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Spring '20/ L. Basic's Test 3- OP, EENT, OR Hazards > OR HAZARD & ANESTHESIA AWARENESS > Flashcards

OR HAZARD & ANESTHESIA AWARENESS Flashcards

1
Q

WHAT IS ONE OF THE BIGGEST PATIENT FEARS

A

INTEROPERATIVE AWARENESS

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2
Q

MEMORY:EXPLICIT

A

CONSCIOUS MEMORY
CONSCIOUS RECOLLECTION OF PREVIOUS EXPERIENCES: EQUIVALENT TO REMEMBERING.
AWARENESS DURING ANESTHESIA DESCRIBES CONSCIOUS RECALL (EXPLICIT MEMORY) OF INTRAOPERATIVE EVENTS

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3
Q

MEMORY IMPLICIT

A

UNCONSCIOUS

PATIENTS CAN RESPOND TO TO COMMANDS AND LACK CONSCIOUS RECALL OF INTRAOPERATIVE EVENTS (IMPLICIT MEMORY)

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4
Q

INTERVIEWING PATIENTS, CAN THEIR MEMORY BE DELAYED?

A

MEMORY FORMATION FOR INTRAOPERATIVE AWARENESS MAY BE DELAYED BEYOND IMMEDIATE RECOVERY PERIOD

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5
Q

HOW MANY AWARENESS CASES WERE IDENTIFIED PRIOR TO LEAVING THE HOSPITAL

A

1/3 OF CASES

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6
Q

WHAT ARE SOME FACTORS THAT WOULD INHIBIT PATIENTS FROM READILY VOLUNTEERING INFORMATION

A

PATIENT MAY NOT VOLUNTARILY REPORT AWARENESS D/T EMBARRASSMENT OR WAS NOT DISTURBED BY THE EXPERIENCE

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7
Q

HOW DO WE ASK IF THEY EXPERIENCED AWARENESS

A

WHAT IS THE LAST THING THEY REMEMBER, WHAT DO THEY REMEMBER?

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8
Q

QUESTIONS TO EVALUATE AWARENESS (5)

A

WHAT WAS THE LAST THING YOU REMEMBER BEFORE GOING TO SLEEP?
WHAT IS THE FIRST THING YOU REMEMBER AFTER YOUR OPERATION?
CAN YOU REMEMBER ANYTHING IN BETWEEN?
CAN YOU REMEMBER IF YOU HAD ANY DREAMS DURING YOUR PROCEDURE?
WHAT AS THE WORST THING ABOUT YOUR PROCEDURE?

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9
Q

INCIDENCE OF AWARENESS IN SWEDEN

A

PROSPECTIVE STUDIES IN SWEDEN: 12,000 PATIENTS = 0.18% (18/10,000) HAD AWARENESS UNDER GENERAL WHERE NMBD WERE USED

  1. 10% (10/10,000) ABSENT NMD
  2. 13% (13/10,000) OVERALL INCIDENCE
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10
Q

INCIDENCE IN U.S. OF AWARENESS

A

1/1000 PATIENTS HAVE AWARENESS

PATIENTS WITH COEXISTING MORBIDITIES TEND TO HAVE MORE FREQUENT INCIDENCE OF AWARENESS.

RISK FOR OPERATIVE AWARENESS GREATER FOR OB AND CARDIAC ANESTHESIA WHERE ANESTHESIA MAY BE LIGHT

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11
Q

3 MAJOR CAUSES OF AWARENESS

A

LIGHT ANESTHESIA

INCREASED PATIENT ANESTHESIA REQUIREMENTS

ANESTHETIC DELIVERY PROBLEMS

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12
Q

LIGHT ANESTHESIA-

name two surges that have light anesthesia

why might doses be reduced

A

REDUCED ANESTHESIA USUALLY DUE HEMODYNAMIC INTOLERANCE OF ANESTHETIC DRUGS

OB OR CARDIAC SURGERIES

REDUCED ANESTHETIC DOSES MAY BE NECESSARY FOR OPTIMAL PHYSIOLOGY AND SAFETY IN HYPOVOLEMIC PATIENTS OR THOSE WITH LIMITED CARDIAC RESERVE

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13
Q

Which asa range have more frequent incidence of awareness

A

ASA 3-5 UNDER GOING MAJOR SURGERY HAVE MORE FREQUENT INCIDENCE OF AWARENESS.

