PACU & Complications (Exam II) COPY

Question 1

According to Standard 1, all patients who have received general anesthesia, regional anesthesia, or __________ shall receive appropriate postanesthesia management.

A. Epidural anesthesia
B. Spinal anesthesia
C. Monitored anesthesia care
D. Sedation only

Answer 1

C. Monitored anesthesia care

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Question 2

Which of the following are requirements according to Standard 2? (Select 3)

A. The patient must be accompanied by a knowledgeable anesthesia care team member.
B. The patient’s condition must be continually evaluated during transport to the PACU.
C. The patient can be transported without evaluating if stable.
D. The patient should receive support appropriate to their condition during transport.
E. A physician is responsible for the discharge of the patient from the postanesthesia care unit

Answer 2

A. The patient must be accompanied by a knowledgeable anesthesia care team member.
B. The patient’s condition must be continually evaluated during transport to the PACU.
D. The patient should receive support appropriate to their condition during transport.

C- For instance, if you have somebody who’s going back to the ICU, you probably are going to keep them on the cardiac monitor and check their blood pressure, pulse, oxygen sort of thing

On the other hand, most of our PACU patients will be be off all mechanical monitors and be more dependent on our observation skills.

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Question 3

According to Standard 3, upon arrival to the PACU, the patient shall be re-evaluated and a __________ provided to the responsible PACU RN by the member of the anesthesia care team.

A. Written report
B. Verbal report
C. Email report
D. Brief report

Answer 3

B. Verbal report

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Question 4

Standard 4 states that the patient’s condition shall be evaluated __________ in the PACU.

A. Occasionally
B. Once
C. Continually
D. Sporadically

Answer 4

C. Continually

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Question 5

Standard 5 specifies that a __________ is responsible for the discharge of the patient from the postanesthesia care unit.

A. Nurse
B. Surgeon
C. Anesthesia technician
D. Physician

Answer 5

D. Physician

This can be a anesthesiologist or surgeon

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Question 6

In 1920, several __________ were opened in the United States as a response to recognizing the need for closer monitoring of post-surgical patients.

A. Intensive Care Units
B. Operating Rooms
C. Postanesthesia Care Units
D. Outpatient Surgery Centers

Answer 6

C. Postanesthesia Care Units (PACUs)

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Question 7

After __________, the number of PACUs increased as the military recognized the critical time period for patients following surgery.

A. The Great Depression
B. World War I
C. The Vietnam War
D. World War II

Answer 7

D. World War II

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Question 8

A study in 1947 showed that over an 11-year period, approximately __________ of deaths in the first 24 hours following surgery were preventable.

A. 30%
B. 50%
C. 70%
D. 90%

Answer 8

B. 50%

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Question 9

In 1949, PACU care became a __________ of care for postoperative patients.

A. New recommendation
B. Standard
C. Suggestion
D. Temporary solution

Answer 9

B. Standard

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Question 10

Which of the following staff members are NOT commonly found in a PACU?

A. Interventional radiologist
B. Respiratory therapists
C. Anesthesia personnel
D. Intensivists or hospitalists
E. Specially trained nurses

Answer 10

A. Interventional radiologist

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Question 11

In some PACUs, __________ or __________ are responsible for overseeing the care of patients if they are admitted to the hospital after surgery.

A. Nurses, nurse practitioners
B. Respiratory therapists, anesthesiologists
C. Intensivists, hospitalists
D. Surgeons, anesthesiologists

Answer 11

C. Intensivists, hospitalists

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Question 12

A __________ therapist may be assigned to float through the PACU to assist with specific needs such as ventilators or airway management.

A. Physical
B. Occupational
C. Respiratory
D. Speech

Answer 12

C. Respiratory

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Question 13

Postoperative care of patients in PACU includes:
A) Monitoring of oxygenation, ventilation, and circulation
B) Only monitoring oxygen levels
C) Monitoring ventilation and oxygenation
D) Monitoring of oxygen and ventilation

Answer 13

A) Monitoring of oxygenation, ventilation, and circulation (HR and BP)

Cornholio - Maybe it’s not common practice to transport patients on oxygen, but you’ve got to take them half mile.
Probably want to make sure you have oxygen. Do I need to take an Ambu bag with every patient? Probably not if I’m going across the hallway, but if I’m going a long way, it’s another story. Think about emergency medications and complications you can kind of encounter in between.

