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Spring '20/ L. Basic's Test 3- OP, EENT, OR Hazards > OR HAZARD & ANESTHESIA AWARENESS > Flashcards

OR HAZARD & ANESTHESIA AWARENESS Flashcards

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1
Q

WHAT IS ONE OF THE BIGGEST PATIENT FEARS

A

INTEROPERATIVE AWARENESS

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2
Q

MEMORY:EXPLICIT

A

CONSCIOUS MEMORY
CONSCIOUS RECOLLECTION OF PREVIOUS EXPERIENCES: EQUIVALENT TO REMEMBERING.
AWARENESS DURING ANESTHESIA DESCRIBES CONSCIOUS RECALL (EXPLICIT MEMORY) OF INTRAOPERATIVE EVENTS

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3
Q

MEMORY IMPLICIT

A

UNCONSCIOUS

PATIENTS CAN RESPOND TO TO COMMANDS AND LACK CONSCIOUS RECALL OF INTRAOPERATIVE EVENTS (IMPLICIT MEMORY)

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4
Q

INTERVIEWING PATIENTS, CAN THEIR MEMORY BE DELAYED?

A

MEMORY FORMATION FOR INTRAOPERATIVE AWARENESS MAY BE DELAYED BEYOND IMMEDIATE RECOVERY PERIOD

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5
Q

HOW MANY AWARENESS CASES WERE IDENTIFIED PRIOR TO LEAVING THE HOSPITAL

A

1/3 OF CASES

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6
Q

WHAT ARE SOME FACTORS THAT WOULD INHIBIT PATIENTS FROM READILY VOLUNTEERING INFORMATION

A

PATIENT MAY NOT VOLUNTARILY REPORT AWARENESS D/T EMBARRASSMENT OR WAS NOT DISTURBED BY THE EXPERIENCE

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7
Q

HOW DO WE ASK IF THEY EXPERIENCED AWARENESS

A

WHAT IS THE LAST THING THEY REMEMBER, WHAT DO THEY REMEMBER?

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8
Q

QUESTIONS TO EVALUATE AWARENESS (5)

A

WHAT WAS THE LAST THING YOU REMEMBER BEFORE GOING TO SLEEP?
WHAT IS THE FIRST THING YOU REMEMBER AFTER YOUR OPERATION?
CAN YOU REMEMBER ANYTHING IN BETWEEN?
CAN YOU REMEMBER IF YOU HAD ANY DREAMS DURING YOUR PROCEDURE?
WHAT AS THE WORST THING ABOUT YOUR PROCEDURE?

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9
Q

INCIDENCE OF AWARENESS IN SWEDEN

A

PROSPECTIVE STUDIES IN SWEDEN: 12,000 PATIENTS = 0.18% (18/10,000) HAD AWARENESS UNDER GENERAL WHERE NMBD WERE USED

  1. 10% (10/10,000) ABSENT NMD
  2. 13% (13/10,000) OVERALL INCIDENCE
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10
Q

INCIDENCE IN U.S. OF AWARENESS

A

1/1000 PATIENTS HAVE AWARENESS

PATIENTS WITH COEXISTING MORBIDITIES TEND TO HAVE MORE FREQUENT INCIDENCE OF AWARENESS.

RISK FOR OPERATIVE AWARENESS GREATER FOR OB AND CARDIAC ANESTHESIA WHERE ANESTHESIA MAY BE LIGHT

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11
Q

3 MAJOR CAUSES OF AWARENESS

A

LIGHT ANESTHESIA

INCREASED PATIENT ANESTHESIA REQUIREMENTS

ANESTHETIC DELIVERY PROBLEMS

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12
Q

LIGHT ANESTHESIA-

name two surges that have light anesthesia

why might doses be reduced

A

REDUCED ANESTHESIA USUALLY DUE HEMODYNAMIC INTOLERANCE OF ANESTHETIC DRUGS

OB OR CARDIAC SURGERIES

REDUCED ANESTHETIC DOSES MAY BE NECESSARY FOR OPTIMAL PHYSIOLOGY AND SAFETY IN HYPOVOLEMIC PATIENTS OR THOSE WITH LIMITED CARDIAC RESERVE

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13
Q

Which asa range have more frequent incidence of awareness

A

ASA 3-5 UNDER GOING MAJOR SURGERY HAVE MORE FREQUENT INCIDENCE OF AWARENESS.