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14
Q

INCREASED PATIENT ANESTHESIA REQUIREMENTS- DRUGS

A

ABUSE OF ETOH; OPIOIDS; AMPHETAMINES AND COCAINE MAY REQUIRE INCREASE ANESTHETIC DOSING

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15
Q

DO GENETICS PLAY A ROLE IN INCREASE PATIENT ANESTHESIA REQUIREMENTS

A

GENETICS MAY PLAY A ROLE

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16
Q

LIKELY TO HAVE AWARENESS (4)

A

IMPAIRED CARDIOVASCULAR STATUS

UNDERGOING EMERGENCY SURGERY

RECEIVE SMALLER DOSES OF VOLATILE ANESTHETICS

TECHNICAL DIFFICULTIES

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17
Q

WHAT MAC DOSE IS USED TO PREVENT CONSCIOUS RECALL

A

A 0.7 MAC OR ABOVE PREVENT CONSCIOUS RECALL

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18
Q

WHAT CAN MASK AWARENESS FOR THE ANESTHESIA PROVIDER

A

NMBD

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19
Q

WHEN IS ANESTHETIC AWARENESS LESS LIKELY TO OCCUR USING WHAT DRUG?

A

VOLATILE ANESTHETICS

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20
Q

WHAT DRUGS ARE THEIR INCREASED AWARENESS

A

NITROUS AND INTRAVENOUSLY ADMINISTERED ANESTHETICS

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21
Q

ANESTHETIC DELIVER PROBLEMS (3)

A

EQUIPMENT PROBLEMS WITH VAPORIZERS

IV DEVICES NOT WORKING

ANESTHESIA MACHINE PROBLEMS

THESE ISSUES ARE USUALLY LESS COMMON REASONS FOR AWARENESS

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22
Q

PSYCHOLOGICAL SEQUELAE- WHAT CAN AWARENESS MANIFEST INTO?

A

~ 1/3 PATIENTS EXPERIENCING AWARENESS WILL MANIFEST IN LATE PSYCHOLOGICAL SEQUELAE

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23
Q

WHAT DO MOST PATIENTS OFTEN RECALL

A

LIGHTS, SOUND, FEELINGS OF HELPLESSNESS, FEAR, ANXIETY

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24
Q

IS PAIN A COMMON AWARENESS COMPLAINT?

A

IT IS LESS COMMON BUT MAY OCCUR WHEN NMBD ARE GIVEN

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25
Q

TELL ME ABOUT AWARENESS AND PTSD

A

CAN DEVELOP PTSD INTERFERING WITH INTERPERSONAL RELATIONSHIPS AND DAILY LIVING

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26
Q

CAN REGIONAL ANESTHESIA AND MAC CREATE PHYSOLGICAL ISSUES

A

PSYCHOLOGICAL ISSUES MAY BE PRESENT DURING REGIONAL ANESTHESIA AND MAC

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27
Q

ACUTE EMOTIONAL REACTION TO AWARENESS CAN DO WHAT?

A

AN ACUTE EMOTIONAL REACTION TO THE EXPERIENCE SIGNIFICANTLY PREDICTED THE DEVELOPMENT OF LATE PSYCHOLOGICAL SEQUELA

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28
Q

SIDE EFFECTS OF AWARENESS

A

FLASHBACKS, ANXIETY, NERVOUSNESS, LONELINESS, NIGHTMARES, FEAR, PANIC ATTACKS

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29
Q

TREATMENT FOR AWARENESS

A

EARLY PSYCHOTHERAPEUTIC THERAPY MAY REDUCE POTENTIAL OF ACUTE AND LONG TERM PSYCHOLOGICAL SEQUELAE.

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30
Q

AS ANESTHESIA PROVIDERS HOW DO WE APPROACH PATIENTS FEELINGS IN REGARD TO AWARENESS

A

AN EXPLANATION OR VALIDATION OF THE AWARENESS MAY EFFECT PRESENCE AND DURATION OF PSYCHOLOGICAL CONSEQUENCES.

