AP Exam 4 part VIII

Question 1

anesthetic management of hypertrophic cardiomyopathy (long QT syndrome) to avoid sudden cardiac arrest

Answer 1

1. BB to keep HR <130 2. avoid agents that prolong QT 3. magnesium or temp pacing if torsades occurs

Question 2

_________ Is the most common CV complication after non-cardiac surgery

Answer 2

MI

Question 3

most MIs occur within _________ hours of surgery and most are asymptomatic

Answer 3

48

Question 4

independent predictors or perioperative MI

Answer 4

1. increase in baseline HR for every 10b/min 2. hx of stroke (CVA) 3. major vascular surgery 4. CKD (Cr > 2.0 preop) 5. advanced age 6. emergency or urgent surgery 7. serious bleeding/transfusion >/= 2 UPRBC

Question 5

airway mortality occurs because of failure to ____________, not ______________

Answer 5

ventilate; intubate

Question 6

avoiding airway related morbidity and mortality

Answer 6

have airway plan A, B, C

Question 7

airway M&M with supraglottic airway (LMA) is related to

Answer 7

1. inadequate seal 2. laryngospasm 3. aspiration of gastric contents

Question 8

what is the gold standard for anticpated difficult airway

Answer 8

fiberoptic bronchoscope with spontaneous ventilation (Video laryngoscopy emerging as alternative)

Question 9

primary morbidity (adverse events) with ET intubation

Answer 9

1. dental trauma (50%) 2. sore throat/hoarseness (40%) 3. injury to lips, tongue, oropharynx, vocal cords, & trachea

Question 10

cases that are high risk for awareness under anesthesia

Answer 10

1. trauma 2. OB 3. Cardiothoracic

Question 11

episodes of awareness under anesthesia most often occur during what stage of anesthesia?

Answer 11

maintenance

Question 12

what are some indications the patient may be experiencing awareness under anesthesia

Answer 12

1. patient movement 2. tachycardia 3. htn

Question 13

awareness under anesthesia is associated with postoperative ____________ and sequelae

Answer 13

PTSD

Question 14

what are some postoperative sequalae related to PTSD 2/2 awareness under anesthesia

Answer 14

1. sleep disturbances 2. nightmares 3. fear of future anesthesia 4. daytime anxiety

Question 15

RF for awareness under anesthesia

Answer 15

1. female 2. younger adults 3. obesity 4. clinician experience 5. pt hx of previous awareness 6. after duty hours or emergency procedures 7. type of surgery: Trauma, OB, CT 8. use of neuromuscular blocking agents

Question 16

most anesthetics cause _______________ amnesia, but not reliable _______________ amnesia

Answer 16

anterograde; retrograde

Question 17

when a critical incident (complication) occurs during anesthesia, what is the anesthesia providers first obligation?

Answer 17

protect patient from further harm, provide pt care that is required and mitigate further injury

Question 18

T/F: critical incidents must be reported even if the outcome was positive

Answer 18

TRUE

Question 19

any death occuring within ________ hours of anesthetic should be reported and evaluated for potential relevancy

Answer 19

48

Question 20

effective risk management depends on _____________________

Answer 20

reporting culture

Question 21

what is a root cause analysis

Answer 21

a retrospective analysis of a critical adverse event

Question 22

root cause analysis is based on the premise that adverse events are caused by…

Answer 22

a combination of factors linked to organizational processes and structures, not just individual human errors

Question 23

objective of root cause analysis

Answer 23

uncover multiple factors/causal chains that contribute to the critical incident, develop systematic changes to make less likely to recur

Question 24

open disclosure of critical incident includes:

Answer 24

1. accurate information about event 2. immediate consequences and remdial action 3. expression of regret 4. other information about preventing such an incident from occuring again

Question 25

process of effective disclosure includes:

Answer 25

1. continuation of care 2. acknowledgement of incident and pt consequences 3. information on what happened and what to expect 4. apology (when appropriate)/expression of regret 5. advice about necessary tx 6. information about necessary tx 7. tangible support regarding: physical, psychological, social, and financial consequences

Question 26

who is the 2nd vicitim of adverse events?

Answer 26

the healthcare provider

Question 27

"human factors" in complications describes

Answer 27

human performance and behavior related to interaction with the environment

Question 28

__________________ is the largest and preventable cause of anesthesia accidents

Answer 28

fatigue

Question 29

acute effects of stress

Answer 29

fight, flight, freeze

Question 30

human factors that contribute to M&M complications

Answer 30

1. poor resilence 2. poor communication and teamwork 3. fatigue 4. stress (both acute and chronic effects)

Question 31

what is the purpose of the anesthesia handoff/transfer of care

Answer 31

1. real time process of of passing pt specific information from one care member to another 2. ensure continuity and safety of pt care