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14
Q

INCREASED PATIENT ANESTHESIA REQUIREMENTS- DRUGS

A

ABUSE OF ETOH; OPIOIDS; AMPHETAMINES AND COCAINE MAY REQUIRE INCREASE ANESTHETIC DOSING

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15
Q

DO GENETICS PLAY A ROLE IN INCREASE PATIENT ANESTHESIA REQUIREMENTS

A

GENETICS MAY PLAY A ROLE

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16
Q

LIKELY TO HAVE AWARENESS (4)

A

IMPAIRED CARDIOVASCULAR STATUS

UNDERGOING EMERGENCY SURGERY

RECEIVE SMALLER DOSES OF VOLATILE ANESTHETICS

TECHNICAL DIFFICULTIES

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17
Q

WHAT MAC DOSE IS USED TO PREVENT CONSCIOUS RECALL

A

A 0.7 MAC OR ABOVE PREVENT CONSCIOUS RECALL

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18
Q

WHAT CAN MASK AWARENESS FOR THE ANESTHESIA PROVIDER

A

NMBD

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19
Q

WHEN IS ANESTHETIC AWARENESS LESS LIKELY TO OCCUR USING WHAT DRUG?

A

VOLATILE ANESTHETICS

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20
Q

WHAT DRUGS ARE THEIR INCREASED AWARENESS

A

NITROUS AND INTRAVENOUSLY ADMINISTERED ANESTHETICS

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21
Q

ANESTHETIC DELIVER PROBLEMS (3)

A

EQUIPMENT PROBLEMS WITH VAPORIZERS

IV DEVICES NOT WORKING

ANESTHESIA MACHINE PROBLEMS

THESE ISSUES ARE USUALLY LESS COMMON REASONS FOR AWARENESS

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22
Q

PSYCHOLOGICAL SEQUELAE- WHAT CAN AWARENESS MANIFEST INTO?

A

~ 1/3 PATIENTS EXPERIENCING AWARENESS WILL MANIFEST IN LATE PSYCHOLOGICAL SEQUELAE

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23
Q

WHAT DO MOST PATIENTS OFTEN RECALL

A

LIGHTS, SOUND, FEELINGS OF HELPLESSNESS, FEAR, ANXIETY

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24
Q

IS PAIN A COMMON AWARENESS COMPLAINT?