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31
Q

WHAT REPORTING IS THERE FOR AWARNESS

A

A REGISTRY EXIST WHERE PATIENTS CAN REPORT EXPERIENCES AND OTHERS CAN LEARN MORE ABOUT PATIENTS’ EXPERIENCES

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32
Q

HOW TO DO PREP PATIENTS FOR SURGERY AND THEIR CONCERNS FOR AWARENESS

A

IMPORTANT TO TALK TO YOUR PATIENTS ABOUT THE ANESTHESIA PROCEDURE

LET THEM KNOW WHAT TO EXPECT. LISTEN TO FEARS AND ANSWER QUESTIONS

LET THEM KNOW WHAT TO EXPECT WITH A MAC CASE OR A REGIONAL WITH SEDATION (MAC).

ALWAYS LET THEM KNOW THEY WILL GET PAIN MEDICINE AND N/V MEDS WHILE ASLEEP AND CAN HAVE MORE IF NEEDED WHEN AWAKE IN PACU

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33
Q

BIS (BISPECTRAL INDEX SYSTEM):

A

MAY SEE IN MANY OR’s TODAY. MYLES ET AL. PERFORMED RCT n= 2500 pts. AT HIGH RISK FOR AWARENESS. IMPORTANT TO REALIZE THAT IF ONE ADDITIONAL PT HAD HAD RECALL IN THE BIS GROUP, IT WOULD HAVE NO LONGER BEEN SIGNIFICANT. THEREFORE, THERE IS NO REAL “GOLD STANDARD” FOR AWARENESS.

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34
Q

MORE BIS STUDIES

A

EKMAN ET AL. : PROSPECTIVE COHORT STUDY: n= 5027 PTS COMPARED WITH HISTORICAL GROUP n= 7826. BIS WAS USED TO GUIDE ANESTHESIA ADMINISTRATION. DEMONSTRATED ONCE AGAIN IF 1 MORE IN BIS GROUP AND 1 LESS IN THE HISTORICAL GROUP REPORTED AWARENESS, THE DIFFERENCE WOULD NOT BE STATISTICALLY SIGNIFICANT. MAY HAVE HAD A HAWTHORNE EFFECT

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35
Q

MORE BIS STUDIES

A

AVIDAN ET AL.: RANDOMLY ASSIGNED PATIENTS TO BIS (n = 967) OR ETCO2 GROUP (n = 974) FOUND NOT DIFFERENCE IN THE INCIDENCE OF DEFINITE AWARENESS IN BOTH GROUPS (2 EACH).

SEBEL ET AL.: PROSPECTIVE NONRANDOM COHORT (n = 19,575). BIS WAS MONITORED IN 38% OF THE PATIENTS AND NO DIFFERENCE IN AWARENESS INCIDENCE WAS FOUND.

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36
Q

AWARENESS PREVENTION PREMEDICATION

A

BENZO (ANTEGRADE AMNESIA)

37
Q

AWARENESS PREVENTION INDUCTION DRUGS?

A

ADEQUATE DOSES OF DRUGS FOR INDUCTION

38
Q

AWARENESS PREVENTION WHAT MED SHOULD WE AVOID UNLESS NECESSARY

A

AVOID MUSCLE PARALYSIS UNLESS NECESSARY

39
Q

VOLATILE GASES SHOULD BE AT LEAST WHAT MAC

A

0.7

40
Q

ANESTHESIA AWARENESS DOES NOT NECESSARILY =

A

LAW SUIT

41
Q

1 OUT OF HOW MANY INJURIES RESULTED IN MALPRACTICE CLAIMS

A

1 OUT OF 25 INJURIES FROM NEGLIGENT CARE RESULTS IN MALPRACTICE CLAIMS AND FEWER CLAIMS WHEN STANDARD OF CARE WAS DELIVERED.

