HEENT Part I Flashcards
what anesthetic technique should be used with ENT surgery?
TIVA, may be difficult to maintain inhalational anesthesia
use of NMB with ENT surgeries?
must ask the surgeon first, they might be monitoring something and NMB may be c/i
with neck surgery, if retractors are used it can put pressure on the _______________ –> _________________
carotid; bardycardia
positioning considerations with ENT surgery
- head is prepped and completely draped or wrapped in towels 2. the ETT if often positioned and taped/padded to forehead 3. nasal and oral RAE common for long surgeries - watch for pressure on nares and lips 4. table may be turned 90 - 180 degrees (disconnect circuit when turning) 5. arms are tucked to ensure no IV kinking
when would you monitor auditory evoked potentials?
- acoustic neuroma 2. trigeminal neuralgia 3. facial nerve decompression
with neuromuscular junction monitoring, you are monitoring the ________________ nerve
facial
surgeries that utilize facial nerve monitoring
- thyroid 2. neck flap 3. dissections for cancer, nerve issues 4. parotid surgeries 5. mastoid surgeries
NIMS tube procedure uses what neurological monitoring
EMG
different ventilation techniques that can be used with ENT surgery
- spontaneous ventilation 2. apneic ventilation 3. jet ventilation
if the ETT is too deep and you are utilizing jet ventilation, what is the risk ?
gastric insuffulation
hypoventilation with jet ventilation can cause
air trapping and barotrauma
if using jet ventilation with ENT surgery, you are using _____________ tidal volumes and ______________ pressures
small; high
what situations would an elective tracheostomy be performed?
- prolonged ventilation in the ICU 2. chronic aspiration risk 3. super morbid obesity 4. free flap or other airway surgery requiring good visualization
T/F: tracheostomy procedures can be done awake, sedated, or under general anesthesia
TRUE
what is a MLT tube
microlaryngoscopy tube it is longer, but smaller diameter
sizes MLT tubes are available in?
4, 5, 6,
what ETT is the best for vocal cord surgery or pt with tracheal stenosis
MLT tube
when is a MLT tube an appropriate choice of airway securing device?
- vocal cord surgery 2. tracheal stenosis 3. tracheal malasia 4. tracheal strictures
what is the disadvantage to MLT tubes
smaller diameter thus increased resistance ventilation
if using a laser for ENT surgery, FiO2 must be less than ___________
30%
T/F: N2O is the gas of choice with laser ENT surgery
false; N2O is contraindicated
what is the fire triad
- oxidizer 2. ignition source 3. fuel
what are examples of oxidizers in the fire triad
- O2 2. N2O
what are examples of ignitions sources in the fire triad
- cable connections 2. fiber optic lights 3. electrocautery 4. electrosurgical laser
what are examples of fuel, in the fire triad
- linens 2. supplies 3. patient 4. alcohol prep solutions 5. surgical drapes
how do you manage airway fire?
- D/C laser 2. remove airway device, turn off gas, remove any flammable material, and pour saline in airway 3. put burning ETT/LMA in saline 4. ventilate pt with air 5. once fire extinguished ventilate with 100% FiO2 6. examine airway with bronchoscopy 7. if damage is minimal - humbidifed O2 via mask 8. reintubate if needed (with smaller ETT) 9. ABG, carboxyhgb, and CXR 10. if airway burn present/suspected –> 40-60% FiO2 + humdity 11. consdier steroids 12. consider trach 13. secure ICU bed for min of 24 hours
leforte I fracture
Maxillary separation from mid face, maxilla is mobile
leforte II fracture
Nasomaxillary fracture
leforte III fracture
Cranial base-facial separation
nasal intubation or NG tube placement is contraindicated with what classifications of leforte fractures
II and III
what is the primary concern with pharyngeal abscess?
airway
what can be used to decrease the risk of renal failure with the administration of contrast media?
- ensure well hydration 2. IV with NaHCO3 3. add N-acetyl-cysteine 4. you can also hydrate + vitamin C
how does N-acetyl cysteine decrease risk of renal failure with contrast media?
binds up the electrons
if pt has an allergy to shellfish and is going to get contrast, how should you pre-tx to decrease risk of reaction
- H1 or H2 blocker (like benadryl) 2. steroids (methylprednisolone)
how should you tx an allergic reaction to contrast media
- supportive care 2. bronchodialators 3. vasopressors
what is the maximum recommended occupational exposure to radiation?
5000 mrem/year
how can occupational radiation exposure be kept to a minimum (ALARA)
- reduce exposure time 2. reduce exposure dose 3. shielding all body parts as much as practical 4. being aware that rapidly replaced cells are at higher risk
if hemorrhagic neurocatastrophic event occurs in the radiology suite, what are the appropriate steps to prevent further complications
- secure the airway 2. support CV system 3. DC heparin 4. administer protamine sulfate
when you administer protamine sulfate you administer ___ mg / 100 units of total heparin adminstered
1
what medications can be given to increase the quality/duration of seizure during ECT
- alfenanil with propofol 2. aminophylline 3. caffeine 4. clozapine 5. etomidate 6. ketamine
when would external beam radiation therapy be utilized?
- children with malignant tumors that cannot be resected by surgery (ex: neuroblastoma)
what is external beam radiation therapy
high energy beams from a machine that target tumor from the outside of the body.
why is a cardiac echocardiogram performed prior to DC cardioversion
to ensure patient is not going to throw a clot
why is glucagon give during ERCP
- relaxes sphicter of oddi 2. spasmolytic, decreases gastric motility
CV response to ECT
- brady + asystole followed by HTN and tachycardia 2. can lead to increases in myocardial O2 demand 3. can cause arrhythmias 4. can cause transient ischemic changes
why is succinylcholine given to patients having ECT
- rapid onset, short duration, and independent reversibility 2. attenuates the potentially dangerous skM contractions produced with seizure activity
what is the 3rd leading cause of hospital acquired acute renal failure
MRI contrast
who is at increased risk of renal failure d/t contrast media
- DM 2. CKD 3. dehydrated pt
mild rxn to contrast media
- uriticaria 2. fever 3. chills 4. facial flushing 5. N/V
with ENT surgery, shared airway is common, therefore _______________ is key!!
effective communication