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Question 14

Which of the following actions should be taken upon a patient’s arrival in the PACU? Select 3
A) Assess airway patency
B) Assess respiratory rate
C) Connect the patient to monitors
D) Administer a diuretic
E) Taking the patient’s weight

Answer 14

A) Assess airway patency
B) Assess respiratory rate & Saturation %
C) Connect the patient to monitors

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Question 15

When assessing a patient on arrival to the PACU, which of the following is NOT required to be evaluated?
A) Mental status
B) Pain level
C) Oxygen saturation
D) PERRLA
D) Heart rate
E) Presence of PONV

Answer 15

D) PERRLA

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Question 16

The following factors should be considered in the treatment of hypoxemia in the PACU:
Select 3

A) Sedation
B) Patient’s mental status
C) Advanced age
D) Room air
E)

Answer 16

A) Sedation
C) Advanced age (>60)
D) Room air

Also assess for respiratory rate and obesity

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Question 17

True or False

One of the biggest things we really worry about after anesthesia is hypovolemia.

Answer 17

FALSE

Corndog - *One of the biggest things we really worry about after anesthesia is hypoxemia. Are they older patients, people that are sedated that still have it in circulation. Do we have them on oxygen? Do they need oxygen? Is the oxygen adequate?

You will see that it’s part of your best efforts to monitor the patient and care for him that things will change between point A and point B. A patient that was 100% in the room may now suddenly be 50-60%, even though they’re still breathing…Having those monitors on quickly is pretty valuable.

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Question 18

What actions should the CRNA take upon the patient’s arrival to the PACU?
A) Reassess the patient
B) Connect the patient to monitors
C) Administer postoperative antibiotics
D) Provide a report to the PACU RN

Answer 18

A) Reassess the patient
B) Connect the patient to monitors
D) Provide a report to the PACU RN

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Question 19

What factors should you consider when giving a report to the PACU RN?
Select 2
A) Type of anesthetic used
B) Every medication and dose administered during surgery
C) Diabetes or hypertension
D) The exact time each medication was administered

Answer 19

A) Type of anesthetic used
C) Diabetes or hypertension

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Question 20

After monitors are placed on the patient in the PACU, the PACU RN assesses the patient and there are ________ separate phases of recovery.
A) 1
B) 2
C) 3
D) 4

Answer 20

B) 2

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Question 21

True or False

The admissions report needs to be specific, organized, and completed only when you have the full attention of the receiving RN.

Answer 21

TRUE

C - So no matter what you do, as far as report, try and make it organized, if you just hop around, it’s very hard for people to kind of follow your train of thoughts.

We all run into people with ADD that only listen for about 5 or 10 seconds.
So if they stop paying attention, start doing something else, sometimes I’ll just stop talking and wait. Sometimes I stare at them.
Sometimes I’ll ask are they listening?
Especially if I’m going to give something kind of important.

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Question 22

What does the acronym SBAR stand for in the context of patient handoff?

A) Situation, Background, Assessment, Recommendation
B) Summary, Background, Assessment, Report
C) Situation, Brief, Assessment, Response
D) Summary, Brief, Analysis, Recommendation

Answer 22

A) Situation, Background, Assessment, Recommendation

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Question 23

Which of the following is most important to communicate during a PACU handoff?
A) Every medication administered during surgery
B) Surgical duration and complications
C) Anesthetic events and complications
D) The name of the anesthesiologist and medications

Answer 23

C) Anesthetic events and complications

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Question 24

When should the CRNA ask if the PACU nurse has any questions about the handoff?
A) At the beginning of the report
B) After confirming patient allergies
C) At the end of the report
D) Before discussing the patient’s anesthesia history

Answer 24

C) At the end of the report

C - …and then at the end make sure that they don’t have any questions.

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Question 25

Which of the following are key features of the SBAR handoff process? Select all that apply.

A) Standardized
B) Covers non-essential patient information
C) Covers pertinent surgical and patient factors
D) Easy to remember
E) Only used for anesthesia providers

Answer 25

A) Standardized
C) Covers pertinent surgical and patient factors
D) Easy to remember

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Question 26

During the ICU handoff, which of the following should be emphasized?

A) Patient’s insurance details
B) The reason for postoperative complications
C) Patient’s family members present
D) Previous surgical procedures

Answer 26

B) The reason for postoperative complications

C - The one thing you’ll see that’s a little bit different here is usually you have the surgeon involved in this as well. So whether it’s the surgical resident, PA, NP or the staff surgeon themselves, somebody goes up there so they can answer a lot of those questions.

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Question 27

Which of the following is true about Phase 1 of recovery in the PACU?

A) It is the less intense phase.
B) HR, SAT, RR, and ECG are continuously monitored.
C) Patients are typically discharged during this phase.
D) Only the patient’s mental status is monitored continuously.

Answer 27

B) HR, SAT, RR, and ECG are continuously monitored.

And airway patency

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Question 28

Which of the following parameters is monitored frequently in Phase 1 of recovery?

