Week 2 highlights

Question 0

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

Answer 0

No, be sure to UNCHECK the box.

Question 1

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

Answer 1

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

Question 2

What are the RED FLAGS in Pre-Op?

Answer 2

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

Question 3

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

Answer 3

The patient

Question 4

What percentage of morbidity in anesthesia is human error?

Answer 4

51-77%

Question 5

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

bonus - what was his tool called?

Answer 5

1/3 or 33.3%

Tool is the IHI Global trigger

Question 6

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

Answer 6

10.6/10,000

Question 7

ASA4E is how many times more risky than ASA4 cases?

Answer 7

4 times

Question 8

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

Answer 8

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

Question 9

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

Answer 9

Men are 80% more likely to die than women.

Question 10

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?

Answer 10

42. 4% for adverse effects

46. 5 for anesthetic overdose

Question 11

Strategies to avoid Risk?

Answer 11

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.

Question 12

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

Answer 12

Overdose of anesthetics

Question 13

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

Answer 13

4 times

Question 14

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

Answer 14

Anesthetic management

Question 15

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

Answer 15

Coexisting Disease

Question 16

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

Answer 16

Males

Question 17

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

Answer 17

0.1-0.2%

Question 18

Stroke is number _ cause of death in the US.

Answer 18

4

Question 19

Stroke the number _ cause of disability in the US.

Answer 19

1

Question 20

What are the treatments for Aneurysm?

Answer 20

Gluing, Coiling, and Clipping

Question 21

What is the fastest growing specialty in surgery?

Answer 21

Neurovascular IR

Question 22

What is Hunt and HESS?

Answer 22

Grade for stroke

Question 23

What is the IHSS Stroke score for?

Answer 23

30 day mortality

Question 24

Three IR Treatments for an Aneurysm are?

Answer 24

Gluing,coiling, clipping

Question 25

Three IR treatments for a clot are?

Answer 25

Penumba, solitaire Fr, trevopro

Question 26

Three drugs that dissolve clots are?

Answer 26

TPA, reopro, integrillin

Question 27

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

Answer 27

Lung CA, 28%

Question 28

EBUS stands for??

Answer 28

Endobronchial ultrasound

Question 29

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

Answer 29

B. (bonus) - Des is the WORST

Question 30

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

Answer 30

Bronchospasm

Question 31

What is the most feared respiratory complication in anesthesia?

Answer 31

Aspiration

Question 32

What does an S3 murmur signify?

Answer 32

Heart Failure

Question 33

What is the PCI goal for a STEMI?

Answer 33

< 90 mins

Question 34

What does the first heart sound represent?

Answer 34

closure of tricuspid & mitral valves (beginning of systole

Question 35

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

Answer 35

1 - 5%

Question 36

What remains the Gold Standard test for cardiac function?

Answer 36

Treadmill stress test

Question 37

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

Answer 37

Tylenol

Question 38

What is the most common complication of cirrhosis?

Answer 38

Fatigue

Question 39

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

Answer 39

Bleeding from esophageal varices

Question 40

Liver disease is reflected by what lab signs?

Answer 40

Increased total bilirubin,

Question 41

What two lab tests best evaluate liver disease?

Answer 41

Serum Albumin & PT

Question 42

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

Answer 42

Chronic

Question 43

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

Answer 43

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

Question 44

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

Answer 44

NSAIDS

Question 45

What is your primary concern with a tooth abscess?

Answer 45

Airway

Question 46

What is a Whipple?

Answer 46

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

Question 47

What should you check in a patient with GI symptoms?

Answer 47

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

Question 48

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

Answer 48

Vomiting

Question 49

Name four issues with morbid obesity.

Answer 49

Airway, IV access, Loss of FRC, metabolism

Question 50

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

Answer 50

80%

Question 51

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

Answer 51

Surgeon is the leading cause

Question 52

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

Answer 52

D. 80%

Question 53

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

Answer 53

D. Diabetes

Question 54

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

Answer 54

C.

