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adv. health assessment > Week 2 highlights > Flashcards

Week 2 highlights Flashcards

0
Q

If you didn’t personally see the patient, can you be listed as the primary evaluator in the pt. chart at Vandy?

A

No, be sure to UNCHECK the box.

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1
Q

HPI, what is it and should it be relatively short or long and detail?

A

History of present illness, keep it short and sweet, focus on the important info, good snapshot of the patient situation presently.

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2
Q

What are the RED FLAGS in Pre-Op?

A

MI within last 6 months, chest pain, stents or new EKG changes.
Pacemaker/AICD.
OSA, hx of difficult airway, asthma within last 2 months.

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3
Q

What is the most reliable source of information about your patient?

A

The patient

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4
Q

What percentage of morbidity in anesthesia is human error?

A

51-77%

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5
Q

Classen (2011) stated what percentage of patients encounter a medical error?

bonus - what was his tool called?

A

1/3 or 33.3%

Tool is the IHI Global trigger

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6
Q

Overall, what is the rate of mortality due to anesthesia?

A

10.6/10,000

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7
Q

ASA4E is how many times more risky than ASA4 cases?

A

4 times

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8
Q

What is the triple low phenomena, what is it associated with?

A

Low BIS, low MAP, low MAC. 30 day mortality is 4x higher with triple low phenomena.

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9
Q

Who is more likely to die from anesthesia related incidents, men or women? Percents?

A

Men are 80% more likely to die than women.

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10
Q

According to the 2009 Anesthesiology study, what is the percent of deaths caused by adverse effects?
What is the percentage of anesthetic overdoses in that same study?

A
  1. 4% for adverse effects

46. 5 for anesthetic overdose

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11
Q

Strategies to avoid Risk?

A

Avoid full stomach, avoid cardiac risks, avoid emergency surgery, avoid emergency C - sections, avoid LIGHT anesthesia - increased risk for LONG term PTSD complications, avoid equipment failure.

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12
Q

In the USA between 1999-2005, 1030 people died of anesthesia related complications to what?

A

Overdose of anesthetics

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13
Q

In a Japanese study emergency surgery for an ASA4 patient increases the risk of anesthesia complications by what factor?

A

4 times

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14
Q

In Japan what was the leading cause of mortality of people with good physical status?

A

Anesthetic management

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15
Q

In Japan what was the leading cause of critical events in those with poor physical status?

A

Coexisting Disease

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16
Q

In the US mortality due to anesthesia is higher in what gender?

A

Males

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17
Q

Percent of patients that experience “awareness” in surgery (non-OB, non-cardiac).

A

0.1-0.2%

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18
Q

Stroke is number _ cause of death in the US.

A

4

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19
Q

Stroke the number _ cause of disability in the US.

A

1

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20
Q

What are the treatments for Aneurysm?

A

Gluing, Coiling, and Clipping

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21
Q

What is the fastest growing specialty in surgery?

A

Neurovascular IR

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22
Q

What is Hunt and HESS?

A

Grade for stroke

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23
Q

What is the IHSS Stroke score for?

A

30 day mortality

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24
Q

Three IR Treatments for an Aneurysm are?

A

Gluing,coiling, clipping

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25
Q

Three IR treatments for a clot are?

A

Penumba, solitaire Fr, trevopro

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26
Q

Three drugs that dissolve clots are?

A

TPA, reopro, integrillin

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27
Q

What kind of cancer is the #2 killer? What percentage of all cancers is it?

A

Lung CA, 28%

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28
Q

EBUS stands for??

A

Endobronchial ultrasound

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29
Q

Which anesthetic gas in current use is the best for a react airway? a) desflurane, b)sevoflurane c) isoflurane d) halothane

A

B. (bonus) - Des is the WORST

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30
Q

What are two possible airway affects of the asthmatic in the OR?

A

Bronchospasm

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31
Q

What is the most feared respiratory complication in anesthesia?

A

Aspiration

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32
Q

What does an S3 murmur signify?

A

Heart Failure

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33
Q

What is the PCI goal for a STEMI?

A

< 90 mins

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34
Q

What does the first heart sound represent?

A

closure of tricuspid & mitral valves (beginning of systole

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35
Q

What percentage of non cardiac surgical patients suffer a cardiac morbidity?

