Remote locations Flashcards
1
Q
What are some satellite locations?
A
- radiology
- cardiac cath lab
- psych units- for ECTs
- endoscopy
- office based practice
- **patients are becoming sicker in these remote units
- not as much personnel or the equipment of the OR
2
Q
What equipment do you need to in Satellite locations per the ASA standards?
(12)
A
- Reliable oxygen source with back-up
- some office settings wont have pipeline
- suction- make sure it is adequate!
- waste gas scavenging
- Monitoring equipment
- must meet basic standards during case and post-anesthesia transport
- self inflating ambu bag (>90% FiO2 delivery)
- adequate patient and anesthesia equipment illumination with battery power back-up
- adequate space to freely access patient and anesthesia equipment.
- emergency cart with defibrillator and drugs
- reliable two-way communication to request help
- adequately trained support staff
- including anesthesia professional available during recovery period
- compliance with safety and building codes
- sufficient safe electrical outlets
3
Q
What are the monitoring standards of care?
A
- Pre and post procedure checklists
- emergency protocols with contact numbers
- ASA/AANA monitoring:
- oxygenation
- spo2
- ventilation
- capnography
- circulation
- ekg, BP
- temperature
- oxygenation
4
Q
What are the different depths of anesthesia?
A
5
Q
What are the four major issues that determine appropriate classification of anesthetic depth?
A
- responsiveness
- airway
- spontaneous ventilation
- CV function
- **must always be ready to support pt for one stage beyond what is planned for.
6
Q
What is MAC?
A
- When an anesthesia provider is involved in the care of a pt while they are having a procedure
- May just be there just in case support is needed
- Do everything the same as normal and always be on the ready to do more.
7
Q
What is an upper endoscopy?
Why might it be done?
What kind of anesthesia is used?
What does EGD stand for?
A
- Endoscopic evaluation of the esophagus, pylorus, and stomach
- sometimes d/t nausea, abdominal pain, foreign body, monitor vericies
- May involve biopys, mucosal/submucosal dissection, dilation, stenting, etc.
- Local oropharyngeal anesthesia with opioid and benzo vs general anesthesi with propofol
- GA with propofol is anywhere from 100-300 mcg/kg/min
- Carrie does:
- gargle 4% lidocaine
- 2 mg/kg propofol to start
- aspiration and laryngospasm common
- EGD = esophagogastroduodenoscopy
8
Q
What groups are high risk during an EGD?
A
- Obese
- OSA
- GERD
- asthma
- obstruction/full stomach
- hepatic disease
9
Q
What is a lower endoscopy?
A
- Sigmoidoscopy and colonoscopy
- Generally involves insufflation of air, may involve the application of external pressure
- increased aspiration risk
- may cause vagal response
- May involve biopsy, polypectomy/mucosal resection, stenting, dilation, etc
10
Q
How can the anesthesia be done for lower endoscopy?
A
- benzos and opioids or propofol (GA)
11
Q
What is ERCP?
A
- Fluoroscopic exam of biliary and pancreatic duct that may involve stenting/removal of stones/laser lithotripsy
- Commonly performed in patients with cholangitis, pancreatitis, bile duct obstruction, pancreatic cancer, etc
- may not be as responsive to pressors, keep ahead
- requires pt to be immobile
- often done in prone position
- GA w/ETT is preferred
12
Q
What is done during a rigid bronchoscopic procedure?
A
- Endobronchial stenting
- biopsy
- laser therapy
- dilation
- cryotherapy
- fiducial marker implant
- **these patients often have significant CV and pulmonary disease
13
Q
What is the preferred method of anesthetic for a rigid bronch?
What are some complications?
A
- TIVA
- propofol, remifentanil, dexmedetomidine, and muscle relaxant
- Complications:
- airway fire
- bronchospasm
- bleeding
- hypoxia
14
Q
What are three features that make providing anesthesia in radiology suites different?
A
- There is no incision
- Access through vasculature (femoral artery)
- Must deal with lots of radiation
15
Q
What are some general considerations/challenges in the radiology suite?
A
- Patient remains immpbile for prolonged periods
- lots of bulky equipment
- limits our ability to access the patient
- can colide with our equipment
- requires us to need extensions
- can press against and possibly harm the patient
- Some rooms dont have scavenging system which will limit GA
- Must try to limit radiation exposure
- radiation causes dose-related cell death, tissue damage and malignancy (DNA ionization and free radical generation)
- direct exposure to pt
- scatter exposure to providers
