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CNOR > Emergency Situations > Flashcards

Emergency Situations Flashcards

1
Q

What 3 questions can be asked to establish a framework for quickly developing an emergency plan of care?

A
  1. What do i know about my patient?
  2. what do i know about the procedure?
  3. what do I know about my available resources?
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2
Q

Since 1963, what society has used a predictive system of classification for anesthetic outcomes for preoperative patients?

A

American Society of Anesthesiologists

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3
Q

What do the ASA classifications range from?

A

ASA I to ASA VI

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4
Q

ASA I is what?

A

healthy individual

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5
Q

ASA VI is what?

A

an individual who has been declared brain dead and is being prepared for organ donation

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6
Q

What does the E following ASA classifications III, IV, and V designate?

A

the procedure as an emergency, requiring immediate action

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7
Q

What does the ASA classification help to do?

A

the starting point for multidisciplinary teams to prioritize staff and equipment and to anticipate potential complications during the surgical procedure

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8
Q

elective procedures allow for what?

A

allow the patient and perioperative team members adequate time to prepare for the surgery

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9
Q

urgent procedures are performed when?

A

performed for conditions that are not considered life-threatening but could progress to an emergency status if not treated

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10
Q

a time frame for urgent procedures is followed based on what?

A

the nature of the condition and the associated complications (i.e. compound fracture and risk for infection)

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11
Q

emergency procedures are what?

A

nonelective surgeries performed when time is a factor in saving a patient’s life or limb

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12
Q

The acute nature of emergency procedures means what?

A

means that less time can be spent conducting a thorough patient assessment or following typical protocols (surgical counts, informed consent)

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13
Q

what is the focus of emergency procedures?

A

to save the patient’s life and prevent systemic deterioration

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14
Q

What is the definition of ASA I

A

a normal, healthy patient

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15
Q

what are examples, including but not limited to ASA I?

A

healthy, nonsmoking, no or minimal alcohol use

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16
Q

What is the definition of ASA II

A

a patient with mild systemic disease

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17
Q

What are examples, including but not limited to ASA II?

A
  1. mild diseases only without substantive functional limitations
  2. current smoker, social alcohol use, pregnancy, obesity (30 < BMI <40), well controlled DM/HTN, mild lung disease
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18
Q

What is the definition of ASA III?

A

a patient with severe systemic disease

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19
Q

What are examples, including but not limited to ASA III?

A
  1. Substantive functional limitations; one or more moderate to severe diseases
  2. Poorly controlled DM or HTN, COPD, morbid obesity (BMI>40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate ejection fraction reduction, ESRD undergoing regularly scheduled dialysis, premature infant PCA < 60 weeks, history (> 3 months) of MI, CVA, TIA, or CAD/stents
20
Q

What is the definition of ASA IV?

A

a patient with severe systemic disease that is a constant threat to life

21
Q

What are examples, including but not limited to ASA IV?

A

Recent (<3months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD, or ESRD not undergoing regularly scheduled dialysis

22
Q

What is the definition of ASA V?

A

a moribund patient who is not expected to survive without an operation

23
Q

What are examples, including but not limited to ASA V?

A

ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction

24
Q

what is the defintion of ASA VI?

A

a declared brain-dead patient whose organs are being removed for donor purposes

25
Q

MH is a what? associated with?

A

a potentially fatal hyermetabolic complication associated with a rare autosomal dominant genetic defect

26
Q

what triggers MH?

A

volatile inhaled anesthetics and the depolarizing muscle relaxant succinylcholine

27
Q

What kind of anesthetics trigger MH?

A

those that end in “ane”

28
Q

How does MH start?

A

the triggering agent initiates a release of large amounts of calcium in skeletal muscle cells, resulting in sustained muscle contractions, a hyper metabolic state, and heat production

29
Q

What are the first signs of an MH crisis?

A

an increase in end tidal CO2 and tachycardia are the first signs

30
Q

What may also show up when an anesthesiologists trys to intubate a patient with MH?