A) Blood Pressure, temperature, and pain
B) Only ECG and SAT
C) Mental status and RR
D) Airway patency and HR

Answer 28

A) Blood Pressure, temperature, and pain

ECG And Mental Status

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Question 29

If a patient is intubated in Phase 1 of recovery, what additional function is monitored?

A) Cardiac output
B) Neuromuscular function
C) Renal function
D) Pain score

Answer 29

B) Neuromuscular function

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Question 30

In Phase 1 of PACU care, how long does the PACU nurse typically remain at the patient’s bedside?
A) 45 to 60 minutes
B) 5 to 10 minutes
C) 15 to 30 minutes
D) 1 to 5 minutes

Answer 30

C) 15 to 30 minutes

Cornelius - the PACU nurse is going to stay at the patient’s bedside for at least the 1st 15 to 30 minutes before they wander off.
If they do, they’re not going to go very far.
Most places they will not care for another patient during this time period and be 1:1 care

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Question 31

Which patients are likely to bypass Phase 1 recovery and go directly to Phase 2?

A) Patients who received general anesthesia
B) Patients who required ICU care postoperatively
C) Patients who received minimal sedation
D) Patients recovering from major trauma surgery

Answer 31

C) Patients who received minimal sedation, such as those in cataract surgery

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Question 32

True or False

Anybody that’s been under general anesthesia has to go to phase one.

Answer 32

True

Question 33

During the first 15 minutes of Phase 1 recovery, how often are vital signs checked?

A) Every 30 minutes
B) Every 10 minutes
C) Every 5 minutes
D) Every 15 minutes

Answer 33

C) Every 5 minutes
-* q5 min for 1st 15 minutes*

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Question 34

What is the goal for the patient’s vital signs during Phase 1 recovery?

A) Keep them within 10% of baseline
B) Keep them within 20% of baseline
C) Maintain a steady decrease from baseline
D) Only monitor for large fluctuations

Answer 34

B) Keep them within 20% of baseline

Question 35

For the remainder of Phase 1 recovery, how often are vital signs checked?

A) Every 5 minutes
B) Every 10 minutes
C) Every 30 minutes
D) Every 15 minutes

Answer 35

D) Every 15 minutes

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Question 36

Which of the following are criteria used to assess a patient’s readiness for discharge in Phase II of recovery? Select 3

A) Standard Aldrete Score
B) Modified Aldrete Score
C) Postaldrete Discharge Score
D) Postanesthesia Discharge Score
E) Variable Aldrete Discharge Score

Answer 36

A) Standard Aldrete Score
B) Modified Aldrete Score
C) Postanesthesia Discharge Score

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Question 37

True or False

Phase I of Recovery is considered the more intense phase

Answer 37

True

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Question 38

Which of the following criteria is NOT included in the Aldrete Score?

A) Activity
B) Respiration
C) Circulation
D) Pain
E) Consciousness
F) Oxygen Saturation

Answer 38

D) Pain

Question 39

Select all that apply for Activity under the Standard Aldrete Score chart:
Select 3

A. Score 2: The patient moves all extremities voluntarily/on command.
B. Score 1: The patient moves two extremities.
C. Score 1: The patient moves only one extremity.
D. Score 0: The patient is unable to move extremities.

Answer 39

A. Score 2: The patient moves all extremities voluntarily/on command.
B. Score 1: The patient moves two extremities.
D. Score 0: The patient is unable to move extremities.

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Question 40

Select all that apply for Respiration under the Standard Aldrete Score:
Select 3

A. Score 2: The patient breathes deeply and coughs freely.
B. Score 1: The patient is dyspneic with shallow or limited breathing.
C. Score 0: The patient is apneic.
D. Score 0: The patient requires oxygen supplementation.

Answer 40

A. Score 2: The patient breathes deeply and coughs freely.
B. Score 1: The patient is dyspneic with shallow or limited breathing.
C. Score 0: The patient is apneic.

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Question 41

Select all that apply for Circulation under the Standard Aldrete Score:
select 3

A. Score 2: Blood pressure is within 25mm of the preanestheitc level
B. Score 2: Blood pressure is within 20 mm of the preanesthetic level.
C. Score 1: Blood pressure is 20-50 mm of the preanesthetic level.
D. Score 0: Blood pressure is more than 50mm different from the preanesthetic level.

Answer 41

B. Score 2: Blood pressure is within 20 mm of the preanesthetic level.
C. Score 1: Blood pressure is 20-50 mm of the preanesthetic level.
D. Score 0: Blood pressure is more than 50 mm different from the preanesthetic level.

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Question 42

Select all that apply for Oxygen Saturation under the Standard Aldrete Score:
Select 3

A. Score 2: Spo2 > 92% on room air.
B. Score 1: Spo2 > 90% on supplemental oxygen.
C. Score 0: Spo2 > 92% even with supplemental oxygen.
D. Score 0: Spo2 < 92% even with supplemental oxygen.

