Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Health Assessment TWU CRNA > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Echinacea (purple coneflower root)

A

Pharmacologic: Activation of cell mediated immunity. Periop Concerns: allergic reaction, decreased immunosuppressant effects, poss. immunosuppression with longterm use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ephedra (mahuang)

A

Pharmacologic: Directly/indirectly Increases heart rate and blood pressure Periop Concerns: Ischemia, Arhythmias, depleted catecholamines, interacts with MAOI D/C: 24 hours prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Garlic (ajo)

A

Pharmacodynamics: Inhibits platelet aggregation, increases fibrinolysis, antihypertensive activity D/C: 7 days prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ginger

A

Pharmacodynamics: Anti-emetic, antiplatelet aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ginkgo (duck-foot tree, silver apricot)

A

Pharmacodynamics: Inhibits platelet activating factor D/C: 36 hours prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ginseng

A

Pharmacodynamics: Lowers blood sugar, inhibits platelet aggregation, increased PT/PTT in animals Periop Concerns: May decrease anticoagulant effect of warfarin D/C: 7 days prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Green tea

A

Pharmacodynamics: Inhibits platelet aggregation and thromboxane A2 formation Periop Concerns: May decrease anticoagulant effect of warfarin D/C: 7 days prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Kava (awa, intoxicating pepper, kawa)

A

Pharmacodynamics: sedation and anxiolysis Periop Concerns: May increase anesthetic effect, long term use increases anesthetic requirement D/C: 24 hours prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Saw palmetto (dwarf palm)

A

Pharmacodynamics: Inhibits 5 alpha reductase (responsible for turning testosterone into DHT) and cyclooxygenase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

St. John’s Wart (goat weed, hardhat, amber)

A

Pharmacodynamics: Inhibits neurotransmitter reuptake, MAO inhibition unlikely Periop Concerns: Decrease serum dig levels, delays emergence, induction CP450 D/C: 5 Days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Valerian (vandal root, all heart, garden heliotrope)

A

Pharmacodynamics: Sedation Periop Concerns: Increase anesthetic effect, acute benzo-like withdrawal, long term use increases anesthetic requirements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anesthesia considerations for ACE inhibitors (-pril) Intraop concerns, management and D/C issues

A

Intraop Concerns: Intolerance of hypovolemia, hypotension Management: Optimize hydration and moderate doses of vasporessors D/C issues: Brief interruption tolerated well, may improve regional blood flow and oxygen delivery and preserve renal function, HOLD am dose day of surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anesthesia considerations for beta blockers (-lol) Intraop concerns, management and D/C issues

A

Intraop Concerns: D/C may increase cardiovascular morbidity and develop of withdrawal symptoms Management: Hydration D/C issues: Should be continued on day of surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anesthesia considerations for Calcium channel blockers Intraop concerns, management and D/C issues

A

Intraop concerns: Decrease. SVR and BP d/t peripheral vasodilation; Neg. into and chronotropic effects Management: Hydration and phenylephrine as needed to maintain atrial pressure D/C issues: Caution in patients with left ventricular dysfunction shown by EF <40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Anesthesia considerations for diuretics Intraop concerns, management and D/C issues

A

Intraop concerns: hypokalemia and hypovolemia Management: Preop potassium levels, hydration D/C issues: Pts rarely show issues with holding morning dose, might be desirable to continue if part of tx for chronic renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Anesthesia considerations for antiarrythmics Intraop concerns, management and D/C issues

A

Intraop concerns: Cardiac depression, prolonged neuromuscular blockade Management: Serum drug levels as needed, if on amio may need vasopressor, inotropes and pacemaker capability D/C issues: Rarely recommended to stop meds, withhold concurrent medications such as ACE-i

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Anesthesia considerations for NSAIDS and anti platelet drugs Intraop concerns and D/C issues

A

Intraop concerns: impaired plt function, altered renal function, GI bleed D/C issues: Antiplatlet drugs such as aspirin, clopidogrel, ticlodipine should be d/c 7-10 days prior, NSAIDS can be continued the day of unless risk of bleeding is high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Anesthesia considerations for anticoagulants (heparin, coumadin, LMWH) Intraop concerns, management and D/C issues

A

Intraop concerns: Increased hemorrhage Management: Reverse heparin w/ protamine, revers coumadin with vitamin k or FFP D/C issues: Heparin IV 6 hours prior and check PTT, Coumadin 3-5 days prior, 5 if INR <1.5 needed, LMWH 12 hours prior to surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Anesthesia considerations for fibrinolytic (streptokinase, TPA, urokinase) Intraop concerns, management and D/C issues

A

Intraop concerns: Hemorrhage Management: Antifibrinolytics (aprotinin) may be indicated D/C issues: usually not an option

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Anesthesia considerations for oral hypoglycemic agents Intraop concerns, management and D/C issues

A

Intraop concerns: Hyperglycemia/hypoglycemia Management: Avoid dehydration and monitor serum glucose D/C issues: Withhold oral agents the day of surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Anesthesia considerations for MOAI’s Intraop concerns, management and D/C issues

A

Intraop concerns: Hypertension secondary to norepinephrine release; meperidine causes excitatory state or depressive phenomena secondary to opioids Management: Avoid triggering agents such as meperidine, pentazocine, dextromethorphan and indirect sympathomimetics D/C issues: Irreversible MAOI’s 2 weeks prior w/ high risk of serious psychiatric consequences, reversible can be continued up to the day of surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Anesthesia considerations for TCA’s Intraop concerns, management and D/C issues

A

Intraop concerns: alpha blocking activity and potential to block norepinephrine reuptake potential for cardiac issues, lowers seizure threshold Management: norepinephrine should be considered the vasopressor of choice D/C issues: gradually over 2 weeks prior to surgery, obtain baseline ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Anesthesia considerations for Lithium Intraop concerns, management and D/C issues

A

Intraop concerns: Ventricular arryhthmias, atropine-resistant sinus brady, dehydration increases lithium levels Management: Hydration D/C issues: 72 hours prior to surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Neuraxial Anesthesia guidelines for LMWH (exonaparin, dalteparin, tinzaparin) When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal, additional info and half-life

A

Before procedure: 24 hours, check anti factor Xa in elderly/renal insufficient Restart after procedure: 24-72 hours Before catheter removal: Should be removed before intiation of LMWH Restart after catheter removal: 4 hours prior to first post dose and at least 24 hours post neuraxial procedure Additional: Wait >24 hours after bloody tap to restart Half-life: 4-7 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Neuraxial Anesthesia guidelines for Fondaparinux (Arixtra) When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal, additional info and half-life

A

Before procedure: Regional - no recommendation, Pain - 4 days (5 half lives) Avoid restarting the medication while catheter is in place Restart after catheter removal: 6 hours Additional info: Longer hold time in patients with renal impairment (CrCl <50-30 ml/min); Contraindicated in CrCl <30 or child-pugh C hepatic failure Half-life: 17-21 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Neuraxial Anesthesia guidelines for Factor Xa-inhibtors (edoxaban, rivaroxaban, apixaban) When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal, additional info and half-life

A

Before procedure: 72 hours Restart after procedure: At least 6 hours, avoid while catheter is in place Before cather removal: 20-30 hours depending on med Restart after catheter removal: 6 hours, longer if bloody tap Additional info: same as fondaparinux Half-life: rivaroxaban: 5-9 hours, apixaban: 6-12 hours, edoxaban: 10-14 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Neuraxial Anesthesia Guidelines for argatroban, a direct thrombin inhibitor When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal, additional info and half-life

A

Before procedure: avoid Restart after procedure: Avoid while catheter is in place Before catheter removal: 34-36 hours Restart after catheter removal: 2 hours Additional info: 1/2 life in hepatic impairment is 181 min Half-life: 40-50 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Neuraxial Anesthesia Guidelines for bivalirudin (angiomax), a direct thrombin inhibitor When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal, additional info and half-life