42
Q

HOW MANY YEARS LATER CAN SOMEONE MAKE A CLAIM FOR AWARENESS

A

UP TO 10 YEARS

43
Q

CLOSED CLAIMS DATA

A

DATABASE CAPTURES CLAIMS FROM LIABILITY INSURERS WHICH COVER 1/3 OF U.S. ANESTHESIOLOGIST

44
Q

FACTORS INFLUENCE PATIENT SUITS (3)

A

POOR COMMUNICATION

UNMET EXPECTATIONS

FINANCIAL PRESSURES ON PATIENT

45
Q

WHEN DO ELECTRICAL SHOCKS OCCUR

A

OCCURS WHEN A PERSON BECOMES PART OF OR COMPLETES AN ELECTRICAL CIRCUIT.

46
Q

WHAT DOES THE BOVIE HAVE THE POTENTIAL TO INTERFERE WITH

A

PULSE OX AND PACEMAKERS

47
Q

WHAT CAN A BOVIE CAUSE INTERFERENCE WITH

A

EKG MONITORING

48
Q

WHAT IS THE CONCERN WITH BOVIE AND ANESTHETICS AGENTS

A

HASTENED END OF EXPLOSIVE ANESTHETICS AGENTS

49
Q

WHO INVENTED THE BOVIE

A

1926 W.T. BOVIE

50
Q

WHAT CARDIAC RHYTHM DOES THE BOVIE HAVE THE POTENTIAL TO CAUSE

A

V-FIB WITH A STRAY WHEN FIRST ACTIVATED OF 50-60 HZ RANGE

51
Q

3 COMPONENTS OF A FIRE

A

IGNITION SOURCE
(SURGEON, BOVIE)

FUEL
(NURSE, PREP)

ANESTHESIA
(OXIDIZER/02)

52
Q

TOXICANTS

A

PRODUCTS OF COMBUSTION

LESS OBVIOUS BUT POTENTIALLY MORE DEADLY RISK
INJURIOUS PRODUCTS FROM BURNING MATERIALS SUCH AS PLASTICS AND OTHER MATERIAL
C02
AMMONIA
HYDROGEN CHLORIDE
CYANIDE

53
Q

INJURIES FROM TOXICANTS

A

AIRWAY TISSUE
LUNG TISSUE
ASPHYXIA

54
Q

WHAT IS THE CONCERN REGARDING OR FIRES AND SPRINKLER DETECTION

A

OR FIRES CAN PRODUCE LARGE AMOUNTS OF SMOKE BEFORE SPRINKLERS DETECT FIRE BY HEAT ACTIVATION THEREFORE EVACUATION ASAP NEEDS TO BE PRIORITY

55
Q

TYPE 1 OR FIRE

A

IN or ON THE PATIENT IS THE MOST COMMON

56
Q

TYPE 1 HIGH RISK PROCEDURES

A 
HIGH RISK PROCEDURES IN WHICH AN IGNITION SOURCE IS USED IN AN OXIDIZER-RICH ENVIRONMENT 
ET FIRES
OROPHARYNX DURING T&A
FIRES IN BREATHING CIRCUIT 
FIRES DURING LAPAROSCOPY
57
Q

FIRES ON PATIENTS: WHAT body parts do they involve

A

HEAD AND NECK OF PATIENT

58
Q

WHAT TYPE OF ANESTHESIA ARE WE MOST CONCERNED WITH PATIENTS CATCHING FIRE

A

REGIONAL OR MAC WHEN PATIENT IS RECEIVING HIGH FLOWS OF SUPPLEMENTAL 02

59
Q

WHAT ARE ITEMS THAT CAN BE READILY IGNITED AND PRODUCE SEVERE BURNS

A

SURGICAL TOWELS, DRAPES AND BODY HAIR CAN BE READILY IGNITED AND PRODUCE SEVERE BURNS

60
Q

WHAT IS THE MAIN CONCERN WITH OXYGEN RICH ATMOSPHERES AND FIRE

A

OXYGEN RICH ATMOSPHERES LOWER THE TEMPERATURE AT WHICH A FUEL WILL IGNITE

THESE FIRES WILL BURN MORE VIGOROUSLY AND SPREAD FASTER

61
Q

FIRE CASE: KATZ & CAMPBELL (2005): FIRE DURING THORACOTOMY. DRY LAP CAUGHT FIRE B/C 100% 02 PRESENT IN THORACIC CAVITY WHILE USING ELECTROCAUTERY.

