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AP I > Emergence & PACU/ICU Transport > Flashcards

Emergence & PACU/ICU Transport Flashcards

1
Q

complications associated with emergence

A 
Airway obstruction
Agitation
Delirium
Pain
Nausea/vomiting
Hypothermia
Shivering
Autonomic lability
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2
Q

when do you start planning emergence?

A

as soon as the patient is asleep

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3
Q

what are 5 main factors to consider when emerging a patient

A 
reversed?
breathing spontaneously?
comfortable?
are they gonna vomit?
can they be safely extubated?
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4
Q

what are 3 factors that directly influence emergence time?

A 
Agent Solubility (directly)
Agent Concentration (directly)
Duration of Anesthesia (directly)
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5
Q

Emergence of inhalational anesthesia depends chiefly on what?

A

pulmonary elimination

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6
Q

____________ blunt the ventilatory responses to both hypercarbia and hypoxemia.

A

IV or inhalational anesthetics

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7
Q

PaCO2 where spontaneous ventilation is initiated

A

Apneic threshold

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8
Q

Maintain FiO2 >_____ during hypoventilation

A

> 0.85

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9
Q

how long do most non-depolarizing blockers work?

A

15-45 mins

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10
Q

a condition where too much CO2 becomes an anesthetic

A

Hypercarbic narcosis

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11
Q

succinylcholine depolarizes the end-plate _______ receptor

A

nicotinic

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12
Q

why does succ have a short duration?

A

short duration due to pseudocholinesterase metabolism of Succs. It works to depolarize the motor end-plate and then diffuses away and is metabolized

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13
Q

which NMB can cause sinus bradycardia?

A

Succ

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14
Q

how to non-depolarizing NMB work?

A

Competitively inhibit end plate nicotinic cholinergic receptor

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15
Q

name 4 possible locations for the nerve stimulator

A

Ulnar nerve
Facial nerve
Posterior tibial nerve
External peroneal nerve

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16
Q

which twitch monitor location most closely reflects blockade at diaphragm?

A

facial nerve

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17
Q

TOF = 4 stimulations @ ___ Hz

A

2

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18
Q

Tetany = __-___ Hz for 5 sec

A

50-100

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19
Q 
4/4 = \_\_%
3/4 = \_\_%
2/4 = \_\_%
1/4 = \_\_%
0/4 = \_\_%
A 
4/4 = 75%
3/4 = 85%
2/4 = 90%
1/4 = 95%
0/4 = 99%
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20
Q

what class of drug do you reverse NMB with?

A

anticholinesterase

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21
Q

side effects of anticholinesterase

A

BLUDS

22
Q

what class of drug is used to counter-act the BLUDS?

A

anti-muscarinic

23
Q

max dose of neostigmine?

peak onset?

A

0.07mg/kg

5-10 mins

24
Q

how do you assess the adequacy of ventilation during emergence?

A
  • ETCO2
  • SpO2 (>90%)
  • Tidal Volume (>250ml)
25
Q

3 major candidates for a NAW or OAW

A

Obesity
OSA
Hx snoring

26
Q

what is the major factor in arousal of OSA patients?

A

hypoxia

27
Q

Factors that increase incidence of PONV

A 
Hx* including motion sickness
Female gender
Hypotension
Non-smoker
Postoperative pain/narcotic use
Type of Surgery: (Eye, ENT, Abdominal, GI/GU)
Anesthetic Rx
Gastric distention
Swallowed heme
28
Q

Surgical sites that have increased risk of PONV.

A 
Intra-abdominal
Laparoscopic
Orthopedic
Gynecological
ENT
Breast 
Plastic
Neurosurgical
29
Q

what class of drug is Zofran?

A

Serotonin 5-HT3 receptor antagonist

30
Q

30mg Toradol = ___mg Morphine

A

10

31
Q

what class of drug is toradol?

A

NSAID

32
Q

Dilaudid = ____ relative potency morphine

How long does it last?

A

8x

4-8 hrs

33
Q 
Fentanyl = \_\_\_\_\_ relative potency to morphine
Duration \_\_\_\_\_hour(s)
A

100x

0.5-1 hrs

34
Q

Titrate narcotics to RR _____ BPM

A

Titrate to RR 10-16 BPM

35
Q

factors for extubation

A 
Airway protective reflexes intact
Clinical stability
Intact neurological function
Adequate pulmonary function
Normal body temp (T 35-37 C)
Normal neuromuscular function
Normal coagulation
36
Q

what is a major contraindication for droperidol?

A

parkinson’s

37
Q

at what stage(s) is it safe to extubate?

A
  1. awake
  2. surgical
    (NOT 2. excitatory or 4. depression)
38
Q

what are some immediate hazards of extubation?

A

laryngospasm
vomiting
bronchospasm

39
Q

purpose of deep extubation

A

Minimize tracheal stimulation

Minimize coughing/bucking

40
Q

Contraindications of deep extubation

A

Difficult mask airway
Difficult intubation
Aspiration risk
Airway edema

41
Q

criteria for deep extubation

A 
MAC 1.3
NMB completely reversed
Spont ventilation at regular rate/rhythm
No airway reflexes
100% O2
Lidocaine (0.5 mg/kg)
42
Q

NEVER extubate a patient deep without _______ in place

A

an oral airway

43
Q

what do you do immediately following extubation?

A 
Suction the pharynx one more time
Place mask on the patient
Keep your right hand on the bag
Test for airway patency
Help them breathe for a while if they are not doing an adequate job on their own.
44
Q

ASA Standard 1 PACU

A

All patients who have received general, regional, or monitored anesthesia care shall receive appropriate post-anesthesia management

45
Q

ASA Standard 2 PACU

A

A patient transported to the PACU shall be accompanied by a member of the anesthesia care team who is knowledgeable about the patient’s condition.
The patient shall be continually evaluated and treated during transport with monitoring and support appropriate to the patient’s condition

46
Q

What must be continually evaluated during pt transport?

A

Ventilation
Oxygenation
Circulation

47
Q

all pts must be transported with what?

A

O2

48
Q

what equipment must you have when transporting an ICU patient?

A 
Cardiac Monitor or defibrillator
Airway management equipment 
Oxygen Source with 30 minute reserve
Standard Resuscitation drugs 
Medication
49
Q

what must be continuously monitored for ICU patients?

A

EKG

SpO2

50
Q

what is included in the PACU report

A 
Pt name, Allergies, preop vitals
ASA class, Medical Hx
Procedure, Surgeon, Anesthesia
Type Anesthesia
Pre-meds, narcotics, paralytics, Rx
Fluids, lines
Orders

AP I (8 decks)

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