A

Before procedure: avoid Restart after procedure: while catheter is in place Before catheter removal: 34-36 hours Restart after catheter removal: 2 hours Additional info: 1/2 life with CrCL <30ml/min is 57min Half-life: 25 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Neuraxial Anesthesia guidelines for dabigatran (Pradaxa), a direct thrombin inhibitor When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal, additional info and half-life

A

Before procedure: 5 days Restart after procedure: 6 hours unless catheter is in place then avoid Before catheter removal: 34-36 hours Restart after catheter removal: 6 hours, 24 hours post traumatic puncture Additional info: consider longer hold times in renal impairment Half-life: 8-17 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Neuraxial guidelines for clopidogrel (plavix) When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal and half-life

A

Before procedure: 5-7 days Restart after procedure: restart immediately if no loading dose, 6 hours if LD Before catheter removal: 24 hours postop Restart after catheter removal: restart immediately, 6 hours if loading dose Half life: 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Neuraxial guidelines for cilostazol (pletal) When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal, additional info and half-life

A

Before procedure: 48 hours Restart after procedure: 6 hours unless catheter still in then avoid Before catheter removal: avoid restarting Restart after catheter removal: 6 hours Additional info: consider extending time prior to catheter placement if renal impairment Half-life: 11-13 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Neuraxial Anesthesia guidelines for Diprydamole/ASA (Aggrenox), an anti platelet drug When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal and half-life

A

Before procedure: 24 hours Restart after procedure: 6 hours unless catheter in place Before catheter removal: avoid Restart after catheter removal: 24 hours post, immediately post neuraxial procedure, 6 hours if loading dose Half-life: 10-12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Neuraxial Anesthesia guidelines for prasugrel (effient), an anti platelet drug When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal and half-life

A

Before procedure: 7-10 days Restart after procedure: Immediately if no loading dose, avoid if catheter in place Before catheter removal: avoid Restart after catheter removal: same as after procedure Half-life: 2-15 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Neuraxial Anesthesia guidelines for ticagrelor (brilinta), an anti platelet drug When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal and half-life

A

Before procedure: 5-7 days Restart after procedure: immediately if no loading dose, avoid if catheter in place Before catheter removal: Avoid Restart after catheter removal: Same as after procedure Half-life: 7 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Neuraxial Anesthesia guidelines for ticlodipine (ticlid), an anti platelet drug When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal and half-life

A

Before procedure: 10 days Restart after procedure: Avoid while catheter in place Before catheter removal: 6 hours Restart after catheter removal: 24 hours post, immediately post neuraxial, 6 hours if loading dose Half-life: 13 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Neuraxial Anesthesia guidelines for cangrelor, an anti platelet drug When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal and half-life

A

Before procedure: 3 hours Restart after procedure: 8 hours Before catheter removal: Avoid Restart after catheter removal: 8 hours Half-life: 3-6 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Neuraxial Anesthesia guidelines for fibrinolytics (streptokinase, alteplase, tenecteplase, reteplase) When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal and additional info

A

Before procedure: 10 days, 48 hours + normal clotting studies including fibrinogen Avoid restarting the medication while catheter in place, if needed then neuro checks Q2 hours Check fibrinogen level before restarting after catheter removal (TPA has the longest half life at 24-46 hours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Neuraxial Anesthesia Guidelines for abciximab (reopro), a GP 2b/3a inhibitor When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal, additional info and half-life

A

Before procedure: 24-48 hours Avoid restarting the medication while catheter is in place Restarting medication after catheter removal is contraindicated for 4 weeks post op Additional info: receptor bound remain for up to 2 weeks Half-life: 30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Neuraxial Anesthesia Guidelines for eptifibatide (integrellin), a GP 2b/3a inhibitor When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal and half-life

A

Before procedure 4-8 hours Avoid restarting medication while catheter is in place Restarting medication after catheter removal is contraindicated for 4 weeks post op Half-life: 2.5 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Neuraxial Anesthesia guidelines for tirofiban (aggrasta), a GP 2b/3a inhibitor When to hold before procedure/catheter removal, when to restart med after procedure/catheter removal and half-life

A

Before procedure: 4-8 hours Avoid restarting medication while catheter is in place Restarting medication after catheter removal is contraindicated for 4 weeks post op Half-life: 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

ASA 1

A

A normal healthy patient Healthy, non-smoking, no/minimal alcohol use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

ASA II

A

mild systemic disease without substantial functional limitations: current smoker, social alcohol drinker, preggo, obesity, controlled HTN/DM, mild lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

ASA III

A

severe systemic disease with 1+ of: poorly controlled DM/HTN/COPD/Morbid Obesity, active hepatitis, ETOH abuse/dependency, pacemaker, reduced EF, ESRD (regular HD), premie or age <60 weeks >3months of: MI, CVA, TIA, CAD/stents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

ASA IV

A

severe systemic disease w/constant threat to life: <3months: MI, CVA, TIA, CAD/stents ongoing cardiac ischemia or severe valve dysfunction severely reduced EF; sepsis/DIC/ARDS/ESRD (no regular HD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

ASA V

A

moribund patient who is not expected to survive without operation: ruptured aneurysm, massive trauma, intracranial bleed w/mass effect, ischemic bowel, MODS or significant cardiac pathology.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

ASA VI

A

declared brain dead patient whose organs will be removed for donor purposes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Pack-Year formula

A

of cigs / 20 x years smoked = PPY (there are 20 ciggies in a pack)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

NMBD allergen tier list

A

Rocuronium > Succinylcholine (anectine) > Atracurium > Vecuronium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Allergies (most common to least)

A

Muscle relaxants > Latex > Antibiotics (PCN) > Local Anesthetics (esters > amides)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Oxygen formula constants

A

Oxygen carrying capacity: 1 g Hgb = 1.34 ml O2 Solubility coefficient of O2 = 0.003 ml O2/100ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Oxygen Saturation formula

A

(Oxygen combined with Hgb / Oxygen carrying capacity) x 100 1. Find Plasma O2 (PaO2 x solubility coE of O2) 2. Subtract plasma O2 from total O2 content (given) 3. Find O2 carrying capacity: Multiply Hgb (given) x 1.34 4. Divide values “2”/”3” and x100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

BMI formula

A

Weight (kg) / Height (m^2) Remember to convert! 1 kg = 2.2 lb 1 cm = 2.54 in.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are 3 key points associated with brachytherapy

A
  1. Seed implantation for prostate cancer 2. Patient will be in the lithotomy position 3. If seeds not successful, patient will need a prostatectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

In what area would we place invasive lines?

A

Preop setting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

2 examples of things we look for when reviewing Anesthesia Records?

A
  1. Malignant Hyperthermia 2. Laryngospasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Who should we ask if there is a question about what type or where the surgery is occurring?

A

The surgeon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Other name for succinylcholine?

A

Anectin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Other name for bupivicaine?

A

Marcaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Major risk associated with Diabetes Mellitus that is relevant to anesthesia?

A

Aspiration due to slower motility presents an aspiration risk during induction and extubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are 3 considerations for patients that have asthma?

A
  1. Do they use an inhaler and what is it? 2. When was the last time they used an inhaler? 3. Should we order an inhaler to be used prior to surgery?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What should we be aware of with COPD patients? (2 things related to airway)

A
  1. Laryngospasm 2. Post-op respiratory depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is Pickwickian’s Syndrome?

A

Hypoventilation associated with obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is a key sign of spinal headache?

A

Headache that gets worse with sitting up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Treatment for spinal headache?

A

Caffeine, laying down, or blood patch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

5 Major anesthesia complications

A
  1. Spinal headache 2. Malignant Hyperthermia 3. Difficulty waking uo 4. Difficult airway 5. Awareness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

When considering a patients blood pressure, what should we look at?

