question

Pulmonary artery

answer

One of two arteries that carry venous (oxygen poor) blood from heart to lungs

question

What type of intubation is preferred with emesis with aspiration?

answer

ETT. LMA or combitube acceptable.

question

What emergency would a cricothyrotomy typically be performed?

answer

Airway obstruction

question

Atropine would be given in which emergency?

answer

Symptomatic bradycardia

question

Adenosine would be given in which emergency?

answer

SVT

question

Amiodarone would be given in which emergency?

answer

V. Tach

question

What medications can be given for a sever case of hyperventilation?

answer

Versed, Valium, or Propofol

question

PVC's are treated with which medicine?

answer

Lidocaine

question

Epi is given in which two emergencies?

answer

V. Fib and asystole

question

Max dose of epi for cardiovascular disease pt

answer

.04mg

question

A beta blocker would be given in which emergency?

answer

Hypertension

question

A fluid bolus of NS and ephedrine can be given with what emergency?

answer

Hypotension

question

What medications are used to treat malignant hypothermia?

answer

Dantrolene, IV cold saline (not Ringer's)

question

Nasopharyngeal airway

answer

When tongue is obstructing airway. Tube is lubricated and passed through the nose into nasal cavity. Sits in oropharynx behind tongue. Well tolerated and can be used on awake pts.

question

Oropharyngeal airway

answer

Also placed to position tongue in more anterior position. Often interfere with intra oral procedures. Not tolerated well with awake pts.

question

Laryngeal mask airway (LMA)

answer

Device that sits over top of larynx. Can be placed blindly. Does not protect against aspiration. Inflated with 30cc to create seal.

question

Endotracheal intubation

answer

End of tube passes through vocal cords and terminates half way between vocal cords and bifurcation of trachea. Important to listen to both lungs after placement. May or May not be cuffed.

question

Combitube

answer

Generally used for specific emergencies. Both cuffs inflated.

question

Pts predisposed to bronchospasm

answer

Allergies, asthma, copd, bronchitis

question

Bronchospasm

answer

Generalized contraction of smooth muscles of small bronchi and bronchioles in lungs causing restriction of air flow of air to and from lungs.

question

Maximum dose of epi for healthy pt

answer

.2mg

question

Liver

answer

Protein and lipid synthesis, bio transformation, detoxification and storage of vitamin A, E, D, K, and B12.

question

Causes of seizures

answer

Liver failure, renal failure, sickle cell disease, brain tumor, meningitis, previous stroke and hypo-hyperglycemia.

question

Medications to treat seizures

answer

Tegretol, Klonopin, Neurontin, luminal, Dilantin, depacon

question

Main function of kidneys

answer

Maintain volume and composition of body fluids. Body's main source of filtration and excrete metabolic end products and toxins.

question

Islets of langerhans

answer

Located in pancreas. Secrete insulin and glucagon. Insulin helps the body store sugar to keep glucose levels in a steady state.

question

Adrenal glands

answer

Secretes epinephrine and norepinephrine. Controls electrolyte balance and carb metabolism.

question

Thyroid

answer

Regulates body's basal metabolic rate.

question

Pterygoid plexus

answer

Network of veins corresponding to 2nd and 3rd parts of maxillary artery

question

Olfactory nerve

answer

1st cranial nerve that controls smell

question

Optic nerve

answer

2nd cranial nerve that controls sight

question

Internal jugular vein

answer

Drains much of blood from head and neck

question

Purkinje fiber system

answer

Causes muscles of heart to contract. Spreads impulse rapidly along heart muscle.

question

Brachiocephalic artery

answer

Branches into right common carotid in neck and right subclavian artery in arm.

question

Hematocrit

answer

% blood volume made up of red blood cells. Men: 42-52% women: 37-48%. Anything below 35% considered anemic.

question

Mental artery

answer

Supplies blood to chin.

question

Ischemia

answer

Reduced blood flow in coronary arteries. Lack of oxygen to heart cells weakens, but does not kill them.

question

Maxillary artery

answer

Supplies blood to maxilla, teeth, sinuses, and portion of nose.

question

Medulla oblongata

answer

Coordinating region for impulses. The seat of many autonomic centers.

question

Normal levels of hemoglobin

answer

Males: 13-18 mg/dL Females: 14-16 mg/dL

question

Oropharynx

answer

Located between soft palate and epiglottis.

question

Facial nerve

answer

7th cranial nerve. Supplies motor fibers to muscles of facial expression.

question

Trigeminal nerve

answer

5th cranial nerve. Supplies sensation to teeth and jaws.

