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Spring 2020 - APA Foundations 1 > Complications - Quiz 3 > Flashcards

Complications - Quiz 3 Flashcards

1
Q

Within how many days can Perioperative Mortality occur?

A

2-30 Days

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2
Q

What is a Six-Sigma Defect Rate?

A

99.999% of cases are free of defect

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3
Q

What is Morbidity?

What are the Minor Incidences?

A

Any complication other than death

  • Hoarseness - watch cuff pressures
  • PONV
  • Drug Error
  • Equipment Malfunction
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4
Q

What are the Goals of the ASA Closed Claims Project?

A
  • Identify Major Areas of Loss
  • Identify Patterns of Injury
  • Identify Prevention Strategies
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5
Q

What are some Unpreventable Anesthetic Mishaps?

A

Sudden Death Syndrome

Fatal Idiosyncratic Drug Reactions

Poor Outcomes even with Proper Management

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6
Q

What are the Top 3 ASA Closed Claims?

A

Death, Injury, and Nerve Damage

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7
Q

What are the ASA Emerging Claim Areas?

A

Regional Anesthesia

Chronic Pain Management

Acute Pain

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8
Q

What are some Human Errors that lead to Preventable Anesthetic Accidents?

A

Med Errors

Airway Mismanagement

Gas Machine Misuse

Fluid Mismanagement

IV Line D/C

Unrecognized Circuit D/C

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9
Q

What are the Factors associated w/ Human Error & Equipment Misuse?

A
  • Poor Preparation
  • Poor Experience/Training
  • Environmental Limitations
  • Physical/Emotional Factors
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10
Q

What are ways to Prevent Anesthetic Complications?

A
  • Improve Patient Monitoring, Techniques, & Education
  • Protocols & Standards
  • Active Risk Management Programs
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11
Q

How do Anesthetic Agents effect the Pediatric Brain?

A

Prolonged/Multiple procedures = Developmental Delays

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12
Q

Which type of Airway Injury is usually 99% the fault of the Anesthesia Provider?

A

Dental Injury

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13
Q

Why is Patient Positioning Important?

A

Risk for Peripheral Nerve Damage

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14
Q

Which Position can cause an Air Embolism?

A

Sitting

Prone

Reverse Trend.

Prevention: Keep venous pressure > 0 at the wound

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15
Q

Which Position can cause Alopecia?

A

Supine

Lithotomy

Trend.

Prevention: Normotension, padding, rotate head

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16
Q

Which Position can cause Compartment Syndrome

A

Lithotomy

Prevention: Maintain Perfusion Pressure & Avoid External Compression

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17
Q

Which Position can cause Corneal Abrasion?

A

Prone

Prevention: Tape & Lubricate eyes

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18
Q

Which Position can cause Retinal Ischemia/Blindness?

A

Prone & Sitting
(Due to Hypotension)

Prevention: Avoid Globe Pressure

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19
Q

Which position can cause Backache, Digit Amputation, Nerve Palsies, And Skin Necrosis?

A

Any Position

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20
Q

How do you prevent Brachial Plexus damage?

A

Avoid stretching or direct compression at neck or axilla

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21
Q

How do you prevent Radial Nerve Damage?

A

Avoid Lateral Humerus Compression

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22
Q

How do you prevent Ulnar Nerve Damage?

A

Padding at Elbow & Forearm Supination

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23
Q

What are some symptoms after a patient experiences awareness?

A

Anxiety

Nightmares

PTSD

Social Problems

24
Q

What are High-Risk cases for Awareness?

A

Major Trauma

Obstetrics

Cardiac Surgery

25
Q

What are the Risk Factors for Awareness?

A

Female

Young

Obese

Clinical Experience

Prior Awareness

After Hours

Emergency Procedures

Use of Muscle Relaxors

26
Q

What are some ways you can prevent Intraoperative Recall?

A

Set Expectations w/ Patient

Give Right Dosage & Amnesic Meds

Document ET Gas Concentration

Use BIS

27
Q

When does the onset of Ischemic Optic Neuropathy occur?

A

Immediately to 12th Post-Op Day

28
Q

How can you prevent Ischemic Optic Neuropathy?

A

Head Up

Minimize Abdominal Constriction

Monitor BP

Limit Hypotension

Avoid Anemia

Procedural Staging

29
Q

What is the most common Cardiovascular Event after Non Cardiac Surgery?

