Quiz 1 part 1 - Curtis portion Flashcards
History of Anesthesia, politics, laws/regulations from lecture 1. Also, the first 10 pages from lectures 2 on Pre-Anesthesia assessment
What were the first anesthesia gases used and what were they used for?
Ether and Nitrous - used for recreation
Before anesthesia was used for surgery, what means were used to accomplish surgery?
blow to head, ETOH, snow/ice
Who was the first to use Ether for surgery but didn’t document it?
Crawford Long - 1842
Who were the first credited to use Ether and Nitrous?
Charles Jackson and Horace Wells
Who had the first successful demonstration of Ether for surgery?
William T.G. Morton - 1846, at Mass General
What were some of the problems associated with early anesthesia? (slide 4)
Infection?? The Occasional Anesthetist - wanted to keep an eye on surgery - couldn't get another residency - high turnover - low pay Patients did not receive continued VIGILANCE
Vigilance requires what 3 things are continually evaluated?
Patient needs
Provider
Anesthesia Machine
Why did the anesthesia specialty first go to the “Sisters”?
The anesthetist had to:
- be satisfied with a subordinate role
- make anesthesia their only interest
- not be more interested in the surgeon and surgery
- accept comparatively low pay
- have natural aptitude and intelligence
Who was Sister Mary Bernard?
First Trained nurse anesthetist at St Vincent’s Hospital, Erie, PA
Who was Alice Magaw?
The Mother of Anesthesia
Who was Agatha Hodgins?
founder of the NANA - early organization of the AANA
What is important about the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982?
It defined conditions that were needed for an anesthesiologist to be reimbursed. The ASA turned the meaning into a standard of safety that looked negatively towards CRNAs
What was important about the ASA anesthesia care team statement of 1995?
the ASA believes that a MDA should be involved in EVERY pt undergoing anesthesia and needs to provide direction to the anesthesia care team. This was not approved by the AANA and looks negatively towards CRNAs
Can CRNAs get educational affiliate membership to the ASA? How can they?
Yes, application needs to be endorsed by 2 anesthesiologists, sign the ACT statement and ASA code of ethics
How many states have no CRNA/MDA supervision clause in their medical practice acts, nurse practice acts, or hospital licensing regulations?
20 States.
What did the Clinton administration do to promote CRNAs?
eliminated Medicare requirement for physician supervision of CRNA
What happened during the Bush administration to CRNA supervision?
Reinstated the physician supervision requirement but created a way for states to “Opt Out” if they desired.
How long has nurse anesthesia been a specialty practice?
125 yrs, has served as a model for other APN groups
What is required for one to become a CRNA?
- state license as RN
- graduate from a COA accredited CRNA program
- pass the certification exam by NBCRNA
What are some of the divisions of the AANA?
Council on Accreditation (COA)
National Board of CRNA (NBCRNA)
Council on Public Interest in Anesth (CPIA)
Which branch under the NBCRNA is responsible for recertification? CCNA or CNOR?
Council on Recertification of Nurse Anesthetists (CNOR)
What is the AANA vision statement?
Recognized Leaders in Anesthesia Care
What is the AANA Mission Statement?
Advancing patient safety and excellence in anesthesia
What are the AANA core values?
Integrity, Professionalism, Advocacy, and Quality
What is the AANA motto?
Supporting our Members - Protecting our Patients
What is the difference between Common Law and Statutory Law (statutes)?
Common Law - judges to define laws based on other actions of government or judgements. If no other precedence has been established, then the judge can make a new law.
Statutory Law is created by the government or congress to meet citizens needs, to formalize existing law or resolve an outstanding issue
What is National Provider Data Bank?
data bank for tracking suits and actions against providers.
What department of the executive branch oversees the FDA?
Department of Health and Human Services
Which department oversees the DEA?
Department of Justice
In Tort Law, what must be proved in order for a case to be criminal?
intentional harm
If found guilty in a tort law case, why does the provider have to pay for damage?
To deter certain activities from taking place again
- to distribute the loss
- make an example to others
- address a social concern
- compensate a victim for loss or injury
- -> exemplary damages are usually high $$
In Tort Law, what is the difference between Damage and Damages?
Damage - harm the plaintiff suffered
Damages - award the plaintiff is seeking from the harm
In a lawsuit, what needs to be proved in order for negligence to be established?
- Duty: was pt informed, was relationship established
- Breach of duty - was standard of care met
- Damage - must suffer phys or mental damage caused by provider
- Cause: (actual) provider directly caused damage (proximate) foreseeable before event took place
- CAN NOT BE AN EXTRAORDINARY EVENT*
What is “Res Ipsa Loquiter”?
It Speaks for Itself … or… It is what it is
What are the types of liability insurance?
O.C.T
Occurrence - cover all acts during policy period, even when you stop coverage
Claims Made - provider is ONLY covered while paying the premiums for coverage
Tail Coverage - Can pay 200% of annual claims made policy to cover that policy period for life (turns it into an Occurrence policy)
What are the 2 verdicts that can be made against a provider in a Criminal Law case?
Felony conviction - prison
Gross Negligence - involuntary man slaughter
Never Alter a medical Record!!!!
Never Ever Alter a Medical Record!!!
What is anesthesia?
A REVERSIBLE, drug induced depression of the CNS resulting in the loss of response to and perception of all external stimuli.
What are the 5 components of anesthetic state?
- Unconsciousness
- -mnesia
- Analgesia
- Immobility
- Attenuation of autonomic responses to noxious stimuli
Minimal Alveolar Concentration
Deals with INHALED agents ONLY
- point at which 50% of humans don’t respond to surgical incision
- “quantal” meaning you are or are not anesthetized
Do anesthetics work on 1 site or multiple?
No single site , works on multiple: Spinal cord, brainstem, hypothalamus, cerebral cortex
How do anesthetics “turn off” CNS?
- depressing neurons
- reducing overall neuronal excitability
- reducing neuron communication by enhancing inhibitory or inhibiting excitatory synaptic transmission
What ion channels do anesthetics work on?
Voltage dependent ion channels
Ligand-gated ion channels
Glutamate-activated ion channels
GABA-activated ion channels
What is the Meyer-Overton Rule?
Potency of gas as anesthetic strongly correlated with their solubility in olive oil. Now substituting Octanol for Olive Oil.
Which theory is most accepted for anesthesia targets, Lipid or Protein targets?
Protein. Even though gases are soluble in oil, they are thought to work on Protein targets.
The IV anesthetics etomidate, propofol, and barbiturates work on which receptor?
GABA-A receptors
When doing a History and Physical the airway is ALWAYS a primary concern for the anesthetist
ALWAYS a concern!!!