question

Vagus nerve

answer

10th cranial nerve. Supplies fibers to many parts of body. (Ears, tongue, pharynx, larynx, thoracic/abdominal viscera).

question

Pulmonary veins

answer

Return oxygenated blood to left atrium from lungs. Only veins that carry oxygenated blood.

question

Superior vena cava

answer

Drains head, neck, and upper extremities into right atrium.

question

Adrenal glad

answer

Secretes epinephrine, norepinephrine, and corticosteroids.

question

Ectopic focus

answer

Displaced central point of origin for cardiac dysrhythmias.

question

Inferior alveolar artery

answer

Supplies blood to teeth, mandible, lower lip, and chin.

question

Inferior vena cava

answer

Drains lower extremities and abdominal viscera into right atrium.

question

Brachial artery

answer

Supplies blood to shoulder, arm, forearm, and hand.

question

Facial artery

answer

Supplies blood to face, tonsil, palate, and submandibular gland.

question

T's of pulseleas electrical activity

answer

Toxins, trauma, thrombosis, tension pneumothorax, tamponade

question

H's of pulseless electrical activity

answer

Hydrogen ion, hypoxia, hypovolemia, hypoglycemia, hypo/hyperkalemia, hypothermia.

question

Pulseless electrical activity (PEA)

answer

Normal appearing tracing, but patient has no pulse.

question

Asystole

answer

Cessation of all contractions. "Flat line" usually follows v. fib or v. tach. Treated with CPR.

question

Ventricular fibrillation v. fib

answer

Course v. fib with prominent, erratic baseline or fine v. fib with far less pronounced vacillations. No p, qrs, or t. Often precedes asystole.

question

Class III

answer

Pt has severe systemic disturbance or disease.

question

Class IV

answer

Patient has a severe, life threatening systemic disorder.

question

Class V

answer

Patient is moribund with little chance of survival. Surgery is done in desperation.

question

Class II

answer

Patient has mild to no systemic disturbance. Smokers included.

question

Class I

answer

Patient has no organic, biochemical, psychiatric, or physiological disturbance.

question

Beta blockers

answer

Reduce the rate and force of contraction of the heart. (Atenolol)

question

Vasodilators

answer

Reduce the pressure vasculature. (Norvasc, lisinopril, diovan)

question

Diuretics

answer

Reduce the volume of fluid in system. Used to treat coronary artery disease. (HCTZ, Lasix)

question

Hypertension

answer

Blood pressure of 140/90 or greater. (Hx of nosebleeds, headaches, and dizziness)

question

Rate of ventricles

answer

20-40

question

Rate of AV node

answer

40-60

question

Rate of atria

answer

60-80

question

Arrest rhythms

answer

Ventricular dysrhythmias

question

Rate of SA node

answer

60-100

question

Social history review of systems

answer

Patients smoking and alcohol history/current use should be noted along with illegal drug use.

question

Ventricular foci

answer

Located in ventricles

question

Supraventricular foci

answer

Located above level of ventricles in atria.

question

Antibiotic prophylaxis for total joint replacement patients

answer

Previous joint infection, 2 yrs following joint replacement, malnourishment, hemophilia, diabetes type I, immunosuppressed or immunocompromised patients.

question

AV blocks

answer

PR length is prolonged or varies in length due to impulse being partially or completely blocked as it attempts to travel from atria to ventricles via AV node.

question

Patients who need antibiotic prophylaxis

answer

Previous infective endocarditis, prosthetic valves, cardiac transplant patients who develop valvulopathy, congenital heart disease.

question

Congestive heart failure

answer

Condition caused by the heart is unable to handle blood volume coming back to it from either the lungs or peripheral circulation.

question

3 characteristics of normal heart rhythms

answer

Rate, regularity, and rhythm.

question

MVP (mitral valve prolapse)

answer

One or more of valve flaps don't close completely allowing redundancy of valve leaflets into left atrium.

question

Rheumatic heart diseases

answer

Condition caused secondary to rheumatic fever (beta hemolytic streptococci) which damages the heart valves, primarily the mitral valve, and causes heart murmur.

question

MI (myocardial infarction)

answer

Heart attack. Six should be performed on patient until 6 months after.

question

Right sided heart failure

answer

Increased pressure of fluid in blood vessels causes fluid to leak into body's tissues causing peripheral edema and ascites

question

Left sided heart failure

answer

Increased pressure of fluid in blood vessels causes fluid to leak into lungs. Patients often present with shortness of breath.

question

Review of systems musculoskeletal

answer

Weakness of extremities, atrophy of muscles, frequent cramping of muscles.

question

Review of systems neurologic

answer

Weakness of extremities, hx of projectile vomiting, headaches, visual disturbances, any unexplained pain or numbness in body.