A

KATZ & CAMPBELL (2005): FIRE DURING THORACOTOMY. DRY LAP CAUGHT FIRE B/C 100% 02 PRESENT IN THORACIC CAVITY WHILE USING ELECTROCAUTERY.

62
Q

WHAT PULMONARY CASES ARE THE MOST CONCERN FOR FIRE

A

CASES INVOLVING STRIPPING OF THE PLEURA OR RESECTION OF PULMONARY BLEBS, CAN EASILY RESULT IN HIGH CONCENTRATIONS OF O2 IN THE CAVITY WHEN LUNG IS REINFLATED DUE TO GAS LEAKAGE

63
Q

SOLUTION TO PREVENT FIRE WHEN SURGEON NEEDS LUNG INFLATED

A

IF SURGEON NEEDS LUNG INFLATED, DO IT WITH CPAP WITH AIR INSTEAD OF O2

64
Q

SOLUTION TO PREVENT FIRE IN 02 RICH ENVIRONMENTS

A

WET LAPS IN 02 RICH ENVIRONMENTS

65
Q

TYPE 2 FIRE

A

REMOTE FROM PATIENT

66
Q

EXAMPLES OF TYPE 2 FIRES

A

PIECE OF EQUIPMENT
CO2 ABSORBER

ALL MATERIALS BURN IN A HIGH O2 ENRICHED ENVIRONMENT: THE HIGHER THE CONCENTRATION OF O2 THE MORE READILY MATERIALS CATCH FIRE:

67
Q

COTTON HUCK TOWEL: 21% 02 - ignition mean?

A

21% 02: IGNITION MEAN 12 SECONDS

68
Q

COTTON HUCK TOWEL: at 95% 02 ignition mean

A

95% IGNITION MEAN 0.1 SECONDS

69
Q

ENDOTRACHEAL TUBE FIRE

A

DEVASTATING

O2 AND OR N2O WILL PRODUCE A BLOWTORCH TYPE OF FLAME

RESULTS IN SEVERE INJURY TO TRACHEA, LUNGS, AND SURROUNDING TISSUES.

70
Q

UNCUFFED ETT FOR CHILD HAVING A T&A

WHAT IS THE FIRE CONCERNS?

A

SURGEON USES LASER TO CAUTERIZE TONSIL BED

WHAT COULD HAPPEN?

WHAT CAN YOU DO TO PREVENT OR DECREASE THE RISK?

71
Q

WHAT PRECENT OF SURGICAL FIRES ARE 02 ENRICHED.

A

MAJORITY OF OR FIRES OCCUR WITH MAC DURING HEAD AND NECK SURGERY

75% OF SURGICAL FIRES ARE O2 ENRICHED

IDEA TO USE <30% O2 IF POSSIBLE. IF NOT CAN ADD ROOM AIR TO REDUCE CONCENTRATION OR CONSIDER LMA/ETT

72
Q

WHAT IS THE FIRE RISK FOR SURGICAL PREPS

A

SOME NEWER SURGICAL PREPS CONTRIBUTE TO FIRES

73
Q

HOW DO THESE PREP COMES PACKAGED?

WHAT OTHER THINGS CONCERN US?

A

THESE SOLUTIONS TYPICALLY COME PRE-PACKAGED WITH A PAINTING STICK APPLICATOR WITH A SPONGE ON THE END (ex. DuraPrep)

IODOPHOR MIXED WITH 74% ISOPROPYL ALCOHOL THUS HIGHLY FLAMMABLE. 4-5 MINUTES TO DRY COMPLETELY!

BEWARE OF POOLS OF SURGICAL PREP

WHAT ISSUE MAY ARISE WITH A LONG DRYING TIME?