A

IT IS LESS COMMON BUT MAY OCCUR WHEN NMBD ARE GIVEN

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25
TELL ME ABOUT AWARENESS AND PTSD
CAN DEVELOP PTSD INTERFERING WITH INTERPERSONAL RELATIONSHIPS AND DAILY LIVING
26
CAN REGIONAL ANESTHESIA AND MAC CREATE PHYSOLGICAL ISSUES
PSYCHOLOGICAL ISSUES MAY BE PRESENT DURING REGIONAL ANESTHESIA AND MAC
27
ACUTE EMOTIONAL REACTION TO AWARENESS CAN DO WHAT?
AN ACUTE EMOTIONAL REACTION TO THE EXPERIENCE SIGNIFICANTLY PREDICTED THE DEVELOPMENT OF LATE PSYCHOLOGICAL SEQUELA
28
SIDE EFFECTS OF AWARENESS
FLASHBACKS, ANXIETY, NERVOUSNESS, LONELINESS, NIGHTMARES, FEAR, PANIC ATTACKS
29
TREATMENT FOR AWARENESS
EARLY PSYCHOTHERAPEUTIC THERAPY MAY REDUCE POTENTIAL OF ACUTE AND LONG TERM PSYCHOLOGICAL SEQUELAE.
30
AS ANESTHESIA PROVIDERS HOW DO WE APPROACH PATIENTS FEELINGS IN REGARD TO AWARENESS
AN EXPLANATION OR VALIDATION OF THE AWARENESS MAY EFFECT PRESENCE AND DURATION OF PSYCHOLOGICAL CONSEQUENCES.
31
WHAT REPORTING IS THERE FOR AWARNESS
A REGISTRY EXIST WHERE PATIENTS CAN REPORT EXPERIENCES AND OTHERS CAN LEARN MORE ABOUT PATIENTS’ EXPERIENCES
32
HOW TO DO PREP PATIENTS FOR SURGERY AND THEIR CONCERNS FOR AWARENESS
IMPORTANT TO TALK TO YOUR PATIENTS ABOUT THE ANESTHESIA PROCEDURE LET THEM KNOW WHAT TO EXPECT. LISTEN TO FEARS AND ANSWER QUESTIONS LET THEM KNOW WHAT TO EXPECT WITH A MAC CASE OR A REGIONAL WITH SEDATION (MAC). ALWAYS LET THEM KNOW THEY WILL GET PAIN MEDICINE AND N/V MEDS WHILE ASLEEP AND CAN HAVE MORE IF NEEDED WHEN AWAKE IN PACU
33
BIS (BISPECTRAL INDEX SYSTEM):
MAY SEE IN MANY OR’s TODAY. MYLES ET AL. PERFORMED RCT n= 2500 pts. AT HIGH RISK FOR AWARENESS. IMPORTANT TO REALIZE THAT IF ONE ADDITIONAL PT HAD HAD RECALL IN THE BIS GROUP, IT WOULD HAVE NO LONGER BEEN SIGNIFICANT. THEREFORE, THERE IS NO REAL “GOLD STANDARD” FOR AWARENESS.
34
MORE BIS STUDIES
EKMAN ET AL. : PROSPECTIVE COHORT STUDY: n= 5027 PTS COMPARED WITH HISTORICAL GROUP n= 7826. BIS WAS USED TO GUIDE ANESTHESIA ADMINISTRATION. DEMONSTRATED ONCE AGAIN IF 1 MORE IN BIS GROUP AND 1 LESS IN THE HISTORICAL GROUP REPORTED AWARENESS, THE DIFFERENCE WOULD NOT BE STATISTICALLY SIGNIFICANT. MAY HAVE HAD A HAWTHORNE EFFECT
35
MORE BIS STUDIES
AVIDAN ET AL.: RANDOMLY ASSIGNED PATIENTS TO BIS (n = 967) OR ETCO2 GROUP (n = 974) FOUND NOT DIFFERENCE IN THE INCIDENCE OF DEFINITE AWARENESS IN BOTH GROUPS (2 EACH). SEBEL ET AL.: PROSPECTIVE NONRANDOM COHORT (n = 19,575). BIS WAS MONITORED IN 38% OF THE PATIENTS AND NO DIFFERENCE IN AWARENESS INCIDENCE WAS FOUND.
36
AWARENESS PREVENTION PREMEDICATION
BENZO (ANTEGRADE AMNESIA)
37
AWARENESS PREVENTION INDUCTION DRUGS?