question

Review of systems pulmonary

answer

Shortness of breath, dizziness, chronic cough, wheezing, productive cough.

question

Review of systems genitourinary

answer

Painful urination, blood in urine, frequent urination, incontinence, discharge in urine.

question

Review of systems gastrointestinal

answer

Loss of appetite, swallowing, change in taste, nausea, vomiting, diarrhea, constipation.

question

Review of systems skin

answer

Bruising, bleeding, discoloration.

question

Review of systems cardiovascular

answer

Headaches, dizziness, nosebleeds, shortness of breath, chest or arm pain, edema.

question

Review of systems general

answer

Weight loss, loss of appetite, weakness, fatigue.

question

4 key questions to ask patient in evaluation

answer

Are they currently under physicians care, do they take any meds, do they have any allergies and reactions they have, review of systems.

question

Asthma

answer

Usually associated with allergies. Increased secretions in the muscles membranes lining bronchioles. Mucus plugs block smaller bronchi making movement of air in and out if lungs difficult. More difficulty with expiration.

question

Focus (foci)

answer

Site in atria or ventricles which is center for generation of impulse.

question

Cushing's disease

answer

Non life threatening. Hyper secretion of glucocorticoids.

question

Glucocorticoids

answer

Allow the body to respond to stress.

question

Addison's disease

answer

Life threatening. Hypo secretion of glucocorticoids.

question

Cirrhosis

answer

Fibrosis or scar tissue in liver. Patients with cirrhosis may have difficulty metabolizing medications and may have prolonged effects of medications.

question

Risks of liver cirrhosis

answer

Prolonged effects of medications, prolonged mental depression can cause hepatic coma, trouble clotting, peripheral edema, ascites.

question

Dyspnea

answer

Difficulty breathing or breathlessness.

question

Bronchitis

answer

Inflammation of the mucous membranes lining the bronchial tubes. Sx should be delayed.

question

Smoking

answer

Predisposes patients to laryngospasm and bronchospasm.

question

Upper respiratory infection (URI)

answer

Common cold or cough which produces increased secretions in airway. Best to delay surgery. Involves sinuses, nasal passages, pharynx, and larynx.

question

Diabetes mellitus

answer

Metabolic impairment where the body is unable to metabolize glucose properly causing increased blood glucose levels. This prevents the body from metabolizing carbs properly.

question

Type I

answer

Insulin dependent diabetes.

question

Type II diabetes

answer

Non insulin dependent

question

Considerations for diabetic patients

answer

Patients with diabetes do not heal as quickly and are more prone to infection. Often placed on antibiotics.

question

Fasting blood sugar (FBS)

answer

125 mg/dL normal or in control

question

Insulin overdose

answer

Give patient sugar, candy, or sugar containing beverage. Glucose IV or glucagon IM if patient is sedated.

question

Emphysema

answer

Enlargement of alveolar sac in lungs along with destruction and scarring of alveoli which makes less surface area available for exchange of O2 and CO2. Smokers.

question

Risks of kidney disease

answer

Patients with kidney disease may have difficulty eliminating medications from their body. Sx should not be scheduled on same day as dialysis.

question

Epilepsy

answer

Seizures. If an incident occurs during anesthesia Valium IV can be given.

question

TIA (transient ischemic attack)

answer

Mini stoke. Sudden neurological loss of function with full recovery in 24 hrs.

question

Cerebrovascular accidents (CVA/stroke)

answer

Neurological impairment caused by disruption of blood supply to area of brain.

question

Ischemic stroke

answer

85% caused by occluded blood vessel.

question

Hemorrhagic stroke

answer

15% caused by ruptured artery (aneurysm)

question

Trimester to best perform surgery

answer

2nd trimester. Most risk to fetus in 1st trimester.

question

Obesity

answer

20 % above ideal body weight [(wt in lbs/height in inches)2] x 703

question

Modifiable risk factors of stroke

answer

High blood pressure, diabetes, heart disease, smoking, TIA, increased red blood cells, sickle cell disorder.

question

Unmodifiable risk factors for stroke

answer

Male, age 55 or older, two times African American, previous stroke, heredity.

question

Considerations for obese patients

answer

Use of a large blood pressure cuff, difficult venous access, patients should be treated in upright or semi fowler position.

question

Protease inhibitors

answer

Patients with HIV take this medications. It prolongs effects of benzodiapam derivatives.

question

INR

answer

International normalized ratio. Patients on anticoagulants usually maintain INR 2-3. Patients usually discontinue anticoagulant 3 days prior to surgery. 1.5 or less needed to operate.

