Simulation Practice Day

Question 1

Simulation Practice Day

Preparation for Administration of Anesthesia

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Answer 1

Machine check

Question 2

Machine check

Answer 2

1. O2 tank check
   
   1. Able to quantify full O2 cylinder amount
2. O2 sensor check
3. Leak test
4. Ventilator check
5. Vaporizer filled
6. Suction

Question 3

After Machine check

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Answer 3

Airway equipment set-up

Question 4

Airway equipment set-up

Answer 4

1. Oral airway with tongue blade
2. Stylet
3. ETT x 2 -functional with 10 cc syringe for balloon inflation
4. Laryngoscope handle with functioning light
5. Laryngoscope blade x2
6. Working laryngoscope and two different blades
7. Endotracheal tubes (X2)

(Cuffs checked & syringe attached)

3. Stylet
4. Stethoscope
5. Tongue blade
6. Oral or Nasal airways
7. Bite Block
8. Tape for eyes & ETT

Question 5

After Airway equipment set-up

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Answer 5

Cart/Medication set-up

Question 6

Cart/Medication set-up

Answer 6

1. Emergency drugs
   
   1. Phenylephrine
   2. Ephedrine
2. Induction agents
   
   1. Hypnotic agent
   2. Narcotic
   3. Muscle relaxant
3. Maintenance relaxant and narcotic

Question 7

After Cart/Medication set-up

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Answer 7

Premedication

Question 8

Premedication

Answer 8

1. Appropriate anxiolytic dose with rationale

Question 9

After Premedication

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Answer 9

Standard of Care monitors

Question 10

Standard of Care monitors

Answer 10

1. SpO2
2. EKG-appropriately select 3 lead or 5 lead based on patient’s PMH
3. Stethoscope
4. BP cuff
5. Nerve Stimulator
6. Temperature monitor

Question 11

After Standard of Care monitors

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Answer 11

Induction of General Anesthesia

Question 12

Induction of General Anesthesia

Answer 12

1. Ensure proper positioning of patient to maximize sniffing position, as well as appropriate table height for intubation
2. Preoxygenate to clinical endpoint
3. Administer induction medication with appropriate dosing
4. Assess patient’s loss of consciousness and apneic state
5. Tape patient’s eyes
6. Mask ventilate, verify adequate ventilation
7. Administer paralyzing agent

Question 13

After Induction of General Anesthesia

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Answer 13

Intubation

Question 14

Intubation

Answer 14

1. Have appropriate size blade and endotracheal tube within reach
2. Insert laryngoscope blade
3. Insert ETT to appropriate depth
4. Inflate cuff
5. Connect circuit
6. Verify tube placement
   
   1. Verbalize condensation in ETT, bilateral chest rise, positive ETCO2
   2. Bilateral breath sounds
7. Secure ETT
8. Institute controlled ventilation
   
   1. Inhalational agent
   2. Controlled ventilation with appropriate ventilator settings
   3. Appropriately adjust fresh gas flows

Question 15

After Intubation

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Answer 15

Extubation

Question 16

Extubation

Answer 16

1. Reduce TV and respiratory rate to increase CO2 level
2. Consider changing ventilator settings to one that will allow for spontaneous ventilation (pressure support/SIMV)
3. Check twitches and draw up appropriate reversal dose
4. Increase O2 flows, 100% O2
5. Turn off anesthetic agent
6. Asses extubation criteria
   
   1. Adequate oxygenation (SpO2 >92%, TV > 5 ml/kg, spont resp >10 bpm, EtCO2 ( < 50 mmHg
   2. Hemodynamically stable
   3. Full reversal of muscle relaxant (sustained tetany, TOF ratio >0.9)
7. Have suction, face mask, and syringe at head of bed
8. Place oral airway
9. Suction oropharynx
10. Loosen ETT tape just enough for easy removal
11. **Reassess extubation criteria
    
    1. All of the above are still relevant, plus patient is neurologically intact (follows verbal commands, intact cough/gag reflex)
12. Deflate cuff
13. Close APL valve to 20, remove ETT while simultaneously compressing ambu bag
14. Immediately place face mask on patient’s face and assess for chest rise and condensation in mask. Be prepared to use Larson maneuver if necessary.