Module 8: Part 1 Flashcards
3 Major Safety Initiatives Addressed in Anesthesia
LAST
Greater used of neuraxial for cesareans
Protocols and devices to improve general anesthesia
communication failures/reasons for malpractice claims
Lack of informed consent
Poor patient rapport
Language barriers
Inadequate discharge instructions (PDPH)
patients have the right to be told…
what to expect and to determine what will be done with their bodies
Patient can make an informed consent only after (3)
Discussion about diagnosis and indications for procedure
Risks, benefits and alternatives
Opportunity to ask questions/answers
special considerations for decision making in OB anesthesia (5)
Patient who is in pain
Patient who has received sedatives
Patient with a birth plan
Emergency procedures
Cultural considerations
2 most common injuries in obstetric anesthesia claims in ASA Closed-Claims database
Maternal nerve injury (19%) and neonatal brain damage (16%)
3rd and 4th most common injuries in OB anesthesia claims
maternal death (15%) and headaches (11%)
More maternal nerve damage claims with ____________ (29%) than ____________ delivery (13%)
More maternal nerve damage claims with vaginal (29%) than cesarean delivery (13%)
Neonatal brain damage is higher in ____________ delivery
cesarean 21% vs vaginal 13%
Block-related events in Obstetric Claims (4)
High spinal/epidural (6%)
Dural puncture headache (6%)
Inadequate analgesia (5%)
Retained catheter (4%)
more than 1/2 of maternal hemorrhage is associated with
abnormal placentation
what is the primary cause of sentinel events?
Poor communication among health care workers
risk factors for pulmonary aspiration (7)
Full stomach
pregnancy
bowel obstruction
GERD
Obesity
GI disorders
Neurologic conditions
difficult or failed intubation in pregnancy
up to x11 greater
most cases of pulmonary aspiration occur
during elective procedures
what promotes aspiration? (3)
Increased gastric pressure, decreased LES and blunted protective airway reflexes
Functions as an anti-reflux barrier
lower esophageal sphincter
LES pressure
20 cm H20
what is prevented by the LES
Passive reflux and regurgitation of gastric contents is prevented by LES
ASA and ACOG NPO recommendations allow for
clear liquids in uncomplicated labor but avoidance of solid food
Morbidity and mortality of aspiration depends on (3)
Chemical nature of the aspirate
Physical nature of the aspirate
Volume of the aspirate
Aspirates with a pH < 2.5 cause
a granulocytic reaction that continues beyond the acute phase
aspiration pneumonitis or Mendelson’s syndrome
acidity of gastric contents results in chemical burn to tracheobronchial tree and alveoli
chemical pneumonitis usually occurs when (2)
pH <2.5 and volume greater than 25 ml (0.4 ml/kg)
most common site of aspiration
R. Lower Lobe
Large particle aspiration causes
atelectasis from obstructed large airways
chemical pneumonitis is a parenchymal reaction with injury to
alveolar epithelium, edema
Aspiration of nonparticulate, neutral liquid leads to
minimal damage
chemical pneumonitis onset
Acute onset or abrupt development of symptoms within minutes (bronchospasm, decreases in PaO2 with increased shunting)
potential signs and symptoms of pneumonitis
will breath hold then have tachypnea, tachycardia, slight respiratory acidosis
significant aspiration S&S
hypoxia caused by greater shunting and usually bronchospasm
general pneumonitis S&S
Bronchial obstruction, pulmonary edema, reduced lung compliance, shunting resulting in hypoxemia, VQ mismatch
bronchospasm algorithm in intubated patient
Abnormal chest xray can be seen when with pneumonitis?
12-24 hrs after clinical signs
Berlin definition of ARDS (4)
Clinical: within 1 week of known clinical insult
Chest imaging: bilateral opacities not explained by effusions
Biochemical: PaO2/FIO2 ratio less than 300 with CPAP or PEEP > 5 cm H2O
Origin of pulmonary edema: not explained by cardiac failure or fluid overload
initial management of aspiration pneumonitis
treatment of hypoxia associated with aspiration
CPAP
PEEP
Mechanical ventilation
Conservative fluid strategy
CPAP in treatment of hypoxia
used in patients breathing spontaneously
function of PEEP (with mechanical ventilation in patients with hypoxia)
restores FRC, reduces pulmonary shunting, and helps reverse hypoxemia
mechanical ventilation in patients with hypoxia
restores FRC, reduces pulmonary shunting, and helps reverse hypoxemia
