Quiz 4 Flashcards
What are the components of the Aldrete score?
activity level, respirations, circulation (BP), consciousness, O2 sat
What is the maximum Aldrete score?
10
What Aldrete score is required for discharge?
8 according to Greg, 9 according to chart
When should patients have the carbohydrate drink?
2 hours prior to surgery
What are some pre-op considerations according to ERAS?
optimize pre-op condition, educate and set realistic expectations, emphasize minimizing fasting period and maintaining hydration
Describe pre-op fasting according to ERAS
fasting for at least 2 hours for clear liquids, consume 2 glasses of water before bed and 2 glasses of water before leaving for hospital, carb rich drink 2 hours prior to surgery
When should pre-meds be given according to ERAS?
2 hours before surgery (Greg says sooner)
What are some common pre-meds for ERAS?
Tylenol, Celecoxib, gabapentin, subQ heparin
What routine pre-op med should you avoid according to ERAS?
benzos
What does ERAS say according to ketamine?
low dose 25-50 mg administered after induction has been reported to improve postop pain relief
What is justice concerned with?
equity or fairness in the distribution of scarce healthcare resources
What does nonmaleficence mean?
do no harm, not intentionally harm patient
Define beneficence
requires that an action be implemented that will bring about good for the patient/responsibility to help patient, to “do good”
What is the “biggest payout” for anesthesia related malpractice?
anoxic brain injury/brain damage
What is the most common cause of anesthesia related malpractice claims?
damaged teeth
What should you do if you are deposed?
answer only the questions asked (Y/N), do not suggest areas of question, detail only when necessary, be medically correct in all answers, do not answer a question you don’t know/understand
Describe selection of council if you’re named in a legal suit
your professional liability carrier will appoint you one- use this versus a personal attorney
What should you make sure happens when you drop a patient off in PACU?
do transfer of care report to licensed personnel and document
Describe PACU layout
located near OR, close to radiology/lab/ICU; open ward with simultaneous patient visibility; must have O2, suction, outlets
What must you consider when discharging a patient?
they must have an adult caretaker to take them home and monitor them for 24 hours
What are anesthetist limitations to hypotensive technique?
lack of understanding, lack of technical expertise, inability to monitor pt adequately
What are patient limitations to hypotensive technique?
cardiac disease, DM, anemia, hemoglobinopathies, polycythemia, hepatic disease, intolerance to hypotensive drugs, ischemic cardiovascular disease, renal disease, respiratory insufficiency, severe systemic hypertension
Describe MAC anesthesia
combination anesthetic- surgical anesthesia with LA infiltration, with or without IV meds for sedation/analgesia; meds cause depressed level of consciousness but pt maintains spontaneous ventilation
Is MAC anesthesia the same thing as conscious sedation?
no
Describe a patient under minimal sedation
pt has normal response to verbal stim; airway, spontaneous ventilation, and CV function is unaffected
Describe a patient under moderate sedation
pt has purposeful response to verbal/tactile stim, no airway intervention is required, pt maintains adequate spontaneous ventilation, CV function is usually maintained
Describe a patient under deep sedation
pt has purposeful response to repeated or painful stim, airway intervention may be required, spontaneous ventilation may be inadequate, CV function usually maintained
Describe a patient under general sedation
pt is unarousable, even with painful stim; airway intervention often required; spontaneous ventilation frequently inadequate, CV function may be imparied
What do MAC cases fall under on the continuum of depth of sedation?
minimal, moderate, and deep sedation
What are benefits of doing a MAC cases?
quicker recovery, shorter PACU time, less N/V, less cost, high patient satisfaction
What are contraindications to MAC?
pt discomfort, surgeon cannot operate safely, pt positioning (prone), inability to effectively medicate, pt cannot maintain airway, skill of surgeon and anesthetist
What does Greg say about MAC cases?
they are harder then general anesthesia case with secured airway
What are some drugs that are commonly used in MAC cases?
amnestics (benzos), analgesics (fentanyl, ketamine), propofol, STP/methohexital, precedex, zofran, NSAIDs, decadron
What percentage of TBW do ICF and ECF make up?
ICF is 2/3, ECF is 1/3
What is normal osmolarity and how is it calculated?
280-290; 2(Na) + glucose/18 + BUN/2.8
What’s the difference between absolute fluid loss and relative loss?
absolute loss is from increased fluid loss or decreased intake, while relative loss is redistribution of water within the body leading to reduced circulating volume (burns, third spacing)
What does a 10% variation in A-line tracing mean?
patient is dry
When correcting for hypernatremia, one should not lower the Na level more than ?
1-2 mEq/hr
What is the formula for TBW deficit?
(0.6x body weight in kg) x [(Na-140)/140]
What is a finding of hyperkalemia on EKG?
narrow peaked T wave
What are two hallmark signs of hypocalcemia?
Trousseau’s- carpopedal spasm
Chvostek’s- masseter spasm
What are EKG findings in hypocalcemia?
prolonged QT and ST segment
What’s a neuromuscular and CNS finding of hypomagnesemia?
hyperactivity
What is the replacement in mL for crystalloid and colloids for every 1 mL loss?
crystalloid is 3 mL, colloid is 1 mL
How do you calculate maintenance fluid requireements?
4,2,1 rule (4 ml/kg/hr for first 10 kg, 2 ml/kg/hr for next 10 kg, 1 ml/kg/hr for each kg above 20)- shortcut: if over 20 kg, take weight and add 40
How do you calculate NPO deficit?
_ hrs NPO x _ ml/kg/hr maintenance rat
What procedures are considered minimally invasive and what is the additional fluid requirement?
short superficial procedures like lower abdomen, hernia repair, small plastics procedures (2 ml/kg)
What procedures are considered moderately invasive and what is the additional fluid requirement?
uncomplicated intraabdominal or orthopedic procedures like upper abdomen, appy, cholecystectomy (4 ml/kg)
What procedures are considered severely invasive and what is the additional fluid requirement?
prolonged highly invasive procedures like upper and lower abdomen, total hip, bowel resection (8 ml/kg)
How do you calculate fluid replacement for the 1st hour?
1/2 NPO deficit + 3rd space loss + maintenance rate
How do you calculate fluid replacement for the 2nd and 3rd hours (each)?
1/4 NPO deficit + 3rd space loss + maintenance rate
How do you calculate fluid replacement for the 4th hour and beyond?
3rd space loss + maintenance rate
What is the estimated blood volume of premature neonates?
90-100 ml/kg
What is the estimated blood volume of full term neonates?
80-90 ml/kg
What is the estimated blood volume of infants?
80 ml/kg
What is the estimated blood volume of adults?
70 ml/kg
Does a serial Hct reflect acute blood loss?
no
How do you calculate allowable blood loss (ABL)?
EBV x (starting Hct - target Hct)/starting Hct
How much does 1 unit of pRBCs raise Hct and Hgb?
Hct by 2-3% and Hgb by 1 g/dL
What are the most to least likely transmitted diseases from blood products?
CMV > Hep B > Hep C > HIV