A

1 - 5%

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36
Q

What remains the Gold Standard test for cardiac function?

A

Treadmill stress test

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37
Q

What is the most commonly encoutered type of drug induced hepatitis?

A

Tylenol

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38
Q

What is the most common complication of cirrhosis?

A

Fatigue

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39
Q

What is the major cause of m and m in the pt with cirrhosis?

A

Bleeding from esophageal varices

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40
Q

Liver disease is reflected by what lab signs?

A

Increased total bilirubin,

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41
Q

What two lab tests best evaluate liver disease?

A

Serum Albumin & PT

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42
Q

A low albumin (half life 20 days) reflects acute or chronic liver disease?

A

Chronic

43
Q

Surgical risk is greater in a liver patient with the following 5 factors…

A

The following: High bilirubin (> 3.0mg/dl), low albumin (< 3.0 g/dD), severe ascites, coma, and poor nutrition.

44
Q

Which class of drugs should you avoid in a patient with a history of ulcers?

A

NSAIDS

45
Q

What is your primary concern with a tooth abscess?

A

Airway

46
Q

What is a Whipple?

A

Resection of antrum of stomach, duodenum, gall bladder, and head of pancreas.

47
Q

What should you check in a patient with GI symptoms?

A

Frequency, recent EDG, How many pillows, treatment and efficacy, hemoptysis

48
Q

What is a major risk factor of a patient with a bowel obstruction?

A

Vomiting

49
Q

Name four issues with morbid obesity.

A

Airway, IV access, Loss of FRC, metabolism

50
Q

At what percentage of kidney failure do you start to see symptoms?

A

80%

51
Q

Quiz 2 questions 3, What was the leading cause of patients that are critical

A

Surgeon is the leading cause

52
Q

How much renal function may be lost before a patient is a symptomatic a) 20%, b) 40% c) 60% d) 80%

A

D. 80%

53
Q

What is the leading cause of kidney disease in the US a) htn b) kidney stones c) polycystic dz d) diabetes

A

D. Diabetes

54
Q

Why are Chronic renal patients anemic a) increased plasma volume relative to RBCs b) destruction of red cells due to chronic infection c) healthy kidneys secrete erythropoietin anephric patients do not d) chronic hematuria

A

C.

55
Q

Which electrolytes are effected by CRF?

A

Na, K, Phos, Mag, Ca

56
Q

Coagulopathy in CRF leads to what four sites of bleeding?

A

GI, epistaxis (nose bleeds), subdural hematoma, hemorrhagic pericarditis.

57
Q

Almost all pediatric codes are due to a) fever b) cardiac anomalies c) congenital defects d) respiratory distress

A

D. Respiratory distress

58
Q

In order to differentiate pre renal (decreased renal perfusion) from acute renal failure (tubular damage) what test might you order?

A

Fractional excretion of filtered sodium, if < 1% = pre-renal failure. If > 1% = obstructive renal failure or ATN

59
Q

Features of a Child’s airway vs adults are?

A

Funnel shaped larynx

60
Q

Most common cancer in children is?

A

Leukemia

61
Q

It is important to discuss the risks of anesthesia in front of the children T/F?

A

False

62
Q

Oxygen consumption of an infant is how many times more than that of an adult?

A

Twice

63
Q

Recent studies have shown that infants have a) decreased sensitivity to pain b) same sensitivity to pain c) increased sensitivity to pain

A

C. Increased sensitivity to pain

64
Q

Occurrence of MH

A

1:100,000 adults and 1:30,000 children

65
Q

Death study was

A

1:10,000 and hospital in Japan was 0.1:10,000

66
Q

What is one of the worst drugs we give?

A

succinylcholine- anaphlatic reaction, histamine relase

67
Q

***What was mainly responsible for critical events in patients with good physical status?

A

Anesthetic management

68
Q

What was mainly responsible for critical events in patients with poor physical status?

A

Coexisting diseases

69
Q

Critical events for cardiac event.

A

Mainly in ASA4, and more so in ASA4E

70
Q

Cardiac arrest due to anesthesia is what?

A

10.6/10,000

71
Q

What is the percentage for adverse effects of anesthetic?

A

42.4

72
Q

Hunt and Hess?

