respond to the pacemaker
123
What electrolyte and acid-base abnormalities can cause decrease cardiac excitability and prevent ventricular capture of the pacemaker's impulse?
Hypokalemia
Hypercalcemia
Respiratory alkalosis
124
Are standard polyvinyl chloride (PVC) ETTs flammable?
Yes
| Red rubber tubes wrapped in reflective metallic tape, silicone tube - other options
125
Name 2 concerns for laser surgery in the airway.
1. Airway fire
| 2. Retinal damage
126
Identify 2 types of acquired immunity.
1. Humoral (B lymphocyte)
| 2. Cell-mediated (T lymphocyte)
127
Which lymphocytes are the source of Ig?
Mature B lymphocyte plasma cells
| Ig account for approx. 20% of total serum proteins
128
Anaphylactic Reaction
| aka Type I hypersensitivity reaction
Antigen-antibody (IgE) reaction
IgE attach to mast cells, if re-exposed mast cells release their contents
1st signs - vasodilation, hypotension, tachycardia
Then - itching, bronchospasm, circulatory collapse
129
Anaphylactic vs. Anaphylactoid Reaction
Anaphylactoid - does NOT involve IgE
Clinically indistinguishable
Equally life-threatening
130
What are the 2 cells that provide endogenous histamine and heparin?
1. Mast cells
| 2. Basophils
131
List the top 5 causative agents involved in anaphylactic reactions during anesthesia.
1. Neuromusclar blocking agents (60%) - *Sux
2. Latex (17%)
3. Antibiotics (15%)
4. Colloids (4%)
5. Hypnotics (3-4%) - *Propofol, thiopental, versed
132
Heat loss from the body is mostly due to...
Radiation (40%)
Convection (30%)
Evaporation (major route in burn pt)
Conduction
133
For each 1 deg C decrease in temp, metabolism decreases by what %?
7%
134
Where are the centers for regulating temperature found?
Hypothalamus
135
Hypothermia is associated with the following...
```
Brady, PVCs, VFib
Increased SVR
Decreased CO
Increased blood viscosity
L. shift in the oxyhgb curve
Impaired coagulation
Thrombocytopenia
Decreased elimination of drugs
Shivering increases O2 demand by 400%
```
136
What endocrine disorder is associated with small cell lung carcinoma?
SIADH
| Lambert-Eaton Syndrome
137
When is Ketorolac contraindicated?
```
PUD or GI bleed
Cerebral vascular bleed
Risk for bleeding
Renal failure or risk for renal failure
Labor and delivery
Receiving ASA or NSAIDS
Allergy to ASA or NSAIDS
```
138
List 5 CV effects of histamine.
1. Relaxes smooth muscle - decrease BP
2. Increase capillary permeability - edema
3. Positive inotropic effect
4. Positive chronotropic effect
5. Stimulate adrenal medulla to release NE and Epi
139
Highly sensitive diagnostic test...
SnNout
| Disease can be ruled OUT if patient is NEG by the test
140
Highly specific diagnostic test...
SpPin
| Disease can be ruled IN if patient is POS by the test
141
What is the Bronsted-Lowry theory?
Acid is a proton donor
| Base is a proton acceptor
142
What is the name for 2 optical isomers mixed together in a solution?
Racemic solution
143
For monitored anesthesia care, is a continuous infusion or intermittent bolus dosing superior?
Continuous infusions
144
After conscious sedation, how long before full/complete recovery of psychomotor/cognitive function?
24-72 hrs
145
What local anesthetics can be used for sensory analgesia with little motor blockade?
0.125- 0.5% bupivacaine
0.2% ropivacaine
1% lidocaine
1% mepivacaine
146
TENS is used for nociceptive or neuropathic pain?
Neuropathic
147
When is controlled/deliberate hypotension indicated?
What is the most reliable agent to elicit deliberate hypotension?
What are the acceptable ranges for SBP and MAP in a normotensive patient?
Major orthopedic procedures
Radical cancer operations
Head and neck surgery
Procedures on the cranium and middle ear
Sodium nitroprusside - rapid and consistent
SBP 80-90, MAP 50-65
148
In the conscious or lightly anesthetized patient who is hypoxic, are respirations increased or decreased?
