NORA Flashcards
Sedation exists as a ________.
continuum
Minimal Sedation
A) Spontaneous unaffected
B) Airway unaffected
C) Normal response to stimuli
D) CV usually maintained
Options:
A) A only
B) A and B
C) B and D
D) A, B, and C
E) All of the above
D
Minimal Sedation
Responsiveness: Normal to verbal stimuli
Airway: Unaffected
Spontaneous Ventilation: Unaffected
CV Function: Unaffected
Moderate Sedation
A) Unresponsive/Unarousable
B) Airway - No intervention
C) Spontaneous ventilation unaffected
D) CV usually maintained
Options:
A) A only
B) A and B
C) B and D
D) A, B, and C
E) All of the above
C
Moderate Sedation
Responsiveness: Purposeful response to verbal/tactile stimuli
Airway: No intervention required
Spontaneous Ventilation: adequate
CV Function: Usually maintained
Deep Sedation
A) Unresponsive/Unarousable
B) Airway - No intervention
C) Spontaneous ventilation unaffected
D) CV may be impaired
Options:
A) A only
B) A and B
C) B and D
D) A, B, and C
E) All of the above
A
Deep Sedation
Responsiveness: Purposeful with REPEATED or painful stimuli
Airway: Intervention may be required
Spontaneous Ventilation: May be inadequate
CV Function: Usually maintained
General Anesthesia
A) Unresponsive/Unarousable
B) Airway - Intervention often required
C) Spontaneous ventilation frequently inadequate
D) CV may be impaired
Options:
A) A only
B) A and B
C) B and D
D) A, B, and C
E) All of the above
E
General Anesthesia
Responsiveness: Unarousable
Airway: Intervention often required
Spontaneous Ventilation: Frequently inadequate
CV Function: May be impaired
What are the 10 remote location standards of practice?
Preanesthesia assessment
Informed consent
POC
Implement/adjust POC
Prepare, dispense, label meds before use
Safety precautions
Monitor/Document
Minimize risk of infection (for everyone)
Time-oriented documentation
Transfer/Continuity of Care
Traditional pharmacotherapy works by?
Transduction
Transmission
Modulation
Perception of pain
Pediatric Patient Considerations include
Pt safety & guardianship of pt welfare
Children < 5 you at greatest risk for adverse events
Always assess for URI, fever, cough, snoring, and sputum production dt increased airway compromise
Pediatric respiratory adverse events are dt
a) multiple drug use
b) resp depression, apnea, obstruction
c) prolonged procedures
d) decreased hr
Options:
A) A only
B) A and B
C) B and D
D) A, B, and C
E) All of the above
D) a, b, c
What are some common causes of pediatric anesthesia adverse events for therapeutic or diagnostic procedures?
Pediatric NPO for clear liquids (all ages)
a) 2 hrs
b) 4-6 hrs
c) 6 hrs
d) 6-8 hrs
a) 2 hrs
Pediatric NPO for solid food and non clear liquids < 6 mos
a) 2 hrs
b) 4-6 hrs
c) 6 hrs
d) 6-8 hrs
b) 4-6 hrs
Pediatric NPO for solid food and non clear liquids 36 months
a) 2 hrs
b) 4-6 hrs
c) 6 hrs
d) 6-8 hrs
c) 6 hrs
Pediatric NPO for solid food and non clear liquids 6 mos
a) 2 hrs
b) 4-6 hrs
c) 6 hrs
d) 6-8 hrs
c) 6 hrs
Pediatric NPO for solid food and non clear liquids 6-36 mos
a) 2 hrs
b) 4-6 hrs
c) 6 hrs
d) 6-8 hrs
c) 6 hrs
Pediatric NPO for solid food and non clear liquids > 36 mos
a) 2 hrs
b) 4-6 hrs
c) 6 hrs
d) 6-8 hrs
d) 6-8 hrs
Geriatric Patient Considerations
- increased age -> increased period complications, loss of function reserve & physiologic
- increased comorbidities
- decreased immunity
- increased ration of adipose -> increased storage of lipid soluble agents
- decreased metabolic function (liver/kidney) will prolong anesthesia effects
- increased cerebral atrophy -> increased sensitivity to anesthetic meds
- decreased circulation time and muscle atrophy results in decreased O2 consumption and blood flow to muscles -> decreased CO
- decreased lung compliance -> v/q mismatch
- decreased thermoregulation
- use written & verbal post instructions
- evaluate preop METS/activity level
- ensure adequate padding/positoning
What is the optimal shock dose for cardioversion
a) 25-50J
b) 50J
c) 360J
d) 100J
Options:
A) A only
B) A and B
C) B and D
D) A, B, and C
E) All of the above
C) 50 to 100 J
Max 360J
Where do you place the cardioversion pads?
One pad - parasternal over 2-3 ICS
One pad - over apex
What are the indications for caridoversion
a) afib/aflutter
b) unstable VT
c) stable VT
d) ST
Options:
A) A only
B) A and B
C) B and D
D) A, B, and C
E) All of the above
D) a,b,c
The DC stimulus is synced to what
A) P wave
B) R wave
C) ST wave
D) T wave
B) R wave
What type of anesthesia meds will you use for cardioversion?
Since it is usually quick (1 minute), rapid recovery, you want quick on and off
Propofol (30-50mcg) or Etomidate -> good for low EF
Cardiovert is usually planned, but can be unplanned/emergent
What type of anesthesia level would you use for cardioversion?
Deep sedation
Room air general (RAG)
What are some considerations for cardioversion
NPO
Supplemental O2
Standard Monitors
Resuscitative Equipment
Can use EEG to monitor depth of sedation
Make sure to use a muscle relaxant prior to cardioversion. T/F
False, not needed
