Patient evaluation & Monitoring in I.V. Conscious Sedation

Question 1

what is needed for Patient Evaluation

Answer 1

 Proper history and physical examination

Question 2

what can evaluation be useful for?

Answer 2

Prevention

Question 3

Medical History Questionnaire
 A tool to?
 Completed by?
 Simple format which is?
 Two standard formats?

Answer 3

 A tool to gather written information about the patient’s health
 Completed by the patient or the patient’s guardian
 Simple format which is easy to understand
 Two standard formats:
 short or long

Question 4

patient interview
 An opportunity to review?
 Obtain detailed information about?
 Cross check any?
 Should be conducted by?
 Gain greater insight to?
 Identifies?

Answer 4

 An opportunity to review the responses made on the written
medical questionnaire
 Obtain detailed information about specific responses
 Cross check any inconsistent responses
 Should be conducted by the person planning and administering the anesthetic (That’s you, doctor!!)

 Gain greater insight to the magnitude of the problem
 Identifies treatment risk

Question 5

The Physical Exam
 Starts when?
 Checks for signs of?
 Assesses?
 Vitals

Answer 5

 Starts when patient walks into the room
 Checks for signs of underlying illness
 Assesses patient general appearance
 Vital signs

Question 6

Mallampati Classification

Answer 6

Question 7

Components of the Upper Airway

Answer 7

Question 8

Consultation
 Request to the PCP or specialist for? used to?
 The consult needs to be:
 When appropriate describe what you?

Answer 8

 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
 When appropriate describe what you plan to do
 Educates the PCP
 You know more of what he/she does than they know what you do

Question 9

Consultation
 The assistance/information may include:
 Providing?
 Information pertaining to?
○ Patient’s ability to?
○ Requests?
○ Determine?

Answer 9

 The assistance/information may include:
 Providing a specific piece of information needed to move forward with
treatment (INR)
 Information pertaining to the patients medical condition
○ Patient’s ability to tolerate treatment
○ Requests further information about patients medical condition
○ Determine optimal condition for treatment

Question 10

Consultation assistance?
 The assistance may include:
 Request that patient be?
○ example?
 Request assistance in?
 Provides?

Answer 10

 The assistance may include:
 Request that patient be optimized prior to treatment
○ Hypertensive patient (lower BP)
 Request assistance in management of patient during perioperative period as necessary (insulin regimen for diabetic patient)
 Provides feedback to the consultant

Question 11

Recognition and Assessment

Answer 11

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

Question 12

Early signs of serious illness arise from?
examples/ progression?

Answer 12

Early signs of serious illness arise from the CNS
 Anxiety
 Fear
 Nausea
 Inadequate blood supply or vital nutrients
○ Oxygen
○ Glucose

 Progression of process
 Confusion
 Agitation
 Combative behavior
 Lethargy
 Coma

Question 13

skin changes

Answer 13

 Diaphoresis (especially of the brow)
 Pallor or grayness of face and limbs
○ Signs of extreme Sympathetic nervous system activation
○ Attempt to conserve core circulation

Question 14

Capillary refill

Answer 14

 The time it takes for the pink to return after blanching the palm or a nail
bed
 Is prolonged if peripheral circulation is compromised
 Color should return in the time it takes to say” capillary refill”

Question 15

Vital signs
 Baseline vital signs when?
 Changes can be used to judge?
 Correlate t?
 Continue monitoring?

Answer 15

 Baseline vital signs when patient is seated
 Changes can be used to judge the seriousness of the
patient’s condition
 Correlate to clinical situation
 Continue monitoring throughout the case

Question 16

possible Symptoms of the patient
 May represent?

Answer 16

 May represent early signs of an emergent situation
○ Difficulty breathing
○ Shortness of breath
○ Nausea
○ Chest pain or pressure
○ lightheadedness
○ Dizziness
○ Headache
○ Abdominal pain

Question 17

most important aspect of IV sedation

Answer 17

suction

Question 18

types of Suction Equipment

Answer 18

 Central suction
 Portable suction
 Suction powered by a non electrical source in event of electrical failure
 Multiple emergency type suction tips readily available

Question 19

yankaur suction tip

Answer 19

Question 20

Monitoring Equipment
 Device to measure? cuff sizes?
 To auscultate?
 O2?
 Electro?
 Temp?
 Ideal that monitor can?

Answer 20

 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

Question 21

Capnography
 Monitoring of concentration or partial pressure of?
 Graph of?
 Advantages of capnography?

Answer 21

 Monitoring of concentration or partial pressure of CO2
 Graph of expiratory CO2 by expired volume

 Advantage of capnography:
 Breath to breath ventilation data
 Respiratory effort
 Real-time feedback on treatment ( i.e. IV med administration

Question 22

Answer 22

pulse oximeter

Question 23

Pulse Oximeter
 Measures?
 Determine percentage of?
 Operates on?

Answer 23

 Measures oxygen saturation of arterial blood
 Determine percentage of oxyhemoglobin in capillaries
 Operates on 650nm and 950nm wave length

Question 24

Nasal Cannula
seal?
dilution?
Cannot Be?
No?
Reservoir?
comfortable?

Answer 24

No Airtight Seal
Significant Air Dilution
Cannot Be Scavenged
No N2O, Inhalation Agents
No Reservoir Bag
Often Uncomfortabl

Question 25

Nasal Hood Common? dilution? volume? Reservoir? scavenge?

Answer 25

Commonplace in Office Less Air Dilution Less Volume Needed Reservoir Bag May Be Scavenged

Question 26

Etiology of Airway Obstruction  Airway Classification? Relaxation of ? Retraction of ? mandible? Airway Support?

Answer 26

Poor Airway Classification Relaxation of Soft Tissues Retraction of the Tongue Depressing the Mandible Inadequate Airway Support

Question 27

Head tilt chin lift

Answer 27

 Displaces the prolapsed tongue from the posterior pharyngeal wall  Eliminates obstruction  Can be used for conscious or unconscious patient

Question 28

first step with airway obstruction

Answer 28

Ambu Bag with Face Mask

Question 29

Airway in Sedation is...

Answer 29

EVERYTHING If Patient is experiencing airway urgency... what can you do?> Nasal and Oral Airways

Question 30

nasal and oral airways

Answer 30

Question 31

Combitube

Answer 31

 Double Lumen Airway  Blindly Inserted  Ventilate Patient Regardless of Tracheal or Esophageal Placement

Question 32

Combitube Indications  Difficult?  Can’t?  Failed?  Can’t Move?>  No?  Significant Upper Airway?

Answer 32

 Difficult Airway  Can’t Ventilate  Failed Intubation  Can’t Move Head/Neck  No Laryngoscope  Significant Upper Airway Bleeding

Question 33

King Laryngeal Tube (LT)  Versatile airway tool offering:  Ease of? ○how?  Low incidence of ?  Minimizes?  Does protect from ?

Answer 33

 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

Question 34

Laryngeal Mask Airway (LMA)  Intended as an Improved Alternative to?  Minimizes?  Simplifies?

Answer 34

 Intended as an Improved Alternative to the Traditional Face Mask  Minimizes Trauma  Simplifies Securing the Airway

Question 35

LMA Advantages  Minimal?  placement time?  Can Use In?  Least Amount of?  class of airway control?  Can Use To?

Answer 35

 Minimal Training  Shortest Placement Time  Can Use In Pediatric Patients  Least Amount of Tissue Trauma  ACLS Class 2B Airway Control  Can Use To Intubate

Question 36

LMA Contraindications  Intact?  Patients At High Risk For?  Laryngeal?  Patients With Decreased?

Answer 36

 Intact Gag Reflex  Patients At High Risk For Aspiration  Laryngeal Foreign Bodies Or Pathology  Patients With Decreased Pulmonary Compliance

Question 37

King LT vs LMA

Answer 37

Question 38

Definitive Airway Control accomplished with?

Answer 38

Endotracheal Intubation

Question 39

Surgical Airway accomplished with?

Answer 39

Cricothyroidotomy

Question 40

Cricothyroidotomy  Palpate the?  Skin Incision over?  Insert Scalpel Handle and ?  Insert?  Inflate ?

Answer 40

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

Question 41

Emergency Airway Management Tools

Answer 41

Question 42

what can prevent emergency airway management strategies, how?

Answer 42

**Oral Pharyngeal Partition**  Should Be Used With Each Patient  Prevents Teeth/Debris From Entering Oropharynx  Helps Absorb Excess Irrigation Fluid  Provides Additional Reaction Time