Brainscape's Knowledge GenomeTM

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


See full index

Health Assessment ORAL first half > Induction and Emergence > Flashcards

Induction and Emergence Flashcards

1
Q

What does MSMAID (P) stand for?

A
  • Monitors on and alarms set
  • Suction on and adquate/nearby
  • Means of PPV (machine check
  • Airway (LMA/ETT)
  • IV and fluids
    • 2nd IV kid
    • fluid warmer/albumin/blood if needed
  • Drugs- emergency and basic
  • P-patient position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Airway setup?

11

A
  1. Appropraite sized face mask
  2. means PPPV
  3. suciton on and accessible
  4. tongue depressor
  5. appropriate sized oral and nasal airways
  6. appropriate sized LMA
  7. laryngoscope handle
  8. 2 diff blades
    • male mac 4/miller 3-4
    • female mac 3/miller 2
  9. ETT 2 sizes
    • male 7.5-8
    • female 6.5-7
    • any sx consideration? laser, nasal intubation, reinforced ETT
  10. Sylet and syringe
  11. tape
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Once you get patient on OR table, what should you ask patient to do?

safe apnea time?

A

Go into sniffing position- makes sure they’re able to without pain/discomfort in neck.

Place monitors on, pre-induction vitals.

Pre-oxygenate

5 minutes of 100% FIO2 at >6L/min = 10 minutes of safe apnea time.

4 VC breaths in 30 seconds = 5 minutes of safe apnea time

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

How do you preoxygenate the patient?

A
  • 5 min 100% Fio2 >6L flow= 10 minutes safe apnea time
  • 4 vital capacity breaths in 30 seconds= 5 min safe apnea time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If patient obese, how can you ensure the ramping is high enough?

A

External acoustic meatus lined with sternal notch= good indicator that axis aligned

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

Once you give induciton meds, now what?

A
  • Test reflexes with eyelash reflex
  • test ventilate with BVM,
    • troubleshoot:
    • reposition
    • use oral airway
    • two hands on mask
    • difficult airway algorithm
    • plan b airway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can you insert if you’re unable to ventilate the patient?

A

LMA!

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

If we can ventilate patient after induction meds, what is the next step?

A
  • Apply PNS and check baseline twitches
  • administer NMB
  • Monitor effectiveness of NMB with PNS
    • eye- asleep
    • ulnar- wake up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What happens after admin of NMB?

A
  • Continue to ventilate while NMB action takes effect
  • tape eyes
  • loss of twitches confirmed with PNS
  • attempt laryngoscopy and tracheal intubation
  • Confirm ETT
    • watch ETT pass VC
    • fogging ETT
    • Bil. chest rise
    • Bil. breath sounds
    • presence of three ETCO2 waveforms
  • Tape ETT
    • depth approx. ID X3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

After intubation and confirm ETT, next steps?

A
  • Continue to ventilate by hand or ventilator
  • adjust flows
  • add other gases
  • start infusion of anesthetic
  • add VA
    • DS/SEV/ISO
      • overpressure!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What should we do to prevent recall during intubation process?

A
  • Keep in mind DOA of induciton agent in relation to onset of NMB
  • may need additional inducation drug
  • use inhalational agent during ventialtion
  • BIS monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Effects of trachela intubaiton on body?

A
  • Very noxious!
  • HTN and increased HR- risk of MI
  • Laryngospasm
  • Bronchospasm
  • Deepen plan of anesthesia with intubation by using lidocaine/narc/induciton agent
  • consider prophylactic bronchodilator therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Standard induction review?

21 steps

A
  1. •Position patient supine in sniffing position
  2. •Turn on oxygen flow
  3. •Begin pre-oxygenation
  4. •Monitors on and vital signs taken (O2 sat, BP, ECG, PNS in place)
  5. •Suction on and ready at head of bed
  6. •Pre-induction medications
  7. •Lidocaine (+/-)/ Induction agent
  8. •Test Lash Reflex
  9. •Give Test ventilation
  10. •Check PNS working
  11. •Continue ventilating by mask
  12. •Paralytic drug
  13. •Continue ventilating by mask
  14. •Tape eyes closed
  15. •Continue ventilation until paralytic drug takes effect (loss of twitches)
  16. •Laryngoscopy and intubation
  17. •Inflate ETT cuff
  18. •Confirm ETT placement—bilateral breath sounds, chest rise and fall, presence of ETCO2 x 3 waveforms
  19. •Tape ETT
  20. •Continue ventilation by bag or ventilator
  21. •Begin maintenance anesthetic

•

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

What is RSI?

when is it used

what does it add/replace

A
  • Rapid sequence induction
  • airway mgmt technique that induces immediate unresponsiveness and muscular relaxation
  • fastest and most effective means of contorlling emergency airway
  • used in situation of full sotmachs-at risk for aspiration
    • pregnant
    • severe DM
    • uncontrolled acid reflux
    • hiatal hernia
    • trauma
  • Adds seliick’s maneuver and removes ventilation from standard induciton sequence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

RSI sequence?

