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NUNA 692 Principles III > NORA > Flashcards

NORA Flashcards

1
Q

NORA unique challenges

A
  • working with non-anesthesia personnel
  • scheduling priorities = rushed prep
  • equipment problems
  • unfamiliar environment
  • inadequate supplies, equipment, etc
  • lax “check-in” policies
  • stressful distance from the patien
  • isolated from other anesthesia providers
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2
Q

ASA statement on NORA locations about what is needed

A
  • O2 source and back up
  • suction meeting OR standards
  • scavenging for volatiles and N2O
  • self-inflating ambu bag with greater than 90% O2 ability, monitoring that meets “basics”, anesthesia machine at OR standards if volatiles and/or N2O being used
  • adequate electrical outlets + emergency back-up
  • adequate lighting + battery back-up
  • adequate space for equipment and patient access
  • crash cart with defibrillator, drugs, and CPR supplies
  • adequately trained staff for anesthesia support
  • dependable communication devices
  • all building and safety codes must be followed
  • trained staff for post-procedure care including transport personnel
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3
Q

BIG deal communication requirement

A

dependable communication devices

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4
Q

what are we doing in these places?

A

EVERYTHING

  • bronchoscopy
  • GI endoscopy
  • cardiac (cath lab)
  • diagnostic radiology
  • interventional radiology
  • ICU (pts too unstable to move)
  • dental
  • plastics
  • ophthalmology
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5
Q

higher frequency of _____ _____ and ______

A

severe injury and death

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6
Q

> 50% NORA-related claims involving deaths: patients received sub-standard anesthesia care _________ by improved _______ techniques

A

preventable
monitoring

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7
Q

sub-optimal ____ and failure to provide _____ _____ were the leading causes of poor outcomes

A

care
safe practice

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8
Q

most claims were related to:

A

inadequate oxygenation and/or ventilation (loss of airway)

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9
Q

______ most common cause - (___% of claims)

A

MAC (50% of claims)

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10
Q

1/3 are due to _____-_____ leading to respiratory depression

A

over-sedation

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11
Q

most claims are d/t over-sedation: limited _______ monitoring or no _______ monitoring at all

A

EtCO2
respiratory

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12
Q

Mean age of NORA patients is ____ ____ _____ than OR patients

A

3.5 years greater

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13
Q

this means more medically ______/more _______/less stable ______ ____

A

complex
comorbidities
surgical risk

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14
Q

NORA has higher percent of ASA

A

ASA III-V patients (37.6% compared to 33%)

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15
Q

because many NORA procedures are minimally invasive, patients are more likely to be _______ _____/____ _____

A

discharged early/same day

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16
Q

general considerations, patient factors:

A
  • ASA
  • comorbidities
  • airway
  • level of sedation
  • analgesia needed
  • basic vs. advanced monitoring
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17
Q

general considerations, environment:

A
  • equipment (basic and ER), personnel, radiation/magnetic fields, temperature, portable monitoring, and O2
  • more non-anesthesia trained personnel being licensed to administer sedation in NORA areas
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18
Q

general considerations, procedure:

A
  • diagnostic v. therapeutic
  • expected duration
  • positioning
  • surgical back-up
19
Q

endoscopy

A
  • airway compression/obstruction
  • prone/semi prone positioning
  • limited access to patient airway
  • aspiration
20
Q

pulmonary

A
  • neck positioning
  • pre-procedure ABG
  • shared airway
  • apneic oxygenation
  • local anesthesia/blunted airway reflexes
21
Q

cardiology

A
  • high risk of dysrhythmias
  • invasive monitoring (art line, CVP, PA)
  • TTE/TEE
22
Q

pediatrics

A
  • general vs. deep sedation with local/regional
  • neuroapoptosis - “feed and wrap”
  • airway obstruction, hypoxia, bradycardia
23
Q

fertility

A
  • neuraxial
  • regional
  • sedation
  • GA
  • anesthetic agent accumulation in the follicular fluid
24
Q

magnets force ______ to align with magnetic field

A

protons

25
Q

radiofrequency current stimulates protons causing them to:

A

spin against the pull of the magnetic field

26
Q

when this current is turned off, MRI sensors detect the ______ ______ as the ______ ______

A

energy released
protons realign

27
Q

the time and amount of energy released varies with the _________ and ________ chemistry

A

environment and tissue chemistry

28
Q

radiofrequency radiation emitted by MRI scanners is absorbed by the patient as ____ _____

A

heat energy

29
Q

magnet strength is measured in _____

A

teslas (T)

30
Q

most common magnet strength

A

1.5 T and 3T (the higher the number, the stronger the scale)

31
Q

now approved in the US is ____ T

A

7 T

32
Q

in the works:

A

10.5 T (weighs 3x more than a Boeing 737)

33
Q

MRI has ____ zones

A

4

34
Q

the zones are _____-_____ T

A

0.5-4 T

35
Q

anesthesia machine, monitors, stretchers, IV poles must be ____ compatible, and all staff must be _________

A

MRI
de-magnetized

36
Q

NORA has _____ mortality rate than the OR

A

lower (0.02% compared to 0.04%)

37
Q

most common minor NORA adverse outcomes:

A
  • PONV
  • inadequate pain control
  • hemodynamic instability
38
Q

most major complications:

A
  • serious hemodynamic instability
  • upgrade of care
39
Q

highest NORA mortality categories:

A

cardiology and radiology (0.05%)

40
Q

significant NORA risk:

A
  • over-sedation
  • inadequate ventilation and oxygenation

all typically during MAC cases

41
Q

when providing NORA, the same ASA safety requirements must be _____ as those in the _____

A

met
OR

42
Q

NORA includes specific challenges related to _____, ______, ______, and ______

A

environment, equipment, personnel, and isolation

43
Q

Many NORA adverse outcomes can be prevented with:

A

vigilant

NUNA 692 Principles III (20 decks)

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