ADEQUATE DOSES OF DRUGS FOR INDUCTION
38
AWARENESS PREVENTION WHAT MED SHOULD WE AVOID UNLESS NECESSARY
AVOID MUSCLE PARALYSIS UNLESS NECESSARY
39
VOLATILE GASES SHOULD BE AT LEAST WHAT MAC
0.7
40
ANESTHESIA AWARENESS DOES NOT NECESSARILY =
LAW SUIT
41
1 OUT OF HOW MANY INJURIES RESULTED IN MALPRACTICE CLAIMS
1 OUT OF 25 INJURIES FROM NEGLIGENT CARE RESULTS IN MALPRACTICE CLAIMS AND FEWER CLAIMS WHEN STANDARD OF CARE WAS DELIVERED.
42
HOW MANY YEARS LATER CAN SOMEONE MAKE A CLAIM FOR AWARENESS
UP TO 10 YEARS
43
CLOSED CLAIMS DATA
DATABASE CAPTURES CLAIMS FROM LIABILITY INSURERS WHICH COVER 1/3 OF U.S. ANESTHESIOLOGIST
44
FACTORS INFLUENCE PATIENT SUITS (3)
POOR COMMUNICATION UNMET EXPECTATIONS FINANCIAL PRESSURES ON PATIENT
45
WHEN DO ELECTRICAL SHOCKS OCCUR
OCCURS WHEN A PERSON BECOMES PART OF OR COMPLETES AN ELECTRICAL CIRCUIT.
46
WHAT DOES THE BOVIE HAVE THE POTENTIAL TO INTERFERE WITH
PULSE OX AND PACEMAKERS
47
WHAT CAN A BOVIE CAUSE INTERFERENCE WITH
EKG MONITORING
48
WHAT IS THE CONCERN WITH BOVIE AND ANESTHETICS AGENTS
HASTENED END OF EXPLOSIVE ANESTHETICS AGENTS
49
WHO INVENTED THE BOVIE
1926 W.T. BOVIE
50
WHAT CARDIAC RHYTHM DOES THE BOVIE HAVE THE POTENTIAL TO CAUSE
V-FIB WITH A STRAY WHEN FIRST ACTIVATED OF 50-60 HZ RANGE
51
3 COMPONENTS OF A FIRE
IGNITION SOURCE (SURGEON, BOVIE) FUEL (NURSE, PREP) ANESTHESIA (OXIDIZER/02)
52
TOXICANTS
PRODUCTS OF COMBUSTION LESS OBVIOUS BUT POTENTIALLY MORE DEADLY RISK INJURIOUS PRODUCTS FROM BURNING MATERIALS SUCH AS PLASTICS AND OTHER MATERIAL C02 AMMONIA HYDROGEN CHLORIDE CYANIDE
53
INJURIES FROM TOXICANTS
AIRWAY TISSUE LUNG TISSUE ASPHYXIA
54
WHAT IS THE CONCERN REGARDING OR FIRES AND SPRINKLER DETECTION
OR FIRES CAN PRODUCE LARGE AMOUNTS OF SMOKE BEFORE SPRINKLERS DETECT FIRE BY HEAT ACTIVATION THEREFORE EVACUATION ASAP NEEDS TO BE PRIORITY
55
TYPE 1 OR FIRE
IN or ON THE PATIENT IS THE MOST COMMON
56
TYPE 1 HIGH RISK PROCEDURES
``` HIGH RISK PROCEDURES IN WHICH AN IGNITION SOURCE IS USED IN AN OXIDIZER-RICH ENVIRONMENT ET FIRES OROPHARYNX DURING T&A FIRES IN BREATHING CIRCUIT FIRES DURING LAPAROSCOPY ```
57
FIRES ON PATIENTS: WHAT body parts do they involve
HEAD AND NECK OF PATIENT
58
WHAT TYPE OF ANESTHESIA ARE WE MOST CONCERNED WITH PATIENTS CATCHING FIRE
REGIONAL OR MAC WHEN PATIENT IS RECEIVING HIGH FLOWS OF SUPPLEMENTAL 02
59
WHAT ARE ITEMS THAT CAN BE READILY IGNITED AND PRODUCE SEVERE BURNS
SURGICAL TOWELS, DRAPES AND BODY HAIR CAN BE READILY IGNITED AND PRODUCE SEVERE BURNS
60
WHAT IS THE MAIN CONCERN WITH OXYGEN RICH ATMOSPHERES AND FIRE
OXYGEN RICH ATMOSPHERES LOWER THE TEMPERATURE AT WHICH A FUEL WILL IGNITE THESE FIRES WILL BURN MORE VIGOROUSLY AND SPREAD FASTER
61
FIRE CASE: KATZ & CAMPBELL (2005): FIRE DURING THORACOTOMY. DRY LAP CAUGHT FIRE B/C 100% 02 PRESENT IN THORACIC CAVITY WHILE USING ELECTROCAUTERY.
KATZ & CAMPBELL (2005): FIRE DURING THORACOTOMY. DRY LAP CAUGHT FIRE B/C 100% 02 PRESENT IN THORACIC CAVITY WHILE USING ELECTROCAUTERY.
62
WHAT PULMONARY CASES ARE THE MOST CONCERN FOR FIRE
CASES INVOLVING STRIPPING OF THE PLEURA OR RESECTION OF PULMONARY BLEBS, CAN EASILY RESULT IN HIGH CONCENTRATIONS OF O2 IN THE CAVITY WHEN LUNG IS REINFLATED DUE TO GAS LEAKAGE
63
SOLUTION TO PREVENT FIRE WHEN SURGEON NEEDS LUNG INFLATED
IF SURGEON NEEDS LUNG INFLATED, DO IT WITH CPAP WITH AIR INSTEAD OF O2
64
SOLUTION TO PREVENT FIRE IN 02 RICH ENVIRONMENTS
WET LAPS IN 02 RICH ENVIRONMENTS
65
TYPE 2 FIRE
REMOTE FROM PATIENT
66
EXAMPLES OF TYPE 2 FIRES
PIECE OF EQUIPMENT CO2 ABSORBER ALL MATERIALS BURN IN A HIGH O2 ENRICHED ENVIRONMENT: THE HIGHER THE CONCENTRATION OF O2 THE MORE READILY MATERIALS CATCH FIRE:
67
COTTON HUCK TOWEL: 21% 02 - ignition mean?
21% 02: IGNITION MEAN 12 SECONDS
68
COTTON HUCK TOWEL: at 95% 02 ignition mean
95% IGNITION MEAN 0.1 SECONDS
69
ENDOTRACHEAL TUBE FIRE
DEVASTATING O2 AND OR N2O WILL PRODUCE A BLOWTORCH TYPE OF FLAME RESULTS IN SEVERE INJURY TO TRACHEA, LUNGS, AND SURROUNDING TISSUES.
70
UNCUFFED ETT FOR CHILD HAVING A T&A | WHAT IS THE FIRE CONCERNS?
SURGEON USES LASER TO CAUTERIZE TONSIL BED WHAT COULD HAPPEN? WHAT CAN YOU DO TO PREVENT OR DECREASE THE RISK?
71
WHAT PRECENT OF SURGICAL FIRES ARE 02 ENRICHED.
MAJORITY OF OR FIRES OCCUR WITH MAC DURING HEAD AND NECK SURGERY 75% OF SURGICAL FIRES ARE O2 ENRICHED IDEA TO USE <30% O2 IF POSSIBLE. IF NOT CAN ADD ROOM AIR TO REDUCE CONCENTRATION OR CONSIDER LMA/ETT
72
WHAT IS THE FIRE RISK FOR SURGICAL PREPS
SOME NEWER SURGICAL PREPS CONTRIBUTE TO FIRES
73
HOW DO THESE PREP COMES PACKAGED? WHAT OTHER THINGS CONCERN US?
THESE SOLUTIONS TYPICALLY COME PRE-PACKAGED WITH A PAINTING STICK APPLICATOR WITH A SPONGE ON THE END (ex. DuraPrep) IODOPHOR MIXED WITH 74% ISOPROPYL ALCOHOL THUS HIGHLY FLAMMABLE. 4-5 MINUTES TO DRY COMPLETELY! BEWARE OF POOLS OF SURGICAL PREP WHAT ISSUE MAY ARISE WITH A LONG DRYING TIME?
74
IS SEVO FLAMMABLE
SEVOFLURANE IS VOLATILE (AT ROOM TEMP LIQUID VOLATIZES INTO A VAPOR) BUT CONSIDERED “NONFLAMMABLE”
75
TELL ME WHEN SEVO AND NITROUS SERVES AS FUEL
HOWEVER SEVO IS NONFLAMMABLE IN AIR BUT CAN SERVE AS FUEL AT CONCENTRATIONS AS LOW AS 11% O2 AND 10% NITROUS OXIDE
76
WHAT CHEMICAL REACTION DOES SEVO UNDERGO
SEVO CAN UNDERGO EXOTHERMIC CHEMICAL REACTION WITH DESICCATED CO2 ABSORBER (SODA LIME OR BARALYME)
