IV sedation & complications Flashcards
what is the infusion rate (per drop) for adults and children?
A) Adult IV infusion set: 10 drops = 1 ml
B) Pediatric infusion: (micro-drip): 60 drops = 1ml
Patient can tolerate up to ____ ml/kg of air in the venous circulation without adverse effect
1 ml/kg
how are hematomas managed?
1) Remove tourniquet to decrease venous pressure
2) Firm pressure with a gauze 5-6 min
3) Apply ice : VC
Subsequent management :
Heat can be applied no less than 4 hours
what are the possible side effects of over-hydration?
Can cause:
pulmonary edema, respiratory distress, tachycardia, increase BP.
how can a clinician recognize an intra-arterial injection?
A) Sever pain radiates peripherally from the site towards the hand or fingers
B) Absence of radial pulse: arterial spasm
C) Mottled skin color : VC
D) Cool limb
what is Phlebitis? what is Thrombophlebitis?
Phlebitis: Inflammation of the veins
Thrombophlebitis: inflammation of the vein wall have
preceded a thrombus formation
what is the most common cause of airway obstruction?
Prolapsed tongue
what would you do in the case of a prolapsed tongue?
Head tilt chin lift
what are the advantages of a laryngeal mask airway?
- Minimal Training
- Shortest Placement Time
- Can Use In Pediatric Patients
- Least Amount of Tissue Trauma Can Use To Intubate
what is a Laryngospasm?
what are the symptoms?
- Partial or complete closure of vocal cords due to direct irritation of cords by foreign matter during light planes of anesthesia
- Pt will make “crowing noises” & have difficulty breathing
how would you manage a Laryngospasm?
- Terminate procedure; back off surgical sites
- Deliver 100% O2
- Position head
- Protrude tongue, and suction oro, naso and hypopharynx - Push on chest, listen for rush of air
- Positive pressure O2
what drug can be given during severe Laryngospasm events?
0.5-1.0 cc(10-20mg) Succinylcholine
what is normal blood glucose level?
70-110 mg/dl
what occurs at a blood glucose of 50-70? what about at 20-50?
A) at 50-70: CNS becomes excitable: Extreme nervousness, sweating and trembling
B) at 20-50: convulsions, Loss of consciousness, Shock
what are the clinical manifestations of a drug allergy?
1) SKIN reaction- most common
2) Bronchospasm
3) Angioedema of Larynx
what are the clinical symptoms of anaphylactic shock?
- Progressive respiratory and circulatory failure
- Itching of nose and hands
- Flushing of face
- Feeling of substermal pressure Labored breathing, stridor, coughing
- Sudden hypotension
- Cyanosis
what is the drug of choice for an anaphylactic reaction?
Epinephrine 0.1mg IV (0.3 cc 1:1000 IM)
can also give Antihistamine and Steroid IM/IV
what is mendelson’s syndrome?
- death due to asphyxiation from vomiting
1) vomit
2) aspirate
3) die
how is vomit aspiration managed?
A) Observe for signs of potential emesis Swallowing
B) Suction readily available
C) seek medical attention
what is the difference between intrinsic and extrinsic asthma?
Intrinsic: Allergy; antigen-antibody response
Extrinsic: infection, exercise, inhalants, emotional stress
how would you manage an asthma attack?
1) Administer bronchodilator
2) 100% O2 by face mask
3) Monitor patient
what drug should be given to an unresponsive pt due to asthma?
Epinephrine subque (0.3mg q30-60 min.)
what drug is given to combat an opioid overdose? what quantity is given?
Naloxone (Narcan)
Supplied as 0.4mg/ml add 3 ml of saline = 0.1mg/ml. Give 0.1 mg slowly and assess the response.
why must a pt be monitored for at least 1 hour after an opioid blocker is administered?
Naloxone is short acting, so reoccurrence of respiratory depression can occur
what drug is given to counteract a benzodiazepine overdose? what dose is given?
Flumazenil (Romazicon) 0.1mg/ml
Give an initial dose of 0.2 mg (2ml) with subsequent doses administered as needed to a maximum dose of 1mg
what are the clinical manifestations of myocardial infarctions?
- May occur at rest, after exercise or emotional stress
- Sudden onset, pain is prolonged
- Described as crushing, substernal
- Not relieved by rest or nitroglycerine
- Nausea, vomiting, cold perspiration Weakness, dizziness, palpitations
how do you manage a pt having a myocardial infarction?
MONA!!!
1) morphine (or nitrous)
2) oxygen
3) Nitroglycerin- repeat 3 times PRN, observe SPB less than 90 mmHg
4) Aspirin
what are the possible complications of intra-arterial injections?
A) Chemical insult : Spasm that will compromise distal circulation.
B) Chemical endarteritis : lead to Thrombosis and ischemia
where are intra-arterial injections most likely to occur?
the medial aspect of the antecubital fossa
where the brachial artery is superficial
what major factors should you control in order to prevent vomiting during surgery?
1) Amount of gastric fluid
2) pH of gastric fluid
3) Presence of solid debris
