AP Exam 4 part VIII Flashcards
anesthetic management of hypertrophic cardiomyopathy (long QT syndrome) to avoid sudden cardiac arrest
- BB to keep HR <130 2. avoid agents that prolong QT 3. magnesium or temp pacing if torsades occurs
_________ Is the most common CV complication after non-cardiac surgery
MI
most MIs occur within _________ hours of surgery and most are asymptomatic
48
independent predictors or perioperative MI
- 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
airway mortality occurs because of failure to ____________, not ______________
ventilate; intubate
avoiding airway related morbidity and mortality
have airway plan A, B, C
airway M&M with supraglottic airway (LMA) is related to
- inadequate seal 2. laryngospasm 3. aspiration of gastric contents
what is the gold standard for anticpated difficult airway
fiberoptic bronchoscope with spontaneous ventilation (Video laryngoscopy emerging as alternative)
primary morbidity (adverse events) with ET intubation
- dental trauma (50%) 2. sore throat/hoarseness (40%) 3. injury to lips, tongue, oropharynx, vocal cords, & trachea
cases that are high risk for awareness under anesthesia
- trauma 2. OB 3. Cardiothoracic
episodes of awareness under anesthesia most often occur during what stage of anesthesia?
maintenance
what are some indications the patient may be experiencing awareness under anesthesia
- patient movement 2. tachycardia 3. htn
awareness under anesthesia is associated with postoperative ____________ and sequelae
PTSD
what are some postoperative sequalae related to PTSD 2/2 awareness under anesthesia
- sleep disturbances 2. nightmares 3. fear of future anesthesia 4. daytime anxiety
RF for awareness under anesthesia
- 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
most anesthetics cause _______________ amnesia, but not reliable _______________ amnesia
anterograde; retrograde
when a critical incident (complication) occurs during anesthesia, what is the anesthesia providers first obligation?
protect patient from further harm, provide pt care that is required and mitigate further injury
T/F: critical incidents must be reported even if the outcome was positive
TRUE
any death occuring within ________ hours of anesthetic should be reported and evaluated for potential relevancy
48
effective risk management depends on _____________________
reporting culture
what is a root cause analysis
a retrospective analysis of a critical adverse event
root cause analysis is based on the premise that adverse events are caused by…
a combination of factors linked to organizational processes and structures, not just individual human errors
objective of root cause analysis
uncover multiple factors/causal chains that contribute to the critical incident, develop systematic changes to make less likely to recur
open disclosure of critical incident includes:
- 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
process of effective disclosure includes:
- 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
who is the 2nd vicitim of adverse events?
the healthcare provider
“human factors” in complications describes
human performance and behavior related to interaction with the environment
__________________ is the largest and preventable cause of anesthesia accidents
fatigue
acute effects of stress
fight, flight, freeze
human factors that contribute to M&M complications
- poor resilence 2. poor communication and teamwork 3. fatigue 4. stress (both acute and chronic effects)
what is the purpose of the anesthesia handoff/transfer of care
- real time process of of passing pt specific information from one care member to another 2. ensure continuity and safety of pt care
