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JW: Principles II > PACU & Complications (Exam II) > Flashcards

PACU & Complications (Exam II) Flashcards

1
Q

What is Standard 1 for postanesthesia care?

A

All patients who have received any type of anesthetic care should receive appropriate post-anesthetic care.

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2
Q

What is Standard 3 for postanesthesia care?

A

Upon arrival to PACU the patient should be re-evaluated and a verbal report to RN should be given by the anesthesia personnel.

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3
Q

What is Standard 4 for postanesthesia care?

A

The patient shall be evaluated continually in the PACU.

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4
Q

What is Standard 5 for postanesthesia care?

A

A physician is responsible for discharge of the patient from the PACU.

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5
Q

What is the more intense phase of post-anesthetic recovery?

A

Phase 1

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6
Q

In what phase are HR, O₂sat, RR, ECG, and airway patency monitored continuously?

A

Phase 1

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7
Q

What has to be assessed if a patient is still intubated in the PACU?

A

Neuromuscular function

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8
Q

What is Standard 2 for postanesthesia care?

A

A patient being transported to PACU has to be monitored and taken by qualified anesthesia personnel.

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9
Q

How often must vital signs be assessed and recorded during the 1st phase of recovery?

A
  • q5 min for 1st 15 minutes
  • q15 min for duration of phase 1.

Target vitals to 20% of baseline.

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10
Q

What tools are used to determine patients criteria for discharge from PACU?

A
  • Standard Aldrete Score
  • Modified Aldrete Score
  • PACU Discharge Score

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11
Q

Describe the Standard Aldrete Score.

A
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12
Q

Describe the Modified Aldrete Score.

A

Modified Aldrete Score

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13
Q

Describe the Postanesthesia Discharge Score.

A
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14
Q

What is the standard for how often vital signs must be checked in Phase II of recovery?

A

30 - 60 min

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15
Q

What should be monitored in Phase II of recovery? (other than vital signs)

A
  • Airway and ventilation status
  • Pain level
  • PONV
  • Fluid balance
  • Wound integrity
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16
Q

What are the most common complications that could be seen in the PACU?

A
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17
Q

What are the causes (anatomically) of upper airway obstruction?

A
  • Loss of pharyngeal muscle tone
  • Paradoxical breathing
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18
Q

What is the treatment of upper airway obstruction?

A
  • Jaw thrust
  • CPAP
  • Oral/Nasal airway
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19
Q

What are laryngospasms?

A

Vocal cord closure leading to loss of air movement and hypoxemia and negative pressure pulmonary edema.

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20
Q

What are the three most common causes of laryngospasms?

A
  • Stimulation of pharynx and/or vocal cords
  • Secretions, blood, foreign material
  • Regular extubations
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21
Q

What is negative pressure pulmonary edema?

A

Non-cardiogenic pulmonary edema that results from high negative intrathoracic pressures attempting to overcome upper airway obstruction.

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22
Q

What is the most common etiology of negative pressure pulmonary edema?

A

Laryngospasm

Occurs in 12% of laryngospasm cases.

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23
Q

What is the physiology behind laryngospasm?

A

Prolonged exacerbation of glottic closure reflex due to superior laryngeal nerve stimulation.

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24
Q

What would laryngospasms present like upon inspection?

A

Faint inspiratory stridor
Increased respiratory effort
Increased diaphragmatic excursion
Flailing of lower ribs