Question 55

Which electrolytes are effected by CRF?

Answer 55

Na, K, Phos, Mag, Ca

Question 56

Coagulopathy in CRF leads to what four sites of bleeding?

Answer 56

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

Question 57

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

Answer 57

D. Respiratory distress

Question 58

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

Answer 58

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

Question 59

Features of a Child's airway vs adults are?

Answer 59

Funnel shaped larynx

Question 60

Most common cancer in children is?

Answer 60

Leukemia

Question 61

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

Answer 61

False

Question 62

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

Answer 62

Twice

Question 63

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

Answer 63

C. Increased sensitivity to pain

Question 64

Occurrence of MH

Answer 64

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

Question 65

Death study was

Answer 65

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

Question 66

What is one of the worst drugs we give?

Answer 66

succinylcholine- anaphlatic reaction, histamine relase

Question 67

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

Answer 67

Anesthetic management

Question 68

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

Answer 68

Coexisting diseases

Question 69

Critical events for cardiac event.

Answer 69

Mainly in ASA4, and more so in ASA4E

Question 70

Cardiac arrest due to anesthesia is what?

Answer 70

10.6/10,000

Question 71

What is the percentage for adverse effects of anesthetic?

Answer 71

42.4

Question 72

Hunt and Hess?

Answer 72

Grading for stroke, grade 1, 2, 3, 4, 5, | headache, severe headache, drowsy, hemiparesis, deep coma

Question 73

What are the standards for pre-anesthesia

Answer 73

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

Question 74

When was the first anesthetic performed?

Answer 74

Robert Liston, Europe, 1846

Question 75

What does the ASA task force remmend for diagnostic data?

Answer 75

Lab, EKG, Radiographs and consultation

Question 76

What are the 6 steps for a preoperative visit

Answer 76

``` 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 ```

Question 77

What was the first anesthetists

Answer 77

Sister Mary Bernard

Question 78

Who peformed 14,000 with no complications

Answer 78

Alice McGraw

Question 79

What are six skills for engaging the patient

Answer 79

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

Question 80

steps for physical exam

Answer 80

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

Question 81

ASA classification

Answer 81

ASA1, ASA2, ASA3, ASA4, ASA5, ASA6

Question 82

Mallampati Classification

Answer 82

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

Question 83

3-3-2 rule

Answer 83

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

Question 84

LEMON

Answer 84

``` look externally, Evaluate 332 Mallampati, obstruction neck mobility ```

Question 85

abnormal upper airway

Answer 85

snoring, stridor, croup, | lower- wheezing rhonchi rales

Question 86

Heart murmurs

Answer 86

Most common-mitral regurgitation, most serious-aortic stenosis

Question 87

Basic neuro exam

Answer 87

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

Question 88

METS

Answer 88

exercise tolerance measured on scale of 1-12,

Question 89

Blood pressure classification

Answer 89

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

Question 90

six effects of smoking

Answer 90

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

Question 91

six effects of durg use on anesthsia

Answer 91

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

Question 92

six effects of ETOH on anesthesia

Answer 92

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

Question 93

MH is the number one cause of death in anesthesia

Answer 93

true

Question 94

What are some signifiicant medical hx

Answer 94

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,

Question 95

NPO guide lines

Answer 95

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

Question 96

3 A's of anestheisa

Answer 96

Analgesia, Anesthesia, Amnesia

Question 97

What is a surgeon's needs for surgery

Answer 97

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

Question 98

patient concerns

Answer 98

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

Question 99

What constitues a good aneshteic plan

Answer 99

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

Question 100

periop systems at Vandy are

Answer 100

Vpimsweb, Vpims, starpanel

Question 101

Most reliable source of information is?

Answer 101

the patient

Question 102

DX and procedure code manual is called

Answer 102

ICD-9

Question 103

What are some preoperative redlfags

Answer 103

``` 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 ```

Question 104

Anesthesia death rates

Answer 104

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