22 steps

A
  1. •Identify patient in need of RSI
  2. •Pre-operative prophylaxis for aspiration
  3. • Bicitra/Reglan/Omeprazole/Pepcid or Zantac
  4. •Anxiolytic
  5. •Narcotic (avoid loss of consciousness to early)
  6. •Monitors on
  7. •Suction on and at head of bed
  8. •Supine-sniffing position
  9. •Pre-oxygenate
  10. •Sellick’s maneuver= cricoid pressure –gradually increase pressure as patient falls asleep
  11. •Induction agent
  12. •Succinylcholine or high dose Rocuronium
  13. •wait for fasciculation or 60 seconds (watch the clock- not the block) DO NOT VENTILATE!
  14. •Laryngoscopy
  15. •Tracheal intubation
  16. •Confirmation of correct placement
  17. •Give assistant permission to release cricoid pressure
  18. •Secure ETT
  19. •Ventilate or turn on ventilator
  20. •Tape eyes
  21. •Adjust flows
  22. •Begin maintenance anesthetic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When can you extubate a patient?

A

when nearly fully awake or deeply anesthesized! no inbeween!

  • must evaluate relative risk of coughing vs obstruction vs aspiration when diciding b/w awake vs deep extubation
  • RSI must be awake!
  • plane 1 or plan 3, avoid plane 2
17
Q

Extubation criteria?

6

A
  1. TV >6 ml/kg
  2. VC> 10 mls/kg (won’t get if extubating deep)
  3. RR <30 breaths/min
  4. Sao2 >90%
  5. ETCO2 <50 -> except copd, asthmatics
  6. sustained tetanic contraction with PNS
18
Q

Nearly fully awake extubation sequence?

9

A
  1. •Muscle relaxant fully reversed and confirmed with PNS (if applicable)
  2. •All respiratory extubation criteria have been met
  3. •Anesthetic medications including volatile agents and infusions turned off
  4. •100% FiO2
  5. •Oropharynx suctioned
  6. •Patient is responsive to commands/purposeful movement
  7. •Sustained (5 second) head lift indicates clinically adequate reversal of NMB
  8. •Patient can maintain and protect own airway
  9. •ETT removed while positive pressure breath is given
19
Q

Deep extubation sequence?

9

A
  1. •Muscle relaxant fully reversed and confirmed with PNS (if applicable)
  2. •All respiratory extubation criteria have been met
  3. •Oropharynx suctioned
  4. •100% FiO2
  5. •Oral or nasal airway may be inserted
  6. •ETT removed while positive pressure breath is given
  7. •Volatile agents or infusions turned off
  8. •Mask airway maintained while patient spontaneously ventilating
  9. •Remain vigilant until patient is responsive and maintaining own airway
20
Q

What is a laryngospasm?

how does it present

when is it seen?

5

A
  1. Prolonged, intense glottic closure
  2. may be present with high pitched squeak to total absence of sound (ominous sign)
  3. suprasternal and supraclavicular drawing in, increased diaphragmatic excursions, flailing of lower ribs resembling a “rocking horse”
  4. caused by contraction of lateral cricoarytenoids, thyroarytenoids, and cricothyroid muscle form stimulation of vagus nerve
  5. most often seen in induction/emergence
21
Q

What are some triggers for laryngospasms?

6

A
  1. Secretions (vomitus, blood, saliva)
  2. foreign body
  3. pain
  4. pelvic or abd visceral stimulation - vagal
  5. stimulating glottis in a light plane of anesthesia
  6. reactive airway dx
22
Q

How can you prevent larngospasm?

4

A
  1. Deep plane of anesthesia reached prior to sx stimulation
  2. either fully awake or deeply anesthetized with extubation
  3. suciton oropharynx prior to extubation
  4. remove ETT with positive pressure breath
23
Q

Layngospasm treatment?

A
  1. Recognize event!
  2. immediate removal of offending stimulus
  3. Larson maneuver, pressure for 3-5 seconds, release for 5-10 seconds
  4. admin 100% fio2 with continuous positive pressure
  5. deepen anesthetic (prop)
  6. small dose short acting muscle relaxant
    1. succ 20-40 mg
24
Q

Stage II anesthesia is dangerous because

A

highest risk for laryngospasm,

eyes will deviate

increase HR/BB

irregular RR, increase SNS STIM.

BREATH HOLDing, can be combative

Health Assessment ORAL first half (7 decks)

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