question

Prothrombin time

answer

Effectiveness of anticoagulant.

question

Right atrium

answer

Receives blood from inferior and superior vena cava (peripheral circulation).

question

Lower airway

answer

Trachea, bronchi, lobular bronchi, bronchioles, and alveoli.

question

Peripheral nervous system

answer

Consists of sensory and motor nerves.

question

Laryngopharynx

answer

Located behind voice box.

question

Internal respiration

answer

Takes place at cellular level. O2 in bloodstream enters cells. CO2 leaves cell and returns to blood.

question

Upper airway

answer

Nasal passages, sinuses, pharynx, and larynx.

question

Max O2 hemoglobin

answer

1.34 mL

question

Anemia

answer

Decreased amount of hemoglobin concentration. Below 35%

question

Diaphragm

answer

Dome shaped muscle that separates the chest cavity from abdominal cavity. Most important muscle of inspiration.

question

Cerebellum

answer

Main motor coordinating area.

question

Stroke volume

answer

Total amount of blood pumped out of left ventricle in one beat. 60 mL.

question

Left atrium

answer

Receives oxygenated blood from lungs via pulmonary vein.

question

Tidal volume

answer

Normal breathing 500 cc of air is inhaled and exhaled.

question

Basilic veins

answer

Located on inner (medial) aspect of forearm.

question

Dead space

answer

No gases are exchanged. 150 cc. Extends from pharynx to bronchioles. Allows CPR to take place.

question

O2 capacity

answer

Blood has a certain amount of O2 it can carry depending on hemoglobin available.

question

Nasopharynx

answer

Located above back of soft palate.

question

External respiration

answer

O2 is inspired and enters the body by coming in contact with blood and alveoli.

question

Pharynx

answer

Located between nose and trachea. 3 parts nasopharynx, oropharynx, laryngopharynx

question

Synapse

answer

A junction between two neurons.

question

Hypoxia

answer

Lack of O2

question

Automaticity

answer

Ability of heart muscle to contract on it's own without nerve stimulation.

question

Best places to check for patients pulse

answer

Carotid arteries and radial arteries.

question

Trachea

answer

Wind pipe.

question

Neurons

answer

Nerve cells

question

Tachycardia

answer

HR above 100 bpm

question

Sensory nerves

answer

Receive messages from environment and and conduct messages back to CNS.

question

CAC (cardioacceleratory center)

answer

Located within medulla. Sympathetic fibers travel down spinal cord to SA node. When stimulated release norepinephrine with increases HR and strength of contractions.

question

Cardiac output

answer

Total amount of blood pumped from left ventricle in one minute.

question

Brain stem

answer

Pons, medulla oblongata, midrain

question

Cephalic vein

answer

Located on outer (lateral) aspect of forearm.

question

Epiglottis

answer

Soft tissue valve located at base of tongue covers larynx. Allows air into lungs and keeps foreign material out.

question

AV node

answer

Located between atria and ventricles. Bundle of His cause ventricles to contract.

question

Thoracic cage

answer

Consists of ribs, sternum, intercostal muscles, diaphragm.

question

Accessory muscles of respiration

answer

Sternocleidomastoid, scalenes, abs which are most important.

question

Central nervous system (CNS)

answer

Consists of brain and spinal column

question

Median cubital vein

answer

Bridge between cephalic and basilic veins.

question

Sinuses

answer

Frontal, maxillary, sphenoid, ethmoid

question

CIC (cardioinhibitory center)

answer

Parasympathetic fibers reach vagus nerve and release acetylcholine which decreases HR and force of contractions.

question

Spinal column

answer

Cerebrum, cerebellum, medulla oblongata

question

Right ventricle

answer

Sends deoxygenated blood to lungs via pulmonary artery.

question

Respiration rate

answer

12-16 per minute

question

QRS complex

answer

Ventricular depolarization

question

Left ventricle

answer

Pumps oxygenated blood to peripheral circulation via aorta.

question

Cricothyrotomy/coniotomy

answer

The passage of a large needle through the cricothyroid ligament. Used in upper airway obstruction.

question

T wave

answer

Ventricular repolarization

question

Angina pectoris

answer

Chest pain. Caused by ischemia. Can be treated with nitroglycerin.

question

Robinul or atropine

answer

Inhibits parasympathetic stimulation of increased saliva. Decreases secretions.

question

Erythrocytes

answer

Red blood cells

question

Dorsal venous plexus

answer

Back of hand.

question

Normal HR

answer

60-100 bpm

question

Bradycardia

answer

HR of less than 60 bpm

question

Blood pressure

answer

Systolic/diastolic. Normal BP 120/80.