A

Check patients health history to get a good idea of their baseline blood pressure as we want it to be 10-15% from that baseline during surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What reading is classified as uncontrolled hypertension?

A

Two or more readings greater than 140

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

If your patient shows with a SBP >200 or DBP > 115, what is this indicative of and what should be done in regards to the procedure?

A

This is indicative of malignant hypertension and the procedure should be delayed until a cardiac consult is obtained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

4 diseases associated with unstable cardiac disease?

A
  1. Aortic stenosis 2. New onset Afib 3. New onset SVT 4. Congestive Heart Failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What would a murmur indicate?

A

Possible congestive heart failure or valve prolapse, delaying surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What would the presence of bruits over the carotid arteries indicate?

A

High risk for stroke, consider delaying surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Risk factors associated with OSA? (4)

A
  1. Snoring (Morning headache that goes away soon after waking) 2. Daytime sleepiness 3. Hypertension 4. Obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Patients mom states that her infant has an upper respiratory tract infection, but needs their scheduled procedure done today as she cannot take off work again for awhile, what is your action as an anesthesia provider?

A

Delay the surgery and explain to the mom that they patient has a hyperactive airway and at high risk for laryngospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is alcohols effect on albumin?

A

Alcohol lowers albumin levels, therefore allowing more free drug available in the system for protein bound drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is metabolic syndrome associated with?

A

Diabetes Mellitus Type 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What vasopressors do we utilize for renal patients on dialysis who may be hypovolemic?

A

Neo and ephedrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is a major issue with patient who have liver or gastric disorders?

A

They tend to bleed more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are Hgb triggers?

A

Hgb triggers are numbers that we begin to worry about, but we look at the patient to see how they are doing (Oxygen supply depends on the amount of blood available)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

When placing an NGT on your patient you get blood content back upon aspiration, what is a possible cause for this?

A

You hit a hiatal hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What is the major intra-op concern when a patient has been taking ACE-i?

A

Hypotension with or without bradycardia, have your vasopressors and hydration available

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What beta blockers do we usually give intraoperatively?

A

metoprolol or esmolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What would be considered massive bleeding?

A

1-2 liters of blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What does ERAS stand for?

A

Enhanced recovery after surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is the goal for ERAS?

A

To go home quickly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Which patients do we want to avoid use of NSAIDS for?

A

Acute or chronic kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

With use of NSAIDs, which surgery presents a high risk of anastomotic leak?

A

Cholorectal surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is are the other names for vitamin k?

A

phytonadione (aqua-mephyton)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What does chiroprecipitate replace?

A

Factor 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What do we worry about intraoperatively with insulin users?

A

Hypoglycemia and infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Can we give contrast media to patients taking metformin?

A

Yes, new research shows that it is not contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is the hypertension caused by with MAOI’s?

A

Norepinephrine release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Why does surgery cause the release of stress hormones?

A

Sympathetic nervous system activity increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What are the 3 stress hormones released during surgery?

A
  1. Glucagon 2. Epinephrine 3. Steroids (Cholesterol based)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Example of glucocorticosterioids

A

cortisols

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Example of mineralocorticoids

A

aldosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Example of Androgens

A

testosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

When does HPA (hypothalamic pituitary axis) suppression occur?

A

Exogenous steroid use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What does the adrenal cortex release?

A

Steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What does the adrenal medulla release?

A

Epinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Why is it relevant that HPA is suppressed with exogenous steroid use?

A

No cortisol will be released by the body, meaning the hypotension will not resolve until steroids are administered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

2 Risk factors for HPA suppression

A
  1. 2 weeks of corticosteroids used within 3 months, doesn’t matter what form of steroid 2. 20mg/day prednisone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is the problem with herbal medications?

A

They are not regulated by the FDA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

When should herbal medications be discontinued if there is no pharmacokinetic data?

A

1 week prior to surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What should you do before giving versed to a patient?

A

Make sure family members are gone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

List the most common allergic reactions from most common to least common

A
  1. Muscle relaxants 2. Latex 3. Antibioitics 4. Local Anesthetics (Esters being more common than Amides)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What is one of the first questions we ask a patient during an emergency?

A

What allergies do they have

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What would be an example of an adverse side effect vs a medication reaction?

A

Adverse SE = Nausea and vomiting Reaction = Airway closure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Describe anaphylactic reactions

A

Involve multi organ system failure, immune mediated (IgE), mediators released from mast cells and basophils, LIFE THREATENING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Describe anaphylactoid reactions

A

non-IgE mediated, mediators released from mast cells and basophils and direct complement activation, LIFE THREATENING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

List the allergic reactions of common NMBD in order from most common to least common

A
  1. Roc 2. Such 3. Atracarium 4. Vecuronium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What causes NMBD to have a high affinity for IgE receptors?

A

Quartenary Ammonium Ions have the high affinity for IgE receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What is hypotension secondary to in an anaphylactic reaction?

A

Histamine, protease, proteoglycans and platelet activating factors; these are all inflammatory markers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What is pulmonary vasodilation and bronchoconstriction secondary to in an anaphylactic reaction?

A

Potent inflammatory leukotrienes (LTC) and prostaglandins (PGD); These cause increased reactivity of the respiratory system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What does pancuronium cause that is good for some cardiac patients?

A

Tachycardia to help with cardiac output, this med lasts a long time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What do LTC and PGD cause?

A

Bronchial constriction and increased vascular permeability (Can give montelukast to prevent action of these and open up airways)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What does histamine cause?

A

Vasodilation, erythema, edema, arterial hypotension, GI constriction, tachycardia, pruritus, urticaria, angioedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

If you suspect a patient is having an allergic reaction to NMBD during a procedure, what action can you take to maintain muscle relaxation?

A

Utilize inhalation anesthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What type of chest redness would you look for to determine if a patient who is under general anesthesia is having an allergic reaction?

A

Non-blanchable redness, most commonly starts on the chest area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Describe latex-mediated reactions

A
  1. Irritant contact dermatitis 2. Type IV cell-mediated reactions 3. Type I IgE mediated hypersensitivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What type of food allergies would indicate a true latex allergy?

A

Bananas, kiwi and tropical fruits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What patient population would be at high risk for developing a latex allergy?

A

Kids with spina biphida or those with long term urologic issues that exposed them to multiple foley catheter insertions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What is the correct way to handle rubber stoppers for medications vials with patients who have latex allergies?

A

Follow hospital policy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What inhalation agent can we use to treat symptoms associated with IV contrast allergies?

A

Mucomyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What is NORA?

A

Non-OR-Anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What would you see that would cause you to suspect contrast induced nephropathy (CIN)?

A

Increased in serum creatinine of 0.5mg/dL or 25% increase from baseline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What is the most common antibiotic allergy?

A

Penicillin (Small risk of cross sensitivity, <2%, to cephalosporin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What is the mediator for ester allergic reactions?

A

para-aminobenzoic acid (PABA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What is the mediator for amide allergic reactions?

A

methylparaben (chemically similar to PABA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

How many “i” are found in the name of ester local anesthetics?

A

one

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

How many “i” are found in the name of amide local anesthetics?

A

two

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

What are 6 key signs of anaphylaxis under General Endotrachial Anesthesia?

A
  1. Urticaria 2. Bronchospasm 3. Upper airway edema 4. Vasodilation 5. Erythema 6. Peripheral Edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

What would you observe that would make you suspect a patient is having bronchospasms while under GETA?

A

high pressures on the vent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

What would you observe that would make you suspect a patient is having upper airway edema while under GETA?

A

swelling in the oral cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What type of feedback mechanism do baroreceptors utilize to regulate body functions?

A

negative feedback

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What effects do you see from nicotine use?

A

Cardiovascular effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

What are the effects on the cardiovascular system seen from nicotine use?

A
  1. Adrenal Stimulation 2. Carotid body and aortic sinus resetting of baroreceptors, mimicking increased sympathetic tone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

What is the effect of adrenal stimulation with nicotine use?

