Chapter 31: Risk + Risk Management

Question 1

Define risk.

Answer 1

Danger or hazard; probability of suffering harm or other untoward outcome

Question 2

Define complication.

Answer 2

A problem that makes a disease or condition worse or more difficult to treat

Question 3

A problem that makes a disease or condition worse or more difficult to treat

Answer 3

Complication

Question 4

Danger or hazard; probability of suffering harm or other untoward outcome.

Answer 4

Risk

Question 5

Define side effect.

Answer 5

Consequence of an agent other than expected

Question 6

Consequence of an agent other than expected

Answer 6

Side effect

Question 7

Define adverse event.

Answer 7

Harmful, usually unexpected

occurrence; deviation from normal course or progression in recovery, health, or well-being

Question 8

Harmful, usually unexpected

occurrence; deviation from normal course or progression in recovery, health, or well-being

Answer 8

Adverse event

Question 9

Define acute.

Answer 9

Occurring during performance of a procedure, administration of a drug, etc.

Question 10

Define intermediate.

Answer 10

Occurring during the existence of a drug or device in a patient

Question 11

Define long-term.

Answer 11

Occurring after elimination of a

drug or removal of a device from a patient

Question 12

ASA, Committee on Professional Liability:
Chair?
Location?
How many insurance companies participate?
Time period?
How many cases per year?
How many claims in database?

Answer 12

Chair: Frederick Cheney, Jr., MD (1985)
Location: University of Washington, Seattle
35 insurance companies participate
Time period: 1985 - present
Cases per year: 300
Claims in database: 7300

Question 13

The goal of the American

Society of Anesthesiologists (ASA) Closed Claims Project is to:

Answer 13

identify major areas of loss in anesthesia, patterns of injury, and strategies for prevention.

Question 14

3 parts of goal of ASA Closed Claims project:

Answer 14

1) ID major areas of loss in anesthesia
2) ID patterns of injury
3) ID strategies for prevention

Question 15

Name five means for confirming success or failure of endotracheal intubation.

Answer 15

1) Chest rises and falls
2) Condensation appears and disappears
3) Compliance of bag (refills)
4) Capnography
5) Auscultation

Question 16

Gold standard for confirming endotracheal intubation

Answer 16

Capnography: 3 repeating waveforms

Question 17

How many adverse respiratory event claims end in death or brain damage?

Answer 17

85%

Question 18

Of those adverse respiratory event claims that ended in death/brain damage, how many were due to esophageal intubation?

Answer 18

18%

Question 19

Of those adverse respiratory event claims that ended in death/brain damage, how many were due to difficult airway?

Answer 19

17%

Question 20

Of those adverse respiratory event claims that ended in death/brain damage, auscultation led to a misdiagnosis in what percentage of cases?

Answer 20

48%

Question 21

Proportion of anesthesia-related morbidity/mortality that are related to airway?

Answer 21

35% (Largest proportion compared to other reasons)

Question 22

Difficult airway, percentage occurrence in: 
Induction:
Intraop:
Extubation:
Recovery:

Of those, percentage that resulted in brain damage/death?

Answer 22

Induction: 67%, 48% in BD/D
Intraop: 15%, 69% in BD/D
Extubation: 12%, 92% in BD/D
Recovery: 5%, 58% in BD/D

Question 23

Of those difficult airway events, an event in which stage of care is most likely to result in brain damage or death?

Answer 23

Extubation/emergence

Question 24

Airway injury during procedure is more likely to be reported in which gender?

Answer 24

Female (69%)

Question 25

Airway injury during procedure is more likely to be reported in what age group?

Answer 25

Adult (96%)

Question 26

Airway injury during procedure is more likely to be reported in inpatient or outpaitent?

Answer 26

Inpatient (73%)

Question 27

Airway injury during procedure is more likely to be reported in what ASA statuses?

Answer 27

ASA I-II (73%)

Question 28

Difficult intubation reported in what percentage of airway injury cases?

Answer 28

39%

Question 29

Most likely site in body to be listed for airway injury?

Answer 29

Larynx (33%)

Question 30

Most likely site in body at which airway injury to would result in death?

Answer 30

Esophagus (19%)

Question 31

Leading cause of airway injury to larynx?

Answer 31

Vocal cord paralysis (34%)

Question 32

Leading cause of airway injury to pharynx?

Answer 32

Perforation (37%)

Question 33

Leading cause of airway injury to esophagus?

Answer 33

Perforation (90%)

Question 34

What factors make a patient more vulnerable to airway injury in the esophagus?

Answer 34

Female
>60 years old
Difficult intubation (62%)

Question 35

Early findings of perforation in the airway include:

Answer 35

Subcutaneous emphysema
Pneumothorax
CXR changes

Question 36

Late findings of perforation in the airway include:

Answer 36

Mediastinitis
Retropharyngeal abcess
Pneumonia

Question 37

Anesthesia-related obstetric mortality?

Answer 37

1:500,000

Overall obstetric mortality is 1:20,000.

Question 38

In relation to obstetric mortality, anesthesia ranks:

Answer 38

3rd or lower

Question 39

Leading cause of obstetric anesthetic mortality?

Answer 39

AIRWAY: failure to secure patient airway + aspiration are the two leading factors