Intra OP procedures Flashcards
what department keeps surgeries sterile?
Central sterile
super important
who hands the equipment during surgery?
scrub techs
why do we ask questions to patient over and over
to ensure
right person
right procedure
right doctor
What happens at the day of surgery
Check in (pre-admission testing), vitals, height and weight (need to be assessed every 24 hours) H&P if necessary
Holding room after OR is ready: family not allowed her (unless child), waiting for surgeon to get there,
check chart to make sure right doctor, procedure, name, mark the patient BEFORE the OR (needs to be done by the doctor, not PA)
Then sign anesthesia consent
Then time out in OR again after giving the surgeon a knife
then VerSed to calm the patient typically IV (AFTER signing)
Once a patient is out of the operating room, what do you do?
Apply monitors (BP, O2 sat, EKG leads, temp strip)
Anesthesia induction (general anesthesia - amnesia, anaglesia, muscle relaxation, and sedation)
What are the anesthetics
Propofol (very rarely make it to five when counting down)
Ketamine
SE of propofol
pain at injection site
SE of ketamine
CNS effects such as hallucinations
What is preferred, ketamine or propofol?
Propofol
What is the muscle relaxant used?
Succinylcholine
CI with h/o malignant hyperthermia
What does isoflurane do?
inhaled anesthetic used in children b4 the IV
then endotracheal intubation
What is malignant hyperthermia
pharmacogenetic response to
hyperthermia
metabolic acidosis
stiff muscles
1st sign of malignant hyperthermia - seen by ansestehsiologist (unexplained tach, increased end-tital CO2, increase of body temp above 38.8, masseter rigidity)
no inhaled anesthesia gases
no depolarizing muscle relaxants
treatment of malignant hyperthermia
crash cart of:
dantrolene
oxygen
body cooling and extra fluids
supportive care
what is the MC anesthesia?
Endotracheal intubation (what we did for lab)
What do you do if endotracheal tube is difficult?
Application of cricoid pressure
Fieroptic laryngoscope
GlideScope
After tube in inserted for anesthesia, what do you do?
infalte bulb to secure airway
connect to O2
Confirm placement by auscultation
Tape in place
Complication of ET tube
damage to teeth
tachy
laryngospams
What does the type of anesthesia depend on?
PMH
Length/difficulty of procedure
preference of surgeon/anesthesiologist
patient’s choice (typically overwritten though)
what are the different types of anestehsia
cnosious sedation
regional
general
combined regional and general
What is a monitored anesthesia care or conscious sedation?
maintain airway but not be moving around too much
typically for endoscopies (you do not remember anything but you can follow commands)
What is spinal/epidural procedures
lidocaine or bupivacaine
for LP
where is epidural infected
any point in vertebral column
What is a laryngeal mask airway?
LMA
for quick procedures
mask in back of throat essentially
not intubation
What are the different positions of spinal anesthesia
Lateral decbitis
sitting and bending forward
What has more SE, epidural or spinal?
Spinal
HA or cauda equina
What are the agents for local anesthesia
lidocaine w/ or w/out Epi
EPI is NOT on distal end points like penis, nose, fingers, and toes
when is local anesthesia done?
Minor skin procedures
post op pain reduction
digital blocks
What is a digital block
numbing the digits with lidocaine
NOT with EPI remember?
inject once, but pull back and move to next site without completely removing the needle
What is patient positioning during surgery
pads where there is pressure
support back/knees/heels
avoid brachial plexus injury
avoid leaning on the patient
cover body parts that are not on the operative fields to keep patient warm
ground pads to skin out of the operative field to ground the patient
Where can a grounding pad not be placed?
Over metal, ask history
What is the skin prep of a patient
Sterile gloves
Prep kits
Performed before being draped
What solution is used for skin prep
Chlorhexidine
Betadine
Bibiclens
Alcohol (fire hazard)
applied with sponges or stick applicator
What is gowning and gloving set up
NO jewelry
nothing on nails
PPE (OR hat, shoe covers, mask, eyewear)
ask where they keep the gown and gloves
Open with sterile technique
Scrub sink to scrub
Enter OR with arms above waste
dry with sterile towel
Don sterile gown + gloves
How to open sterile packs
Open away from yourself and make sure the inside does not touch anything
How are patients draped
depends on surgery
draped with sterile towels around surgical site and specialized drape placed atop the patient (based on the procedure)