A

Grading for stroke, grade 1, 2, 3, 4, 5,

headache, severe headache, drowsy, hemiparesis, deep coma

73
Q

What are the standards for pre-anesthesia

A

I- document preanesthesia assessment
II- informed consent
III- specific plan of anesthesia

74
Q

When was the first anesthetic performed?

A

Robert Liston, Europe, 1846

75
Q

What does the ASA task force remmend for diagnostic data?

A

Lab, EKG, Radiographs and consultation

76
Q

What are the 6 steps for a preoperative visit

A 
review the record,
Interview and preform focused assessment 
order and review lab tests
order pre-op meds
ensure consent has been obtained
document all above have been down
77
Q

What was the first anesthetists

A

Sister Mary Bernard

78
Q

Who peformed 14,000 with no complications

A

Alice McGraw

79
Q

What are six skills for engaging the patient

A

professionalism, empathy, lay language, personal touch, eye contact, eye level

80
Q

steps for physical exam

A

airway, heart sounds, breath sounds, vital signs, height and weight, neuro exam, verify mobility disability

81
Q

ASA classification

A

ASA1, ASA2, ASA3, ASA4, ASA5, ASA6

82
Q

Mallampati Classification

A

1-complete visualization of soft palate
2- complete visulization of uvula
3- visualization of base of uvula
4- soft palate is not visible at all

83
Q

3-3-2 rule

A

3 fingers for mouth opening, 3 fingers from tip of chin to hyoid bone, 2 fingers from hyoid bone to thyroid cartilage

84
Q

LEMON

A 
look externally, 
Evaluate 332
Mallampati,
obstruction
neck mobility
85
Q

abnormal upper airway

A

snoring, stridor, croup,

lower- wheezing rhonchi rales

86
Q

Heart murmurs

A

Most common-mitral regurgitation, most serious-aortic stenosis

87
Q

Basic neuro exam

A

walking, balance, memory, PEARL, ROM, grip and motor, symmetry, vision, speech orientation

88
Q

METS

A

exercise tolerance measured on scale of 1-12,

89
Q

Blood pressure classification

A

HTN stage 1 is, 140/99 HTN stage 2 is 160/100,

90
Q

six effects of smoking

A

addiction, heart disease, stroke, lung cancer, ETOH use, illegal drugs, unprotected sex

91
Q

six effects of durg use on anesthsia

A

addiction, tachycardia, increased tolerance, arrhythmias, MI, pulmonary edmea

92
Q

six effects of ETOH on anesthesia

A

, , tolerance, CV disease, cirrohosis, risk of vomiting, behavioral changes, decreased LOC

93
Q

MH is the number one cause of death in anesthesia

A

true

94
Q

What are some signifiicant medical hx

A

drugs, ETOH, full stomach, risk of ulcers, pregnant, hep c, hiv, old trach site, risk of cardiac events due to drug use, difficult IV access,

95
Q

NPO guide lines

A

6hrs- solid and formula milk, 4 hrs light meal, 2 hours clear liquids,
exclusions- GERD, hiatal hernia, diabetes, gastric motility disorders, intra-abdominal masse, bowel obstruction

96
Q

3 A’s of anestheisa

A

Analgesia, Anesthesia, Amnesia

97
Q

What is a surgeon’s needs for surgery

A

immobility, positioning, muscel relaxation, ability to post-op test

98
Q

patient concerns

A

N&V, pain, death, paralysis, awareness, acting/talking crazy

99
Q

What constitues a good aneshteic plan

A

proficiency in the plan, support of patient, anesthesiologist, and surgeon, back up plan , all materials prepared for speciic plan

100
Q

periop systems at Vandy are

A

Vpimsweb, Vpims, starpanel

101
Q

Most reliable source of information is?

A

the patient

102
Q

DX and procedure code manual is called

A

ICD-9

103
Q

What are some preoperative redlfags

A 
documented cardiac hx with no EKG or relevant medical claerance
patients with MI in the last 6 months, 
pacemaker
OSA
TB
Abnormal labs
rheumatoid arthritis
hx of MH pt/family
lupus-draw PCV/BMP
moderate-severe pulmonary HTN
104
Q

Anesthesia death rates

A

315/year, 34 year r/t anesthesia, 80% male, 55% ae 25-54, highest death rate/risk factor is age >85

adv. health assessment (2 decks)

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