Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NA 1 > NORA - Exam 6 > Flashcards

NORA - Exam 6 Flashcards

1
Q

Which kind of anesthesia ensures amnesia?

A

general

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How must your meds be labeled?

A
  1. Drug name
  2. Strength
  3. Amount (if you can’t tell from the container)
  4. expiration date (if not using within 24 hours)
  5. time
  6. initials
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Does mild sedation need etCO2 per AANA?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When do you have to monitor temperature? When is it optional?

A

Standard: GA
Optional: mild, moderate, deep sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What age of child is at greatest risk for adverse events of sedation? What are these events?

A

Less than 5 years of age; respiratory depression, apnea etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the relationship between length of surgery and adverse reactions?

A

Less than 1 hour, reduced amount of adverse reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the cause of most adverse anesthetic events?

A

Multiple anesthetic agents being used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

NPO for food/non-clear liquids for:
<6 months
6-36 months
>36 months

A

< 6 months: 4-6 hours
6-36 months: 6 hours
36< months: 6-8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is cardioversion?

A

Synchronized countershock to the R wave of the QRS to convert unstable afib/flutter, stable VT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does cardioversion work?

A

Closes an excitable gap in the myocardium, causing currents to re-enter and excite the electrical system of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Do patients need to be NPO for cardioversion?

A

No if emergent
Yes if non-emergent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Optimal shock conversion for afib/flutter

A

50-100 J
up to 360 J

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Paddle placement for cardioversion

A
  1. Parasternally over 2nd to 3rd intercostal space
  2. Other paddle over apex of the heart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anesthetic technique for cardioversion

A
  1. TIVA
    -Versed beforehand
    -Propofol/etomidate as anesthetic (IV)
  2. Muscle relaxant NOT necessary
  3. MUST intubate if patient has not fasted (anesthetic plan is changed to general ETT)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is radiofrequency catheter ablation?

A

Catheter with an electrode on the tip guided on fluoroscopy to an area of the heart muscle that demonstrated accessory electrical conductivity

-Usually for SVT, but can treat other arrhythmias

-Catheter guided via femoral artery and vein to the area of accessory electrical pathway or internal jugular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is cryoablation?

A

liquid nitrous oxide cause -22 to -75 C
-Safer in AV node region compared to RFCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is ice mapping?

A

Temporary freezing to see if it will fix the arrhythmia, if it does, cool further to permanently destroy tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Retrosternal angina pain of mild/moderate intensity for 1-2 minutes. Is this normal during RFCA?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Anesthetic choice for RFCA

A

-Moderate sedation + local +analgesia
-Kids: use LMA/GETT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why is TIVA ideal for RFCA?

A

Because the pulmonary artery is occluded, resulting in a loss of 25% of CO
-Interferes with inhalation of volatile anesthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is important to monitor during RFCA?

A

ECG
-Patient stops taking all antiarrhythmics before this procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Possible injury as a result of RFCA?

A

1.Thermal injury to esophagus during RFCA of left atrium
-Arterioesophageal fistual can occur!
2. CVA
3. Cardiac tamponade
4. Aortic valve damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Is it okay if there is space between the esophageal probe and the esophagus? What is the purpose of using an esophageal probe?

A

No; to monitor the temperature of the left atria – don’t want thermal injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Most electrophysiology procedures require MAC. Which electrophysiology procedures require GETT

A

RFCA Atrial fibrillation
V-Tach/V-Fib RFCA WITH epicardial approach
Lead extraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Is endoscopy okay for pregnant women?

A

Yes; but should be delayed until after delivery if possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which drugs are okay to give in pregnancy?

A

Most IV drugs, except versed
-Can give versed, but it crosses placental barrier and creates CNS depression
Volatile anesthetics (unsure)
No N2O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What does endoscopy do to aspiration risk?

A

increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the position/anesthetic technique for endoscopy?

A

moderate/deep sedation MAC
supine or LLD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What additional medication should be considered with upper endoscopy?

A

antisialogogues

30
Q

Colonoscopy position and anesthetic technique

A

Deep sedation, sometimes GA
Left lateral decubitus

31
Q

Adverse event that can occur due to colonscopy procedure?

A

Vagal response
-Distention of the colon

32
Q

ERCP preoperative assessment includes what labs?

A

CBC
liver chemistry
amylase/lipase levels
clotting function

33
Q

ERCP preoperative assessment includes what particular patient issues?

A

-Use of anticoagulants
-Bleeding history
-Prothestic heart valves
Risk of bleeding in general
-Allergies to IV contrast

34
Q

What is the position/technique for ERCP?

A

Deep sedation or general ETT
Prone, semi-prone or LLD

35
Q

What are emergent concerns with endoscopy, colonoscopy and ERCP?

A

Vomiting, aspiration, laryngospasm, bleeding, severe bradycardia, hypotension, bowel rupture, or duct rupture

36
Q

How does CT work?

A

Dense structures reduces energy of x-ray beam

37
Q

How does MRI function?

A

Dipole movement of the hydrogen atom

38
Q

What is the fringe field of the MRI?

