Who's Who and What's What!
Make it Count!
Let's Cool You Down!
I'm so Toxic!
Stop the Bleeding!
Understood the Assignment!
All Panic and No Disco!
100
This is who should be verifying the patient's name and date of birth.
Preop RN, OR RN, Anesthesia Care Provider & Surgeon/Proceduralist.
100
This is the name of what should be done before each case to ensure that ALL evidence from the previous patient and procedure has been removed.
The Room Survey.
100
During a Malignant Hyperthermia (MH) Crisis, after the first dose is given, this is the amount of Dantrolene that you would give the patient if their symptoms were not resolving.
After initial dose, maintenance dantrolene should be continued (1mg/kg/dose every 4-6 hours). If the initial symptoms re-occur, another full dose is given.
100
This is the type of anesthesia used when making a skin incision or when administering nerve blocks.
Local anesthetics.
100
This protocol can be activated if the patient meets criteria for excessive bleeding.
Massive Transfusion Protocol (MTP).
100
This is the area of the gown that is considered sterile.
The chest to the level of the sterile field and the sleeves from 2 inches above the elbow to the proximal edge of the cuff.
100
This is how often horizontal surfaces in the OR should be damp dusted.
Before the first surgical procedure of the day
200
Consent etiquette is required when filling out consents. These are some items that you must be sure to check.
No abbreviations, must include laterality and levels, must match the order in the EMR, must be signed by the patient/patient representative and surgeon PRIOR to leaving PREOP.
200
This is the correct sequence when performing closing counts, starting with the patient/surgical wound.
From the patient/surgical wound, to the mayo stand, to the back table, to the kick bucket, to the sponge bags, to off the field.
200
These are known to be triggering agents.
Inhaled anesthetic agents or Succinylcholine.
200
These are some skin complications that can arise from local anesthetic infiltration.
Petechaie, Bruising, Hematoma, Soft Tissue Injury, and LAST.
200
These individuals are able to initiate the order of MTP.
Advanced Providers, MDs, DOs, Surgical Residents.
200
This is the name of the gloving technique that you would use when gowning and gloving yourself.
Closed gloving.
200
This is how you should protect the sterile field IF you have set up, but the case is unexpectedly delayed.
*The sterile field can be covered with sterile cuffed drapes
*A portion of the back table that will not be used immediately can be covered
*Remember to prepare the sterile field as close to the time of use as possible
300
This is how recent a history and physical must be updated for an inpatient surgical patient.
Within the last 24 hours.
300
This is what must be written on the white count board for any sponges being placed inside a cavity.
The number of items placed in the cavity and the number of items removed from the cavity.
300
This is an anesthetic agent that can be used in a patient with a history of MH.
Propofol.
300
This is the reversal agent for Local Anesthetic Systemic Toxicity (LAST).
Intralipid 20%.
300
This is the criteria that needs to be met in order to initiate MTP.
Administration of 8-10 units of RBCs to an adult in less than 24 hours.
Acute Administration of 4-5 units of RBCs in one hour.
Pediatric patients who are requiring blood products for resuscitation.
300
The best practice you should do when you first enter the operating room space for the start of your shift.
Best practice is to perform a First Scrub of the Day.
300
This is why pre-operative education with the patient and their family (if applicable) is so important.
To help the patient achieve long lasting changes in their health status.
400
This is what should be done before the patient's surgical site is marked.
Checking the physician's orders, checking the consent, asking the patient to verify the procedure, and checking imaging or radiologist's reports to confirm the procedure.
400
This is the name of the count that must be performed PRIOR to the patient entering the OR.
Initial or Baseline Count.
400
This is an EARLY sign of MH.
Increased ETCO2.
Sinus Tachycardia.
Masseter (jaw) rigidity.
Muscle rigidity.
400
This is a sign and symptom you may see in a patient exhibiting symptoms of LAST.
Tinnitus, Blurred Vision, Dizziness or Lightheadedness, Tongue Paresthesia.