question

Flow of blood through the heart

answer

Inferior/superior vena cava, right atrium, tricuspid valve, right ventricle, pulmonary valve, pulmonary artery, lungs, pulmonary vein, left atria, mitral valve,eft ventricle, aortic valve, aorta, peripheral circulation.

question

Antecubital space

answer

Anterior surface of elbow located between arm and forearm.

question

SA node

answer

Located in right atrium. Acts as pacemaker. Produces sinus rhythms.

question

Systolic phase

answer

Both ventricles contracting simultaneously.

question

P wave

answer

Atrial depolarization

question

Phlebitis

answer

Inflammation of vein

question

Capillaries

answer

Smallest arteries where the exchange of O2, CO2, cell by products, and nutrients are exchanged between blood and cells of body.

question

Diastolic phase

answer

Both atria contracting simultaneously.

question

Autonomic nervous system

answer

Sympathetic and parasympathetic nervous system

question

Motor nerves

answer

Carry out responses from CNS.

question

Cardiac cycle

answer

One alternate contraction and relaxation of atria and ventricles followed by a short pause.

question

Cerebrum

answer

Thought area of brain.

question

Sympathetic nervous system

answer

Speeds things up. Innervates arteries and veins causing vasoconstriction and increased heart rate. Thoracic and lumbar spine.

question

Parasympathetic nervous system.

answer

Slows things down. Decreases heart rate and blood pressure. Skull and sacrum.

question

Aorta

answer

Main trunk from which arterial system proceeds.

question

Hemoglobin

answer

Supplies O2 to body's tissues. Composed of one protein (globin) and four non proteins (hemes)

question

Lingual artery

answer

Supplies blood to tongue of floor of mouth.

question

Treatment for hypovolemia

answer

Pressure to area, cauterization, IV fluid replacement.

question

Treatment for malignant hypothermia

answer

Activate EMS, hyperventalite w/ 100% O2, dantrolene sodium, IB cold saline NOT ringers lactate, ice packs to groin, axilla, neck, cold saline lovage to stomach, bladder, rectum, transport to hospital.

question

Treatment for anaphylaxis

answer

Activate EMS, 100% O2, monitor vitals, epinephrine, Benadryl, decadron, ACLS protocol while waiting for EMS

question

Treatment for stroke (CVA)

answer

Activate EMS, not time if incident, monitor vitals closely, place in position of comfort, 100% O2, IV access give bolts of NS/lactated ringers solution, do not treat BP unless greater than 220/120, transport to hospital, note time

question

Treatment for mild allergic reaction

answer

Place patient in upright or reclined position, 100% O2, monitor vitals, Benadryl

question

Treatment for seizures

answer

IV access, Valium 5mg IV or medazolam 3mg, continue to monitor vitals, activate EMS

question

Treatment of syncope (fainting)

answer

Tredelenburg position, ABC's, head tilt chin lift, 100% O2, monitor vitals, relax/reassure patient

question

Treatment of acute adrenal deficiency

answer

Terminate procedure, monitor vitals, tredelenburg position if hypotensive, activate EMS,IV access, steroid administration, fluid bolus, transport to hospital

question

Treatment of hypoglycemia

answer

Activate EMS, IV access, measure blood sugar with glucometer, 1 amp of glucose, IV infusion of dextrose or glucogan IM if no IV

question

Treatment of intra arterial injection

answer

Activate EMS, secure catheter DO NOT REMOVE, 10 cc lidocaine w/o epinephrine, ice pack to limb

question

Propofol

answer

Mimics barbiturates. Rapidly redistributed and metabolized due to being highly bound to fat.Does not tend to predispose to laryngospasm and has antiemetic properties. Discard after 12 hrs.

question

Treatment for high blood pressure 200/100

answer

Terminate procedure, check monitor function, attempt to determine cause, record vitals every 5 min, consider EMS, IV access, beta blockers (labetalol, esmolol, atenolol)

question

Treatment for asystole/PEA

answer

CPR, epinephrine IV may repeat every 3-5 min, one dose of vasopressin may be given to replace 1st and 2nd dose of epi

question

Treatment of ventricular fibrillation

answer

Activate EMS, CPR/AED, cont CPR and establish IV, give epinephrine 1 mg every 3-5 min, CPR/repeat shocks as above, may give single dose vasopressin to replace 1st and 2nd dose epi, amiodarone, lidocaine, and magnesium considered as well.

