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Outpatient Flashcards

1
Q

How is cost affected by outpatient facilities?

A
  • Deceased financial burden to patient

- 3rd party payer can identify suitable procedures to reduce costs

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2
Q

How is the medical field affected outpatient centers?

A
  • ↑ inpatient beds

- ↓ noscomial infections

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3
Q

What are some social advantages of outpatient?

A
  • ↓ interuption of ADLs

- Care from parents/caretakers ↓ anxiety,confusion and pain

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4
Q

Staffing advantages of outpatiens.

A
  • Uniform schedules
  • Efficient time utilization
  • Predictable outcomes
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5
Q

Disadvantages of outpatient facilities.

A
  • ↓ privacy
  • Multiple screening trips
  • Need for home care
  • Patient compliance
  • ↓ orientation time
  • ↓ post op observation
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6
Q

What is the only age limit for outpatient?

A

Premature babies

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7
Q

What is the typical length of surgery for outpatient

A
  • Less than 2 hours

- Not to exceed 4 hours

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8
Q

Most common surgeries at outpatient facilities?

A
  • Opthalmologic

- Gynecological

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9
Q

What procedures are acceptable for outpatient?

A
  • Minimal blood loss
  • Minimal fluid shifts
  • High surgeon skill
  • Low post op pain
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10
Q

Why are premies not appropriate for outpatient?

A
  • Anemia
  • Underdeveloped gag reflexes
  • Temperature control
  • Apnea
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11
Q

3 types of premie apnea.

A
  • Short (6-15 sec)
  • Prolonged (>15)
  • Periodic breathing
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12
Q

What can apnea lead to, and when?

A
  • Hypoxemia and bradycardia

- As late as 12 hours post op

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13
Q

When can a premie be an outpatient?

A

-50-60 weeks post conceptual age

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14
Q

What disorders of an infant prevent them from being outpatient?

A
  • Bronchopulmmonary dysplasia

- SIDS risk (until 1 year)

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15
Q

Children should be free from bradycardia and apnea for how long before surgery?

A

6 months

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16
Q

What kind of age should you consider?

A

Physiologic not chronologic age

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17
Q

Those 85 yo and greater are at a great risk of what the week following surgery?

A

-Hospital admission and death

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18
Q

A patient w/ convulsive disorder or MH susceptibility must be scheduled when?

A

-Early in the day for longer obs

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19
Q

What must be managed carefully w/ cystic fibrosis?

A
  • Respiratory distress

- Hydration

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20
Q

When is obese patients acceptable for outpatient?

A

ASA class 1 or 2

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21
Q

When can sickle cell crisis begin?

A
  • Hypoxia
  • Acidosis
  • Dehydration
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22
Q

Sickle cell criteria for outpatient

A
  • No organ disease
  • No crisis in the past year
  • Compliant medical care
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23
Q

Social considerations for outpatient

A
  • Patient compliance
  • Responsible caregiver
  • Discharge accomadations
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24
Q

Unacceptable patients conditions for outpatient?

