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Sp: Sim Lab 1 > Session 11 > Flashcards

Session 11 Flashcards

1
Q

normal induction sequence (3)

A

pre-op
induction
extubation

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2
Q

8 phases of induction

A

anxiolysis
pt to room/table
monitors attached
pre-oxygenated
anesthetic time out
induction
airway management
prepare for incision

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3
Q

anxiolysis

A

fear

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4
Q

anxiolysis medications

A

versed (1-2mg up to 4mg)
fentanyl (25-50mcg)

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5
Q

versed should not be given to

A

elderly pts
progresses dementia/alzheimers

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6
Q

move to operating table

A

do not let IV get pulled out

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7
Q

move to operating table steps

A
  1. untie knots
  2. lock gurney and table
  3. pt move over
  4. ensure pt doesnt move too far
  5. secure pt w/belt
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8
Q

monitors

A

1) NIBP (3-5 min inter)
2) EKG (5 lead std)
3) pulse ox (iv arm ring)
4) temp
5) capnography (tight seal on mask, have pt exhale forcefully)
6) O2 analyzer (w/cap)
7) PNS (post induction)

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9
Q

Pre-Oxygenation

A

flush out nitrogen in alveoli

maximally saturate the hemoglobin/blood w/O2

denitrogenation

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10
Q

Situations where hypoxia can quickly occur

A
  • supine obese pts
  • sedation (drug induced)
  • paralysis
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11
Q

PreOx Method: Tidal Volume Ventilation

A

*most effective
vol of air inhaled and exhaled w/normal breathing

3+ mins w/good seal

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12
Q

PreOx Method parameters

A

FiO2 100%
O2 10-12L/min
open APL valve
facemask seal

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13
Q

PreOx Method: Vital Capacity Ventilation

A

max vol of gas that can be exhaled following maximal inspiration

4 breaths over 30 sec
or
8 breaths over 60 sec

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14
Q

PreOx issues

A

claustrophobic pts

blow by technique w/higher %O2
or
have pt hold mask

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15
Q

How do we confirm pre-Ox successful?

A

EtO2 > 85%

SpO2 (not perfect measurement)

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16
Q

Anesthesia Time Out Steps (8)

A
  1. Name/Dob/Surgery
  2. allergies
  3. pre-op meds/proceds
  4. Plan
    • general vs MAC
    • LMA vs ETT
  5. suction, O2, monitors, vaporizers
  6. Additional procedures
  7. sequential compression devices
  8. misc items
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17
Q

induction overal steps (14)

A
  1. Pt head tilt/chin lift
  2. give meds
  3. confirm asleep verbal
  4. eyelid reflex test
  5. test ventilate
  6. tape eyes
  7. paralytic
  8. DL or LMA
  9. Ventilator
  10. Volatile agent
  11. reduce fresh gas flw
  12. tem p probe/PNS
  13. Position accordingly
  14. warming device
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18
Q

how to speed up induction speed

A

increase %
increase FGF
increase RR or TV (increase minute vent)

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19
Q

additional procedures to perform post inductions

A

PIV
A Line
Central Line
Foley
Block

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20
Q

sequential compression device prevent

A

DVT

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21
Q

common induction medications

A

fentanyl
lidocaine
propofol

rocuronium(post reflex check)

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22
Q

fentanyl onset

A

3-7 mins

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23
Q

fentanyl alleviates

A

alleviates sympathetic response to intubation

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24
Q

lidocaine induction effect

A

helps attentuate sting of propofol

lg doses reduce airway reflexes

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25
Q

lidocaine mechanism

A

Na+ antagonist
blocks nerve impulses

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26
Q

propofol effect

A

stings
high-lipid solubility
== fast speed

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27
Q

rocuronium onset

A

90-120 seconds to flow through entire body circulations

28
Q

verbally test pt unconsciousness

A

ask pt to:
take deep breath
open eyes
etc

29
Q

test eyelid reflex

A

rub eyelashes

30
Q

test ventilate

A

Manual Mode
checking to see if mask ventilation is possible

31
Q

test ventilate confirmation phrase

A

“I can mask ventilate this pt, you may paralyze”

