Anesthesia
May be needed during induction to prevent aspiration or help visualize vocal cords, required for rapid sequence induction, continue until instructed to release
What is cricoid pressure?
Education of patient and family, optimize patient condition prior to admission, minimal fasting, multimodal analgesics, return to normal diet/activity day of surgery, discharge to home
What are key elements of ERAS?
Can denature blood proteins, making the removal of the blood more difficult
What is hot water?
Complete prior to bringing in a case cart, complete from top to bottom, include flat surfaces
What is damp dusting?
Proximity of an eyewash station to the location of chemical use and storage.
What is 10 seconds, easily accessible and on an unobstructed path?
The administration of sedative, analgesic, and/or anxiolytic agents by a physician or by a nurse under physician supervision.
What is moderate sedation?
Preoperative Phase: Increased risk of myocardial infarction within 1 hour of use, hyperreactive airway, anxiety, paranoia, psychosis
Intraoperative Phase: Tolerance to induction agents, unknown tolerance to anesthesia agents, hyperreactive airway, bispectral index (BIS) elevation, increased myocardial infarction risk within 1 hour after use
Postoperative Phase: Unknown tolerance to analgesics, possible increase in pain perception, withdrawal
What are physiological effects of cannabis in the surgical patient?
Covering a sterile field
-When?
-Why?
-How?
1. Open a sterile field as close to time of use as possible, do not set up ahead of time.
2. If not used immediately, cover to reduce contamination.
3. Cover and uncover in a manner that prevents contamination. First drape cuff at halfway point, second drape from opposite side and completely cover cuff of first drape. Pull drapes up and away.
Specimen handling on the sterile field (5 items).
1. Handle the specimen as little as possible
2. Keep the specimen moist
3. Cover the specimen or place it into an appropriately sized container
4. Label the covered or contained specimen
5. Protect the specimen in a secure location on the back table or other sterile field location
Bonus:
-place in fixative as soon as possible after removal
-keep moist with sterile saline in a basin or wrapped in a saline-dampened sponge, labeled, and protected
Legal term for the actions of a reasonable and prudent professional in similar circumstances
Ringing in the ears, tingling around the lips, metallic taste in the mouth, visual disturbances, change in mental status
What is Local Anesthetic Systemic Toxicity (LAST)?
Providing Care when extended observation/intervention is required, such as patients having difficulty emptying bladder or managing pain
What is Phase III Postanesthesia care?
Factors are: quality of packaging material, storage conditions, methods and conditions of transport, handling (dropped), and environmental conditions
What is shelf-life and sterility are event-related?
Do not use for these for trendelenburg safety precautions, may cause compression over the acromion leading to a brachial plexus injury
What are shoulder braces?
Resources for community support, access to health care, education, economic conditions, employment opportunities, and physical living conditions
What are Social Determinants of Health?
Neostigmine, edrophonium, sugammadex, flumazenil
What are reversal agents?
Scores recovery after anesthesia by gauging respiration, activity, circulation, consciousness, and oxygen saturation
What is the Aldrete Scale?
List 5 of the 8 times sterile gloves should be changed.
1. After each patient procedure
2. Every 90 to 150 minutes
3.When a visible defect of perforation is noted
4. Immediately after direct contact with bone cement
5. After touching optic eye pieces on a microscope
6. After touching a fluoroscopy machine
7. After touching a surgical helmet system hood or visor
8. When suspected or actual contamination occurs
Bonus: discard the top gloves after sterile draping and don another
Potential complications include: hypo or hyper tension, phrenic nerve irritation, decreased cardiac output and respiratory effort, hypercarbia, increased diaphragmatic pressure, and gas embolism
What is gas insufflation?
An organization that focuses on the care that has been delivered, where providers can talk about errors/near misses/actual harm without reprisal, and which delivery of care will be changed to avoid a recurrence of similar events
Protocol for treatment of MH (At least 6/8).
1.Stop the surgery and discontinue inhalational agents and succinylcholine or maintain anesthesia with non-triggering agents
2. Get the MH cart and dantrolene
3. Call for help
4. Hyperventilate with 100% oxygen at 10 L/min
5. Give 2.5 mg/kg dantrolene rapidly by IV until patient responds
6. Obtain blood gases
7. Cool the patient if core temp is >39 degrees C (102.2 F) and stop when decreased to <38 degrees C (100.4 F)
8. Provide appropriate treatment for dysrhythmias and abnormal electrolytes
What are at least 7 of the 12 items on the Surgical Safety Checklist for Pre-Procedure?
Identity of patient
Procedure and procedure site
Consents
Site marked by person performing the procedure
H&P
Preanesthesia assessment
Diagnostic test results
Blood products
Special equipment/devices/implants
Beta blockers
VTE prophylaxis
Normothermia
Name the 6 considerations taken into account when assembling an instrument set.
Type of surgery
Patient population
Needs of the specialty surgery providers
Weight of the tray (not to exceed 25 lbs)
Sterilization methods of the contents
Weight of the instruments
Implanted Electronic Device Precautions
-If safe, inactivate or reprogram
-Place dispersive pad close to surgical site but far from device generator and leads
-Keep electrode cords away from generator
-Device should not be in between active electrode and dispersive pad
-Activate ESU for shortest amount of time, use lowest power settings, use alternate technology such as bipolar or ultrasonic devices
Physicians, health care facilities, and other health care providers that voluntarily join together to give coordinated high-quality care to their patients covered by Medicare
What is an Accountable Care Organization?