IV sedation & complications

Question 1

what is the infusion rate (per drop) for adults and children?

Answer 1

A) Adult IV infusion set: 10 drops = 1 ml

B) Pediatric infusion: (micro-drip): 60 drops = 1ml

Question 2

Patient can tolerate up to ____ ml/kg of air in the venous circulation without adverse effect

Answer 2

1 ml/kg

Question 3

how are hematomas managed?

Answer 3

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

Question 4

what are the possible side effects of over-hydration?

Answer 4

Can cause:

pulmonary edema, respiratory distress, tachycardia, increase BP.

Question 5

how can a clinician recognize an intra-arterial injection?

Answer 5

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

Question 6

what is Phlebitis? what is Thrombophlebitis?

Answer 6

Phlebitis: Inflammation of the veins

Thrombophlebitis: inflammation of the vein wall have
preceded a thrombus formation

Question 7

what is the most common cause of airway obstruction?

Answer 7

Prolapsed tongue

Question 8

what would you do in the case of a prolapsed tongue?

Answer 8

Head tilt chin lift

Question 9

what are the advantages of a laryngeal mask airway?

Answer 9

• Minimal Training
• Shortest Placement Time
• Can Use In Pediatric Patients
•  Least Amount of Tissue Trauma Can Use To Intubate

Question 10

what is a Laryngospasm?

what are the symptoms?

Answer 10

• 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

Question 11

how would you manage a Laryngospasm?

Answer 11

• 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

Question 12

what drug can be given during severe Laryngospasm events?

Answer 12

0.5-1.0 cc(10-20mg) Succinylcholine

Question 13

what is normal blood glucose level?

Answer 13

70-110 mg/dl

Question 14

what occurs at a blood glucose of 50-70? what about at 20-50?

Answer 14

A) at 50-70: CNS becomes excitable: Extreme nervousness, sweating and trembling

B) at 20-50: convulsions, Loss of consciousness, Shock

Question 15

what are the clinical manifestations of a drug allergy?

Answer 15

1) SKIN reaction- most common
2) Bronchospasm
3) Angioedema of Larynx

Question 16

what are the clinical symptoms of anaphylactic shock?

Answer 16

• Progressive respiratory and circulatory failure
• Itching of nose and hands
• Flushing of face
• Feeling of substermal pressure Labored breathing, stridor, coughing
• Sudden hypotension
• Cyanosis

Question 17

what is the drug of choice for an anaphylactic reaction?

Answer 17

Epinephrine 0.1mg IV (0.3 cc 1:1000 IM)

can also give Antihistamine and Steroid IM/IV

Question 18

what is mendelson’s syndrome?

Answer 18

• death due to asphyxiation from vomiting

1) vomit
2) aspirate
3) die

Question 19

how is vomit aspiration managed?

Answer 19

A) Observe for signs of potential emesis  Swallowing
B) Suction readily available
C) seek medical attention

Question 20

what is the difference between intrinsic and extrinsic asthma?

Answer 20

Intrinsic: Allergy; antigen-antibody response

Extrinsic: infection, exercise, inhalants, emotional stress

Question 21

how would you manage an asthma attack?

Answer 21

1) Administer bronchodilator
2) 100% O2 by face mask
3) Monitor patient

Question 22

what drug should be given to an unresponsive pt due to asthma?

Answer 22

Epinephrine subque (0.3mg q30-60 min.)

Question 23

what drug is given to combat an opioid overdose? what quantity is given?

Answer 23

Naloxone (Narcan)

Supplied as 0.4mg/ml add 3 ml of saline = 0.1mg/ml. Give 0.1 mg slowly and assess the response.

Question 24

why must a pt be monitored for at least 1 hour after an opioid blocker is administered?

Answer 24

Naloxone is short acting, so reoccurrence of respiratory depression can occur

Question 25

what drug is given to counteract a benzodiazepine overdose? what dose is given?

Answer 25

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

Question 26

what are the clinical manifestations of myocardial infarctions?

Answer 26

• 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

Question 27

how do you manage a pt having a myocardial infarction?

Answer 27

MONA!!!

1) morphine (or nitrous)
2) oxygen
3) Nitroglycerin- repeat 3 times PRN, observe SPB less than 90 mmHg
4) Aspirin

Question 28

what are the possible complications of intra-arterial injections?

Answer 28

A) Chemical insult : Spasm that will compromise distal circulation.

B) Chemical endarteritis : lead to Thrombosis and ischemia

Question 29

where are intra-arterial injections most likely to occur?

Answer 29

the medial aspect of the antecubital fossa

where the brachial artery is superficial

Question 30

what major factors should you control in order to prevent vomiting during surgery?

Answer 30

1) Amount of gastric fluid
2) pH of gastric fluid
3) Presence of solid debris