Increase both frequency and TV
149
List the 3 most common causes of delayed awakening in the PACU.
1. Prolonged action of anesthetic drugs
2. Metabolic causes - hypo/hyperglycemia, disturbances in Na, K, and Ca levels
3. Neurologic injury
150
What is the most common cause of hypoxemia following general anesthesia?
Increased intrapulmonary shunting from a decreased FRC relative to closing capacity
151
What is the most common anesthetic complication requiring hospital admission after out-patient surgery?
PONV
152
What are the 2 most common reasons for delayed discharge?
1. Excessive post-op pain
| 2. PONV
153
What is the best indicator of fluid status in the patient who has been NPO for 24 hours?
Urine output
154
A thyromental distance
6 cm
155
Allen's Test
| What does a positive Allen's test indicate?
Adequate collateral flow from the ulnar artery
* Negative Allen's test is a relative contraindication to Aline
- This test has not been shown to be of any value
156
Possible Risk for Latex Allergy
Children with spina bifida
Food allergies - avocados, bananas, chestnuts, stone fruits
Frequent exposure to latex
157
Patient has an allergy to soy and soy products. What is your concern?
Possible propofol allergy
158
As a rule of thumb, most herbal medications should be d/cd for a min of...
What is the exception?
2 weeks prior to surgery
Ephedra - 24-36 hrs prior
159
What is the most critical factor for determining heat loss during surgery?
Most adult patients remain normothermic when OR temp is above what value?
OR temp
23 deg C (Infants 26 deg C)
160
What are the concentrations of Na, Cl, K, Ca, and lactate in LR?
```
Na - 130
Cl - 109
K - 4
Ca - 3
Lactate - 28
```
161
Hetastarch
Duration of action?
Max dose?
24-36 hrs
20 mL/kg/day
*May increase serum amylase levels
162
What fluid is used to correct free water deficit in normovolemic or hypovolemic hypernatremia?
D5W
163
What is the most frequent infection associated with blood transfusion?
Viral hepatitis - Hep B or C*
*Cryo is most likely to transmit hepatitis b/c it is pooled
164
What is the most common virus transmitted with blood transfusions?
Cytomegalovirus
165
Banked blood is devoid of what 4 things?
1. Plts
2. Factor 5
3. Factor 8
4. 2,3-DPG
166
Banked blood accumulates what 4 things?
1. CO2
2. Lactate
3. K
4. Hgb
167
It is always mandatory to administer blood through a filter of what size?
170 micron filter
168
What signals a febrile reaction during a blood transfusion?
An increase in temp > 1 deg C
169
What is the most common adverse reaction to blood transfusion?
Febrile reaction
170
What can happen after vast quantities of stored blood are rapidly infused? What electrolyte imbalance?
Citrate toxicity
Hypocalcemia - > 500 mL/min, > 20 units/hr
Metabolic alkalosis - metabolism of citrate to bicarbonate
171
What is the first sign of hemolytic reaction in the anesthetized patient?
Appearance of free hgb in the urine
| Hematuria
172
What are the classic signs of hemolytic reaction in an awake patient?
Chills
Fever
Chest and flank pain
Nausea
173
What is the legal term for administration of an anesthetic to an unwilling patient?
```
Battery
Intentional tort (civil wrong)
```
174
Define libel and slander.
Libel - defamation by written means
| Slander - defamation by verbal means
175
What is the term used for the hospital being responsible for the CRNA?
Respondeat superior
176
Define negligence.
Failure to use reasonable care
177
What is the most common cause of malpractice claims against anesthesiologists?
Tooth damage
178
Under which class of laws does the CRNA practice?
Common law
| Civil law
179
Define res ipsa loquitur.
"The thing speaks for itself"
180
If a patient awakens with peripheral nerve injury in a body region unrelated to surgery, what legal doctrine applies?
Res ipsa loquitur
181
The most frequent lawsuit involves what perioperative incident?
Inadequate ventilation/oxygenation
182
Define proximate cause.
Cause that was foreseeable before the event took place