400
This is the MTP process.
400
This is how long a patient who is scheduled for surgery under general anesthesia will have to be delayed after you find out in your pre-operative interview that they had a piece of cake for breakfast this morning?
8 hours
400
This is how you would let your gown unfold if you were gowning yourself off the back table.
Step back from the back table and allow the gown to unfold.
500
This is how the surgeon should mark the site on the patient's skin.
Their initials.
500
This is the type of sponge/towel that MUST be used for intentional packing.
X-Ray Detectable or Radiopaque.
500
This is the first thing you should do if your patient is showing signs and symptoms of an MH Crisis.
Call for help!!
500
This is where your Intralipid 20% can be found.
In the Lipid Rescue Kit, PYXIS, and in Pharmacy.
500
This must be completed after the administration of blood products to the patient.
Transfusion Record and EMR Documentation.
500
This is one thing the RN Circulator can do to ensure the patient does not suffer from any nerve injury or damage during positioning.
The appropriate positioning aids.
500
This is the FIRST step in reprocessing surgical instruments after they have been used during a procedure.
Cleaning bioburden off instruments.
600
This is how the surgeon should mark a patient who has a cast on and is scheduled for an ORIF of the left wrist.
Surgeon's initials on the anatomical diagram.
600
This is the first thing you should do if you have an incorrect count.
Recount! Notify the surgeon it is incorrect.
600
These are the carts that must be in the room if your patient is showing signs and symptoms of an MH Crisis.
MH Cart and the Code Blue Cart!
Make sure you know where both are!
600
This is the available dose of Intralipid 20%.
250mL or 500mL. Please be sure you where and how much of this is kept at your facility.
600
This is who must be notified with either the continuation or the discontinuation of MTP.
Blood Bank.
600
This is a complication we are concerned about when a patient is in the Trendelenburg position for an extended period.
Increased intraocular pressure.
600
This is when biological monitoring should never be used.
In IUSS (Immediate Use Steam Sterilizers)
700
Procedures that require an anatomical diagram to be used.
Burn patients, ureteral stent placement, oophorectomy via vaginal approach, and eye enucleation or if the patient refuses.
700
If there is a miscount of soft goods at any point in the procedure AND the missing soft good is retrieved from the cavity, you must do this.
Intraoperative imaging MUST be taken even though count has been resolved.
700
This is the name of the professional organization you should also call during an MH Crisis.
MHAUS
MHAUS Hotline
1.800.644.9737
1.800.mh.hyper
700
This is another name for Intralipid 20%.
Liquid Emulsion OR Fat Emulsion.
700
This is how often vitals are taken while the patient is receiving MTP.
Continuously, every 15 minutes during transfusion, if not more frequently.
700
This is the most likely physiological effect that can occur when a patient is in the lithotomy position.
Hip dislocation.
700
This is the wound class that you would document if you were in a laparoscopic appendectomy and the surgeon encounters purulent inflammation of the appendix.
Wound Class IV
800
This is what the OR RN should do if they are taking their patient to surgery, but the patient's site has not been marked AND there is also no Anatomical Diagram.
STOP and have it completed.
800
This is what we do when someone interrupts the visual and audible counts between the circulator and the scrub.
Restart! Pause for the Gauze!
800
This is how many mg's are in a vial of dantrolene. This is how many mg's are in a vial of ryanodex.
20 in dantrolene and 250 in ryanodex
800
This is where your patient should be transferred to after an occurrence of LAST.
ICU or higher level of care.
800
These are the names of the equipment that is used for rapid blood infusion.
Belmont, 3M Ranger, Level 1.
800
This is how to determine how long a wrapped item on the shelf in the core is sterile.
Sterility of wrapped items is Event Related for wrapped items and 5 years for heat-seal pouches and 3 years for self seal pouches.
Dropping it on the floor, moisture detected on the packaging, rips or tears in the packaging.
800
This is the phase of healing where hemostatis, phagocytosis and edema occur.
Inflammation.