32
Q

test ventilation considerations

A

avoid corneal abrasion
CE mask technique

33
Q

if test vent is difficult w/good mask seal

A

add an oral airway

34
Q

if test vent is difficult w/oral airway

A

use 2 hand technique
ask preceptor/attending to help squeeze bag

35
Q

tape eye process

A

tape upper eyelid first
use tape pulldown
seal

36
Q

when do you paralyze

A

after you confirm that pt is unconscious and that pt can mask ventilate

37
Q

Old drug to reverse rocuronium

A

neostigmine

38
Q

if reversing Roc w/neostigmine how long do you have to wait to give neostigmine?

A

30 mins post-Roc

39
Q

what drug immediately reverses rocuronium

A

suggamadex

40
Q

prepare for incision (8 steps)

A

IV functioning/drip rate
position appropriate
muscle paralysis
airway/circuit clear
vent/flow/agent good
monitors/vitals good
analgesia adequate
antibiotics given

41
Q

RSI

A

rapid sequence induction (RSI)

42
Q

RSI goal

A

reduce risk of pulmonary aspiration of gastric content

43
Q

RSI indications (9)

A

pt not achieved NPO
emergency
delayed gastric empty
pregnant
vomiting
+/- airway concerns
H/O gastric bypass
uncontrolled GERD
symptom hiatal hernia

44
Q

RSI AKA

A

rapid sequence induction and intubation (RSII)

45
Q

RSI steps (10)

A

Equipment ready
NG tube suction
PreOxygenate
Cricoid pressure (10N)
Induce
Paralyze
Cricoid pressure (30N)
Intubate (no twitches)
Confirm CO2
Release Cricoid

46
Q

what do you skip during RSI?

A

Do not mask ventilate

47
Q

RSI relative contraindications

A

avoidance increase ICP
avoidance increase BP/HR

48
Q

what can cause ICP

A

unstable aneurysm

49
Q

Arguments against cricoid pressure

A

induce lower esophageal sphincter relaxation (vomiting)

displace larynx

incorrect manipulation

induces nausea

50
Q

Modified RSI

A

need for RSI
limitation exist that preclude proper RSI

51
Q

Modified RSI indications

A

risk of rapid hypoxemia
lack of time to pre-ox

52
Q

how is a modified RSI different?

A

ventilate w/mask prior to intubation

53
Q

what pressure do you ventilate w/during modified RSI?

A

<20cmH20

54
Q

RSI quick data

A

pre-oxygenation
cricoid pressure
avoid mask vent

55
Q

Modified RSI quick data

A

possibly different NMBD
different NMBD timing
PPV prior to intubation
cricoid pressure timing

56
Q

Induction Overview Steps (16)

A

pt into OR
time “it is 0730”
click EMR buttons
assist pt to table
monitors
pre-ox
verify/secure ETT/LMA
additional procedures
position pt
confirm monitor/line functioning
warming device
anesthesia ready
Abx (surgeon arrives)
Surgical Time Out
Surgery begins

57
Q

EMR buttons once pt in OR - St Lukes

A

anesthesia start
in room
start data collection

58
Q

EMR buttons once pt in OR - liberty

A

anesthesia start
fill in OR room time
auto vital
appropriate MACH

59
Q

EMR Pre-Ox buttons - St Lukes

A

Pt chart reviewed
Time out
Pre OX

60
Q

EMR Pre-Ox buttons - Liberty

A

pt evaluated
preoxygenation
call attending

61
Q

EMR buttons post-ETT - St Lukes

A

induction
RSI/Cricoid
Intubation
LMA applied

62
Q

EMR buttons post-ETT - Liberty

A

Induction

63
Q

EMR buttons - anesthesia ready - St Lukes

A

anesthesia Ready

64
Q

EMR buttons surgery starts - St Lukes

A

Surgery Starts

65
Q
A

Sp: Sim Lab 1 (23 decks)

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