A

sustained muscle rigidity may be manifested by difficulty intubating

31
Q

What may the surgeon note with MH at the field?

A

dark unsaturated blood at the surgical field

32
Q

What are other s/sx of MH?

A
  1. hypertension
  2. mottling of the skin
  3. cola-colored urine
  4. hyperkalemia
  5. metabolic and respiratory acidosis
  6. ventricular arrhythmias
33
Q

What is a late sign of MH?

A

an extreme rise in body temp (over 110 degrees F)

34
Q

What are severe complications of MH?

A

cardiac arrest, brain damage, systemic organ failure, and death

35
Q

What patient population should a nurse/provider not use triggering agents for MH in?

A

patients with underlying muscle conditions (muscular dystrophy, myotonia) or a family history of unexplained death during general anesthesia

36
Q

What are the 12 steps for treatment of MH?

A
  1. notify the surgeon to stop the procedure ASAP. If surgery must be continued, assist the anesthesia care provider to exchange inhaled anesthesia agents to IV non triggering agents
  2. discontinue volatile agents and succinylcholine
  3. get dantrolene and the MH cart
  4. call for help (MH code) or 911 per facility protocol
  5. Hyperventilate with 100% Oxy at flows of 10 L/min to flush volatile anesthetics and lower EtCO2, if availabile, insert activated charcoal filters into the inspiratory and expiratory limbs of breathing circuit. The filter may become saturated after 1 hour; therefore, a replacement set of filters should be substituted after each hour of use
  6. initiate additional venous access with a large bore IV catheter if possible. Give IV dantrolene 25 mg/kg rapidly and repeat as frequently as needed until the patient responds with decreased etCO2, decreased muscle rigidity, and a lowered heart rate. Large doses (>10mg/kg) may be required for patients with persistent contractures or rigidity
  7. assist with the insertion of an arterial line. send blood gas specimens (venous or arterial) as ordered
  8. relay lab results to the surgical team
  9. assure additional meds are available (calcium chloride or calcium gluconate, insulin, sodium bicarb)
  10. insert a 3 way foley
  11. cool the patient if his or her core temp is greater than 102 degrees fahrenheit (39 degrees celsius) or if it is less but rapidly rising. Stop cooling when the patient’s temperature has decreased to less than 100.4 degrees (38 degrees)
  12. When stabilized, arrange for transport to the ICU
37
Q

At the onset of MH symtpoms, think what?

A

SHS-Cool

38
Q

What does SHS cool stand for?

A

first action: STOP the inhalant anesthesia and STOP the surgery
Second action: HYPERVENTILATE the patient with 100% oxygen
Third action: START dantrolene
Fourth action: COOL the patient

39
Q

When does LAST occur?

A

when toxic amounts of a local anesthesia agent enter the bloodstream

40
Q

LAST is based on 3 major risk factors?

A
  1. impaired renal or hepatic function, which interferes with drug metabolism and excretion;
  2. an inadvertent injection of local anesthetic into a highly vascular tissue or bloodstrem
  3. an amount of drug injected exceeding the max recommended dosage
41
Q

What s/sx of LAST typically occur before the other?

A

CNS signs and symptoms typically occur before cardiovascular manifestations

42
Q

What are s/sx of LAST related to

A

directly related to the patient’s blood concentration of the drug

43
Q

s/sx of LAST typically occur within what?

A

1 minute of administration of the local anesthetic agent, and, if left untreated, can be life-threatening

44
Q

what can be included in the timeout to help prevent LAST?

A

incorporating dosing parameters and patient-specific maximum doses for local anesthetics as part of the time out

45
Q

What should be monitored in combination with documentation of what with local anesthetic?

A

local anesthetic dosages should be monitored and documented along with the patient’s reaction to the medication

46
Q

Constant monitoring of patient receiving local anesthetics does what?

A

helps to detectm CNS and cardiovascular changes indicative of a LAST reaction

47
Q
A

CNOR (12 decks)

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