Answer 42

A. Score 2: Spo2 > 92% on room air.
B. Score 1: Spo2 > 90% on supplemental oxygen.
D. Score 0: Spo2 < 92% even with supplemental oxygen.

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Question 43

True or False

What is the primary difference in the Modified Aldrete Scoring System compared to the original version?

A. It has a higher oxygen saturation threshold
B. It focuses on the heart rate rather than circulation.
C. It provides more detailed criteria for assessing patients.
D. It removes the oxygen saturation score entirely.

Answer 43

C. It provides more detailed criteria for assessing patients.

The O2 Saturation’s a little bit lower

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Question 44

The Modified Aldrete Scoring System is often used for:

A. Sedation monitoring during patient recovery
B. General anesthesia recovery only.
C. ICU discharge criteria.
D. Monitoring heart rate and rhythm only.

Answer 44

A. Sedation monitoring during patient recovery

C - This is really used more for like sedation monitoring, sometimes not necessarily for discharge criteria…what I mean by sedation monitoring is not something like a RASS score, but as far as like sedation while there there.

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Question 45

Which of the following are correct for the O2 Saturation scoring in the Modified Aldrete Score?

A. The patient is able to maintain O2 saturation >90% on room air. (Score: 2)
B. The patient is able to maintain O2 saturation >92 on room air. (Score: 2)
C. The patient needs O2 inhalation to maintain O2 saturation >90%. (Score: 1)
D. The patient’s O2 saturation is <90%, even with O2 supplementation. (Score: 0)

Answer 45

A. The patient is able to maintain O2 saturation >90% on room air. (Score: 2)
C. The patient needs O2 inhalation to maintain O2 saturation >90%. (Score: 1)
D. The patient’s O2 saturation is <90%, even with O2 supplementation. (Score: 0)

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Question 46

Which of the following factors is included in the Post Anesthesia Discharge Scoring System?

A. Body temperature regulation
B. Nausea and vomiting control
C. Intraoperative medication administration
D. Level of consciousness during surgery
E. Respiratoin

Answer 46

B. Nausea and vomiting control

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Question 47

Select all that apply regarding Vital Signs (BP and Pulse) for Post-anesthesia discharge scoring system:
Select 3

A. Vital signs within 20% of preoperative baseline (2 points)
B. Vital signs 20-40% of preoperative baseline (1 point)
C. Vital signs 20-50% of preoperative baseline (1 point)
D. Vital signs >50% of preoperative baseline (0 points)
E. Vital signs >40% of preoperative baseline (0 points)

Answer 47

A. Vital signs within 20% of preoperative baseline (2 points)
B. Vital signs 20-40% of preoperative baseline (1 point)
E. Vital signs >40% of preoperative baseline (0 points)

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Question 48

Select all that apply regarding Activity for Post-anesthesia discharge scoring system:
Select 3

A. Steady gait, no dizziness (2 points)
B. Patient must walk 100 feet unassisted, no dizziness (2 points)
C. Requires assistance (1 point)
D. Able to walk with support for short distance (1 point)
E. Unable to ambulate (0 points)

Answer 48

A. Steady gait, no dizziness (2 points)
C. Requires assistance (1 point)
E. Unable to ambulate (0 points)

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Question 49

Select all that apply regarding Nausea and Vomiting for Post-anesthesia discharge scoring system:
Select 3

A. Minimal, treat with PO meds (2 points)
B. Nausea absent for discharge (2 points)
C. Moderate, treat with IM meds (1 point)
D. Continues, repeated treatment required (0 points)
E. Vomiting requires continuous IV treatment required (0 points)

Answer 49

A. Minimal, treat with PO meds (2 points)
C. Moderate, treat with IM meds (1 point)
D. Continues, repeated treatment required (0 points)

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Question 50

Select all that apply regarding Pain for Post-anesthesia discharge scoring system:
Select 2

A. Acceptable control per the patient, controlled with PO meds (2 points)
B. Not acceptable to the patient, not controlled with PO meds (1 point)
C. Pain must be rated 0/10 (0 points)
D. Pain control can be achieved with non-pharmacologic methods only

Answer 50

A. Acceptable control per the patient, controlled with PO meds (2 points)
B. Not acceptable to the patient, not controlled with PO meds (1 point)

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Question 51

Select all that apply regarding Surgical Bleeding for Post-anesthesia discharge scoring system:

A. Minimal, no dressing changes required (2 points)
B. Moderate, up to 2 dressing changes required (1 point)
C. Severe, more than 3 dressing changes required (0 points)
D. Minimal, up to 1 dressing change, small amount of bleeding from the surgical site is acceptable (2 points)
E. Bleeding must be fully stopped (0 points)