74
Q

IS SEVO FLAMMABLE

A

SEVOFLURANE IS VOLATILE (AT ROOM TEMP LIQUID VOLATIZES INTO A VAPOR) BUT CONSIDERED “NONFLAMMABLE”

75
Q

TELL ME WHEN SEVO AND NITROUS SERVES AS FUEL

A

HOWEVER SEVO IS NONFLAMMABLE IN AIR BUT CAN SERVE AS FUEL AT CONCENTRATIONS AS LOW AS 11% O2 AND 10% NITROUS OXIDE

76
Q

WHAT CHEMICAL REACTION DOES SEVO UNDERGO

A

SEVO CAN UNDERGO EXOTHERMIC CHEMICAL REACTION WITH DESICCATED CO2 ABSORBER (SODA LIME OR BARALYME)

77
Q

MANUFACTURERS OF SEVO SUGGEST REGARDING CO2 ABSORBERS

A

AVOID DESICCATED CO2 ABSORBENTS; MONITOR TEMP OF ABSORBERS AND INSPIRED SEVO CONCENTRA TION. SUDDEN UNEXPECTED INFLUX OF SEVO INHALATION REMOVE CIRCUIT AND ASSESS FOR THERMAL OR CHEMICAL INJURIES

78
Q

WHAT TYPE OF ABSORBENTS MUST WE USE

A

USE ABSORBENTS THAT DO NOT CONTAIN STRONG ALKALI. EXAMPLE AMSORB CONTAINS CALCIUM HYDROXIDE AND CALCIUM CHLORIDE AND NO STRONG ALKALI.

79
Q

AMSORB

A

UNREACTIVE WITH CURRENTLY USED VOLATILE ANESTHETICS

DOES NOT PRODUCE CARBON MONOXIDE OR COMPOUND A

WILL NOT INTERACT WITH SEVO AND UDERGO AN EXOTHERMIC CHEMICAL REACTION

80
Q

WHAT DO I DO? FOR AIRWAY FIRE

A

FRESH GAS DELIVERY MUST BE STOPPED: ACCOMPLISHED BY TURNING OFF FLOWMETERS, DISCONNECTING THE CIRCUIT FROM MACHINE, OR DISCONNECTING THE CIRCUIT FROM THE ETT
REMOVE ETT
M/M (P. 24) SAYS THE ORDER IS NOT AS IMPORTANT AS THE FACT THAT BOTH ARE DONE IMMEDIATELY IF NOT AT THE SAME TIME. WHAT DO YOU THINK?
STERILE WATER OR SALINE INTO AIRWAY TO EXTINGUISH ANY BURNING EMBERS
RESUME VENTILATION OF PATIENT WITH AIR (PREFERABLY)
AVOID O2 AND NITROUS
EXAMINE TUBE FOR MISSING PIECES
AIRWAY RE-ESTABLISHED
CONSIDER BRONCHOSCOPE
TREAT FOR SMOKE INHALATION AND POSSIBLE TRANSFER TO BURN CENTER

81
Q

closed claim project found 2.6% of awareness during ga were

demographic?
asa?
age?
class of procedure?

A

female
asa 1 or 2
elective procedure
less than 60 yrs

82
Q

how do you supply ungrounded power to the OR

A

use of an isolation transformer

83
Q

is there a direct electrical connection between the power supplied form the utility company on primary side and the power induced by the transformer on the ungrounded side or secondary side?

A

no direct connection

84
Q

is power isolated from the ground in the OR

why is that

A

Yes

85
Q

faulty equipment into an ips

A

no shock hazard- just converts the isolated power to conventional grounded power.

86
Q

line isolation monitor what is it monitoring

A

monitors the integrity of the IPS (isolation transformer)

87
Q

if a faulty piece of equipment is plugged in- the IPS becomes grounded- what detects that

A

Line isolation monitor

88
Q

what is the LIM set to alarm at

A

2-5mA

89
Q

when one faulty piece of equipment is plugged in is it a dangerous situation?

A

means its not totally isolated from the ground anymore - - it requires a second fault to be dangerous. a second piece of equipment that is faulty would then create a dangerous shock.
if several piece of equipment have a leak it can cause the LIM to go off.

Spring '20/ L. Basic's Test 3- OP, EENT, OR Hazards (8 decks)

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