Week 1 Flashcards
part one
Who prepared Nitrous Oxide and is known as the pioneer of chemistry?**
years
Joseph Priestly
pioneer of chem 1773
1776- prepared N20
Pioneer of chemistry.
Who coined the term ‘laughing gas’?
year
Humphrey Davy in 1800
Tied to N2O.
What significant event did Crawford Long host in 1842?
‘Ether party’ or ‘ether frolics’
learned of anesthetic component b/c one dude didn’t even realize he had a massive gash on his leg
One attendee didn’t realize they had a big gash on their leg.
Who used Nitrous Oxide for tooth extractions in 1844?***
Horace Wells
i have in my notes that Colton (medstudent) hosted n20 lectures
Colton, a medical student, hosted nitrous oxide lectures.
What happened during Wells’ display of N2O at MassGeneralH in 1845?
It was not a success; the patient experienced pain.
Who successfully used ether at MGH in 1846?
William Morton
he gets the credit over Crawford long
He received credit for his success over Wells.
What anesthetic did Dr. James Simpson use in 1847?
Chloroform
OB used chloroform at a private party of physician colleagues)
at this time there was no way to measure the amount given
Used at a private party of physician colleagues.
Who is considered the first anesthetist around 1847?
Dr. John Snow
Created a chloroform atomizer to measure dosage.
What did Dr. John snow invent?
choloroform atomizer to measure anesthetic
What was found about chloroform in 1848?
It was later found to be cardio-toxic, causing massive MIs.
Who provided chloroform anesthesia for Queen Victoria in 1853?
John Snow.
What role did Catherine S Lawrence play during the Civil War?
Provided anesthesia
* first war to establish field hospitals
* wrote a 175 page autobiography, detailing her anesthesia practice
First war to establish field hospitals.
Who was the first nurse known to specialize in anesthesia?
year
Sister Mary Bernard in 1877.
What happened in 1885 with Dr. Corning
did a “spinal” w/ cocaine but there was no CSF
THE FIRST EPIDURAL
What significant procedure did Dr. Corning perform in 1885?
Spinal anesthesia with cocaine
Considered ‘the first’ epidural.
What title was bestowed upon Alice Magaw? and why**
‘Mother of anesthesia’
bestowed by Dr. Mayo (Clinic) for her mastery of open drop ether
For her mastery of open drop ether.
What characterized the beginning of anesthesia?
Haphazard practices
thought to be subservient to surgeons and unworthy of physician intellect
bad pay and NO training LOL
No training, minimal pay, and subservience to surgeons.
What did Agatha Hodgins do in 1908?
Pioneered nitrous oxide technique and taught anesthesia.
she was taught by Dr. Crile to give anesthesia to dogs, rabbits
, and humans
What was significant about the Lakeside General Hospital School in 1915?
It was the first anesthesia program.
What ruling did Judge Hurt make in 1917?
Margaret Hatfield was not engaged in the practice of medicine.
help if your notes are better
What inhalational agent was introduced in 1923?
Ethylene
Better than anything else at the time.
How was ethylene as an anesthetic discovered?
‣ greenhouse had an area of dead plants- came back to life when put outside- and vice versa when returned to the greenhouse
* ethylene was being pumped into that part and putting the plants to sleep
What was the purpose of Na lime in 1927?
To absorb CO2
used in submarines!
Used in submarine air filtration systems.
What was a problem with cyclopropane introduced in 1930?
It was explosive and HEAVY
why some older ORs have plugs 5ft high
What organization was founded by Agatha Hodgins in 1931?*****
NANA
5$ due and $1 initiation
NO BOYS ALLOWED
$5 dues plus $1 initiation fee; no boys allowed.
Tell me about the Chalmers-Frances vs Nelson case in 1934
‣ California supreme court affirmed the superior court finding for nurse anesthetist, ruling that nurse anesthesia practice was legal
what was invented in 1934 by Shawn Lundy
‣ Shawn Lundy- Na Pentothal- fast induction agent for IV induction
* Na Pentothal takes a while to wear off
What significant event occurred in 1939?
AANA was founded by Agatha Hodgins.
4 month program in illinois
What muscle relaxant was introduced in 1942?
D-tubocurarine.
When was the first certification exam for nurse anesthetists held?
1945.
What significant change occurred in 1947?
Men were allowed to join AANA.
What was approved in 1950 regarding nurse anesthesia programs?
All programs had to be accredited.
What relaxant was introduced in 1952?
Succinylcholine
Faster than D-tubocurarine.
What did Beecher and Todd publish in 1954?
A prospective analysis of anesthesia outcomes.
What was a significant finding from the 1954 study?
Nurse anesthetists had a death rate half that of anesthesiologists.
‣ 10 university hospitals contributed data for approx 600k anesthetics
What was introduced in 1956?
Halothane
Minimal side effects but caused halothane hepatitis.
why is halothane primarily used in peds
S/e is halothane hepatitis which is not typically seen in kids
What anesthetic was introduced in 1959?
Methoxyflurane- caused renal failure- didn’t last long
Caused renal failure.
What anesthetic was introduced in 1972?
Enflurane- caused seizures on EEG
Caused seizures on EEG.
Who became the first male president of AANA in 1972?
John Garde.
Who became the first black president of AANA in 1973?
Goldie Brangman.
What happened in 1976 regarding AANA?
Division of AANA and COA took place.
What was approved in 1977 for CRNAs?
Mandatory CEUs.
What anesthetic was introduced in 1980?
Isoflurane
Considered the best for faster induction and emergence.
What anesthetic was introduced in 1992?
Desflurane
Irritating to the airway.
What anesthetic was introduced in 1994?
Sevoflurane
great for mask induction w/ kids
Used for mask induction, especially in pediatrics.
T/F desflurane can be used for mask induction
FALSE
too heavy and irritating to the airway
What significant event occurred in 1996?
CCNA administered the first certification exam via computer.
What happened in 2007 regarding nurse anesthesia organizations?
CCNA and COR joined to form NBCRNA.
What was published in 2010 regarding anesthesia providers?
A study reviewed outcomes between anesthesiologists and solo CRNAs.
What program was introduced in 2016?
Continued Professional Certification (CPC).
What must CRNAs do by 2024 or 2025?
Take a 150 question exam every 8 years.
What name change was passed by AANA members in 2020?
Change to American Association of Nurse Anesthesiology.
What happened in 2022 regarding AANA’s building?
Sold the building in Park Ridge and built a new one in Rosemont, Illinois.
What complaint was filed against AANA in June 2024?
ASA filed a complaint for trademark infringement.
What are the three components of CPC introduced in August 2024?
MAC Check, MAC Ed, and MAC Dev.
What is the total body water (TBW) percentage of total body weight?
60% or 42L of TBW
Totaling approximately 42 liters.
What is the intracellular fluid (ICF) percentage of body weight?
Approximately 40% (28L)
Totaling about 28 liters.
What is the extracellular fluid (ECF) percentage of body weight?
20% (14L)
Totaling about 14 liters.
What is the formula for calculating fluid replacement?
Deficit + maintenance + insensible loss + blood loss = hourly replacement.
what are the 2 types of intravascular fluid
plasma- 4% of BW (3L)
ISF- interstitial volume- fluid b/t cells- 16% (11L)
What is the 4/2/1 Rule for fluid maintenance?**
For a 70 Kg patient: 110 ml/hr maintenance requirement.
1st 10kg is 4mL/kg = 40 mL
2nd 10kg is 2mL/kg = 20 ML
remaining = 1 mL/ kg= 50 mL
40 + 20 + 50
calculate fluid maintenance for an 86kg man and what is his deficit if he has been NPO for 10 hours**
1st 10kg is 4mL/kg= 40 mL
2nd 10kg is 2mL/kg = 20 mL
remaining 1mL/kg = 66 mL/kg/ HR
40 + 20 + 66
maintenance= 126 mL/hr
deficit = 126 * 10 = 1260 mL deficit
What is the minimum insensible loss for fluid replacement?
what is moderate and what is extreme (like GI sx)
4 ml/Kg/hr. min
6mL/kg/hr mod
8 mL/kg/hr Extreme
how do you calculate fluid deficit
howeverlong they are NPO by maintenance
ex 70 kg man has 110 mL/hr maintenance= 880 mL deficit
how do you replace a fluid deficit
replace half the deficit the 1st hour and 1 quarter for the 2nd and 3rd hour then go to maintenance
What is the formula for calculating Allowable Blood Loss (ABL)?
(hgB initial - HgB allowable / HgB initial) x EBV
ABL = (Hg initial - Hg allowable) x EBV / Hg initial.
what is EBV and how do you calculate it
EBW x KG = EBV
What is the ASA guideline for transfusion based on hemoglobin levels?
Transfusion rarely needed if Hg >10 gm/dl; almost always needed if Hg <6 gm/dl.
What routine monitors help guide anesthesia?
Blood pressure, EKG, pulse oximeter, precordial, temperature.
How is ABL calculated?
ABL = (Hg initial - hg allowable) / Hg initial x EBW
Example: Ex - 4900 x (13-8) / 13 = 1884 ml (ABL)
What should you monitor for signs of with ABL?
Look for signs of hypovolemia by checking hemos.
What are routine monitors used in anesthesia?
Blood pressure, EKG, pulse oximeter, precordial, temperature, capnography, nerve stimulator.
What is the history of noninvasive blood pressure monitoring?
Introduced in Italy by Riva Rocci in 1896; Harvey Cushing introduced it in the US.
What are common sources of error in blood pressure measurement?
Inappropriate cuff size and rapid deflation can lead to false readings.
location of cuff
What is the correct size for a blood pressure cuff?**
Length should be 80% and width 40% of the extremity circumference.
what happens if a BP cuff is too small**
falsely high reading
too big = false low
Where should a blood pressure cuff be placed for accurate readings?
The cuff should be at the level of the heart for the most accurate reading.
◦ Pulse goes from aortic root (SBP is lowest, DBP is highest) to periphery (dorsalis pedis- SBP is highest, DBP is lowest)
◦ BP cuff at level of heart- most accurate reading
BP cuff above level of heart- false low
‣ BP cuff below level of heart- false high
What happens if the blood pressure cuff is above the heart?**
It gives a false low reading.
What happens if the blood pressure cuff is below the heart?**
It gives a false high reading.
What is the function of automated blood pressure devices?
They use the oscillometric method to measure systolic, diastolic, and mean pressures.
why do STAT BP cycles cause inaccuracies
doesn’t give arm time to be reperfused and causes inaccuracies
What are indications for an arterial line?
Critically ill patients
multiple lab testing
cardiac disease
controlled hypotensio
and major surgery.
What is Allen’s Test used for?
To test for collateral flow via the ulnar arch.
What are the results of Allen’s Test?
Return of color within 6 sec indicates a patent ulnar arch; delay of 7 to 10 sec indicates slow arch filling; 10 sec or greater indicates incomplete arch.
What equipment is needed for arterial line insertion?**
20g Angio/arrow.
arm board
iodine/ETOH wipe
4x4 Tegaderm
1% Lidocaine
glove
glasses
transducer setup.
What is the technique for inserting an arterial line?
Arm on arm board, dorsiflexed, palpate radial artery, clean, inject local, insert catheter at 45 degrees, advance until flash, then change angle to 30 degrees.
What are potential complications of arterial line insertion?**
Thrombosis, skin necrosis, hematoma, and spasm from vigorous flush.
What is the purpose of a pulse oximeter?
To continuously monitor hemoglobin saturation and heart rate.
What principle does a pulse oximeter use?**
It uses spectrophotometry and the Beer-Lambert law.
What wavelengths of light are used in pulse oximetry?*
Near-infrared light at 940 nm and visible red light at 660 nm.
What factors can limit pulse oximeter accuracy?
Dyes, nail polish, tourniquet, movement, hypothermia, hypotension, and non-pulsatile flow.
What is the dose for Methylene Blue in treating vasoplegic syndrome?
2 mg/kg IV over 5 mins, with a max dose of 7-8 mg/kg.
What is cerebral oximetry used for?
To assess cerebral oxygenation using near infrared spectroscopy.
What is the function of a precordial stethoscope?
To continuously monitor heart and breath sounds.
What are methods to prevent hypothermia during anesthesia?
Increase room temperature, warm fluids/gases, use Bair hugger blankets.
What does capnography evaluate?
It evaluates CO2 waveform and measures CO2 concentration.
What is a capnogram?
A plot of CO2 concentration over time.
What does a waveform in capnography indicate?
It provides information about pulmonary, cardiovascular, and metabolic status.
what year does the AANA recognize the descriptor CRNA or certified registered nurse anesthesiologist?
2019
What is the formula for Fluid replacement?
deficit + maintenance + insensible loss + blood loss = hourly replacement
What are the guidelines for calculating insensible loss?
minimum - 4ml/kg/hr
moderate- 6ml/kg/hr
extreme- 8ml/kg/hr
What are the guidelines for calculating blood loss?
3ml crysalloid for 1 ml blood loss
1 ml colloid for 1 ml blood loss
1ml blood for 1 ml blood loss
automated blood pressure devices use what type of method?***
oscillometric method
what is the protocol for goal directed fluid therapy?
IV infusion 1-3ml/kg/hr for maintenance
then small bolus of cryalloid (250ml) as needed
replace blood loss at 1:1 with colloid
then vasopressors/inotropes
name the phases of ETCO2 waveform
Phase 1- baseline
Phase 2- Exhalation
phase 3- Expiratory Plateau
Phase 4- inhalation
Invasive blood pressure monitoring should be at ______mmHg which gives a _____mL/Hr flush**
300, 3-5mL
what is the Pa02 for these given Sp02
100, 90, 80, 70
70,60,50,40
Hyperventilating the patient would cause ETCO2 to go up or down?
down
Hypoventilating the patient would cause ETCO2 to go up or down?
up
What would cause the ETCO2 waveform to not go back down to baseline?
rebreathing CO2
exhausted sotalime
Where is the spirometer located on the circuit?**
Expiratory limb
Preoxygenating also is known as ____
denitrogenation