question

Treatment of ventricular tachycardia

answer

100% O2, amiodarone 150mg IV over 10 min, prepare for synchronous cardio version

question

Treatment for premature ventricular contractions (PVC)

answer

Try to determine cause (ie hypoxia) and correct, lidocaine IV repeat every 5-10 min until 3mg/kg administered

question

Treatment of supraventricular tachycardia

answer

Place patient in supine position, adenosine 6mg, after 1-2 min adenosine 12mg, 3rd dose given in 1-2 min as needed.

question

MONA

answer

Morphine, oxygen, nitroglycerin, aspirin

question

Treatment for symptomatic bradycardia

answer

Terminate procedure, 100% O2, establish IV, atropine, may need ER for transcutaneous pacing.

question

Treatment for heart attack

answer

Activate EMS, closely observe vitals, 100% O2 via mask, make pt comfortable/reassure, attach AED/defibrillator, aspirin 325mg, establish IV with normal saline slow drip, morphine 2-4 mg every 5-10 min

question

Symptoms of heart attack

answer

Chest pain, anxiety, weakness, sweating, cardiac dysrhythmias, drop in blood pressure.

question

Black

answer

Nitrogen

question

Yellow

answer

Compressed air

question

Topical anesthetics

answer

Benzocaine and lidocaine.

question

Treatment for angina attack

answer

100% O2 via mask, nitroglycerin under tongue 3 times every 5 min, if not relieved by third dose pt is having a heart attack, monitor pt, loosen tight clothing, put pt in comfortable position.

question

Hypnosis

answer

Loss of consciousness. Patients want to lose consciousness and feel that they are asleep. (Propofol, brevital)

question

Relaxation and immobility

answer

Essential for patient to be relaxed and immobile during procedure. (Versed, Propofol, brevital, ketamine)

question

Treatment for hyperventilation

answer

Terminate treatment and remove foreign bodies from mouth and surgical instruments from sight, maintain airway, verbally calm patient, monitor vitals, NO O2, have pt breathe into bag to recapture CO2. Advanced: IV versed, Valium, Propofol, continue to monitor vitals, discontinue breathing bag, activate EMS if condition deteriorates.

question

Gray

answer

Carbon dioxide

question

Hypercarbio

answer

Increased CO2 levels

question

Treatment for emesis with aspiration

answer

Activate EMS, keep IV, 100% O2 via bag/mask, turn patient on right side with head down (tredelenburg), tonsil suction, removal of visible foreign bodies, intubation, transport to care facility.

question

Scavenging system

answer

Reduces levels of noxious agents to acceptably low levels by exhausting then outside operating room.

question

Ventilator

answer

Breathes for patient. Using bellows type apparatus with positive and negative pressures to move gases in and out of lungs.

question

Vaporizer

answer

Facilitates the conversion of liquid anesthetic agents to gases suitable for delivery.

question

Anesthesia machines

answer

Provides O2 and NO2 to the patient. The flow meter determines ratio and rate at which gases are delivered.

question

Typical GA regimen

answer

Consists of anxiolytic, narcotic, and IV anesthetic agent.

question

Capnography

answer

Monitoring the patients CO2 in expired air

question

Halogenated hydrocarbons

answer

Inhalation agents that come in liquid form and are poured into vaporizers that allow for controlled evaporation and release for administration of gas. Sevoflurane, desflurane, isoflurane.

question

Non de polarizing agents

answer

Used for long procedures. Their mode of action is to block acetylcholine receptors at neurotransmitter junction causing prolong muscle relaxation. (Rocuronium, curare, pavulon)

question

Anticholinesterases

answer

Reverse effects of depolarizing agents (muscle relaxers)

question

Depolarizing agents

answer

Cause depolarization of muscle with contraction and prolonged relaxation (succinylcholine). Used for intubation and treatment of laryngospasm. Can cause dysrhythmias especially in children and can trigger malignant hypothermia.

question

Muscle relaxants

answer

Block nerve impulses at neurotransmitter junction where nerve stimulation causes muscle to contract causing paralysis.

question

Steroids

answer

Prevent swelling by stabilizing cell membranes and also prevent acute adrenal deficiency and nausea. (Decadron, solu medrol, solu cortel)

question

Nitrous oxide

answer

Administered with O2 concentration no less than 30%. Following administration necessary to wash out with 100% O2 for 3-4 min to prevent diffusion hypoxia. Pt to remain in office for 15 min after.

question

General anesthesia (GA)

answer

The pt is not arousable even with painful stimulation. Airway intervention is required and positive pressure ventilation may be required. CV function may be impaired.

question

Meds that help with nausea

answer

Antienimetics. Antihistamines, antipsychotics, reglan, zofran, corticosteroids, benzodiazepines

question

Benadryl

answer

Primary drug used in mild allergic reactions.