Answer 51

A. Minimal, no dressing changes required (2 points) (Correct)
B. Moderate, up to 2 dressing changes required (1 point) (Correct)
C. Severe, more than 3 dressing changes required (0 points)

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Question 52

Which of the following would most likely prevent a patient from being discharged or admitted under the Post-anesthesia discharge scoring system?
Select 3

A. Nausea and Vomiting Score of 1
B. More than 3 dressing changes
C. Nausea and Vomiting Score of 0
D. Activity score of 1
E. Pain score of 1

Answer 52

B. More than 3 dressing changes (Surgical Bleeding Score of 0)

C. Nausea and Vomiting Score of 0 Continues: Repeated treatment

E. Pain score of 1: Not acceptable or controlled by PO meds

Cornelius - …somebody that continues to have nausea and vomiting…We will admit patients to the hospital because they have continual nausea and vomiting. We don’t send people home with continual pain. From a procedural standpoint, look at their wounds. If you’ve got somebody that’s oozie or continuing to bleed, they’re soaking dressings. They don’t need to go home like that.

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Question 53

During Phase II of recovery, how often are vital signs taken?
A. Every 15-30 minutes
B. Every 30-60 minutes
C. Every 1-2 hours
D. Every 5 minutes

Answer 53

B. Every 30-60 minutes

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Question 54

What determines if a patient can move directly to Phase II without staying in Phase I?
A. The type of surgery
B. The patient’s vital signs
C. The patient’s sedation level
D. The patient’s age

Answer 54

C. The patient’s sedation level and airway status

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Question 55

In addition to airway and ventilation, what else is monitored during Phase II of recovery?
A. Vital signs every 15 minutes
B. Blood glucose levels
C. Fluid balance
D. Blood pressure only

Answer 55

C. Fluid balance

Slide 22

Question 56

Which of the following is not included in the standard monitoring during Phase II of recovery?
A. Pain level
B. PONV
C. Wound integrity
D. Temperature regulation

Answer 56

D. Temperature regulation

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Question 57

What complication is often responsible for cardiac arrest in the PACU?
Select 2

A. Intraoperative MI
B. Hypertension
C. Aortic dissection
D. Septic shock
E. Occluded airway

Answer 57

A. Intraoperative MI
E. Respiratory arrest due to an occluded airway

Slide 24

Question 58

In Dr. C’s story, what rhythm abnormality did the patient display that raised concerns for Wolff-Parkinson-White syndrome (WPW)?

A. Delta wave on EKG
B. ST elevation
C. PR interval elongation
D. T-wave inversion

Answer 58

A. Delta wave on EKG

slide 24

Question 59

What is a common complication cause of hypertension in post-anesthesia care besides pain?

A. Tachycardia
B. Dysrhythmia
C. Urinary retention
D. Prolonged sedation

Answer 59

C. Urinary retention

Slide 24

Question 60

What are potential causes of altered mental status in the PACU setting?

A. Pain and hypertension
B. Dysrhythmias and MI
C. Urinary retention and sedation
D. Prolonged sedation and confusion

Answer 60

D. Prolonged sedation and confusion

C - it’s just prolonged sedation, so be mindful of the medications you’re giving them. Some things like gabapentin and dexmedatomadine have been implicated in prolonged sedation.

Slide24

Question 61

According to the graph, which of the following complications occurred the least in the PACU?

A. Dysrhythmia
B. Major cardiac arrest
C. Altered mental status
D. Upper airway support

Answer 61

B. Major cardiac arrest

Question 62

Which of the following symptoms would NOT typically be associated with Local Anesthetic Systemic Toxicity (LAST)?

A. Tachycardia
B. Tingling and numbness
C. Ringing in the ears
D. Hyperthermia

Answer 62

D. Hyperthermia

Slide 24

Question 63

What is the primary airway complication to be concerned with postoperatively?
A. Laryngospasm
B. Airway Obstruction
C. Vocal Cord Palsy
D. Hypoxemia

Answer 63

B. Airway Obstruction

C - So the big thing we have to worry about here is generally airway obstruction. A lot of times we cause this problem for ourselves because the patient’s either too sedated, has tissue edema.

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Question 64

Which of the following can cause airway obstruction after surgery?
A. Sedation and tissue edema
B. Traumatic intubation
C. Expanding hematoma
D. All of the above

Answer 64

D. All of the above

Slide 26

Question 65

Vocal cord palsy can cause airway obstruction as a result from damage to which nerve during neck surgeries?
A. Phrenic nerve
B. Vagus nerve
C. Recurrent laryngeal nerve
D. Hypoglossal nerve

Answer 65

C. Recurrent laryngeal nerve

Slide 26

Question 66

What is one of the most common causes of residual neuromuscular block in PACU?

