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Flashcards in Monitoring in Special Locations Deck (33):
1

Where could we monitor in non-OR locations? (6)

Radiology
Interventional radiology
Cardiology
Endoscopic Clinic
ER
Electroconvulsive therapy (ECT) --need NMB!

2

What monitors do you need in special locations?

All standard monitors

ECG
BP
Resp
Temp
Twitch

3

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

4

What are pre-anesthesia checks that need to be made? (7)

  • Reliable source of O2 and backup
  • Suction
  • 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)

5

What do you need during electroconvulsive therapy? (3)

Hypnotic
NMB
Airway/bite block

6

What are mild reactions to contrast dye? (6)

Nausea
Warmth
Headache
Rash
Urticaria
Urination

7

What are severe reactions to contrast dye? (10)

Vomiting
Rigors
Faintness
Chest pain
Severe urticaria
Bronchospasm
Chest pain
Abdominal pain
Arrhythmias
Renal failure

8

What are life threatening reactions to contrast dye?

Glottic edema
Pulmonary edema
Life threatening arrhythmias
Cardiac arrest
Seizures/unconsciousness

9

What is special to know about intervential aneurysm coiling?

pt must be 100% relaxed

10

In MRI, where do you place the twitch monitor?

on the foot

11

What's this?

Open MRI

12

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

13

What are major problems with MRI rooms?

High fixed magnetic field always on

High power pulse radio frequency used during scanning

14

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!

15

What is the white stripe on the floor of a MRI room mean?

30 - 50 Gauss line

16

How far must you be away from the MRI?

7- 8 feet, 10 to be safe

17

What will have a projectile effect in MRI? 

  • Gas tanks 
  • Scissors
  • Hair pins

 

18

What will have a twisting effect in MRI?

  • Aneurysm clips
  • cochlear implants

19

What will cause burns in the MRI?

  • tattoos (iron)
  • ECG wires
  • pulse ox cable

20

What will cause image artifact in MRI?

All metals produce voids
Other equipment produce noise

21

What will cause device malfunction (4)

PCA pumps
Pacemakers
Ventilators
ECG morphology
 

22

What metals are OK in the MRI?

silver
gold
 

23

What will cause this morphology?

MRI

24

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?

True 

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

25

You may not have an MRI if you have: (10)

Pacemaker
Neurostimulator
Metal clips in your eyes
Implanted port device
IUD
Metal plate, pins, screws or surgical staples
Retained bullets
Any other large metal objects.

26

ECG monitoring of what leads minimize artifact?

V5 and V6

27

What monitors are not affected by MRI?

What is?

  • BP
  • Capnography
  • Liquid crystal temp strips used only!

 

  • Pulse ox special probes need to be used in MRI (fiber optic)
  • computer based monitoring system
  • telemetry systems

28

What kind of electrodes minimize interference?

carbon

29

What ventilators are gas powered?

fluidic

30

What is the name of MRI patient monitor?

inVivo

31

Temperature of pt may fluctuate while pt is in MRI. True or false?

True, heating by magnet field and cooling by the AC.

32

What must the gas cylinder be made of to be used in MRI?

Aluminum, or non-ferrous.

33

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