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Sp: Sim Lab 1 > Session 11 > Flashcards

Session 11 Flashcards

1
Q

normal induction sequence (3)

A

pre-op
induction
extubation

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2
Q

8 phases of induction

A

anxiolysis
pt to room/table
monitors attached
pre-oxygenated
anesthetic time out
induction
airway management
prepare for incision

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3
Q

anxiolysis

A

fear

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4
Q

anxiolysis medications

A

versed (1-2mg up to 4mg)
fentanyl (25-50mcg)

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5
Q

versed should not be given to

A

elderly pts
progresses dementia/alzheimers

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6
Q

move to operating table

A

do not let IV get pulled out

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7
Q

move to operating table steps

A
  1. untie knots
  2. lock gurney and table
  3. pt move over
  4. ensure pt doesnt move too far
  5. secure pt w/belt
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8
Q

monitors

A

1) NIBP (3-5 min inter)
2) EKG (5 lead std)
3) pulse ox (iv arm ring)
4) temp
5) capnography (tight seal on mask, have pt exhale forcefully)
6) O2 analyzer (w/cap)
7) PNS (post induction)

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9
Q

Pre-Oxygenation

A

flush out nitrogen in alveoli

maximally saturate the hemoglobin/blood w/O2

denitrogenation

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10
Q

Situations where hypoxia can quickly occur

A
  • supine obese pts
  • sedation (drug induced)
  • paralysis
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11
Q

PreOx Method: Tidal Volume Ventilation

A

*most effective
vol of air inhaled and exhaled w/normal breathing

3+ mins w/good seal

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12
Q

PreOx Method parameters

A

FiO2 100%
O2 10-12L/min
open APL valve
facemask seal

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13
Q

PreOx Method: Vital Capacity Ventilation

A

max vol of gas that can be exhaled following maximal inspiration

4 breaths over 30 sec
or
8 breaths over 60 sec

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14
Q

PreOx issues

A

claustrophobic pts

blow by technique w/higher %O2
or
have pt hold mask

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15
Q

How do we confirm pre-Ox successful?

A

EtO2 > 85%

SpO2 (not perfect measurement)

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16
Q

Anesthesia Time Out Steps (8)

A
  1. Name/Dob/Surgery
  2. allergies
  3. pre-op meds/proceds
  4. Plan
    • general vs MAC
    • LMA vs ETT
  5. suction, O2, monitors, vaporizers
  6. Additional procedures
  7. sequential compression devices
  8. misc items
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17
Q

induction overal steps (14)

A
  1. Pt head tilt/chin lift
  2. give meds
  3. confirm asleep verbal
  4. eyelid reflex test
  5. test ventilate
  6. tape eyes
  7. paralytic
  8. DL or LMA
  9. Ventilator
  10. Volatile agent
  11. reduce fresh gas flw
  12. tem p probe/PNS
  13. Position accordingly
  14. warming device
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18
Q

how to speed up induction speed

A

increase %
increase FGF
increase RR or TV (increase minute vent)

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19
Q

additional procedures to perform post inductions

A

PIV
A Line
Central Line
Foley
Block

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20
Q

sequential compression device prevent

A

DVT

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21
Q

common induction medications

A

fentanyl
lidocaine
propofol

rocuronium(post reflex check)

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22
Q

fentanyl onset

A

3-7 mins

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23
Q

fentanyl alleviates

A

alleviates sympathetic response to intubation

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24
Q

lidocaine induction effect

A

helps attentuate sting of propofol

lg doses reduce airway reflexes

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25
lidocaine mechanism
Na+ antagonist blocks nerve impulses
26
propofol effect
stings high-lipid solubility == fast speed
27
rocuronium onset
90-120 seconds to flow through entire body circulations
28
verbally test pt unconsciousness
ask pt to: take deep breath open eyes etc
29
test eyelid reflex
rub eyelashes
30
test ventilate
Manual Mode checking to see if mask ventilation is possible
31
test ventilate confirmation phrase
"I can mask ventilate this pt, you may paralyze"
32
test ventilation considerations
avoid corneal abrasion CE mask technique
33
if test vent is difficult w/good mask seal
add an oral airway
34
if test vent is difficult w/oral airway
use 2 hand technique ask preceptor/attending to help squeeze bag
35
tape eye process
tape upper eyelid first use tape pulldown seal
36
when do you paralyze
after you confirm that pt is unconscious and that pt can mask ventilate
37
Old drug to reverse rocuronium
neostigmine
38
if reversing Roc w/neostigmine how long do you have to wait to give neostigmine?
30 mins post-Roc
39
what drug immediately reverses rocuronium
suggamadex
40
prepare for incision (8 steps)
IV functioning/drip rate position appropriate muscle paralysis airway/circuit clear vent/flow/agent good monitors/vitals good analgesia adequate antibiotics given
41
RSI
rapid sequence induction (RSI)
42
RSI goal
reduce risk of pulmonary aspiration of gastric content
43
RSI indications (9)
pt not achieved NPO emergency delayed gastric empty pregnant vomiting +/- airway concerns H/O gastric bypass uncontrolled GERD symptom hiatal hernia
44
RSI AKA
rapid sequence induction and intubation (RSII)
45
RSI steps (10)
Equipment ready NG tube suction PreOxygenate Cricoid pressure (10N) Induce Paralyze Cricoid pressure (30N) Intubate (no twitches) Confirm CO2 Release Cricoid
46
what do you skip during RSI?
Do not mask ventilate
47
RSI relative contraindications
avoidance increase ICP avoidance increase BP/HR
48
what can cause ICP
unstable aneurysm
49
Arguments against cricoid pressure
induce lower esophageal sphincter relaxation (vomiting) displace larynx incorrect manipulation induces nausea
50
Modified RSI
need for RSI limitation exist that preclude proper RSI
51
Modified RSI indications
risk of rapid hypoxemia lack of time to pre-ox
52
how is a modified RSI different?
ventilate w/mask prior to intubation
53
what pressure do you ventilate w/during modified RSI?
<20cmH20
54
RSI quick data
pre-oxygenation cricoid pressure avoid mask vent
55
Modified RSI quick data
possibly different NMBD different NMBD timing PPV prior to intubation cricoid pressure timing
56
Induction Overview Steps (16)
pt into OR time "it is 0730" click EMR buttons assist pt to table monitors pre-ox verify/secure ETT/LMA additional procedures position pt confirm monitor/line functioning warming device anesthesia ready Abx (surgeon arrives) Surgical Time Out Surgery begins
57
EMR buttons once pt in OR - St Lukes
anesthesia start in room start data collection
58
EMR buttons once pt in OR - liberty
anesthesia start fill in OR room time auto vital appropriate MACH
59
EMR Pre-Ox buttons - St Lukes
Pt chart reviewed Time out Pre OX
60
EMR Pre-Ox buttons - Liberty
pt evaluated preoxygenation call attending
61
EMR buttons post-ETT - St Lukes
induction RSI/Cricoid Intubation LMA applied
62
EMR buttons post-ETT - Liberty
Induction
63
EMR buttons - anesthesia ready - St Lukes
anesthesia Ready
64
EMR buttons surgery starts - St Lukes
Surgery Starts
65

Sp: Sim Lab 1 (23 decks)

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