question

Treatment for bronchospasm

answer

100% O2, albuterol, atrovent, epinephrine, intubation/ventilation, steroid injection, Benadryl, activate EMS.

question

Deep sedation analgesia

answer

The patient cannot be easily aroused bit has purposeful response after repeated or painful stimulation. Pt may require maintenance I'd airway and ventilation but CV function usually maintained.

question

Moderate sedation conscious sedation

answer

Purposeful response to verbal or light tactile stimulation with no compromise of the airway and spontaneous ventilation. CV function usually maintained.

question

Laryngospasm

answer

Protective reflex of vocal cords which attempt to prevent passage or foreign matter to lungs. Crowing sounds or labored breathing from patient.

question

Treatment for laryngospasm

answer

100% O2, establish proper head position, suction with tonsillar, positive pressure O2 via bag/mask, succinylcholine.

question

Treatment for airway obstruction. Foreign bodies.

answer

100% O2, tredelenburg position, retraction of tongue with gauze, forceps, or suture, suctioning of oropharynx. Advanced: Abdominal thrusts, direct laryngoscopy, cricothyrotomy.

question

Phenergan

answer

Potentiates narcotic effects.

question

Vistaril

answer

Potentiates narcotics and barbiturates. Useful in sedation technique.

question

Anticholinergics

answer

Decrease secretion of salivary glands. Block vagus nerve and can cause tachycardia. (Robinul, atropine, scopolamine).

question

Minimal sedation (anxiolytics)

answer

Normal response to verbal stimulation with airway reflexes, ventilation, and CV function unaffected.

question

Volume of one carpule of local anesthetic

answer

1.7 mL Mg/cc * 1.7 to get concentration.

question

Flumazenil

answer

Like narcan but used to reverse effects of benzodiazepam derivatives.

question

Narcan

answer

Used in treating respiratory depressant and sedative effects of narcotics. Most widely used narcotic agonist antagonist.

question

Mallampati class II

answer

Visualization of soft palate, fauces, and uvula.

question

Mallampati class I

answer

Visualization of soft palate, fauces, uvula, anterior/posterior pillars.

question

Mallampati class III

answer

Visualization of soft palate and base of uvula.

question

Mallampati class IV

answer

Soft palate not visible at all.

question

Which monitor tracks both ventilation and circulation?

answer

Pulse oximeter

question

Capnograph/capnometer

answer

Monitors ventilation in real time by measuring the level of O2 the patient exhales.

question

1% solution equals

answer

One gram of medication in 100% mL solution. [1g also = 10oomg]

question

Concentration %

answer

Mg/cc

question

Receptor sites

answer

Specialized sites on ion channels to which natural neurotransmitter substances or drugs attach usually leading to opening of channel for passage of positively and negatively charged ions.

question

Drug reversal agents

answer

Narcan and flumazenil

question

Additional desirable attributes of anesthetics

answer

Maintenance if homeostasis, rapid, smooth, comfortable induction, lack of post up nausea/vomiting, retention of reflexes to prevent aspiration, feeling of well being post op, rapid recovery, easily adapted for use in children and seniors, easy administration, cost effective.

question

Treatment for hypotension

answer

Tredelenburg position, support airway, 100% O2, monitor vitals, consider EMS, IV access, fluid bolus normal saline 10-20mL, ephedrine or phenylephrine IV

question

Pulse oximeter

answer

Device measures and displays the level of oxygenated hemoglobin compared with total hemoglobin at site if probe. Measures pulse rate and ventilation. Normal O2 sat 96-100%

question

Precordial

answer

Designed to listen to breath sounds during anesthesia. Placed on supersternal notch.

question

Vasoconstrictors in local

answer

Epinephrine or neo cobefrin added to anesthetics to prolong duration by causing blood vessels to construct.

question

Amides

answer

Metabolized in bloodstream. Chemical structure derived from ammonia.

question

Esters

answer

Metabolized in bloodstream. Chemical structure of acid and alcohol. Procaine and cocaine.

question

Electrocardiograph

answer

Used to monitor electrical activity of heart.

question

AED

answer

Automatic external defibrillator. Device automatically assesses heart rhythm and delivers shock if necessary.

question

Defibrillator

answer

Only practical and definitive treatment for ventricular fibrillation

question

Brown

answer

Helium

question

Brevital

answer

Ultra short acting barbiturate. 1% solution not highly bound to fat. Side effects: apnea on induction, laryngospasm, bronchospasm, hypotension, tachycardia, hiccups, muscle twitching. Use caution with asthma or seizure disorders.