A

Electromagnetic energy greatly drops off just outside the margins of the bore of the electromagnet

39
Q

Zones of the MRI?

A

Zone 1: Freely accessible
Zone 2: MRI personnel determine who passes through here
Zone 3: Restricted area, can only enter after being screened for ferromagnetic material
Zone 4: MRI scanner room (is within zone 3)

40
Q

Anesthesia considerations For CT?

A

-Patient must be supine
-Full spectrum of anesthesia may be delivered
-Anaphylaxis from ICM
-Diabetic patients cannot take metformin –> lactic acidosis

41
Q

What increases risk for ICM anaphylaxis

A
  1. Asthma history**
  2. hx of allergy***
  3. multiple morbidities
  4. HOCM
42
Q

How to treat anaphylactoid reaction of ICM?

A

-Corticosteroids (pretreatment)
-H1 and H2 blockers

43
Q

Safe metals for MRI?

A

Stainless steel
nonferrous
nickel
titanium

44
Q

What could happen to cardiac pacemakers in the MRI?

A

Literally anything

45
Q

Potentially harmful items in MRI?

A

-Penile implants
-brain/dorsal column stimulators
-Heart valves
-AICD
-permanent eyeliners/tattoos
-prosthesis
-implanted pumps
-internal metal plates
-aneurysm clips
-metallic sutures
-shrapnel
-tissue expanders with metallic ports

46
Q

How to prevent induced current and tissue loops?

A

Ensure leads and IV tubing are NOT touching the patient at all
Patient tissue should be touching itself
-e.g. hand cannot touch thigh, legs cannot touch each other

47
Q

Does MRI affect pregnant women?

A

no

48
Q

Technique of anesthetic for IR?

A
  1. Full spectrum, mostly GA
  2. Goal is to have rapid recovery so you can assess patient neuro status
49
Q

What is the antidote to heparin?

A

Protamine 1 mg/100units of heparin

50
Q

Why are pediatric patients (<5) at greatest risk for adverse effects?

A

Overmedication; apnea, respiratory depression, respiratory obstruction

51
Q

AICD components

A

Pulse generator
Lead electrode

52
Q

Cardiac pacemaker types

A

Unipolar - Generator is used at other pole
-More susceptible to interference
Bipolar

53
Q

What is generally the underlying rhythm (2) in a patient with an AICD?

A

Pulseless Vtach or Vfib

54
Q

After the leads are placed procedurally for AICD placement, is the next part of the procedure stimulating?

A

Yes; they may also induce vfib

55
Q

AICD
-Vfib treatment
-V-tach treatment

A

Vfib - shock in 10-15 seconds
V-tach anti-tachycardic pacing

56
Q

Which arrhythmia in pediatrics is most commonly treated with radiofrequency ablation?

A

SVT

57
Q

Why is glycopyrrolate used during colonoscopy?

A

Bradycardia
Anti-peristalsis to pass into the cecum

58
Q

At what point during an EGD/colonoscopy is the most stimulating part

A

Dilator insertion
-Give propofol before this portion

59
Q

For NORA cardiac procedures, what should always be on the patient in case of emergency?

A

Transcutaneous pacing pads

60
Q

Three rhythms requiring AICD placement; most common population characteristics?

A

SVT
-Young, healthy
-Symptomatic

Ventricular Dysrhythmias
-Elderly
-Low EF, CAD, CHF

-Low EF, BBB
-Paces both ventricles

61
Q

Definition of contrast-induced renal impairment?

A

Cr increase by 0.5 mg/dL

62
Q

When does contrast media renal impairment show up? For how long

A

24-48 hrs up to 5 days

63
Q

How can you lessen contrast media renal impairment?

A

IV hydration (increase extracellular fluid)
Smaller doses of dye
DC nephrotoxic drugs
Acetylcesteine

64
Q

What adverse system outcome can occur specifically because of the MRi procedure?

A

Nephrogenic systemic fibrosis
-Caused by gadolinium contrast agent
-Scleroderma internally and externally
-Occurs days/months after exposure
-Renal impairment puts you at risk

65
Q

What kind of cylinder can enter the MRI?

A

Aluminium!
“Brushed metal”

66
Q

Elective cardioversion
-indications

A

-Afib
-aflutter
-SVT

67
Q

Elective cardioversion
-anesthesia mgmt
-equiptment

A

-review labs (cbc, coags, lytes), EKG, NPO status
-IV agents: benzos, thiopental, methohexital, etomidate (myoclonus may interfere with rhythm interpretation) propofol
-good depth of anesthesia, shock, monitor airway/recovery

-monitors, O2 source, NRB, suction, crash cart, airway equiptment

68
Q

Cardioseal
-indications
-process

A

closure of septal defects (PDA, ASD) by deploying umbrella device
-fem access needed + use of contrast + introducer to place device (can have hoTN in this moment)

69
Q

Cardioseal
-equipment
-anesthesia mgmt

A

-AGM, cart, monitor, airway equipment and drugs

-GA + ETT REQUIRED due to continuous TEE, possibly need pt immobile
-maybe art line, maybe fluoro
-1.5-2hr case
-pt monitored 24 hrpostop

70
Q
A

NA 1 (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions