Patient evaluation & Monitoring in I.V. Conscious Sedation Flashcards

1
Q

what is needed for Patient Evaluation

A

 Proper history and physical examination

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2
Q

what can evaluation be useful for?

A

Prevention

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3
Q

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

A

 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

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4
Q

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

A

 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

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5
Q

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

A

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

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6
Q

Mallampati Classification

A
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7
Q

Components of the Upper Airway

A
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8
Q

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

A

 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

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9
Q

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

A

 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

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10
Q

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

A

 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

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11
Q

Recognition and Assessment

A

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

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12
Q

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

A

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

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13
Q

skin changes

A

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

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14
Q

Capillary refill

A

 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”

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15
Q

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

A

 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

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16
Q

possible Symptoms of the patient
 May represent?

A

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

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17
Q

most important aspect of IV sedation

A

suction

18
Q

types of Suction Equipment

A

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

19
Q

yankaur suction tip

A
20
Q

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

A

 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

21
Q

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

A

 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

22
Q
A

pulse oximeter

23
Q

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

A

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

24
Q

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

A

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

25
Q

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

A

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

26
Q

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

A

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

27
Q

Head tilt chin lift

A

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

28
Q

first step with airway obstruction

A

Ambu Bag with
Face Mask

29
Q

Airway in Sedation is…

A

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

30
Q

nasal and oral airways

A
31
Q

Combitube

A

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

32
Q

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

A

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

33
Q

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

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

34
Q

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

A

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

35
Q

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

A

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

36
Q

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

A

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

37
Q

King LT vs LMA

A
38
Q

Definitive Airway Control accomplished with?

A

Endotracheal Intubation

39
Q

Surgical Airway accomplished with?

A

Cricothyroidotomy

40
Q

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

A

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

41
Q

Emergency Airway Management Tools

A
42
Q

what can prevent emergency airway management strategies, how?

A

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