A
  • Unstable ASA 3 or 4
  • Active substance abuse
  • Physcosocial problems
  • Seizures
  • Untreated sleep apnea
  • Uncontrolled diabetes
  • Isolation needs
  • Pain not controlled w/ oral meds
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25
How old can the H&P be?
- 30 days for stable | - 72 hours for high risk
26
Lab values can be how old?
60 days if stable - K 7 days if on diuretic/digitalis - Glucose morning of surgery
27
CXR in downs is looking for what?
subluxation of atlantoaxial junction
28
Indications for EKG
- CV disease - Murmur - HTN - Over 40 yo - Family history long QT - Sleep apnea - Anatommic airway obstruction
29
Patients that take ACE inhibitors may need what?
Vasoprressin for low BP
30
2 types of noninfectious runny nose?
- Allergic (seasonal) | - Vasomotor (crying)
31
2 types of infectious runny nose?
- Viral (common cold) | - Bacterial (strep)
32
Symptomatic URTI should be rescheduled when?
4 weeks later
33
Asymptomatic URTI can be done if?
- Child older than one - Surgery not on thorax or abd - No ETT planned
34
Anesthesia can increase respiratory complication how much?
2-7 fold
35
Risk factors for URTI bronchspasm / comlications?
- < 5 yo - Premature - 2nd hand smoke - Secretions - Nasal congestion - ENT sx - Reactive airway disease
36
Common aspiration prophylaxis?
- Antacids - Gastrokinetics - H2 agonists - PPI
37
General anesthesia in SDS.
- Short acting - Rapid onset / offset - NSAIDS - Minimize physiologic changes - Minimize post op side effects
38
Why is ETT use minimized?
- Post op croup - Sore throat - ↓ ability to resume PO
39
When to give fluids?
- Procedure > 30 min - Procedures with ↑ PONV and pain - Prolonged fasting - Bleeding - ABX
40
Advantages of regional anesthesia.
- Shorter recovery - ↓ inpatient admission - Post op pain relief - GA alternative
41
Regional disadvantages.
- Patient / surgeon cooperation - More time needed - Orthostatic Hypotension - Inability to pee - PDPH
42
Common post op complications
- Nausea / vomiting - Pain - Peds - Certain Procedures
43
Major postop morbidities
- MI - Stroke - PE - Respiratory failure
44
What increases PONV
- Ambulation - Postural Hypotension - Pain - Meds - Oral intake - low O2 - Reversal agents
45
What increases PONV?
- HX of PONV - Mandibular sx - Eye sx - Plastic sx
46
What can help PONV?
- Decadron - Droperidol - Ephedrine - Reglan - Zofran - Phenergan - OG tube
47
4 items to help post op pain
- Regional - NSAIDS - LA wound infiltration
48
Post op phase 1
- VSS - Off O2 - Sit in chair - Protect airway - Oriented
49
Post op phase 2
- Responsible caregiver - pain controlled - PONV minimal - Void - No resp distress
50
In MAC case, a patient must be able to
- Protect airway - Breathe independently - No LOC
51
ASA guideline for MAC
- Pulse Ox - ECG - BP - Temp - Capnography
52
Incidence of brain damage / death is higher in MAC or General?
MAC
53
Deep sedation is signified by what?
- Not easily aroused - Responds to painful stimuli - May need assistance w/ airway - CV unaltered
54
What is the difference between MAC and moderate sedation?
- Moderate sedation can be directed by physician performing procedure - MAC must have anesthesia personal
55
What things can cause delayed awakening
- Prolonged anesthesia - Metabolic causes - Neurologic injury
56
Most common cause of hypotension?
Hypovolemia
57
Hypothermia causes what?
Venoconstriction
58
What causes PAC and PVC's
- Hypomag - Hypokalemia - ↑ sympathetic tone - Myocardial ischemia
59
What is first line / 2nd line treatment for laryngospasm?
- Positive pressure | - Succs
60
Droperidol concerns
dont give QT prolongation
61
What is a D&C used for?
- Removal of endometrial lining - Spontaneous abortion - Cervical stenosis - Bleeding
62
What position of D&C?
Dorsal lithotmy (<40 degrees)
63
Meds for D&C bleeding?
- Methergine | - Oxycotcin (uterus contraction)
64
Causes of severe post op bleeding in D&C?
- Cervical injury - Uterine atony / Perf - Retained conception products
65
What is a hysteroscopy?
- Allows exam of endometrial cavity | - Diagnose uterine bleed
66
Distension may be needed in hysteroscopy, what can be used?
- NS - Sorbitol - Mannitol - CO2
67
What type of needle reduces risk of PDPH?
-pencil point
68
What sensory level for hysteroscopy?
T10 belly button
69
Reasons for TMJ surgery?
- Ankylosis - Tumor - Chronic dislocation - osteoarthtitis - Painful disc dislocation
70
TMJ Complication
- Facial and trigeminal nerve damage - Hearing loss - Vertigo - Ear fullness - Hemorrhage
71
Why TMJ arthroscopiclly?
- Better blood and lymphatic flow | - Less periarticular tissue disruption
72
People needing GA for dental surgery?
- MR - Children - Oral sepsis - Seizures - TMJ
73
What will lingual nerve damage cause?
Tongue numbness
74
What will alveolar nerve damage cause?
Lip numbness
75
What is horner's syndrome and when do you get it?
- Droopy eyelid | - Interscalene block
76
A mouth gag can cause what?
-ETT kinks and dislodgement
77
What to check after gag?
- Obstructions - BBS - Chest movement - PIP
78
Where is ETT secure for T and A?
Midline lower lip
79
Hypercapnia can cause vasodilation and cause what?
increased bleeding
80
What is the most common arthroscopic procedure?
Knee
81
Most common complication of knee arthroscopy?
-Hemarthrosis
82
Where is knee trocar placed?
-Lateral and medial to patellar

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