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!
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 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.
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 complications that can arise from local anesthetic infiltration.
Petechaie, Bruising, Hematoma, Soft Tissue Injury, and LAST.
200
These individuals are able to activate/order 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.
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 first thing you should do when you enter the operating room space for the start of your shift.
Best practice is to perform a First Scrub of the Day.
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 what you should wear on your hands and your wrist during the first scrub of the day and anytime you are scrubbed in to a case.
500
This is the name of the item used when marking the surgical site.
Surgeon's initials using an indelible marker at the surgical site.
500
This is a time, during surgery, that an Intraoperative Count MUST be completed.
Permanent relief of staff or anytime a count is warranted.
500
This is a LATE sign of MH.
Hyperthermia.
Myoglobinuria (dark urine).
Cardiac dysrhythmia.
Multiple Organ Failure.
500
This is the proper technique to follow when administering a nerve block.
Aspirate 5mL prior to injecting. Slowly administer 5mL of medication. Repeat until syringe is empty.
500
This must be checked prior to transfusion.
Patient’s Name/Trauma Name, MRN, Blood Bank ID/ Typenex# (may or may not be present), Blood Unit Number, Blood Type & Rh Compatibility, Expiration Date, Special transfusion requirements, if indicated.
500
This has a direct effect on the number of microbial contaminations within the procedural suite/area.
600
This is how the surgeon should mark the site on the patient's skin.
Their initials.
600
This is the type of sponge/towel that MUST be used for intentional packing.
X-Ray Detectable or Radiopaque.
600
This is the first thing you should do if your patient is showing signs and symptoms of an MH Crisis.
Call for help!!
600
This is where your Intralipid 20% can be found.
In the Lipid Rescue Kit, PYXIS, and in Pharmacy.
600
This must be completed after the administration of blood products to the patient.
Transfusion Record and EMR Documentation.
600
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.
700
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.
700
This is the first thing you should do if you have an incorrect count.
Recount! Notify the surgeon it is incorrect.
700
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!
700
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.
700
This is who must be notified with either the continuation or the discontinuation of MTP.
Blood Bank.
700
This is one of the physiologic effects of the Trendelenburg position.
Increased intraocular pressure.
800
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.
800
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.
800
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
800
This is another name for Intralipid 20%.
Liquid Emulsion OR Fat Emulsion.
800
This is how often vitals are taken while the patient is receiving MTP.
Continuously, every 15 minutes during transfusion, if not more frequently.
800
This is the most likely injury that can occur when a patient is in the lithotomy position.
Hip dislocation.
900
These are some of the procedures that require the Anesthesia Care Provider to mark the site.
ALL peripheral nerve blocks: interscalene, femoral, popliteal.
900
This is when final count must be performed.
At skin closure.
900
This is the medication that is currently being used to treat MH.
Dantrolene. Ryanodex in some markets.
900
This is how local anesthetics work.
Preventing the surgical stimuli from reaching the central nervous system.
900
This is how many licensed personnel must verify each blood unit, AND document the administration in the EMR.
2. 1 of these 2 must also be the one to administer the blood.
900
This is an important element to record after surgery regarding the perioperative skin antisepsis.
Hypersensitivity or response to the solution used.
1000
This is how the ACP should mark the site before performing a dependent procedure that is laterality specific.
With their initials AFTER the surgeon marks the surgical site.
1000
This is where we place needles after they have been used during surgery.
Needle Counter.
1000
This is the calculation dosage for Dantrolene.
2.5 mg/kg.
1000
These are the patient populations that are most at risk for LAST.
Infants, Pregnancy, Elderly, End Organ Dysfunction.
1000
These are the physiological goals of MTP.
Support adequate perfusion and oxygenation, prevent/reverse metabolic acidosis, hypothermia, and coagulopathy, prevent hyperkalemia and hypocalcemia.
1000
This is what you should see the scrub tech do after you open an extra peel-pouch Frazier suction and place it on the sterile field.
Flush the cannula with sterile water.
1100
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.
1100
This is what we do when someone interrupts the visual and audible counts between the circulator and the scrub.
Restart! Pause for the Gauze!
1100
This is how many mg's are in a vial of dantrolene.
20.
1100
This is where your patient should be transferred to after an occurrence of LAST.
ICU or higher level of care.
1100
These are the names of the equipment that is used for rapid blood infusion.
Belmont, 3M Ranger, Level 1.
1100
This is how to determine how long a wrapped item on the shelf in the core is sterile.
Event related.
Dropping it on the floor, moisture detected on the packaging, rips or tears in the packaging.