A

Intraoperative tachycardia and post-op delayed wound healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

What is the definition of hypoxemia?

A

Low concentration of oxygen in the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Why is carbon monoxide dangerous to oxygenation?

A

Carbon monoxide has a 200-250x greater affinity for Hgb than oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What does carbon monoxide lead to in smokers?

A

Reduction in oxygen transportation and an increased risk of hypoxemia in smokers Reduces availability of O2 binding sites and carrying capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

What causes the increased risk of infection in smokers?

A

increased sympathetic tone from nicotine and have decreased macrophage function (fight infections)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Interventions that can be utilized in smokers for respiratory or airway complications?

A

Patient will have a hyperactive airway, we can give lidocaine, make sure patient is fully sedated prior to intubation, and utilize gases during induction to dilate bronchi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

What is the worry when a patient has a severe cough and what can we do to prevent it?

A

Laryngospasm that can be prevented by utilizing an oral airway, lidocaine or propofol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

By what percent can the carboxyhgb in smokers be increased from the normal 1-1.5%?

A

Can be as high as 5-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

What type of shift does carbon monoxide cause on the oxyhemoglobin dissociation curve?

A

left shift due to a reduction in 2,3 DPG from inhibition of glycolysis in erythrocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

4 factors that would cause a left shift on the oxyhemoglobin dissociation curve?

A
  1. Decreased PCO2 2. Decrease temp 3. Decrease 2,3 DPH 4. Increased pH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

What does a left shift on the oxyhemoglobin dissociation curve represent?

A

Hgb does not want to let go of oxygen, it is left-locked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

4 factors that would cause a right shift on the oxyhemoglobin dissociation curve?

A
  1. Increased PCO2 2. Increased temp 3. Increased 2,3 DPG 4. Decreased pH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

What does a right shift on the oxyhemoglobin dissociation curve represent?

A

Hgb wants to get rid of oxygen to the tissues; Right released

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

What type of shift would an increase in P50 cause on the oxyhemoglobin dissociation curve?

A

Right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

What type of shift would methemoglobin cause on the oxyhemoglobin dissociation curve?

A

Left

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

What type of shift would fetal hemoglobin cause on the oxyhemoglobin dissociation curve?

A

Left

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

What type of shift would maternal hemoglobin cause on the oxyhemoglobin dissociation curve?

A

Right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

What type of shift would sickle cell cause on the oxyhemoglobin dissociation curve?

A

Right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

What is 2,3 DPG responsible for?

A

RBC production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

When do you start seeing a reduction in HR, BP and circulating catecholamines after smoking cessation?

A

12-24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

What does not improve post 24 hours of smoking cessation?

A

pulmonary function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

When do carboxyhemoglobin and cyanide levels drop after smoking cessation?

A

24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

After smoking cessation, what does lower nicotine levels in the body assist in improving?

A

improves vasodilation and toxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

What test can be incorporated to asses alcohol history?

A

CAGE (cut, annoyed, guilty, eye) 2 positive responses mean patient is at high risk for alcoholism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

What are 4 anesthesia implication for chronic alcohol users?

A
  1. Aspiration d/t slowed gastric motility 2. Increased MAC requirements 3. Increase depressant effects of opioids and benzos 4. Resistance to nondepolarizers (roc, vec, cis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

What does 1 MAC mean?

A

50% of patients won’t move and 50% of patients will move

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

2 Anesthesia implications for acute alcohol users?

A
  1. Lower MAC needed b/c alcohol is already causing the relaxant effects 2. Synergy with other depressant drugs such as opioids, which effect would be doubled
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

What are the 4 reasons why aspiration risk is higher in chronic alcohol users?

A
  1. Gastric motility slowed 2. Gastroesphageal sphincter tone is diminished 3. Increased intraabdominal pressure 4. Elevated gastric acid levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

What anesthesia considerations should we take when we have an elderly patient who is a chronic alcohol user?

A

Want to either skip giving benzos or decrease the dose given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

Why do we see a delayed effect of medications when we give them to elderly patients?

A

Circulatory time in their system is not as fast as younger populations

167
Q

When is it okay to cancel a surgery if a patient tests positive for illicit drugs?

A

You can cancel an elective surgery if the clinical presentation is mostly sympathetic in nature

168
Q

Anesthesia implications for alcohol withdrawal?

A

Hypnotics, opioids, and gas requirements are increased

169
Q

When do you delay a surgery for results from a urine test?

A

Positive pregnancy test Viable age women should be pregnancy tested unless they have had a hysterectomy. Will still be able to go to the OR, but will have to take precautions if the patient is pregnant.

170
Q

Eye changes linked to opioid, amphetamine and PCP use

A
  1. opioid = constriction 2. amphetamine = dilation 3. PCP = nystagmus
171
Q

What does Intermittent Acute Porphyria effect?

A

Hgb (Porphyria is useful to help Hgb to bind iron)

172
Q

Triggers for intermittent acute porphyria?

A

Barbiturates and etomidate

173
Q

What do we gear laboratory and diagnostic testing towards for anesthesia?

A

Improved care, change in management or avoidance of problems

174
Q

What would be considered low risk surgeries that do not require routine labs?

A

EGD, cataracts, D&C

175
Q

What type of procedure would we consider getting a baseline Creatinine?

A

A patient receiving IV contrast

176
Q

What patient population, receiving intermediate-risk surgeries would lab testing be indicated for?

A

Patients >64 or with medical co-morbidities such as hypertension, kidney disease or diabetes

177
Q

What should all patients going through high-risk surgeries receive?

A

CBC, chem panel, type and screen or type and cross

178
Q

Within how many months would test results be acceptable as long as the patients medical condition has not changed at all?

A

Results within 6 months

179
Q

When should you order a pre-op chest X-ray?

A

Patient undergoing cardiothoracic surgery, with a major known respiratory condition such as COPD, or presenting with symptoms of a respiratory condition, CHF, malignancy or acute respiratory illness within the past 6 months

180
Q

When would you want a PFT?

A

Severe COPD, SOB, orthopnea, or undergoing CT surgery to get a baseline

181
Q

When would you order a urinalysis prior to surgery?

A

Patients with symptoms or history of UTI, or undergoing knee/hip replacement

182
Q

When should we obtain a baseline 12-lead EKG for males/females?

A

male >40 female >50

[Or younger with active s/s (chest pain)]

183
Q

When should you get a baseline EKG for patients under the normal age range stipulations?

A

Any patient showing signs or symptoms of cardiac disease and any patient undergoing cardiothoracic surgeries

184
Q

What question should we ask a patient to assess for cardiac risk factors?

A

“Are you able to walk up a flight of stairs?

185
Q

When do you decide on the type of sedation for a specific patient?

A

Pre-op area

186
Q

What type of airway should be utilized in a patient who is going to be in the prone position?

A

ETT

187
Q

What 4 pre-op issues should you specifically address before going to the OR?

A
  1. Airway anatomy, can use regional if difficult airway 2. Anticipated post surgical pain 3. Requirement for NMBD (Will need intubated) 4. Hx of PONV - give antiemetics that hit all receptors
188
Q

What are the two types of real anesthesia?

A
  1. General 2. Regional
189
Q

What is MAC anesthesia?

A

Monitored Anesthesia Care (used to bill)

190
Q

What two categories are included in regional anesthesia?

A
  1. Central-neuraxial 2. Peripheral nerve blocks
191
Q

What is a common denominator of anesthesia risk?

A

ASA classification

192
Q

What is the ASA classification system?

A

Scoring system to asses fitness of patients subjected to anesthesia and surgery

193
Q

What would the addition of an E to ASA 6 mean?

