ASA American Society of Anesthesiology
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What does the ASA establish for the patient?
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Cardio-pulmonary status ( determines what stress managment can be used)
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How is ASA I classified?
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no difficulty experienced when walking up a flight of stairs
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How is ASA II classified?
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pt is short of breath on reaching the top of the stairs
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How is ASA III classified?
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pt stops frequently while climbing and does not reach the top of the flight of stairs
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How is ASA IV classified?
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cannot walk at all w/out being short of breath
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How is the ASA measured for people with arthritis?
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Walking 2 blocks (not stairs)
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If the pt has severe arthritis, how is the ASA determined?
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If the pt can lie down flat, they are okay
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What ASA statues are considered high risk pts?
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ASA III and IV
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What ASA high risk pt do we treat?
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ASA III (IV -> goes to the ER)
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What can be used as stress management for ASA I and II pts?
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benzodiazepenes or benadryl
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What is the longest acting benzodiazepene?
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Diazepam (Valium)
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What are two shorter acting benzodiazepenes?
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Midazolam and Triazoalm
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What is 3rd party liability?
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Need to make sure pt comes and leaves with someone so that they do not harm themselves/others
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Which ASA statues can you use epinephrine?
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ASA I and II (CAN'T in III and IV)
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In what position would you treat a pt with an ASA status of III or IV?
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Semi-sitting for only 1.5hrs
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What can you not use while treating the pt if they are using their intercostal and neck muscles to breath?
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Rubber dam
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What is the only stress management used for pts with ASA III or IV status?
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Oxygen with Nitrous Oxide
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What is the one exception for stress management concerning ASA III and IV pts?
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COPD pt does not receive oxygen --> because it will take away the respiratory drive
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What do you do if the COPD pt has an asthma attack (medical emergency) in the chair?
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Give them oxygen (ONLY oxygen)
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What are the PO2 and PCO2 for mild COPD?
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PO2 - 75 PCO2 -Normal 35-40
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What are the PO2 and PCO2 for moderate COPD?
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P02 < or = 60 PCO2 -Normal 35-45
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What are the PO2 and PCO2 for severe COPD?
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PO2 50
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What ASA status is a pt with COPD?
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Automatically ASA III ( chronic hypoxia )
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What stimulates the respiratory drive in COPD patients?
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chronic hypoxia (DO NOT use O2 and nitrous oxide)
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Which ASA status can you not use benzodiazepines?
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ASA III
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Which severity of COPD can you use a low dose of Valium/Atrivan? (cautiously)
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mild COPD
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What conditions automatically put the pt in an ASA III status?
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Taking digoxin, nitroglycerine patch (for angia), isosorbide ->potent vasodilator (for unstable angia), theophyliine )for moderate-severe asthma , and COPD
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What is the ASA Conscious sedation status for ASA I?
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has no systemic disease, CS is OK, no PCP consult
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What is the ASA conscious sedation status for ASA II?
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one mild/well controlled disease, CS is OK, no PCP consult
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What is the ASA conscious sedation status for ASA III?
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multiple/moderately controlled systemic disease, need PCP consult
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What is the ASA conscious sedation status for ASA IV?
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poorly controlled systemic diseases, CS done by anesthesiologist in hospital
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What is the oral dosage of Diazepam (Valium) for a pt less than 50?
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5-10mg hs, or 5-10mg PO 1 hr prior to procedure
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What is the max dosage for diazepam (Valium)?
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10mg (5mg for the petite pt)
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How many mg/kg for Diazepam (Valium)?
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0.1mg/kg
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What is the oral dosage of Lorazepam?
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1-2mg PO hs, 1-2mg 1 hr prior to procedure
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In what type of patients do you want to avoid benzodiazepines?
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Prego, Fatties, and Oldies, Pts taking CNS drugs or H2 blockers)
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What is the antidote for benzodiazepines?
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Flumazemil
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What is the oral dosage of Diazepam(Valium) for a pt that is over 50 or lean and petite?
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2-5mg hs, or 2-5mg PO 1 hr prior
