Medications, dilutions, and machine

Question 1

Ampule

Answer 1

Glass vile. Use filter needle to draw up. Edges can be sharp

Question 2

Vial

Answer 2

Plastic top with rubber stopper. Can be multi-dose but only with the same patient. Not sterile under the cap.

Question 3

What must be on every drug label

Answer 3

1.) Medication name
2.) Medication concentration
3.) Date it was drawn
4.) Time it was drawn
5.) Initials of who drew it

Question 4

Induction agent label color

Answer 4

yellow

Question 5

Paralytic label color

Answer 5

red

Question 6

narcotic label color

Answer 6

blue

Question 7

sedative label color

Answer 7

orange

Question 8

sympathomimetics label color

Answer 8

purple

Question 9

Anti-muscarinic label color

Answer 9

green

Question 10

local anesthetic label color

Answer 10

gray

Question 11

Process for drawing medication

Answer 11

1.) retrieve med from drawer
2.) look/read/confirm medication name and concentration
3.) draw up medication
4.) reconfirm medication and concentration
5.) replace needle with syringe cap
6.) place filled out medication label

Question 12

Phenylephrine dilution

Answer 12

Vial - 10mg/ml
Dilute to 100mcg/ml (bolus)
Dilute to 40mcg/ml (infusion)

Question 13

Sufenta dilution

Answer 13

Vial 50mcg/ml
Dilute to 5mcg/ml

Question 14

Precedex dilution

Answer 14

Vial 200mcg/2ml
Dilute to 4mcg/ml or 10mcg/ml (bolus)
Dilute to 4mcg/ml

Question 15

Levophed

Answer 15

Vial 16mg/4ml
Don’t bolus levophed
Dilute to 64mcg/ml (infusion)

Question 16

Epinephrine dilution

Answer 16

Ampule 1:1000 or 1mg/ml
Dilute to 10mcg/ml (little epi)
Dilute to 4mcg/ml (infusion)

Question 17

Nicardipine dilution

Answer 17

25mg/10ml vial
Dilute to 0.25mg/ml
Dilute to 0.1mg/ml

Question 18

Ephedrine

Answer 18

Vial or ampule 50mg/ml
Dilute to 5 or 10mg/ml
No infusion

Question 19

Syringe sizes for induction

Answer 19

Versed: 3ml syringe
Lidocaine: 5ml syringe
Fentanyl: 100mcg vial 3ml syringe
Fentanyl: 250mcg vial 5ml syringe
Propofol: 20ml syringe
Rocuronium: 5ml syringe
Succinylcholine: 10ml syringe
Ancef 10ml syringe (if needing 3g use 20ml)

Question 20

Anesthesia checkout check list

Answer 20

1.) check auxiliary oxygen cylinder
2.) Verify suction
3.) Turn on anesthesia machine and confirm AC power
4.) verify availability of required monitors and alarms
5.) Verify that pressure is adequate in the spare cylinders on the back of machine
6.) verify piped gas pressure greater than or equal to 50psig
7.) verify that vaporizers are adequately filled
8.) Verify no leaks in gas supply line between flow meters and common gas outlet
9.) test WAGD on back of machine
10.) Calibrate oxygen monitor
11.) verify carbon dioxide absorbent isn’t exhausted
12.) breathing system pressure and leak testing
13.) verify gas flows through the circuit (make sure ventilator works)
14.) document completion of checkout procedures
15.) confirm ventilator settings and evaluate readiness to deliver anesthesia care

Question 21

How to very pressure in spare tanks on back of machine

Answer 21

1.) disconnect wall supply
2.) flush the O2 system
3.) turn key on O2 tank to open it
4.) verify pressure is adequate in tank
5.) close valve on tank
6.) bleed system via flush
7.) reconnect pipeline

Question 22

How to verify there are no leaks in the gas supply lines and flow meters and common gas outlet

Answer 22

1.) verify flowmeter is off, vaporizers closed, machine is on manual/spon, and bypass is flipped
2.) connect bulb to CGO and squeeze to empty bulb
3.) allow bulb to remain negative for 10 seconds
4.) remove bulb
5.) FLIP BYPASS SWITCH BACK

Question 23

How to test breathing system pressure and leak test

Answer 23

1.) turn APL valve to 40cmH2O
2.) ensure vaporizers and flowmeters are closed
3.) Use your finger to occlude the Y piece of circuit
4.) Press the flush button until 40cmH2O is achieved
5.) hold that pressure for 5-10 seconds
6.) open APL valve to ensure rapid release of pressure

Question 24

Steps that need checked between each case

Answer 24

1.) verify suction
2.) verify required monitors
3.) verify vaporizers are adequately full
4.) verify CO2 absorbent is not exhausted
5.) breathing system pressure and leak testing
6.) verify gas flows properly through circuit
7.) document completion of checkout process
8.) confirm vent settings and evaluate readiness to deliver anesthesia care