Patient Evaluation and Monitoring Flashcards
what are the two standard formats for medical history questionnaire
short and long
the patient interview should be conducted by who
the person planning and administering the anesthetic
what is the purpose of the medical history questionnaire
- a tool to gather written information about the patients health
- completed by the pt or guardian
- simple format which is easy to understand
what are the purposes of the patient interview
- an opportunity to review the responses made on the written medical questionnaire
- gain greater insight to the magnitude of the problem - identifies the treatment risk
the physical exam starts when:
the patient walks in the room
what is the purpose of the physical exam
- check for signs of underlying illness
- assesses patient general appearance
- vital signs
what are the components of the upper airway
- nasopharynx
- oropharynx
- laryngopharynx
what is a consultation
request to the PCP or specialist for assistance/information that you will use to manage your patient
the consult needs to be:
- concise
- specific regarding what you want done
the assistance/information with consultations may include:
- providing a specific piece of information needed to move forward with treatment
- information pertaining to the patients medical consition
- patients ability to tolerate treatment
- requests further information about patients medical condition
- determine optimal condition for treatment
the assistance may include:
- request that patient be optimized prior to treatment: HTN pt
- request assistance in management of patient during perioperative period as necessary (insulin regimen for diabetic patient)
what is the purpose of recognition and assessment
to determine the level of illness the provider must be able to interpret the signs and symptoms that indicate an existing or pending emergent situation
what are the early signs of serious illness arise from the CNS
- anxiety
- fear
- nausea
- inadequate blood supply or vital nutrients: oxygen and glucose
what is the progression of process
- confusion
- agitation
- combative behavior
- lethargy
- coma
what are the skin changes
- diaphoresis (especially of the brow)
- pallor or grayness of face and limbs: signs of extreme sympathetic nervous system activation, attempt to conserve core circulation
what is capillary refill
the time it takes for the pink to return after blanching the palm or a nail bed
capillary refill is prolonged if peripheral circulation is:
compromise
color should return in the time it takes to say:
“capillary refill”
what are the vital signs for
- baseline vital signs when patient is seated
- changes can be used to judge the seriousness of the patients condition
- correlate to clinical situation
- continue monitoring throughout the case
what are the symptoms that may represent early signs of an emergent situation
- difficulty breathing
- shortness of breath
- nausea
- chest pain or pressure
- lightheadedness
- dizziness
- headache
- abdominal pain
the most important part of IV sedation is:
suction
what is the suction equipment
- central suction
- portable suction
- suction powered by an non electrical source in event of electrical failure
what is the yankaur suction tip
rigid smooth plastic anatomically shaped
multiple suction ports
controlled suction
what is the purpose of monitoring equipment
- device to measure blood pressure and heart rate with multiple size cuffs
- to auscultate the heart and lungs
- pulse oximetry with appropriate probes
- electrocardiogram
- temperature monitor
- ideal that monitor can print
what is capnography
- monitoring of concentration or partial pressure of CO2
- graph of expiratory CO2 by expired volume
what is an advantage of capnography
- breath to breath ventilation data
- respiratory effort
- real time feedback on treatment
what does the pulse oximeter do
- measures oxygen saturation of arterial blood
- determine percentage of oxyhemoglobin in capillaries
what wavelength does a pulse oximeter use
650nm and 950nm
describe the nasal canula
- no airtight seal
- significant air dilution
- cannot be scavenged
- no N2O, inhalation agents
- no reservoir bag
- often uncomfortable
describe nasal hood
- commonplace in office
- less air dilution
- less volume needed
- reservoir bag
- may be scavenged
what are the etiology of airway obstruction
- poor airway classification
- relaxation of soft tissues
- retraction of the tongue
- depressing the mandible
- inadequate airway support
what does the head tilt chin lift
displaces the prolapsed tongue from the posterior pharyngeal wall
- eliminates obstruction
- can be used for conscious or unconscious patient
describe the combitube
- double lumen airway
- blindly inserted
- ventilate patient regardless of tracheal or esophageal placement
what are the indications for combitube
- difficult airway
- cant ventilate
- failed intubation
- cant move head/neck
- no laryngoscope
- significant upper airway bleeding
the king laryngeal tube is a versatile airway tool offering:
-ease of insertion: quick insertion requiring no laryngoscopy
- low incidence of sore throat and trauma
- minimizes gastric insufflation
- does protect from aspiration
what is the laryngeal mask airway for
- intended as an improved alternative to the traditional face mask
- minimizes trauma
- simplifies securing the airway
what are the LMA advantages
- minimal training
- shortest placement time
- can use in pediatric patients
- least amount of tissue trauma
- ACLS class 2B airway control
- can use to intubate
what are the LMA contraindications
- intact gag reflex
- patients at high risk for aspiration
- laryngeal foreign bodies or pathology
- patients with decreased pulmonary compliance
describe LMA vs king tube
- quick establishment of the airway
- effective ventilation
- better ventilation than OPA/NPA
- does not protect from aspiration
describe king tube vs LMA
- rapid establishment of the airway
- effective ventilation
- protects from aspiration
- easy to use and train
- can be used to facilitate intubation
what is definitive airway control
endotracheal intubation
what is the surgical airway procedure
cricothyroidotomy
what is the procedure for the cricothyroidotomy
- palpate the cricothyroid membrane
- skin incision over the cricothyroid membrane
- insert scalpel handle and rotate 90 degrees
- insert endotracheal tube
- inflate cuff and ventilate
what are the emergency airway management tools
- laryngeal mask airway
- combitube
- cricothyroidotomy
- kingtube
what is the oral pharyngeal partition
- should be used with each patient
- prevents teeth/debrid from entering oropharynx
- helps absorb excess irrigation fluid
- provides additional reaction time