A. Inadequate reversal
B. Failure to provide oxygen
C. Undiagnosed sleep apnea
D. Administration of opioids

Answer 66

Inadequate reversal

C - Just make sure your patients are fully reversed… we may not necessarily give the most appropriate doses. So calculate the patient’s actual dose based off their train of four and make sure that they’re getting an appropriate dose

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Question 67

Which condition can be managed with CPAP or BiPAP in the PACU to prevent airway obstruction?
A. Laryngospasm
B. Obstructive Sleep Apnea
C. Vocal Cord Palsy
D. Airway Edema

Answer 67

B. Obstructive Sleep Apnea (OSA)

Slide 26

Question 68

What is the treatment of upper airway obstruction?

Answer 68

• Jaw thrust
• CPAP
• Oral/Nasal airway

Question 69

What are laryngospasms?

Answer 69

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

Question 70

What are the three most common causes of laryngospasms?

Answer 70

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

Question 71

What is negative pressure pulmonary edema?

Answer 71

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

Question 72

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

Answer 72

Laryngospasm

Occurs in 12% of laryngospasm cases.

Question 73

What is the physiology behind laryngospasm?

Answer 73

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

Question 74

What would laryngospasms present like upon inspection?

Answer 74

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

Question 75

At what pressure should the bag be squeezed when treating laryngospasm?

Answer 75

Do not squeeze bag during laryngospasm.

Question 76

How should a BVM be utilized in laryngospasm emergency?

Answer 76

Apply facemask with tight seal and 100% FiO₂ and closed APL valve.

Do NOT squeeze the bag.

Question 77

What is the first step in treatment of laryngospasm?

Answer 77

Call for help

Question 78

What should be done after a BVM is utilized for laryngospasm?

Answer 78

• Suction airway
• Chin lift and/or jaw thrust
• Oral/nasal airways
• Laryngospasm notch pressure

Question 79

What is Larson’s point?
What is its significance?

Answer 79

Pressure point behind of the lobule of the pinna of each ear that can help relieve laryngospasm.

Question 80

What will indicate a patient who is crumping out from your inability to break a laryngospasm?

Answer 80

• Tachycardia
• Fast desaturation

Question 81

What should be done for a laryngospasm thats failed to respond to conventional treatment?

Answer 81

Atropine, Propofol, Succinylcholine, reintubate.

Question 82

What initial dose of Succinylcholine is typically used for laryngospasm?

Answer 82

1/10 of normal dose

Question 83

What neuromuscular blocking drug can cause bradycardia in pediatric patients.

Answer 83

Succinylcholine

Question 84

What would be noted on visual assessment that would indicate to the CRNA that a patient is developing airway edema?

Answer 84

Facial and scleral edema

Question 85

What factors can precipitate airway edema?

Answer 85

• Prolonged intubation (especially in prone or trendelenburg cases).
• Cases with ↑EBL (aggressive fluid resuscitation).

Question 86

What should be done prior to extubation with expected pulmonary edema?

Answer 86

• Suction Oropharynx
• ETT cuff leak test

Question 87

How is an ETT cuff leak test done?

Answer 87

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.

Question 88

When are airway hematomas most often seen?

Answer 88

• Neck dissections
• Thyroid removal
• Carotid surgeries

Question 89

A rapidly expanding hematoma may precipitate ____________ edema.

Answer 89

supraglottic

Question 90

In the instance of airway hematoma, deviated tracheal rings and compression of the tracheal below the ________ ________ are seen.

Answer 90

cricoid cartilage

Question 91

What is the treatment for airway hematoma post extubation?

Answer 91

• Decompress airway be releasing surgical clips or sutures.
• Remove SQ blood clot before reintubating
• Reintubate
• Surgical backup (tracheostomy)

Question 92

What surgeries and procedures is vocal cord palsy associated with?

Answer 92

• ENT surgery
• Thyroidectomy & parathyroidectomy
• Rigid Bronchoscopy
• Hyperinflated ETT cuff

Question 93

If vocal cord palsy is unilateral, then the patient is often ___________.

Answer 93

asymptomatic

Question 94

How would damage to the external branch of the superior laryngeal nerve present?

Answer 94

• Vocal weakness and “huskiness”
• Paralyzed cricothyroid muscle
• Loss of tension → vocal cord looks “wavy”.

Question 95

What does bilateral Recurrent Laryngeal Nerve damage result in?

Answer 95

Aphonia & paralyzed vocal cords

Question 96

What position do the vocal cords assume with bilateral Recurrent Laryngeal Nerve damage?

Answer 96

Intermediate position (not adducted or abducted).

Question 97

What is the biggest risk associated with bilateral Recurrent Laryngeal Nerve damage?

Answer 97

Airway obstruction during inspiration

Question 98

How long does it typically take for the hypocalcemia associated with thyroid surgery to present?

Answer 98

24 - 48 hours postop

Slide 46

Question 99

Kaitlyn STOP

What is Chvostek’s sign?

Answer 99

Facial spasm

Slide 46

Question 100

KRISTA’s START

What is Trousseau’s sign?
A. Facial twitching when the cheek is tapped
B. Carpal spasm with blood pressure cuff inflation
C. Spasm of the lower limbs when standing
D. Muscle weakness during deep breathing

Answer 100

B. Carpal spasm with blood pressure cuff inflationCarpal spasm w/ BP cuff

Slide 46

Question 101

Which of the following complications may develop after thyroid surgery? (Select all that appl)
A. Hypocalcemia
B. Hematoma formation
C. Recurrent laryngeal nerve damage
D. Tracheal injury

Answer 101

A. Hypocalcemia - Can see 24 to 48 hrs post-op
B. Hematoma formation - can be immediate or within 24 hours
C. Recurrent laryngeal nerve damage

Slide 46

Question 102

True or False

Incomplete reversal of muscle relaxants is necessary after surgery

Answer 102

FALSE

Complete reversal of muscle relaxants is necessary after surgery

Slide 47

Question 103

Which of the following are included in the clinical evaluation for residual neuromuscular blockade? Select all that apply.
A. Deep breathing
B. Ability to hold the head up for 5 seconds
C. Grip strength
D. Ability to maintain eye contact
E. Ability to lift legs off the bed
F. Tongue protrusion

Answer 103

B. Ability to hold the head up for 5 seconds
C. Grip strength
E. Ability to lift legs off the bed
F. Tongue protrusion

Slide 47

Question 104

True or False

If a patient shows clinical signs, it means their airway reflexes have fully returned.

Answer 104

False
Just because you see these signs doesn’t mean your patient’s airway reflexes have returned.

Slide 47

Question 105

**

What medication class are OSA patients sensitive to?

Answer 105

Opioids

Question 106

Which of the following statements are true about Obstructive Sleep Apnea (OSA)? (Select 4.)
A. It is considered a syndrome where patients have a partial or complete blockage of the upper airway.
B. It is a condition where patients have no airway obstruction during sleep.
C. Patients with OSA are obviously prone to airway obstruction.
D. Patients with OSA should be extubated while still sedated.
E. Before extubation, patients with OSA should be fully awake and following commands.
F. Patients with OSA should ideally bring their CPAP machine to surgery.

Answer 106

A. It is considered a syndrome where patients have a partial or complete blockage of the upper airway.

C. Patients with OSA are obviously prone to airway obstruction.

E. Before extubation, patients with OSA should be fully awake and following commands.

F. Patients with OSA should ideally bring their CPAP machine to surgery.

Slide 48

Question 107

What is the STOP-BANG assessment?

Answer 107

Snore
Tired
Observed
Pressure
BMI > 35
Age > 50
Neck circumference > 16 in
Gender (male)

Question 108

What score on the STOP-BANG assessment is indicative of a low risk for OSA?

Answer 108

0 - 2

Question 109

What score on the STOP-BANG assessment is indicative of a intermediate risk for OSA?

Answer 109

3 - 4

Question 110

What score on the STOP-BANG assessment is indicative of a high risk for OSA?

Answer 110

5 - 8

Question 111

What is the full STOP-BANG questionnaire?

Answer 111

Question 112

What are common causes of arterial hypoxemia in a PACU patient?

Answer 112

• Room air
• Hypoventilation

Question 113

What are common treatments for arterial hypoxemia in the PACU patient?

Answer 113

• O₂
• Opioid/Benzo reversal
• Stimulate patient

Question 114

What is Diffusion Hypoxia?

Answer 114

Rapid diffusion of N₂O into alveoli at end of anesthetic.

Dilutes PaO₂ and PaCO₂ → hypoxemia w/ ↓ respiratory drive.

Question 115

How long can diffusion hypoxia persist after discontinuation of N₂O anesthetic?

Answer 115

5-10 min

Question 116

What are the standard treatment thresholds for hypertension in the PACU?

Answer 116

SBP > 180
DBP > 110

Question 117

What medications (and doses) are typically used for treatment of systemic HTN in the PACU?

Answer 117

Labetalol (5 - 25mg)
Hydralazine (5 - 10mg)
Metoprolol (1 - 5mg)

Question 118

Hypotension that is due to decreased preload is __________.

