Putting It All Together Flashcards

1
Q

t/f, preop assessment must be done by anesthesia provider

A

true

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2
Q

What 2 interviewing techniques are most important

A

Active listening

Empathetic responses

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3
Q

Name some goals of preop assessment

A

-optimize care
-minimize periop M&M
-minimize surgery delays
-Determine post op disposition
-evaluate health status
-optimize preop condition
-Formulate a plan
-communicate w/ team
-communicate w/ pt
-educate
-efficiency

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4
Q

Primary goal for preop interview

A

listen & improve pt well being via trusting/supportive relationship

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5
Q

FIFE acronym

A

F-feelings
I-ideas
F-function
E-expectations

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6
Q

The pinnacle of patient-centered care is ______ _______ ________

A

shared decision making

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7
Q

ASA PS ____

A normal healthy patient
Healthy, nonsmoking, no or minimal alcohol use

A

PS 1

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8
Q

ASA PS ___

A patient with mild systemic disease
Mild diseases only without substantive functional limitations.

Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease

A

PS 2

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9
Q

ASA PS ___

A patient with severe systemic disease
Substantive functional limitations; one or more moderate to severe diseases.

Examples include (but not limited to): poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥ 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA < 60 weeks, history (>3 months) of MI, CVA, TIA, or CAD/stents

A

PS 3

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10
Q

A patient with severe systemic disease that is a constant threat to life

Examples include (but not limited to): recent (< 3 months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis

A

PS 4

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11
Q

ASA PS ___

A moribund patient who is not expected to survive without the operation

Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction

A

PS 5

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12
Q

ASA PS ___

A declared brain-dead patient whose organs are being removed for donor purposes

A

PS 6

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13
Q

ESRD not going to dialysis. What PS class?

A

PS 4

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14
Q

ESRD going to dialysis. What PS class

A

PS 3

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15
Q

ASA PS ___

emergency

A

PS E

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16
Q

What class procedure is highly invasive and may require blood tx, invasive monitors, or post op ICU

A

Class C procedure

17
Q

Routine lab test preop?

A

NO

18
Q

What type of analgesia/anesthesia improves all outcomes related to preventative pain management

A

Epidural

19
Q

Aka pre-emptive analgesia

A

Preventative analgesia

20
Q

List some risk factors for PONV

A

-female
-hx of PONV
-non-smoker
-<50yo
-surg >3hrs
-opioid use
-volatile anesthetics
-reversal agents
-abd surg
-gynecologic/breast surgery
-laparoscopic surg

21
Q

What med can you NOT GIVE w/ parkinson’s and GI obstruction

A

Reglan (&N2O)

22
Q

What PONV med do you have to worry about sedation effects (up to 12hrs)

A

Droperidol

23
Q

Intraop hypercarbia, tachycardia, elevated temp, muscle rigidity, metabolic acidosis, rhabdo, hyperk+ arrythmias

***d/t uncontrolled elevation of intracellular Ca++ d/t ryanodine receptor mutation

A

Malignant hyperthermia (MH)

24
Q

MH triggering agents

A

-volatile agents

-SCh

-heat exposure

25
Q

What receptor is mutated in MH patients

A

Ryanodine

26
Q

MH tx.

A

Dantroline 10mg/kg

(reconsituted w/ sterile water)

27
Q

Will all MH suseptible pts display symptoms after exposure to trigger agent?

A

NO

28
Q

Key w/ MH

A

Identify pts at risk

29
Q

Pseudocholinesterase deficiency pts have a hard time metabolizing what 5 drugs?

A

-SCh

-Mivacurium

-ester LA

-remifentanil

-heroin

30
Q

What does the dibucaine # indicate

A

% inhibition of pseudocholinesterase

31
Q

What 2 genotypes and dibucaine #s are relatively mild forms of pseudocholinesterase deficiencies?

A

W-W, #80 (10 minutes)

W-A, #60 (20-30 minutes)

32
Q

What genotype and dibucaine # is severe and requires postop ventilation?

A

A-A, #20 (8 hours!!)