77
MANUFACTURERS OF SEVO SUGGEST REGARDING CO2 ABSORBERS
AVOID DESICCATED CO2 ABSORBENTS; MONITOR TEMP OF ABSORBERS AND INSPIRED SEVO CONCENTRA TION. SUDDEN UNEXPECTED INFLUX OF SEVO INHALATION REMOVE CIRCUIT AND ASSESS FOR THERMAL OR CHEMICAL INJURIES
78
WHAT TYPE OF ABSORBENTS MUST WE USE
USE ABSORBENTS THAT DO NOT CONTAIN STRONG ALKALI. EXAMPLE AMSORB CONTAINS CALCIUM HYDROXIDE AND CALCIUM CHLORIDE AND NO STRONG ALKALI.
79
AMSORB
UNREACTIVE WITH CURRENTLY USED VOLATILE ANESTHETICS DOES NOT PRODUCE CARBON MONOXIDE OR COMPOUND A WILL NOT INTERACT WITH SEVO AND UDERGO AN EXOTHERMIC CHEMICAL REACTION
80
WHAT DO I DO? FOR AIRWAY FIRE
FRESH GAS DELIVERY MUST BE STOPPED: ACCOMPLISHED BY TURNING OFF FLOWMETERS, DISCONNECTING THE CIRCUIT FROM MACHINE, OR DISCONNECTING THE CIRCUIT FROM THE ETT REMOVE ETT M/M (P. 24) SAYS THE ORDER IS NOT AS IMPORTANT AS THE FACT THAT BOTH ARE DONE IMMEDIATELY IF NOT AT THE SAME TIME. WHAT DO YOU THINK? STERILE WATER OR SALINE INTO AIRWAY TO EXTINGUISH ANY BURNING EMBERS RESUME VENTILATION OF PATIENT WITH AIR (PREFERABLY) AVOID O2 AND NITROUS EXAMINE TUBE FOR MISSING PIECES AIRWAY RE-ESTABLISHED CONSIDER BRONCHOSCOPE TREAT FOR SMOKE INHALATION AND POSSIBLE TRANSFER TO BURN CENTER
81
closed claim project found 2.6% of awareness during ga were demographic? asa? age? class of procedure?
female asa 1 or 2 elective procedure less than 60 yrs
82
how do you supply ungrounded power to the OR
use of an isolation transformer
83
is there a direct electrical connection between the power supplied form the utility company on primary side and the power induced by the transformer on the ungrounded side or secondary side?
no direct connection
84
is power isolated from the ground in the OR why is that
Yes
85
faulty equipment into an ips
no shock hazard- just converts the isolated power to conventional grounded power.
86
line isolation monitor what is it monitoring
monitors the integrity of the IPS (isolation transformer)
87
if a faulty piece of equipment is plugged in- the IPS becomes grounded- what detects that
Line isolation monitor
88
what is the LIM set to alarm at
2-5mA
89
when one faulty piece of equipment is plugged in is it a dangerous situation?
means its not totally isolated from the ground anymore - - it requires a second fault to be dangerous. a second piece of equipment that is faulty would then create a dangerous shock. if several piece of equipment have a leak it can cause the LIM to go off.

Spring '20/ L. Basic's Test 3- OP, EENT, OR Hazards (8 decks)

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