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25
At what pressure should the bag be squeezed when treating laryngospasm?
**Do not squeeze bag during laryngospasm**.
26
How should a BVM be utilized in laryngospasm emergency?
Apply facemask with tight seal and 100% FiO₂ and closed APL valve. ***Do NOT squeeze the bag***.
27
What is the first step in treatment of laryngospasm?
Call for help
28
What should be done after a BVM is utilized for laryngospasm?
- Suction airway - Chin lift and/or jaw thrust - Oral/nasal airways - Laryngospasm notch pressure
29
What is Larson's point? What is its significance?
Pressure point behind of the lobule of the pinna of each ear that can help relieve laryngospasm.
30
What will indicate a patient who is crumping out from your inability to break a laryngospasm?
- Tachycardia - Fast desaturation
31
What should be done for a laryngospasm thats failed to respond to conventional treatment?
Atropine, Propofol, Succinylcholine, reintubate.
32
What initial dose of Succinylcholine is typically used for laryngospasm?
1/10 of normal dose
33
What neuromuscular blocking drug can cause bradycardia in pediatric patients.
Succinylcholine
34
What would be noted on visual assessment that would indicate to the CRNA that a patient is developing airway edema?
Facial and scleral edema
35
What factors can precipitate airway edema?
- Prolonged intubation (especially in prone or trendelenburg cases). - Cases with ↑EBL (aggressive fluid resuscitation).
36
What should be done prior to extubation with expected pulmonary edema?
- Suction Oropharynx - ETT cuff leak test
37
How is an ETT cuff leak test done?
Remove small amount of air from cuff and assess for air movement around the cuff. If air cannot be heard then leave the tube in place.
38
When are airway hematomas most often seen?
- Neck dissections - Thyroid removal - Carotid surgeries
39
A rapidly expanding hematoma may precipitate ____________ edema.
supraglottic
40
In the instance of airway hematoma, deviated tracheal rings and compression of the tracheal below the ________ ________ are seen.
cricoid cartilage
41
What is the treatment for airway hematoma post extubation?
- Decompress airway be releasing surgical clips or sutures. - Remove SQ blood clot before reintubating - Reintubate - Surgical backup (tracheostomy)
42
What surgeries and procedures is vocal cord palsy associated with?
- ENT surgery - Thyroidectomy & parathyroidectomy - Rigid Bronchoscopy - Hyperinflated ETT cuff
43
If vocal cord palsy is unilateral, then the patient is often ___________.
asymptomatic
44
How would damage to the external branch of the superior laryngeal nerve present?
- Vocal weakness and "huskiness" - Paralyzed cricothyroid muscle - Loss of tension → vocal cord looks "wavy".
45
What does bilateral Recurrent Laryngeal Nerve damage result in?
Aphonia & paralyzed vocal cords
46
What position do the vocal cords assume with bilateral Recurrent Laryngeal Nerve damage?
Intermediate position (not adducted or abducted).
47
What is the biggest risk associated with bilateral Recurrent Laryngeal Nerve damage?
Airway obstruction during inspiration
48
How long does it typically take for the hypocalcemia associated with thyroid surgery to present?
24 - 48 hours postop
49
What is Chvostek's sign?
Facial spasm
50
What is Trousseau's sign?
Carpal spasm w/ BP cuff
51
What are some ways to assess for residual neuromuscular blockade?
- Grip strength - Tongue protrusion - Ability to lift legs - Able to hold head up for 5 seconds
52
What medication class are OSA patients sensitive to?
Opioids
53
What is the STOP-BANG assessment?
**S**nore **T**ired **O**bserved **P**ressure **B**MI > 35 **A**ge > 50 **N**eck circumference > 16 in **G**ender (male)
54
What score on the STOP-BANG assessment is indicative of a low risk for OSA?
0 - 2
55
What score on the STOP-BANG assessment is indicative of a intermediate risk for OSA?
3 - 4
56
What score on the STOP-BANG assessment is indicative of a high risk for OSA?
5 - 8
57
What is the full STOP-BANG questionnaire?
58
What are common causes of arterial hypoxemia in a PACU patient?
- Room air - Hypoventilation
59
What are common treatments for arterial hypoxemia in the PACU patient?
- O₂ - Opioid/Benzo reversal - Stimulate patient
60
What is Diffusion Hypoxia?
