Session 9: Drawing Meds, Dilutions, Anesthesia Machine and Setup Flashcards
(93 cards)
1
Q
ampule
A
glass vial
requires filter needle to remove glass shards
2
Q
vial
A
plastic topper w/rubber stopper
multi-dose to SAME pt
not sterile under cap (alc swab)
3
Q
where do you swab the ampule
A
around the neck
4
Q
where do you swab the vial
A
rubber stopper after removing cap
5
Q
equipment for medication
A
syringe
needle
filter needle
blunt tip needle
syringe cap
label / marker
alcohol swab
6
Q
syringes
A
regular (slip tip)
luer lock
insulin
7
Q
Every label must have these 5 items
A
Name (trade or generic)
Concentration
Date drawn up
Time drawn up
Initials of who drew it up
8
Q
JCAHO fine for improper med label
A
15,000
9
Q
how long are meds good for after being drawn up?
A
12 hrs
10
Q
Yellow
A
Induction Agents
11
Q
Red
A
Paralytics
12
Q
Blue
A
Narcotics
13
Q
Orange
A
Sedatives
14
Q
Purple
A
Sympathomimetics
15
Q
Green
A
Anti-muscarinic
16
Q
Gray
A
Local Anesthetics
17
Q
Med label colors can
A
change at each hospital
18
Q
swiss cheese model
A
decreases risk of using incorrect med
- multiple levels of checks = less likely that the holes will line up resulting in an error
19
Q
Process to Drawing up Meds
A
- Retrieve med from drawer
- Look/Read/Confirm name/conc
(one vial at a time) - Draw up med
- Reconfirm med and concentration
- Replace need w/syringe cap
- Label appropriately (5 items)
20
Q
Drawing up vials
A
flip plastic top off
wipe top w/alcohol
let dry (sterility)
insert needle
invert vial
inject air
draw up med
21
Q
Drawing up ampule
A
alcohol swap neck
use 4x4 gauze and break neck
use filter needle to draw up
*do not inject air or invert
22
Q
phenylephrine vial
A
10mg/mL
23
Q
phenylephrine bolus
A
100mcg/mL
24
Q
phenylephrin infusion
A
40 mcg/mL
25
Sufenta vial
50mcg/mL
26
sufenta dilution
5 mcg/mL
27
precedex vial
200mcg/2mL
28
precedex bolus
4mcg/mL
or
10mcg/mL
29
precedex infusion
4mcg/mL
30
levophed vial
16mg/4mL
31
levophed bolus
Do not bolus levophed
32
levophed infusion
64mcg/mL
33
regular insulin
use insulin syringe to dose
do not dilute (keep high conc)
34
epinephrine ampule
1:1000 (1mg/mL)
35
epinephrine bolus little Epi
10 mcg/mL
36
epinephrine infusion
4mcg/mL
37
nicardipine vial
25mg/10mL
38
nicardipine dilutions
0.25mg/mL
or 0.1mg/mL
39
ephedrine vial/ampule
50mg/mL
40
ephedrine bolus
5 mg/mL
or
10 mg/mL
41
ephedrine infusion
No infusion dose
42
double dilution
used to go from 1mg/mL to 10mcg/mL
syringe method
IV bag method
43
big epi
100mcg/mL
44
little epi
10mcg/mL
45
syringe method
9mL saline in 10mL syringe
add 1mL of conc. med
** 1/10 of original conc.
9mL saline in NEW 10mL syringe
add 1mL of 1st dilution
**1/100 of original conc.
46
IV bag method
take 1 mL of conc med and put it into 100mL bag of saline
**1/100 of original conc.
47
Factor multiplier
(for IV bags)
multiple original conc by # of bags it takes to equal 1000mL
drop concentration UNIT by factor of 1000
48
50 mL IV bag FM
20
49
100mL IV bag FM
10
50
250mL IV bag FM
4
51
500mL IV bag FM
2
52
1000mL IV bag FM
1
53
Versed induction syringe
3mL syringe
54
lidocaine induction syringe
5mL syringe
55
fentanyl induction syringe
100mcg vial = 3mL syringe
250mcg vial = 5mL syringe
56
propofol induction syringe
20mL syringe
57
rocuronium syringe
5mL syringe
58
succinylcholine syringe
10mL syringe
59
ancef syringe
<2 g = 10mL syringe
2g+ = 20mL syringe
60
anesthesia cart
inside is clean
- use clean hands/gloves only
61
types of medication carts
pyxis
accudose
omnicell
62
types of anethesia machines
draeger fabius
apollo and perseus
GE aisys
63
Anesthesia machine Med Gases/Suction Basic Components (6)
Flowmeters
Auxillary O2 outlet
Flush
WAGD
Suction
Pipe/Cylinder pressure gauges
64
WAGD
waste anesthesia gas disposal
65
vaporizers
isoflurane - purple
sevo - yellow
des - blue (electrical cord)
66
breathing apparatus (8 parts)
APL
one-way valves
bag
CO2 absorber
ventilator
ventilator interface
pressure guage
O2 analyzer
67
monitors
EKG
pulse oximetry
Capnography/Gas analyzer
NIBP
temp
peripheral nerve stimulator (in drawer)
68
Anesthesia Machine Check Procedures
1. Aux O2/Ambu
2. Suction adequate
3. Machine On
4. Monitors/Alarms/Cords/Pieces
5. E Cylinder Pressure
6. Piped gas Pressure
7. Vaporizer Volume
8. Low pressure
9. WAGD (Scavenging)
69
what should the regulator be set to for the aux O2 cylinder for mask breathing?
6-8 L/min
70
what should the regulator be set to for the aux O2 cylinder for nasal cannula?
4 L/min
71
what serves as a back up in case an issue arises w/anesthesia machine?
aux O2 w/ambu bag
72
full aux O2 tank PSI
2000 PSI
73
purpose of aux O2 tank
provide PPV at 100% FiO2
74
what suction device should we not use?
Neptune
-300mmhg
too strong negative pressure
75
what are we checking on suction?
no leaks
no cracks
needs blunt tipped yankeur installed
76
what type of power is supplied to anesthesia machine?
AC
77
what outlet do you plug the anesthesia machine into?
red outlet
78
what does a red outlet mean?
its on the generator
79
what is the anesthesia machines power backup?
battery
80
required machine monitors(7)
EKG
Pulse Ox
NIBP (or A-line)
Capnography (CO2)
Temp
Gas analyzer
O2 sensor
81
extra monitors
train of four monitor
BIS
82
high pressure system check
1. Disconnect wall pipeline
2. O2 flush
3. Open tank w/key
4. Pressure >50PSI
5. Close tank
6. O2 flush
7. Reconnect wall pipeline
83
intermediate pressure check
piped gas gauges read >50PSI
84
Vaporizer check
adequately filled w/fill line
filler ports tightly closed
port key is specific to agent
85
Low pressure check verifies that
there are no leaks in gas supply line between the flowmeters and common gas outlet
86
Low pressure check procedures
1. flowmeter off
2. vaporizers closed
3. manual/spont mode
4. bypass fipped
5. connect bulb to CGO
6. squeeze to evacuate bulb
7. allow bulb to remain negative to 10+seconds
8. remove bulb
9. Flip bypass back
87
how do you know the low p check passes?
bulb does not re-inflate for 10+ seconds
88
squeezing the bulb causes
negative pressure
89
scavenging system check
floater in between line
90
low floater
high circuit pressure
91
high floater
low circuit pressure
92
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