A

The addition of E indicates that it is an emergency, although the class 6E doesn’t actually exit, all organ retrieval in brain-dead patients is done urgently

194
Q

What are the 7 causes of death related to anesthesia listed in order from most common to least

A
  1. Equipment failure 2. Intubation complications 3. Pulmonary aspiration 4. Postop respiratory depression 5. Anaphylactic Shock 6. Cardiac Arrest 7. Medication error
195
Q

What is a major side effect of neostigmine that should be considered when administering it?

A

Severe bradycardia, sometimes asystole

(glycopyrrolate administered first, then neostigmine to prevent this)

196
Q

Which patient population should we worry about emergence delirium?

A

Elderly patients

197
Q

What is the afferent (sensory) nerve that stimulates the carotid sinus?

A

Cranial Nerve IX (Hering’s Nerve)

198
Q

What efferent (mechanical) nerve stimulates the aortic arch?

A

Cranial Nerve X

199
Q

Where does Hering’s nerve send signals to?

A

The medulla

200
Q

What do you see if the medulla uses sympathetic nerve fibers to stimulate the heart?

A

Contractility, stroke volume and cardiac output

201
Q

What anatomical landmarks are considered the upper airway?

A
  1. Nose 2. Pharynx 3. Larynx
202
Q

What anatomical landmarks are considered the lower airway?

A

Trachea

203
Q

3 major anatomical parts found in the nose?

A
  1. Nasal septum 2. Cribriform plate 3. Vascular Mucosa
204
Q

What is the cribriform plate part of?

A

The ethmoid bone

205
Q

What do we avoid placing if there is an ethmoid fracture?

A

Do not place an NGT!!!

206
Q

What do we use to cause vasoconstriction of nasal vascular mucosa?

A

Aferin or neosynpehrine

207
Q

What CN provides motor innervation for the tongue?

A

CN 12, the Hypoglossal

208
Q

What sections is the tongue divided into?

A

Anterior 2/3 and Posterior 1/3

209
Q

Sensory information such as pain, touch, pressure and temperature are innervated by which CN to the anterior portion of the tongue?

A

CN 5 (Trigeminal)

210
Q

What specific branch of the Trigeminal nerve innervates the anterior portion of the tongue?

A

V3 branch

211
Q

What CN innervates the anterior portion of the tongue to sense taste?

A

CN 7 the Facial Nerve

212
Q

What CN supplies taste and general sensation to the posterior portion of the tongue?

A

CN IX, the glossopharyngeal nerve

213
Q

What CN innervates the middle portion of the posterior portion of the tongue?

A

CN X the Vagus nerve

214
Q

What are the branches of the Trigeminal Nerve?

A

V1: Sensory = Ophthalmic V2: Sensory = Maxillary V3: Motor and Sensory = Mandibular

215
Q

Which branch of the Trigeminal Nerve is the lingual portion?

A

V3

216
Q

What area is considered the Pharynx?

A

Base of the skull to the level of the cricoid cartilage anteriorly and the inferior border of C6 posteriorly

217
Q

Starting at the base of the skull, what are the levels of the pharynx in order?

A
  1. Nasopharynx 2. Oropharynx 3. Hypopharynx (Laryngopharynx)
218
Q

What CNs innervate the nasopharynx?

A

IX (Glossopharyngeal) and small anterior portion of V (Trigeminal)

219
Q

What CNs innervate the oropharynx?

A

IX (Glossopharyngeal) and X (Vagus)

220
Q

What CNs innervate the Larryngopharynx?

A

IX (Glossopharyngeal) and X (Vagus)

221
Q

What are the 2 main motor CNs that innervate the pharynx?

A
  1. Stylophryngeus muscle IX (Glossopharyngeal) 2. Other pharyngeal muscles innervate by X (Vagus)
222
Q

What level of the spine is the larynx found?

A

C3-C6

223
Q

What is considered the “Watchbox” of the respiratory tract?

A

Larynx which is also called the voice box

224
Q

What is considered the last segment of the upper airway?

A

Larynx

225
Q

What does the Larynx protect?

A

Protects the lower airway from stomach particles

226
Q

What is the larynx made up of?

A

Bone and cartilage

227
Q

What bone is at the top of the larynx?

A

Hyoid bone

228
Q

What do we consider the Adams Apple?

A

Cartilages of the Larynx

229
Q

What are the 4 cartilages of the Larynx?

A
  1. Thyroid cartilage 2. Cricoid cartilage 3. Arytenoids 4. Epiglottis
230
Q

What is the narrowest part of the pediatric airway?

A

Cricoid cartilage

231
Q

What is the narrowest part of the adult airway?

A

Vocal cords

232
Q

Why do we need to know which part of the airway is the narrowest?

A

This determines the size of the ETT

233
Q

What cranial nerve branches into the superior and recurrent laryngeal nerves that provide sensory/motor innervations of the larynx?

A

Vagus Nerve, cranial nerve 10

234
Q

What is the site that we place the tip of a MAC blade?

A

Valleculae

235
Q

Describe the epiglottis

A

Leaf-shaped cartilage behind the root of the tongue

236
Q

What does the sniffing position allow for?

A

Allows alignment for best visualization of the airway

237
Q

What is the other name for the sniffing position?

A

Magill’s Position

238
Q

What type of flexion/extension moves the chin towards the chest?

A

Cervical Flexion

239
Q

What type flexion/extension moves the head on the neck?

A

Atlanta-occipital extension extends the head on the neck

240
Q

What 3 Axis are basically aligned when the patient is in the optimal sniff position?

A
  1. Oral axis 2. Pharyngeal Axis 3. Laryngeal Axis
241
Q

What piece of equipment do we use to assist us in getting the patient into the sniff position?

A

A pillow

242
Q

What patient population is contraindicated for the sniffing position?

A

Patient with suspected cervical spine injury

243
Q

What type of neck signals difficult airways?

A

Short and thick necks

244
Q

What neck circumference is associated with difficult intubations?

A

40 cm

245
Q

What BMI is associated with difficult airways?

A

BMI >= 40kg/m2

246
Q

What type of teeth interfere with blade position during intubation?

A

Long upper incisors

247
Q

Why is someone who is edentulous difficult to ventilate?

A

No seal

248
Q

What physical sign of difficult airway could facial hair hide?

A

Thyrometal distance

249
Q

What does facial hair interfere with?

A

Proper mask ventilation

250
Q

How much more prevalent are difficult airways in diabetic patients?

A

10x

251
Q

What occurs in 30-40% of insulin-dependent patients?

A

Limited joint mobility syndrome

252
Q

What patient population is usually affected by prayers sign?

A

Diabetes Mellitus

253
Q

Which joints are affected in Prayer’s sign?

A

Interphalaneal joints of the fourth and fifth fingers

254
Q

What is the 3-3-2 rule?

A

Incisor distances 3 finger breadths, hyoid-mental distance 3 finger breadths, thyroid to mouth distance 2 finger breadths

255
Q

What does checking mouth opening give us a look at?

A

Access to airway and obtaining glottic view

256
Q

What does check the tip of mentum to hyoid bone give us information about?

A

Can tongue be deflected to accommodate the laryngoscope

257
Q

What does the acronym LEMON stand for?

A

L- look externally E - Evaluate the 3-3-2 rule M - Mallampati (>3 =difficult) O - Obstruction (epiglottitis, peritonsillar abscess, trauma) N - Neck mobility (limited neck mobility)

258
Q

What does the Cormack-Lehane Classification tell us?

A

Describes laryngeal view during direct laryngoscopy

259
Q

What can you see on the Cormack-Lehane Grade 1?

A

Complete or nearly complete view of the glottic opening

260
Q

What can you see on the Cormack-Lehane Grade 2?

A

Posterior region of the glottic opening

261
Q

What can you see on the Cormack-Lehane Grade 3?

A

Epiglottis only

262
Q

What can you see on the Cormack-Lehane Grade 4?

A

Soft palate only

263
Q

What can you not see on the Cormack-Lehane Grade 2?

A

Anterior commissure

264
Q

What can you not see on the Cormack-Lehane Grade 3?