question

Barbiturates

answer

Taken up by body fat and release into system slowly prolonging effects. Depress respiratory and cardiac function. No analgesic effect and detoxified by liver. Amnesia and hypnotic effects.

question

Ketamine

answer

Dissociative anesthetic, provides analgesic effects, amnesia, highly lipid soluble. Increases blood pressure, heart rate, cardiac output, increases salivation with can predispose laryngospasm.

question

Diazepam

answer

Valium. Amnesia effects. Less cardiac and respiratory depressant. May have prolonged side effects. May be pain on injection.

question

Medazolam

answer

Versed. Similar to Valium but faster acting and water soluble. Respiratory depressant.

question

Anxiolytics

answer

Benzodiazepine family of meds. Cause increased pressure in eye and should be used with caution on patients with glaucoma.

question

Amnesia

answer

Failure to remember events related to surgery. Versed/benzodiapines.

question

Narcotics

answer

Provide systemic pain control. Respiratory depressant and potential for addiction. May produce drowsiness, euphoria and hypotension. (Morphine, Demerol, fentanyl, remifentanil)

question

Analgesia

answer

Insensitivity to pain. Patient feels no pain during surgical procedure. (Fentanyl, local, ketamine).

question

Basic requisites of an anesthesia

answer

Lack if toxicity, non flammable, non addictive, possess minimal allergenicity.

question

Rapid redistribution

answer

Release of drug from it's initial receptor site and it's movement through bloodstream to other body structures.

question

Pharmacodynamics

answer

Effects drugs have on various body systems.

question

Morphine

answer

Major effects on CNS. Major action analgesia, but also causes euphoria, drowsiness, and sedation. Side effects include nausea, respiratory depression and hypotension.

question

Demerol

answer

Same pharmacological effects as morphine.

question

Pharmacokinetics

answer

Effects body has on drugs

question

Homeostasis

answer

The body's normal state which there is minimal variation in respiration and circulation.

question

Fentanyl

answer

Rapid onset of action. Profound respiratory depressant. High doses may cause chest wall rigidity.

question

Vital centers

answer

Centers in brainstem that control physiological processes ie blood pressure, pulse, and respiratory rate.

question

Narcotic agonist antagonists

answer

Standard narcan. Narcotics reversible with drugs that antagonize effects. All relieve pain and provide some degree if sedation. (Narcan, talwin, stadol).

question

Green

answer

Oxygen

question

Blue

answer

Nitrous oxide

question

Opioid receptor sites

answer

Respond to natural opioids produced in body ie endorphins. Ketamine exerts some effects through these receptors.

question

Central sites

answer

Responsible for euphoric feeling that accompanies opioid administration.

question

Narcotic receptors

answer

3 levels of activity. Opioids affect transmission of painful impulses initially at site of injury, then spinal cord on the way to brain, and finally at receptor sites in brain.

question

Relay center

answer

An ovoid structure in central portion of brain that relays sensory input to cerebral cortex.

question

Room air

answer

20% oxygen

question

Anxiolytic

answer

Anxiety reducing.

question

Neo-cobefrin

answer

Vasoconstrictor compounded with marcaine. Less cardiac and CNS stimulation than epinephrine.

question

Hypnotic

answer

Sleep inducing.

question

Wakefulness system

answer

System in brain that maintains the state of consciousness or wakefulness.

question

Epinephrine

answer

Sympatho- mimetic amine (mimics sympathetic nervous system) with pronounced cardiovascular effects.

question

Symptoms of stroke

answer

Paralysis, localized weakness, headache, numbness, slurred speech, inability to speak (aphasia), memory loss, dizziness, blindness to one eye, confusion, loss of consciousness, double vision, ataxia.

question

Malignant hypothermia symptoms

answer

Genetically transmitted myopathy that is triggered by some inhalation agents and succinylcholine. First sign is tachycardia followed by massager muscle rigidity, elevates temperature, carbon dioxide retention, total body rigidity, or lethal arrhythmias.

question

Symptoms of syncope

answer

Syncope is a loss of consciousness due to sudden sharp, transient drop in blood pressure. This is caused by the shunting of blood flow to extremities by sympathetic nervous system which causes blood to pool in extremities decreasing blood flow to brain. Symptoms include diaphoresis, pallor, nausea, light headedness, and tachycardia

question

Symptoms of acute adrenal insufficiency

answer

Hypotension, pallor, diaphoresis, nausea, tachycardia, headache, extreme fatigue, high fever, shaking, abdominal pain and confusion.

question

Hyperventilation

answer

When patient is breathing at a rate faster than his or her normal breathing pattern or breathing more deeply than the body requires. Pt exhales too much carbon dioxide. Pt will feel anxious and light headed.

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