Rapid diffusion of N₂O into alveoli at end of anesthetic. Dilutes PaO₂ and PaCO₂ → hypoxemia w/ ↓ respiratory drive.
61
How long can diffusion hypoxia persist after discontinuation of N₂O anesthetic?
5-10 min
62
What are the standard treatment thresholds for hypertension in the PACU?
SBP > 180 DBP > 110
63
What medications (and doses) are typically used for treatment of systemic HTN in the PACU?
Labetalol (5 - 25mg) Hydralazine (5 - 10mg) Metoprolol (1 - 5mg)
64
Hypotension that is due to decreased preload is __________.
Hypovolemic shock
65
Hypotension that is due to decreased afterload is __________.
Distributive shock
66
Hypotension that is due to intrinsic pump failure is __________.
Cardiogenic shock
67
What are four common causes of decreased preload?
- Third spacing - Inadequate fluid replacement - Neuraxial blockade → SNS tone loss - Bleeding
68
What are four common causes of decreased afterload?
- Sepsis - Anaphylaxis - Critical illness - Iatrogenic sympathectomy
69
What are the two primary types of allergic reactions?
Anaphylactic & Anaphylactoid
70
What is the drug of choice for hypotension in an allergic reaction?
Epinephrine
71
What are the most common drug classes to cause anaphylactic reactions?
72
What inflammatory mediators can cause bronchial constriction and increased vascular permeability?
Leukotrienes and Prostaglandins
73
__________ drugs are associated with quaternary ammonium ions.
Neuromuscular blocking
74
What patient populations are at high risk for latex allergy?
- Repeated exposures (HCW's) - Spina Bifida patients
75
What are the three latex-mediated reactions?
- Irritant contact dermatitis - Type IV cell-mediated reactions - Type I IgE-mediated hypersensitivity reactions
76
What antibiotic causes a direct histamine release?
Vancomycin
77
What is the most common ABX allergy?
Penicillin
78
What two surgical procedures mentioned in lecture can lead to sudden sepsis?
Procedures involving urinary tract & biliary tract manipulation
79
What are the three most common causes of intrinsic pump failure?
- Myocardial ischemia/infarction - Tamponade - Dysrhythmias
80
What is the risk stratification guideline for non-cardiac surgery?
81
What are factors that decrease myocardial O₂ supply?
82
What are factors that increase myocardial O₂ supply?
83
What are the most common causes of sinus tachycardia?
- SNS stimulation - ↓ volume - Anemia - Shivering - Agitation
84
Risk for atrial dysrhythmias is greatest after what types of surgeries?
Cardiac and Thoracic
85
What are risk factors for atrial dysthrythmias?
- Pre-existing cardiac conditions - Hypervolemia - Electrolyte abnormalities - O₂ desaturation
86
Patients that are hemodynamically unstable due to atrial dysrhythmias require _________.
cardioversion
87
What medications tend to work well for atrial fibrillation?
- β blockers - CCBs
88
Greater than ____ ms QRS complex is considered wide.
120 ms
89
What should be investigated with true ventricular tachycardia?
H's & T's
90
What procedures are associated with bradydysrhythmias?
- Bowel Distention from GI stuff - ↑ ICP (Trendelenburg, etc.) - ↑ Intraocular (eye sx's) - Spinal Anesthesia
91
High spinals reaching the _______ level can block the cardioaccelerator fibers.
T1 - T4
92
What risk factors for Postoperative Cognitive Dysfunction (POCD) were discussed in lecture?
-  > 70 years old - Pre-operative cognitive impairment - ↓ Functional status - EtOH abuse
93
What intra-operative factors are associated with POCD?
- Surgical blood loss (HCT < 30%, PRBC infusions) - ↓ BP - NO administration - GETA
94
What is the #1 cause of delayed awakening?
Residual sedation from anesthetic
95
For delayed awakening secondary to opioids treat with ________ mcg of naloxone.
20 - 40 mcg
96
For delayed awakening secondary to benzodiazepines treat with ________ mg of flumazenil.
0.2mg
97
For delayed awakening secondary to scopolamine treat with ________ mg of ___________.
0.5 - 2mg IV Physostigmine.
98
What (besides residual sedation) are some common reasons for delayed awakening from anesthesia?
- Hypothermia < 33°C - ↓BG - ↑ICP - Residual NMBD's
99
What are some basic recommendations for discharge from PACU?
100
What is/are the criteria for Determination of Discharge from PACU Score?

JW: Principles II (28 decks)

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