A

Any part of the glottic opening

265
Q

What can you not see on the Cormack-Lehane Grade 4?

A

Any part of the larynx

266
Q

What Cormack-Lehane Grade is this View? Describe what you see

A

Grade 1 ; Complete or nearly complete view of the glottic opening

267
Q

What Cormack-Lehane Score would this be? Describe what you can see

A

Grade 2; Posterior region of the glottic opening

268
Q

What Cormack-Lehane score would this view be? Describe what you see

A

Grade 3; Epiglottis only

269
Q

What Cormack-Lehane score would this view be? Describe what you see

A

Grade 4; Soft Palate only

270
Q

What Cormack-Lehane score would this view be? Describe what you canbot see

A

Grade 1; You can see everything

271
Q

What Cormack-Lehane score would this view be? Describe what you cannot see

A

Grade 2; You cannot see the anterior commissure

272
Q

What Cormack-Lehane score would this view be? Describe what you cannot see

A

Grade 3; You cannot see any part of the glottic opening

273
Q

What Cormack-Lehane score would this view be? Describe what you cannot see

A

Grade 4; You cannot see any part of the larynx

274
Q

How dose a Corrmack-Lehane grade 3 correlate to intubation?

A

Harder intubation

275
Q

How dose a Corrmack-Lehane grade 4 correlate to intubation?

A

Requires alternative approach to intubation

276
Q

History of what type of treatment predisposes a patient to difficult airway?

A

Radiation d/t stiffness of the neck and not being able to open the mouth

277
Q

What does the mneumonic BOOTS stand for and what is it used for?

A

Beard, Obese (BMI >26), Old (>55), Toothless, Snoring;

This is used to pre-determine a possible difficult airway

278
Q

What 4 questions do we ask before any airway management?

A
  1. Can I ventilate this patient?
  2. Can I intubate this patient?
  3. Can I use a supraglottic airway?
  4. Can I place an invasive airway?
279
Q

When we ask ourselves, can I use a supraglottic airway, what 5 things do we consider risk factors for LMA placement?

A
  1. Limited mouth opening
  2. Upper airway obstruction
  3. Altered pharyngeal anatomy which can prevent an adequate seal of the device such as radiation theraoy
  4. Poor lung compliance requiring excessive peak inspiratory pressure
  5. Increased airway resistance requiring excessive PIP
280
Q

When we ask ourselves, can I place an invasive airway, what 5 things do we consider as risk factors for ETT placement?

A
  1. Abnormal neck anatomy (tumor, hematoma, abscess, hx of radiation)
  2. Obesity
  3. Short neck
  4. Laryngeal Trauma
  5. Limited access to cricothyroid membrane (halo, neck flexion deformity)
281
Q

Which patent population do we decrease or omit benzos for?

A

Elderly patients w/ OSA or those with neurological impairment

282
Q

Examples of Alpha 2 agonists

A
  1. Clonidine
  2. Dexmedetomidine
283
Q

What type of anesthesia does dexmedetomidine help extend the effects of?

A

Regional anesthesia

284
Q

What two effects other than anitiemetic, does scopolamine provide?

A

Antisialogogue and some sedation

285
Q

Which antisialogogue provides the anti-spit effect without sedation?

A

glycopyrolate

286
Q

What is Glycopyrolate used for?

A

To decrease salivary, bronchial and GI secretions

287
Q

What about Glycopyrolate makes it unable to cross the blood brain barrier?

A

It is a quartenary amine

288
Q

What is the most common phase of anesthesia associated with aspiration?

A

Induction

289
Q

What patient populations shoud we pay particular attention to for aspiration precautions?

A
  1. Pregnant patients
  2. Morbid obesity
  3. Significant GERD
  4. “Full stomach” patients
  5. Diabetics with gastroparesis
290
Q

What does cricoid pressure prevent?

A

Prevents substances from the belly going into the upper airway to cause aspiration

291
Q

What effect does the endotracheal tube have on risk for aspiration?

A

Reduces it

292
Q

What type of extubation should we do to help prevent aspiration?

A

Awake extubation with airway reflexes intact

293
Q

What patient populations would we use RSI as an aspiration precaution?

A

Full stomach or high risk patients

294
Q

What is the issue with utilizing alpha 2 agonists to blunt the SNS response during laryngoscopy?

A

Expensive meds

295
Q

What does SCIP stand for and how many core measures does it include?

A

Surgical Care Improvement Project; 9 core measures

296
Q

3 things to consider controlling postop?

A
  1. Pain
  2. PONV
  3. Postoperative shivering
297
Q

What patient characteristics are associated with increased risk PONV?

A
  1. Female (young and obese or menstruating)
  2. Prior Hx of PONV
  3. Non-smokers
298
Q

Anesthetics associated with PONV?

A
  1. General Anesthesia
  2. Increased duration of anesthesia
  3. Intraop use of opioids
  4. Use of nitrous
299
Q

What anesthesia technqiue actually decreases risk of PONV?

A

Total IV Anesthesia (TIVA) with propofol

300
Q

Surgical characteristics that increase the risk of PONV?

A
  1. Laparoscopic procedures
  2. Gynecologic Procedures
  3. Opthalmologic procedures (strabismus)
  4. Ear and nasal procedures
  5. Shoudler surgery
301
Q

Where do 5HT3 antagonists target?

A

Chemoreceptor Trigger Zone (CTZ)

302
Q

Where do H1 Antagonists target?

A

Chemoreceptor Trigger Zone (CTZ)

303
Q

Why are H1 receptor antagonists not good for elderly patients who have a hard time coming out of anesthesia?

A

H1 receptor antagonists such as diphenhydramine or dimenhydrinate produce sedative effects

304
Q

What are the side effects of scopolamine patches?

A

Dry mouth, drowsiness, blurred vision, sedation and mydriasis

305
Q

What receptors does scopolamine patches inhibit?

A

M1 and H1 receptors in the hypothalamus and CTZ

306
Q

Which drugs are considered butyrophenons?

A

droperidol and metoclopramide

307
Q

What are the physiologic effects of metoclopramide?

A

Promotion of gastric motility, blockade of dopamine receptors in the CTZ and weak 5HT3 antagonistic properties

308
Q

What are the side effects associated with droperidol?

A

Prolonged QT interval and increased sedation

309
Q

What class of drug is promethazine considered to be?

A

Phenothiazines

310
Q

What receptors does promethazine block?

A

Blocks H1 receptors in the CTZ

311
Q

What side effects can promethazine produce?

A

EPS and sedation

312
Q

When are steroids most effective for prophylaxis of PONV?

A

Prior to induction of anesthesia, goal is to give when pt is asleep d/t intense perineal itching

313
Q

What are the physiologic effects of postop shivering?

A

Generation of heat and increased O2 demand and CO2 production

314
Q

In which patient population is postop shivering not well tolerated in?

A

Marginal CV and pulmonary reserve patients

315
Q

How do we treat postop shivering?

A

Active warming and medications such as meperidine

316
Q

How do volatile anesthetics effect postop shivering?

A

They lower the threshold for shivering

317
Q

What does NPO stand for?

A

nil per os

318
Q

What are the NPO guidelines for solid foods, nonclear liquids, meds and clear liquids prior to surgery?

A
  1. Patient should not have any solid foods or nonclear liquids for 6-8 hours prior to surgery
  2. Medications may be taken with a small sip of water up to 2 hours prior to surgery
  3. A small amount (few sips) or clear liquid is ok up to 2 hours prior to surgery.
319
Q

When is coffee considered a clear liquid?

A

Coffee is considered a clear liquid as long as it does not have any cream or milk added

320
Q

In the clinical setting, what do we tell patients in regard to NPO status and medications?

A

Patients should not eat or drink anything after midnight and take their AM meds 2 hours prior to surgery with a small sip of water

321
Q

What are the NPO guidelines for pediatric patients?

