Remote Locations Flashcards

1
Q

What must you make sure to turn off before leaving a room?

A

The O2 source. No pipeline available, only large cylinders. Limited O2 supply.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Equipment needed for satellite

A
  • O2 source with backup
  • Suction
  • Scavenging
  • Monitoring equipment
  • Ambu bag with PEEP
  • Enough electrical outlets
  • Adequate lighting, with battery power back-up
  • Emergency cart with defibrillator, drugs, and other emergency stuff
  • Reliable communication for help
  • Compliance with all safety and building codes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ASA requires monitoring of

A

Oxygenation (O2 sat)
Ventilation (EtCO2)
Circulation (EKG and BP)
Temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Considerations for radiology suites

A
  • Patients often immobile for long periods of time
  • Bulky equipment may get in the way of easily accessing the patient
  • Lack of scavenging can limit GA options if you end up needing them
  • You need lead aprons with thyroid shields
  • Dosimeters should be worn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Adverse reactions to contrast media require these interventions

A
  • O2
  • Bronchodilators (B2 agonists)
  • Antihistamines
  • Corticosteroids (blocking the immune response, and supporting the SNS)

If patient is at risk, you may want to consider giving prophylactic corticosteroids and H1 & H2 antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Contrast reactions are more likely in patients with

A
  • Bronchospasm history
  • History of other allergies
  • Renal or cardiac disease
  • Extremes of age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What should you be aware of if your patient says they were itchy the last time they received contrast medium?

A

They may have a similar reaction, or it could be worse the next time they receive it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why is contrast medium nephrotoxic?

A

Free oxygen radicals are release that damage renal tubules and the microvascular circulation. It can also cause microvascular obstruction.

Contrast media is hypertonic, so if your patient is dehydrated, it could be extremely concentrated within the nephron and cause damage. NPO deficits should be replaced prior to receiving contrast. Hydration is also key to its clearance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If a patient has a bad response to contrast media, azotemia starts at __-__ hours, and peaks at ___-___ days. It’s important to avoid surgical procedures during this period.

A

24-48 hours

3-5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can the effects of contrast be minimized?

A
  • Hydration is the first line of protection
    • -> Give 1mL/kg of NS 4 hours before the procedure, and continue for 12 hours after the procedure.
  • Careful administration and limitation of total dose
  • Monitor serum Cr levels for 72 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

This PO drug can be given to blunt the renal effects of contrast for the with CRI (name and dose)

A

N-Acetylcysteine

600mg BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Minimimal Sedation
Moderate Sedation/Analgesia
Deep Sedation/Analgesia
General Anesthesia

A

Minimal Sedation
- Anxiolysis
- Pt responds normally to verbal commands
- Normal cardiac and pulmonary function
Moderate Sedation
- Responds to commands alone or with light tactile stimulation
- Normal cardiac and pulmonary function
Deep Sedation
- Not easily aroused, but responds purposefully to repeated or painful stimuli
- Normal cardiac function, but ventilation may be impaired, and may need help maintaining an airway (oral/nasal airway)
General Anesthesia
- Loss of consciousness
- Not aroused by painful stimuli
- Often needs help ventilating and maintaining an airway
- Cardiovascular function may be impaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

During MAC, is coughing good or bad?

A

Good, because it means the patient is able to manage and protect their own airway. It’s only bad when they start having stridor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In MRI, the strong magnetic field exerts a strength of ___ Tesla, or ___ Gauss

A

1.5 Tesla
15,000 Gauss

(The earth’s magnetic field is only about 0.5 Gauss)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MRI and EKG leads

A

Either use ones that are MRI compatible, or frequently switch the positions of normal ones during the scan. Failure to do so could cause burns.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where does anesthesia induction occur when providing anesthesia for MRI

A

In an adjacent area. Can’t be within the room, because airway equipment such as laryngoscopes can’t be used within the MRI’s magnetic field. Patient is then transported on MRI safe stretcher, and connected to the anesthesia machine. Patient is emerged in the same area where the induction took place (where emergency equipment is available)

