Where could we monitor in non-OR locations? (6)
Electroconvulsive therapy (ECT) --need NMB!
What monitors do you need in special locations?
All standard monitors
What are general considerations when monitoring in a special location? (4)
Type of anestheia to be delivered
Relative hazard of environment
Distance of pt from anesthetist
Other factor like electrode interference in MRI
What are pre-anesthesia checks that need to be made? (7)
Reliable source of O2 and backup
Ambu bag able to deliver 90% oxygen
Adequate drugs, supplies
Emergency backup power
Adequate light to see pt, machine, etc.
In any location with inhaled agents, need O2 analyzer, disconnect alarm, oxygen fail safe alarm, scavenging, gas evacuation system, acceptable method of preventing inadvertent mix of gases. (Same as standard OR)
What do you need during electroconvulsive therapy? (3)
What are mild reactions to contrast dye? (6)
What are severe reactions to contrast dye? (10)
What are life threatening reactions to contrast dye?
Life threatening arrhythmias
What is special to know about intervential aneurysm coiling?
pt must be 100% relaxed
In MRI, where do you place the twitch monitor?
on the foot
What is the criteria for equipment use in the MRI?
Magnetic field created by equipment is not dangerous to pt (creating heat)
Make sure equipment functions properly
Equipment has no intrinsic effect on quality of images
What are major problems with MRI rooms?
High fixed magnetic field always on
High power pulse radio frequency used during scanning
What is the strength of MRI?
1.5 - 4.0 Tesla
Earth's magnetic field is 0.5 - 1 Gauss
10,000 Gaus = 1 Tesla!
What is the white stripe on the floor of a MRI room mean?
30 - 50 Gauss line
How far must you be away from the MRI?
7- 8 feet, 10 to be safe
What will have a projectile effect in MRI?
What will have a twisting effect in MRI?
What will cause burns in the MRI?
pulse ox cable
What will cause image artifact in MRI?
All metals produce voids
Other equipment produce noise
What will cause device malfunction (4)
What metals are OK in the MRI?
What will cause this morphology?
Large weakly magnetic objects result in image degradation not magnetic forces on the patient if they are near the region to be scanned. True or false?
Harrington rods, hip protheses
Orthodontic braces and retainers
Bone or joint plates, pins or screws
Joint replacements or protheses
Implanted metal mesh
Body piercing jewelry
Some tattoos, or tattooed eyeliner
You may not have an MRI if you have: (10)
Metal clips in your eyes
Implanted port device
Metal plate, pins, screws or surgical staples
Any other large metal objects.
ECG monitoring of what leads minimize artifact?
V5 and V6
What monitors are not affected by MRI?
Liquid crystal temp strips used only!
- Pulse ox special probes need to be used in MRI (fiber optic)
- computer based monitoring system
- telemetry systems
What kind of electrodes minimize interference?
What ventilators are gas powered?
What is the name of MRI patient monitor?
Temperature of pt may fluctuate while pt is in MRI. True or false?
True, heating by magnet field and cooling by the AC.
What must the gas cylinder be made of to be used in MRI?
Aluminum, or non-ferrous.
What problems may be encountered at remote locations? (6)
Lack of continuous electrical supply
Lack of continuous O2 and N2O
Difficulty storing drugs and equipment
Lack of maintenance equipment
Difficulty in transport of stuff
Lack of skilled help