A

No solid foods for 8 hours, formula is okay up to 6 hours prior, breastmilk is okay up to 4 hours prior and clear liquids are okay up to 2 hours prior to surgery

322
Q

What effect doe chewing gum have?

A

Increased gastric emptying and motility

323
Q

How fast would we see a drop in O2 saturation numbers in a a patient whos BMI is >40?

A

Saturation will drop within 30 seconds

324
Q

What does denitrogenation allow for?

A

A safety buffer during periods of hypoventilation and apnea

325
Q

At what O2 sat would a patient be considered under safe apnea levels?

A

<90%

326
Q

What are the PaCO2 changes in the 1st minute of apnea and then the minutes following?

A

1st minute: 6mmHg increase

After 1st minute: 3-4mmHg increase per minute

327
Q

5 goals of preoxygenation?

A
  1. Bring patients saturation as close to 100% as possible
  2. Denitrogenate the residual capacity of the lungs to max oxygen storage
  3. Denitrogenate and maximally oxygenate the bloodstream
  4. Practice in every case when time allows
  5. Replaces nitrogen volume of the lung with O2 to provide for diffusion into the alverolar capillary blood after the onset of apnea
328
Q

What is a necessity to preoxygenation regardless of technique?

A

Application of a tight fitting mask and use of 100% O2

329
Q

5 Indicators of adequate preoxygenation?

A
  1. Fogging on the face mask
  2. Movement of the reservoir bag
  3. Presence of capnopgrah waveform (3 waveforms)
  4. Increasing O2 saturation
  5. The expired O2 concentration nears inspired O2 concentration
330
Q

When would we expect to see decreased O2 saturation when giving Versed?

A

In very sick patients

331
Q

3 points associated with Slow preoxygenation technique

A
  1. Tidal volume breathing for 3 minutes (normal breathing)
  2. Fresh gas flow of 5L/min, lung denitrogenation is 95% complete after 3 minutes
  3. Most patients are adequately preoxygenated after 3 minutes of tidal volume breahting with an inspired fraction of oxygen (FIO2) of 100%
332
Q

2 points associated with fast preoxygenation?

A
  1. Vital capacity breath
    * 4 vital capacity breaths ate FIO2 = 100% over 30 seconds
  2. Modified vital capacity breathing
    * 8 deep breaths for 60 second period
333
Q

What does the mneumonic BURP stand for?

A

Backward, upward (towards cephalid), rightward, pressure (can help or harm your view)

334
Q

By what percent does proper cricoid pressure lower the incidence of failure?

A

10% to 2%

335
Q

4 points of the Sellick Maneuver?

A
  1. Apply pressure before the patients loses consciousness
  2. Keep pressure
  3. Pressure before decr. LOC = 2kg or 20 newtons
  4. Pressure after decr. LOC = 4kg or 40 newtons
336
Q

5 complications associated with cricoid pressure?

A
  1. Esophageal rupture if patient actively vomiting
  2. Airway obstruction
  3. Impaired glottic visualization
  4. Difficult with laryngoscopy
  5. Difficult intubation
337
Q

Describe Larson’s maneuver

A

The applciation of firm pressure to the laryngospasm notch located just behind the earlobe

338
Q

What is the proper procedure for applying pressure to the laryngospasm notch?

A

Apply 3-5 seconds of pressure then release for 5-10 seconds and repeat until spasm relief

339
Q

Describe the location of the laryngospasm notch

A
  1. Behind the lobule of the pinna of each ear
  2. Anteriorly bounded by the ascending ramus of the mandible adjacent to the condyle
  3. Posteriorly by the mastoid process
  4. Cephalad by the base of the skull and external auditory canal
340
Q

2 goals of Larson’s maneuver

A
  1. Displaces the mandible anteriorly to help open the airway
  2. Breaks laryngospasm by causing the light anesthetized patient to sigh
341
Q

3 key points of awake intubation

A
  1. Premedication and sedation
  2. Topicalization
  3. Airway blocks (Nerve blocks)
342
Q

4 classes of meds utilized in the premedication and sedation stage of an awake intubation

A
  1. Antisialagogues
  2. Mucosal vasoconstrictors
  3. Aspiration prophylaxis agents
  4. Sedative/hypnotics
343
Q

When do we administer antisialagogues for an awake intubation?

A

30 minutes prior

344
Q

Why do we not give antisialagogues that cause tachycardia to patients with CAD?

A

slows diastolic filling time

345
Q

Which of the three antisialagogues are tertiary amines, meaning they can cross the blood brain barrier?

A

Atropine and scopolamine

346
Q

Why is bleeding considered a bad thing in the oral cavity?

A
  1. Obscurring vision
  2. Foreing body and laryngospasm as it is irritating
347
Q

2 Nasal Mucosal Constrictors?

A
  1. Cocaine
  2. Phenylephrine
348
Q

3 classes of drugs used for aspiration prophylaxis

A
  1. H2 blockers (decreased secretion of acid from parietal cells)
  2. PPI (not as effective as H2 blockers)
  3. Metoclopramide
349
Q

In which patient populations would we avoid giving scopolamine or metoclopramide to?

A

Patients exhibity CNS symptoms d/t possible exacerbation of EPS

350
Q

4 medications used for topicalization in awake intubation?

A
  1. Lidocaine
  2. Cocaine
  3. Benzocaine
  4. Cetecaine
351
Q

Of the medications utilized for topicalization in awake intubations, which are likely to cause methemoglobin? What type of change would this cause to the oxyhgb dissociation curve?

A

Benzocaine and Cetecaine; Would cause a left shift

352
Q

What is the drug of choice to reverse methemoglobin?

A

Mehtyline Blue

353
Q

6 locations to utilize when doing airway blocks

A
  1. Nasal cavity
  2. Nasopharynx
  3. Oropharynx
  4. Larynx
  5. Trachea
  6. Vocal cords
354
Q

Names the cranial nerve innervating each region of the airway

A
  1. Blue area = Trigeminal or CN 5
  2. Yellow area = Glossopharyngeal or CN 9
  3. Red area = Vagus or CN 10
355
Q

What provides sensory innervation to the nasal cavity and nasopharynx?

A

Sphenopalatine ganglion (Meckel’s ganglion) and the anterior ethmoidal nerve

356
Q

When placing nerve blocks in the nasal cavity or nasopharynx, what are we targeting?

A

The V2 branch of the trigeminal nerve, which supplies the maxillary area

357
Q

What are the three regions innervated by Cranial Nerve 5 in the nasal cavity and nasopharynx?

A

V1 = opthalamic

V2 = Maxillary

V3 = Mandibular

358
Q

What location are we trying to reach when we are placing a Sphenopalatine Nerve Block?

A

The V2 area of the Trigeminal Nerve

359
Q

3 key points of placing a Sphenopalatine Nerve Block?

A
  1. 20-G angiocatheter used to reach the V2 area
  2. 4mL of lidocaine/phenylephrine is rapidly injected
  3. About 2 minutes should be allowed for the anesthetic to take effect
360
Q

What cranial nerve provides sensory innervation to the oropharynx?

A

Cranial nerve 9, the glossopharyngeal nerve

361
Q

In the oropharynx, where does the afferent limb of the gag reflex arise from?

A

Stimulation of deep pressure receptors found in the posterior third of the tongue

362
Q

4 key points to minimizing gag reflex stimulation

A
  1. Instruct patient to breathe in a nonstop, panting fashion
  2. Avoid pressure on the base of the tongue
  3. Administer opioids
  4. Perform blockade of the GPN
363
Q

Where would we inject lidocaine to perform a glossopharyngeal nerve block?

A

The base of the posterior tonsillar pillars (palatopharyngeal fold)

DON’T FORGET TO PLACE LIDOCAINE ON BOTH PILLARS

364
Q

3 complications associated with GPN blocks

A
  1. Intra-arterial injection, which could result in headache or seizures
  2. Hypopharyngeal swelling and mucosal bleeding
  3. Tachycardia d/t blockade of afferent nerve fibers of the GPN that arise from the carotid sinus
365
Q

How does the Vagus nerve branch in the laryngeal region?

