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1Fall24 PoA II > PACU & Complications pt1 (Exam II) > Flashcards

PACU & Complications pt1 (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 2 for postanesthesia care?

A

Patient transported to PACU shall be accompanied by member of anesthesia team. Continually evaluated/treated/monitored throughout transport.

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3
Q

What is Standard 3 for postanesthesia care?

A

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

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4
Q

What is Standard 4 for postanesthesia care?

A

The patient shall be evaluated continually in the PACU.

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5
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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6
Q

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

A

Phase 1

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7
Q

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

A

Phase 1

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8
Q

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

A

Neuromuscular function

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9
Q

How often must vital signs be assessed and recorded during the 1st phase of recovery? What is the target for vital management?

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? (3)

A
  • Standard Aldrete Score
  • Modified Aldrete Score
  • PACU Discharge Score
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11
Q

Describe the Standard Aldrete Score.

A

A-R-C-C-S
0-2 score
0 = bad
2 = good

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12
Q

Describe the Modified Aldrete Score.

A

Modified Aldrete Score
only difference is the saturation?

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13
Q

Describe the Postanesthesia Discharge Score.

A

V-A-N/V-P-B
0-2 score

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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) (5)

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, 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.

22
Q

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

A

Laryngospasm

Occurs in 12% of laryngospasm cases.

23
Q

What is the physiology behind laryngospasm?

A

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

24
Q

How would laryngospasms present upon inspection? (4)

A
  • Faint inspiratory stridor
  • Increased respiratory effort
  • Increased diaphragmatic excursion
  • Flailing of lower ribs
25
Q

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

A

Do not squeeze bag during laryngospasm. Wait for pt to breath

26
Q

How should a BVM be utilized in laryngospasm emergency?

A

Apply facemask with tight seal and 100% FiO₂ and closed APL valve (~40 cmH₂O).

Do NOT squeeze the bag.

27
Q

What is the first step in treatment of laryngospasm?

A

Call for help

28
Q

What should be done after a BVM is utilized for laryngospasm? (4)

A
  • Suction airway
  • Chin lift and/or jaw thrust
  • Oral/nasal airways
  • Laryngospasm notch pressure (larsons point)
29
Q

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

A

Pressure point behind of the lobule of the pinna of each ear that can help relieve laryngospasm. Apply 3-5 seconds, release 5-10 seconds, maintain tight facemask seal.

30
Q

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

A
  • Tachycardia
  • Fast desaturation
31
Q

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

A
  • Atropine, Propofol, Succinylcholine
  • Reintubate
32
Q

What initial dose of Succinylcholine is typically used for laryngospasm?

A

1/10 of normal dose
(~0.1mg/kg)

33
Q

What neuromuscular blocking drug can cause bradycardia in pediatric patients.

A

Succinylcholine

34
Q

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

A

Facial and scleral edema

35
Q

What two factors can precipitate airway edema?

A
  • Prolonged intubation (especially in prone or trendelenburg cases).
  • Cases with ↑EBL (aggressive fluid resuscitation).
36
Q

What two things should be done prior to extubation with expected airway edema?

A
  • Suction Oropharynx
  • ETT cuff leak test
37
Q

How is an ETT cuff leak test done?

A

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
Q

When are airway hematomas most often seen? (3)

A
  • Neck dissections
  • Thyroid removal
  • Carotid surgeries
39
Q

A rapidly expanding hematoma may precipitate ____________ edema.

A

supraglottic

40
Q

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

A

cricoid cartilage

41
Q

What is the treatment for airway hematoma post extubation? (4)

A
  • Decompress airway be releasing surgical clips or sutures.
  • Remove SQ blood clot before reintubating
  • Reintubate
  • Surgical backup (tracheostomy)
42
Q

What surgeries and procedures is vocal cord palsy associated with? (4)

A
  • ENT surgery
  • Thyroidectomy & parathyroidectomy
  • Rigid Bronchoscopy
  • Hyperinflated ETT cuff
43
Q

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

A

asymptomatic
pt may just sound hoarse, cough

44
Q

How would damage to the external branch of the superior laryngeal nerve present? (3)

A
  • Vocal weakness and “huskiness”
  • Paralyzed cricothyroid muscle
  • Loss of tension → vocal cord looks “wavy”.
45
Q

What does bilateral Recurrent Laryngeal Nerve damage result in?

A

Aphonia & paralyzed vocal cords

46
Q

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

A

Intermediate position (not adducted or abducted - midway).

47
Q

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

A

Airway obstruction during inspiration

48
Q

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

A

24 - 48 hours postop

49
Q

What is Chvostek’s sign?

A

Facial spasm

50
Q

What is Trousseau’s sign?

A

Carpal spasm w/ BP cuff

1Fall24 PoA II (34 decks)

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