Post-Anesthesia Care

Question 1

6 major concerns with transport to PACU

Answer 1

1. Oxygenation
2. Ventilation
3. Circulation
4. Upper airway support
5. Nausea and vomiting
6. Systemic HTN

Question 2

What to monitor during transport:

Answer 2

Pulse ox

Adequate ventilation

Question 3

Minute ventilation increases by how much for every 1mmHg increase in arterial PCO2

Answer 3

2L/min

Question 4

6 treatments to alveolar hypoventilation

Answer 4

1. Supplemental O2
2. Raise head of bed 30degrees
3. Normalizing the PaCO2
4. External stimulation of pt to wakefulness
5. Reversal of opioid or benzodiazepine
6. Mechanical ventilation

Question 5

Should you always transport with supplemental oxygen?

Answer 5

YES

Question 6

Does N2O make a difference with transportation?

Answer 6

Diffusion hypoxia

Question 7

What does elimination of N2O at the end of anesthesia produces in the reduction of concentrations of the accompanying volatile agents, contributing to speed of emergence?

Answer 7

Significant acceleration

Question 8

What 2 things does N2O do?

Answer 8

Adds to MAC

Provides analgesia

Question 9

4 paradoxical breathing patterns

Answer 9

1. Retraction of eternal notch
2. Exaggerated abdominal muscle activity
3. Collapse of chest wall
4. Protrusion of abdomen with inspiratory effort (rocking horse motion)

Question 10

When does upper airway obstruction become evident with residual muscle relaxant?

Answer 10

Once calmly resting in PACU

Question 11

Gold standard for assessing residual blockade?

Answer 11

Sustained 5sec head lift

Question 12

Treatment for laryngospasm:

Answer 12

1. Jaw thrust with CPAP (40cm H2O)

2. If fails, sux (.1-1 mg/kg IV)

Question 13

Do to attempt to pass at Rachael tube through glottis that is closed due to laryngospasm?

Answer 13

NO

Question 14

5 possible causes to pulmonary edema:

Answer 14

1. IV fluid volume overload
2. CHF
3. Sepsis
4. Transfusion-related pulmonary edema
5. Post-obstructive pulmonary edema

Question 15

Exaggerated negative pressure generated by inspiration against closed glottis

Answer 15

Post-obstructive pulmonary edema

Question 16

What pts have increased risk of ability to generate greater negative inspiratory pressures?

Answer 16

Muscular healthy pts

Question 17

What is the most common cause of upper airway obstruction leading to post-obstructive pulmonary edema

Answer 17

Laryngospasm

Question 18

Arterial hypoxemia is manifested within how long of upper airway obstruction

Answer 18

90min

Question 19

3 treatments to post-obstructive pulmonary edema

Answer 19

Oxygen
Diuresis
PP ventilation

Question 20

Most effective treatment for hypothermia:

Answer 20

Warming pt and meperidine

Question 21

6 risk factors for PONV

Answer 21

1. Female
2. History of motion sickness
3. Previous PONV
4. Nonsmoking
5. Postop opioids
6. Cost-effective management of PONV

Question 22

Percent of decrease if antiemetic is given for PONV

Answer 22

26%

Question 23

When to given dexamethasone?

Answer 23

Start of surgery

Question 24

When should give ondansetron?

Answer 24

30 min before end of anesthesia

Question 25

SBAR standardized handoffs

Answer 25

Situation
Background
Assessment
Recommendation

Question 26

Most common missed information during handoffs:

Answer 26

Prop cognitive function
Lines/catheters
Antiemetics

Question 27

6 key checklist elements

Answer 27

1. Patient ID
2. Patient allergy info
3. Antibiotic info
4. I/O
5. Estimated blood loss
6. Pain management

Question 28

Sender gives a message and receiver repeats this back; the sender then confirms the message thus closing the loop

Answer 28

‘Closed loop’ communication