17
Q

Contraindications to MRI scans

A
  • Pacemakers
  • Aneurysm clips
  • Intravascular wires
  • First trimester of pregnancy (although little data exists to support this)
  • Metal implants (need to be monitored for increase in temperature)
18
Q

Procedures that occur in interventional neuro-radiology

A

Endovascular approach to CNS lesions or related circulatory structures

  • Embolization of AVMs
  • Aneurysm coilings
  • Angioplasty of atherosclerotic lesions
  • Thrombolysis of acute embolic strokes
  • Carotid stent placement
19
Q

Anesthetic considerations for neuro-radiologiy

A
  • May need deliberate hypotension or tight BP control (obtain an a-line)
  • Also have all ASA monitors
  • Foley catheter
  • 2 IVs
20
Q

Meds used for deliberate hypotension

A

Esmolol, labetolol, SNP

21
Q

Meds for deliberate HTN

A

Phenylephrine to increase BP by 30-40%

22
Q

What is important on emergence for neuro-radiology?

A

Antiemetics***
We don’t want coughing, bucking, or retching following the procedure that could lead to device migration or intracranial hemorrhage

23
Q

Risks involved in interventional cardiology

A

Hemorrhage of coronaries, infection, ischemia of coronaries or distal limb to access point, thromboembolic events, contrast reactions.
Bottom line is, there area lot of risks, so make sure you are prepared to handle an emergency situation.

24
Q

These are provocative agents used to induce coronary spasm

A

Ergonovine maleate
or
Methylergonovine maleate

25
Q

Interventional cardiology for pediatrics

A

Warm the room
Use atropine to treat sinus bradycardia
Usually require general anesthesia
Give midazolam .5mg/kg or inhalational induction
Blood loss is less tolerated than in adults
Hematocrit is monitored frequently
Also monitor for hypoglycemia and hypocalcemia

26
Q

EP Studies

A

Electrophysiology Studies

  • minimally invasive procedure that tests the electrical conduction system of the heart to assess the electrical activity and conduction pathways of the heart
  • often long procedures that can be done with an LMA
  • heart rhythms are often very unstable because they are told to stop their heart meds prior to the procedure
27
Q

Pacemaker insertion

A

Can be done under sedation

  • Internal defibrillators may need brief period of GA
  • Case is usually hemodynamically unstable
  • Get an a-line if EF < 20%
28
Q

What type of anesthesia is needed for cardioversion? (LA, sedation, or GA?)

A

GA

29
Q

Anesthetic procedure for cardioversion

A

1) Pre-oxygenate
2) Incremental doses of induction med until LOC and loss of lid reflex occurs
3) Remove facemask
4) Deliver synchronized shock
5) Closely monitor heart rhythm
6) Manually ventilate until spontaneous respirations return
6) Remain with patient until they are alert and awake. Hand off to ACLS trained ICU nurse

30
Q

Contraindications to ECT

A
  • Pheo (don’t want more SNS output)
  • Increased ICP
  • Recent CVA
  • High risk pregnancy
  • Aortic and cerebral aneurysms
31
Q

To prevent profound bradycardia from initial PSNS discharge that occurs with ECT, what can be given?

A

.2mg Glycopyrrolate

32
Q

Anesthesia for ECT

A

1) Pre-oxygenate
2) Induce anesthesia, and ensure that you can mask the person adequately
3) Insert bite block
4) Inflate the BP cuff
5) Paralyze the patient with .5mg/kg Sux
6) Induce the seizure
7) Ventilate the patient until they awaken

33
Q

What is the gold standard induction agent for ECT?

A

Methohexital!! .75-1mg/kg –> because it reduces the seizure threshold. Beware, because it can cause extreme pain on induction.

Propofol can be used as well, but reduces seizure duration, so it’s not very common.

34
Q

Treatment for PSNS and SNS discharge with ECT

A

PSNS –> .2mg Glycopyrrolate

SNS –> Esmolol and labetolol