Answer 118

Hypovolemic shock

Question 119

Hypotension that is due to decreased afterload is __________.

Answer 119

Distributive shock

Question 120

Hypotension that is due to intrinsic pump failure is __________.

Answer 120

Cardiogenic shock

Question 121

What are four common causes of decreased preload?

Answer 121

• Third spacing
• Inadequate fluid replacement
• Neuraxial blockade → SNS tone loss
• Bleeding

Question 122

What are four common causes of decreased afterload?

Answer 122

• Sepsis
• Anaphylaxis
• Critical illness
• Iatrogenic sympathectomy

Question 123

What are the two primary types of allergic reactions?

Answer 123

Anaphylactic & Anaphylactoid

Question 124

What is the drug of choice for hypotension in an allergic reaction?

Answer 124

Epinephrine

Question 125

What are the most common drug classes to cause anaphylactic reactions?

Answer 125

Question 126

What inflammatory mediators can cause bronchial constriction and increased vascular permeability?

Answer 126

Leukotrienes and Prostaglandins

Question 127

__________ drugs are associated with quaternary ammonium ions.

Answer 127

Neuromuscular blocking

Question 128

What patient populations are at high risk for latex allergy?

Answer 128

• Repeated exposures (HCW’s)
• Spina Bifida patients

Question 129

What are the three latex-mediated reactions?

Answer 129

• Irritant contact dermatitis
• Type IV cell-mediated reactions
• Type I IgE-mediated hypersensitivity reactions

Question 130

What antibiotic causes a direct histamine release?

Answer 130

Vancomycin

Question 131

What is the most common ABX allergy?

Answer 131

Penicillin

Question 132

What two surgical procedures mentioned in lecture can lead to sudden sepsis?

Answer 132

Procedures involving urinary tract & biliary tract manipulation

Question 133

What are the three most common causes of intrinsic pump failure?

Answer 133

• Myocardial ischemia/infarction
• Tamponade
• Dysrhythmias

Question 134

What is the risk stratification guideline for non-cardiac surgery?

Answer 134

Question 135

What are factors that decrease myocardial O₂ supply?

Answer 135

Question 136

What are factors that increase myocardial O₂ supply?

Answer 136

Question 137

What are the most common causes of sinus tachycardia?

Answer 137

• SNS stimulation
• ↓ volume
• Anemia
• Shivering
• Agitation

Question 138

Risk for atrial dysrhythmias is greatest after what types of surgeries?

Answer 138

Cardiac and Thoracic

Question 139

What are risk factors for atrial dysthrythmias?

Answer 139

• Pre-existing cardiac conditions
• Hypervolemia
• Electrolyte abnormalities
• O₂ desaturation

Question 140

Patients that are hemodynamically unstable due to atrial dysrhythmias require _________.

Answer 140

cardioversion

Question 141

What medications tend to work well for atrial fibrillation?

Answer 141

• β blockers
• CCBs

Question 142

Greater than ____ ms QRS complex is considered wide.

Answer 142

120 ms

Question 143

What should be investigated with true ventricular tachycardia?

Answer 143

H’s & T’s

Question 144

What procedures are associated with bradydysrhythmias?

Answer 144

• Bowel Distention from GI stuff
• ↑ ICP (Trendelenburg, etc.)
• ↑ Intraocular (eye sx’s)
• Spinal Anesthesia

Question 145

High spinals reaching the _______ level can block the cardioaccelerator fibers.

Answer 145

T1 - T4

Question 146

What risk factors for Postoperative Cognitive Dysfunction (POCD) were discussed in lecture?

Answer 146

• > 70 years old
• Pre-operative cognitive impairment
• ↓ Functional status
• EtOH abuse

Question 147

What intra-operative factors are associated with POCD?

Answer 147

• Surgical blood loss (HCT < 30%, PRBC infusions)
• ↓ BP
• NO administration
• GETA

Question 148

What is the #1 cause of delayed awakening?

Answer 148

Residual sedation from anesthetic

Question 149

For delayed awakening secondary to opioids treat with ________ mcg of naloxone.

Answer 149

20 - 40 mcg

Question 150

For delayed awakening secondary to benzodiazepines treat with ________ mg of flumazenil.

Answer 150

0.2mg

Question 151

For delayed awakening secondary to scopolamine treat with ________ mg of ___________.

Answer 151

0.5 - 2mg IV Physostigmine.

Question 152

What (besides residual sedation) are some common reasons for delayed awakening from anesthesia?

Answer 152

• Hypothermia < 33°C
• ↓BG
• ↑ICP
• Residual NMBD’s

Question 153

What are some basic recommendations for discharge from PACU?

Answer 153

Question 155

What is/are the criteria for Determination of Discharge from PACU Score?

Answer 155