A

Myocardial Infarction

5% of patients > 45 yo

30
Q

How can a high level of spinal block at the T4 level effect the patient?

A

Cardiopulmonary Arrest

Happens 18-54 minutes after insertion

31
Q

What are the signs and symptoms leading to arrest from Spinal Anesthesia?

A

Gradual decline in HR & BP (20% < Baseline)

Cyanosis

32
Q

How can Spinal Anesthesia cause Hearing Loss?

A

CSF Leak

Treat w/ Blood Patch?

33
Q

How can General Anesthesia cause Hearing Loss?

A

Middle Ear Barotrauma

Vascular Injury

Drug Ototoxicity

Surgical Manipulation

S/P CPR

34
Q

What are the types of Hypersensitive Allergic Reactions?

A
  1. Immediate - Atopy, Urticaria, Anaphylaxis
  2. Cytotoxic: - Hemolysis, HIT
  3. Immune Complex
  4. Delayed, Cell-Mediated - Contact dermatitis, Graft Rejection
35
Q

What would an anaphylactic reaction look like?

A

Respiratory Distress and/or Circulatory Shock

Can die from choking or irreversible shock

36
Q

What are Mediators of Anaphylaxis?

A

Histamine

Leukotriens

Prostaglandin

Platelet-Activating Factor

Tumor Necrosis Factor

37
Q

What is the difference b/t Anaphylactic and Anaphylactoid Reactions?

A

They look the same, but Anaphylactoid doesn’t depend on IgE Antibody interaction w/ Antigen

38
Q

How do you treat Anaphylactic Reactions?

A
  • Stop giving the Med
  • 100% O2
  • Give Epi, Benadryl, Ranitidine, Steroid
  • Intubate/Trach
  • Fluid Bolus
39
Q

What drugs are the most common causes of Allergic Reactions?

A

Muscle Relaxants - Roc, Sux

40
Q

Which type of Local Anesthetics have more risk for allergic reactions?

A

Esters

41
Q

What is the 2nd most common cause of Anaphylaxis during anesthesia?

A

Latex - mild to life threatening

Should Absolutely Avoid Latex Use

42
Q

What is a late sign of Malignant Hyperthermia?

A

Increased Core Temperature

43
Q

What causes Malignant Hyperthermia?

A

All gases & Sux

44
Q

How does Dantrolene Work?

A

Binds to Ryr-1 Receptor and directly stops muscle contraction & calcium release.

2.5mg/kg q5 min

Max Dose: 10mg/kg

45
Q

What is the greatest complication after giving Dantrolene?

A

(Relatively safe)

Muscle Weakness, Resp. Insufficiency, & Aspiration

46
Q

What are signs of Bronchospasm?

A

Prolonged Expiration

High Inspiratory Pressure

Exp. Wheeze

Decreased O2 Sat

47
Q

The presence of what three things at the same time can cause a Fire in the OR?

A

Cautery

Oxygen

Alcohol Prep

48
Q

Steps to take after Complications happen

A
  1. Prevent more injury
  2. Report Incident
  3. Analyze Cause
  4. Disclosure - talk openly, timely, accurately & express regret
49
Q

What is a Critical Event

A

When a complication occured or had the potential to occur

50
Q

What is a Sentinal Event?

A

When a serious complication occured

51
Q

What positions causes Common Peroneal Palsy?

A

Lithotomy, Lateral Decubitus

Prevention: Pad upper fibula

52
Q

Ischemic Optic Neuropathy is common reported after which procedures?

A

Cardiopulmonary Bypass

Radical Neck Dissection

Abdominal & Hip Procedures

Spinal Surgery in Prone Position

53
Q

What patient factors would put them at risk for Ischemic Optic Neuropathy?

A

HTN

DM

CAD

Smoking

54
Q

Other than MH, what else can Dantrolene be used for?

A

Neroleptic Malignant Syndrome

&

Thyroid Storm Hyperthermia

55
Q

What is the difference between Complete and Partial Laryngospasms?

A

Complete: silent, pardoxial chest movement, tracheal tug, no ventilation

Partial: Crowing noise, mismatch of breathing effort & effectiveness

56
Q

To reduce fires during a tonsillectomy, what should you keep the FIO2 under?

A

Keep FIO2 < 30%

(And wait 3 minutes for chloraprep to dry)

Spring 2020 - APA Foundations 1 (10 decks)

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