A
  1. Superior Laryngeal Nerve
  • Internal laryngeal branch
  • External laryngeal branch
  1. Recurrent Laryngeal Nerve (Inferior Laryngeal branch)
366
Q

Name structures labeled 1, 2, 3 and 4

A
  1. Superior Laryngeal Nerve
  2. Recurrent Laryngeal Nerve
  3. Internal Laryngeal Branch
  4. External Laryngeal Branch
367
Q

What nerve innervates the Larynx?

A

Superior Laryngeal Nerve

368
Q

What regions are affected when we utilize a superior laryngeal nerve block?

A
  1. Hypopharynx
  2. Upper glottis
  3. Vellecula
  4. Epiglottis
369
Q

Would these be considered above or below the trachea? Hypopharynx, Upper glottis, Vellecula, Epiglottis

A

Above the trachea

370
Q

What is the most lateral aspect of the hyoid bone that can be palpated?

A

The greater cornu of the hyoid

371
Q

What are the two main landmarks utilized when placing an SLN block?

A
  1. Cornu of hyoid
  2. Cornu of thyroid
372
Q

What do we know has occured after we feel a slight resistance as the needle is advanced through the membrane when placing an SLN block?

A

The needle has entered the pre-epiglottic space

373
Q

When placing an SLN block, you aspirate air, what could be the cause of this and how should you respond?

A

The needle has gone too deep and may have entered the pharynx. You should withdraw the needle until no air can be aspirated.

374
Q

When placing an SLN block, you aspirate blood, what would this indicate and how should you respond?

A

The needle has cannulated the superior larygngeal vein or the carotid artery. The needle should be directed more anteriorly.

375
Q

Why do we want to avoid instertion of the needle into the thyroid cartilage?

A

To prevent the possiblity of injecting lidocaine at the level of the vocal cords, possibly causing laryngeal edema and airway obstruction

376
Q

How would we minimize the risk of intravascular injection when placing an SLN block?

A

Identify the carotid artery and displace posteriorly

377
Q

5 possible causes of hypotension and bradycardia associated with placing an SLN block?

A
  1. Vasovagal reaction r/t painful stimuli
  2. Digital pressure on the carotid sinus
  3. Excessive manipulation of the larynx causing vasovagal reaction
  4. Large dose of or accidental intravascular admin of local anesthetics
  5. Direct neural stimulation of the branch of the vagus nerve by the needle
378
Q

What is recommended to be administered prior to performing an SLN block?

A

Anticholinergics

379
Q

Which nerve innervates the trachea and vocal cords for both sensory and motor fibers?

A

Right recurrent laryngeal nerve

380
Q

What portion of the right recurrent laryngeal nerve, if blocked will cause stridor?

A

Blocking the sides will cause stridor

(We want to block the middle portion)

381
Q

Positioning and Landmarks associate with placing a Translaryngeal (Transtracheal) block

A
  1. Supine position with neck extension
  2. Thyroid cartilage is palpated at midline and followed caudally until a depression and a firm ring of tissue are identified
  3. The identified tissue are the cricothyroid groove and cricoid cartilage
  4. Overyling the cricoid groove is the cricothryoid membrane
382
Q

What is the only procedure that we actually want the patient to cough, causing spread of the local anesthetic?

A

Translaryngeal Block

383
Q

How do we avoid laryngeal trauma when placing a translaryngeal block?

A

Never point the tip of the needle in a cephalad direction

384
Q

Which patients would be contraindicated for translarygneal block due to the possible increased HR, MAP, ICP and intraoccular presssure from coughing?

A

Elevated ICP or open globe, care should be taken in patients with severe cardiac disease

385
Q

What type of nerve block is being demonstrated in this picture?

A

Glossopharyngeal Nerve Block

386
Q

Name the structrures 1-4

A
  1. Condyle
  2. Mastoid Process
  3. Pressure Point for Larson’s Maneuvre
  4. Base of Skull
387
Q

Name the areas labeled 1-8

A
  1. Inspiratory Reserve Volume
  2. Tidal Volume
  3. Residual Volume
  4. Expiratory Reserve Volume
  5. Vital Capacity
  6. Inspiratory Capacity
  7. Functional Residual Capacity
  8. Total Lung Capacity
388
Q

Name the Phases of Anesthesia associated with Aspiration risk 1-7

A
  1. Induction
  2. Maintenance
  3. Emergence/PACU
  4. Obstetrical-related
  5. Difficult intubation
  6. Cricoid Pressure
  7. Hx of reflux
389
Q

What head positioning is associated with these axis alignments?

A

Neutral Head Positioning

390
Q

What head positioning is associated with these axis alignments?

A

Head is elevated but not extended

391
Q

What head positioning is associated with these axis alignments?

A

Head is extended but not elevated

392
Q

What head positioning is associated with these axis alignments?

A

Head is elevated and extended, this is the optimal sniff position

393
Q

What are the structures labeled 1 and 2 in this picture?

A
  1. The right and left true vocal cords
  2. Epiglottis
394
Q

Where in this image would we place the tip of a mac blade? The ET-Tube?

A

Mac-blade tip goes at #3

ET-Tybe goes at #4

395
Q

Name the areas 1-3

A
  1. Nasopharynx
  2. Oropharynx
  3. Hypopharynx (Laryngopharynx)
396
Q

What does the PUSH mneumonic stand for?

A

tonsillar Pillars

Uvula

Soft palate

Hard palate

397
Q

What does the mallampati score assess?

A

The relationship between tongue size and the oral cavity

398
Q

What is the largest structre in the mouth?

A

The tongue

399
Q

How do we increase predictive power when assessing a patients airway for possible difficulty?

A

Utilzing multiple airway exam methods

400
Q

5 key points for the mallampati score

A
  1. Sit upright (semi-fowlers)
  2. Extend the neck
  3. Open the mouth wide
  4. Stick out the tongue
  5. Do not phonate
401
Q

Where must the tongue be displaced during direct laryngoscopy to expose the glottic opening?

A

In the submandibular space

402
Q

What are the borders of the submandibular space?

A
  1. Superior border - mentum (chin)
  2. Inferior border - hyoid bone
  3. Lateral border - either side of the neck
403
Q

What does the thyromental distance estimate?

A

The size of the submandibular space

404
Q

How many finger-breadths/cm indicates an easy intubation per the thyromental distane evaluation?

A

Greater than or equal to 6 cm/3 finger-breadths

405
Q

How many cm indicates an difficult intubation per the thyromental distane evaluation?

A

Greater than 9cm

406
Q

What does a thyromental distance of less than 6cm indicate?

A
  1. Mandibular hypoplasia
  2. Small mandibular space
407
Q

What does a thyromental distance greater than 9 cm indicate?

A
  1. Larynx assumes a caudal position
  2. Tongue will move caudally
  3. The glottic opening will shift beyond the line of site
408
Q

What does the mandibular protrusion test assess?

A

The function of the temporomandibular joint

409
Q

When assessing the mouth opening of a patient, how many finger-breadths/cm indicate enough room for a laryngoscope or LMA?

A

>3 fingers/6cm

410
Q

When attempting to assess mouth opening of a patient who is edentulous, what are we measuring?

A

The interalveolus distance

411
Q

What class of mandibular protrustion test is indicated in this image and describe it.

A

Class 1; Patient can move LI past UI and bite the vermillion of the lip

412
Q

What class of mandibular protrustion test is indicated in this image and describe it.

A

Class 2; Patient can move the LI in line with UI

413
Q

What class of mandibular protrustion test is indicated in this image and describe it.

A

Class 3; Patient cannot move LI past UI, indicating increased risk of difficult intubation.

Advanced Health Assessment TWU CRNA (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions