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Special Pop Exam 1 > Week 5: Part 3 > Flashcards

Week 5: Part 3 Flashcards

1
Q

What do you need to make sure you have ready/with you when transporting a patient?

A

Enough people to help
Monitors, oxygen, ambu/portable ventilator
Infusion pumps and portable monitors (adequate battery level)
Extra anesthetic drugs, vasopressors, muscle relaxants, sedatives
Intubation equipment
Defibrillator/pacer
Who is getting the elevator!!!!!

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2
Q

Definition of GA and levels of sedation or analgesia (Table 38-4)

A
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3
Q

What is the practical definition of general anesthesia?

A

1 second loss of consciousness is considered general anesthesia

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4
Q

what pediatric age group is at greatest risk for adverse events?

A

Children under five are at greatest risk for adverse events

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5
Q

what do you need to know when taking care of peds patients?

A

Length of procedure, stimulation
Ability to maintain normothermia, and how close is the monitoring equipmemt
Assessment of airway to include URI, snoring, cough or fever, loose dentition/missing teeth

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6
Q

what are the issues with geriatric patients?

A

Increased risk of postop delirium
Effects of the lipid-soluble drugs
Liver and kidney function changes and effects
CV function and reserves
Lung compliance
Positioning, arthritis, joint issues

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7
Q

Common terms used in radiation exposure

A

Exposure (Roentgen)
Absorbed dose (Rad-radiation absorbed dose or Gray)
Dose equivalent (sievert-Sv)
Effective dose (sievert-sv)

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8
Q

T/F Exposure from fluoroscopy (interventional radiology, Cardiac cath, EP lab, GI suite) is a lot greater than simple X-ray

A

TRUE

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9
Q

The effect of ionizing radiation on biological tissues are classified as?

A

Deterministic (severity of tissue damage is dose dependent, such at a cataract or infertility)

Stochastic (probability of occurrence is dose related, such as in cancer or genetic effect)

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10
Q

Staff exposure to radiation can be minimized by:

A

Limiting the time of exposure to radiation
Increasing the distance from the source of radiation
Using protective shielding (lead aprons, thyroid shields, and leaded eyeglasses)
Using radiation dose badges
Radiation accumulates over time

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11
Q

How is MRI field strength measured?

A

MRI field strength is measured in the units Gauss (G) and Tesla (T). 1T = 10,000 G.

The Earth’s magnetic field is approximately 0.3 to 0.7 G, whereas the standard MRI generates a field of 1.5 up to 3 T!!

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12
Q

Anesthesia for MRIs

A

Can take an hour
Hypothermia potential
Loud vibrating, knocking noises
Sedation, LMA, ET
Precedex
Children, critically ill, movement disorders, claustrophobia, PTSD, anxiety disorders

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13
Q

How do MRIs work?

A
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14
Q

Contrast agents (often containing the element Gadolinium) may be given to a patient intravenously before or during the MRI to _______

A

to increase the speed at which protons realign with the magnetic field. The faster the protons realign, the brighter the image.

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15
Q

Advantages of MRI

A

No ionizing radiation like CT and Xrays
Can see non-bony tissues more clearly
(brain, spinal cord, nerves, muscles, ligaments and tendons)

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16
Q

Disadvantages of MRI

A

More costly than CT and Xray

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17
Q

What are the considerations for MRIs?

A

Ferromagnetic equipment (IV pole, pumps, gas cylinders, stethoscope, laryngoscope and pens) can be lethal
Jewelry, some eyeglasses, watches, badges, credit cards
Resuscitation: Review the procedure for MRI patient
MRI safe equipment (EKG patches, ETCO2 capnography, MRI specific pulse OX….)
Extra long circuits, extension IV tubing
Audible and visual alarms
Contrast: gadolinium to enhance the images

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18
Q

What are some unique problems/contraindications associated with MRI?

A

AICD, Cardiac pacemakers may malfunction (be inhibited, reprogramming, heat up), insulin pumps and other implantable devices, cochlear implants, Deep brain stimulators, implanted pumps
Intracerebral clips might move
Large area tattoos with ferromagnetic inks
Transdermal medication patch may cause a burn
Bullet fragments and shrapnel

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19
Q

Is it safe to undergo an MRI during pregnancy?

A

yes, anytime is fine

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20
Q

What kind of anesthesia would you need for CT>

A

Motionless patient for several minutes to an hour
Minimal sedation to full general anesthesia

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21
Q

what are the types of patients we would do anesthesia for for a CT?

A

extremes of age, mental disabilities, medical issues, claustrophobia, multi-trauma

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22
Q

Intravenous contrast agents used in radiology are eliminated by:

A

the kidneys

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23
Q

IV contrast agents are ___ compounds

A

iodinated

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24
Q

IV Contrast agents are classified according to:

A

Osmolarity (high, low, or iso-osmolar)
Ionicity (ionic or nonionic)
Number of benzene rings (monomer or dimer)

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25
Q

Which IV contrast agent type has less adverse reactions and less pain on injection?

A

nonionic

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26
Q

what are the indications for IV contrast agents?

A

Radiologic and MRI

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27
Q

IV contrast agents adverse reactions are divided into two groups:

A
  1. Renal adverse reactions
  2. Hypersensitivity reactions
    Immediate (<1 hour)
    Non-immediate (> 1 hour)
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28
Q

Contrast-Induced nephropathy (CIN) is defined as:

A

Increase in serum creatinine of 0.5 mg/dL or a 25% increase from baseline within 48-72 hours after iodinated contrast medium

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29
Q

What are the risk factors forContrast-Induced nephropathy (CIN)?

A

renal disease, prior renal surgery, proteinuria, diabetes, dehydration, hypertension, advanced age, concomitant use of nephrotoxic drugs and patients on metformin

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30
Q

Preventative measures against contrast-induced nephropathy include:

A

adequate hydration, maintaining a good urine output, and using sodium bicarbonate infusions to improve elimination of the contrast agent

31
Q

what are the most frequent immediate reactions for hypersensitivity reactions?

A

Pruritus and Urticaria

32
Q

what are the most frequent nonimmediate reactions for hypersensitivity reactions?

A

Pruritus and Exanthema

33
Q

should you use corticosteriods and antihistamines ahead of time for hypersensitivity reactions?

A

this is controversial to pretreat but you should use them if the patient is having active s/s

34
Q

How would you treat a hypersensitivity reaction?

A

Stop the causative agent
Oxygen
Secure the airway
Fluids
Vasopressors and inotropes
Bronchodilators
Pre-treat with corticosteroids and antihistamines (questionable)

35
Q

what kind of anesthesia is usually done for angiography?

A

Usually under local with MAC

General/ET (stroke, subarachnoid hemorrhage, increased ICP or depressed levels of consciousness)

36
Q

do you need a motionless field for angiography?

A

YES

37
Q

Contrast dye injections into cerebral arteries can cause _______

A

burning and/or pruritus around the face and eyes

38
Q

_____ from IV fluid and IV contrast administration is a consideration for angiography

A

Full bladder

39
Q

Interventional Neuroradiology is defined as:

A

: treatment by endovascular access for the purpose of delivering therapeutic drugs and devices

40
Q

What are the anesthesia considerations for Interventional neuroradiology?

A

Hybrid environment
Conscious sedation or general anesthesia
Absolute immobility!!!

41
Q

What kind of procedures are done in interventional neuroradiology

A

Occlusive or opening procedures
Cerebral aneurysm, AVMs and vascular tumors
Sleep-Awake-Sleep procedure

42
Q

what should you be prepared to do in interventional neuroradiology?

A

Be prepared to treat bradycardia/asystole during carotid angioplasty and stenting
control BP(increase/decrease) (A-line) and end-tidal CO2

43
Q

what are the dangers of protamine?

A

You can immediately kill the patient if you don’t give a test dose they could have a fetal anaphylactic reaction

44
Q

what do you want your ACT value to be during interventional neuroradiology procedures? How do you do this?

A

2-3X the baseline
Heparin Bolus: 5000 U w additional boluses to keep ACT 2-3X baseline value

45
Q

Two most catastrophic complications in interventional neuroradiology:

A

intracranial hemorrhage and thromboembolic stroke

46
Q

Interventional Cardiology includes:

A

EP lab
Transesophageal Echo (TEE)
Cardiac Cath lab
Cardioversions (AFIB)
Transcatheter aortic valve implantation (TAVI)

47
Q

Transcatheter aortic valve implantation (TAVI)

A

Super high risk
Not surgical candidates

48
Q

What procedures are done in interventional radiology?

A

Invasive Vascular Access Placement (Ports & Lines)
TIPS – Transjugular Intrahepatic Portosystemic Shunt (Varices)
TheraSpheres Placement (Liver Tumors) – radioactive glass beads that are injected into the liver tumor directly (radioactive concerns)
Kyphoplasty - treats spinal compression fractures using a balloon-like device to prevent bones from collapsing.

49
Q

Why would a TIPS procedure be done?

A

Significant Hepatic Dysfunction
Bridge to Transplant

50
Q

What are the major indications for ECT treatment?

A

Treat major Depressive disorders
Psychotropic medication failure
Need for urgent symptom control

51
Q

How frequent can ECT be done?

A

Repeated multiple times each week up to 6 - 12 treatments (what works best)

52
Q

what are he physiologica responses during ECT?

A

Physiologic response of generalized motor seizure and acute CV response

53
Q

What are the proposed mechanisms by which ECT is effective?

A

Monoamine neurotransmitter theory
(increasing dopamine, serotonin, adrenergic and possible GABA and glutamine neurotransmission)

Neuroendocrine theory (release of pituitary or hypothalamic hormones)

Neurotrophic theory (increasing signaling in the brain)

54
Q

What drug is considered the “gold Standard” for ECT?

A

Methohexital

55
Q

At lower doses,methohexitalcan _______

A

paradoxically increase or activate cortical EEG seizure discharges in patients with temporal lobe epilepsy.
this property makes a bolus dose ofmethohexitalthe intravenous anesthetic of choice for electroconvulsive therapy.

56
Q

Methohexital induction dose =

A

Induction dose is 1 to 1.5 mg/kg in adults.

57
Q

Methohexital is the only Barb that _____

A

lowers seizure threshold

58
Q

what is the goal for ECT?

A

Tonic-clonic seizure that can last 60 seconds or more

59
Q

What is the choice of anesthetic for ECT?

A

Etomidate, ketamine, precedex, propofol (sometimes provider preference, availability, patient needs)

60
Q

Anesthetic considerations for ECT

A

Preop: Zofran, Toradol, beta - blockers (labetalol), glyco Vs Atropine

During Procedure: Bite block, O2 by mask, Propofol/methohexital, Sux, hyperventilate (Lower Extremity Tourniquet – monitor seizure)

Post Op: Mask patient until awake or able to maintain own airway

Mask, LMA, ET

61
Q

What are the anesthesia goals for ECT?

A

Unconsciousness and muscle relaxation

62
Q

Table 33-11

ECT

A
63
Q

How do Hyperventilation/Hypocapnia affect ECT?

A

Prolong seizure or reduce seizure threshold
Prevent rise in ICP
Facilitate more rapid orientation after ECT

64
Q

You see (sympathetic/parasympathetic) effetcts during the 1st 15 secs of ECT. Followed by ____

A

Parasympathetic efects (bradycardia/asystole) first 15 seconds

Followed by increased hemodynamic responses (can last several min) tachycardia, hypertension, increased cerebral O2 consumption and increased myocardial O2 consumption

65
Q

When might you see a vagal response in endo?

A

Vagal on distention of colon

66
Q

what are the anesthesia issues with endo?

A

airway, N/V, position, rapid turnover
Lateral/Prone position issues

67
Q

what are some of the comorbidities you see with endo patients?

A

GERD, liver failure, anemia, OSA, obstruction

68
Q

what kind of procedures are done in endo? what kind of anesthesia is done?

A

Heavy sedation/TIVA with propofol
colonoscopy, esophagoscopy, endoscopic retrograde cholangiopancreatography (ERCP)

69
Q

why are ERCPs done?

A

Diagnosis and treat both biliary and pancreatic disease

70
Q

what kind of drugs should you avoid during an ERCP?

A

Avoid drugs that affect the sphincter of Oddi:
Relax it: anticholinergics, glucagon, CA channel blockers

71
Q

What drugs relax the sphincter of oddi?

A

anticholinergics, glucagon, CA channel blockers

72
Q

what kind of anesthesia is done for an ERCP?

A

General or deep sedation

73
Q

What does SOAP-ME stand for?

A

suction
oxygen
airway
positioning
meds
equipment/etco2

Special Pop Exam 1 (16 decks)

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