Patient evaluation & Monitoring in I.V. Conscious Sedation Flashcards
what is needed for Patient Evaluation
Proper history and physical examination
what can evaluation be useful for?
Prevention
Medical History Questionnaire
A tool to?
Completed by?
Simple format which is?
Two standard formats?
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
patient interview
An opportunity to review?
Obtain detailed information about?
Cross check any?
Should be conducted by?
Gain greater insight to?
Identifies?
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
The Physical Exam
Starts when?
Checks for signs of?
Assesses?
Vitals
Starts when patient walks into the room
Checks for signs of underlying illness
Assesses patient general appearance
Vital signs
Mallampati Classification
Components of the Upper Airway
Consultation
Request to the PCP or specialist for? used to?
The consult needs to be:
When appropriate describe what you?
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
Consultation
The assistance/information may include:
Providing?
Information pertaining to?
○ Patient’s ability to?
○ Requests?
○ Determine?
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
Consultation assistance?
The assistance may include:
Request that patient be?
○ example?
Request assistance in?
Provides?
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
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
Early signs of serious illness arise from?
examples/ progression?
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
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
Capillary refill
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”
Vital signs
Baseline vital signs when?
Changes can be used to judge?
Correlate t?
Continue monitoring?
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
possible Symptoms of the patient
May represent?
May represent early signs of an emergent situation
○ Difficulty breathing
○ Shortness of breath
○ Nausea
○ Chest pain or pressure
○ lightheadedness
○ Dizziness
○ Headache
○ Abdominal pain
most important aspect of IV sedation
suction
types of Suction Equipment
Central suction
Portable suction
Suction powered by a non electrical source in event of electrical failure
Multiple emergency type suction tips readily available
yankaur suction tip
Monitoring Equipment
Device to measure? cuff sizes?
To auscultate?
O2?
Electro?
Temp?
Ideal that monitor can?
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
Capnography
Monitoring of concentration or partial pressure of?
Graph of?
Advantages of capnography?
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
pulse oximeter
Pulse Oximeter
Measures?
Determine percentage of?
Operates on?
Measures oxygen saturation of arterial blood
Determine percentage of oxyhemoglobin in capillaries
Operates on 650nm and 950nm wave length
Nasal Cannula
seal?
dilution?
Cannot Be?
No?
Reservoir?
comfortable?
No Airtight Seal
Significant Air Dilution
Cannot Be Scavenged
No N2O, Inhalation Agents
No Reservoir Bag
Often Uncomfortabl
Nasal Hood
Common?
dilution?
volume?
Reservoir?
scavenge?
Commonplace in Office
Less Air Dilution
Less Volume Needed
Reservoir Bag
May Be Scavenged
Etiology of Airway Obstruction
Airway Classification?
Relaxation of ?
Retraction of ?
mandible?
Airway Support?
Poor Airway Classification
Relaxation of Soft Tissues
Retraction of the Tongue
Depressing the Mandible
Inadequate Airway Support
Head tilt chin lift
Displaces the prolapsed tongue from the posterior pharyngeal wall
Eliminates obstruction
Can be used for conscious or unconscious patient
first step with airway obstruction
Ambu Bag with
Face Mask
Airway in Sedation is…
EVERYTHING
If Patient is experiencing airway urgency… what can you do?> Nasal and Oral Airways
nasal and oral airways
Combitube
Double Lumen Airway
Blindly Inserted
Ventilate Patient Regardless of Tracheal or Esophageal
Placement
Combitube Indications
Difficult?
Can’t?
Failed?
Can’t Move?>
No?
Significant Upper Airway?
Difficult Airway
Can’t Ventilate
Failed Intubation
Can’t Move Head/Neck
No Laryngoscope
Significant Upper Airway Bleeding
King Laryngeal Tube (LT)
Versatile airway tool offering:
Ease of?
○how?
Low incidence of ?
Minimizes?
Does protect from ?
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
Laryngeal Mask Airway (LMA)
Intended as an Improved Alternative to?
Minimizes?
Simplifies?
Intended as an Improved Alternative to the Traditional
Face Mask
Minimizes Trauma
Simplifies Securing the Airway
LMA Advantages
Minimal?
placement time?
Can Use In?
Least Amount of?
class of airway control?
Can Use To?
Minimal Training
Shortest Placement Time
Can Use In Pediatric Patients
Least Amount of Tissue Trauma
ACLS Class 2B Airway Control
Can Use To Intubate
LMA Contraindications
Intact?
Patients At High Risk For?
Laryngeal?
Patients With Decreased?
Intact Gag Reflex
Patients At High Risk For Aspiration
Laryngeal Foreign Bodies Or Pathology
Patients With Decreased Pulmonary Compliance
King LT vs LMA
Definitive Airway Control accomplished with?
Endotracheal Intubation
Surgical Airway accomplished with?
Cricothyroidotomy
Cricothyroidotomy
Palpate the?
Skin Incision over?
Insert Scalpel Handle and ?
Insert?
Inflate ?
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
Emergency Airway Management Tools
what can prevent emergency airway management strategies, how?
Oral Pharyngeal Partition
Should Be Used With Each Patient
Prevents Teeth/Debris From Entering Oropharynx
Helps Absorb Excess Irrigation Fluid
Provides Additional Reaction Time
