Intro to the OR, anesthesia set up, crisis management, airway management
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Questions and Answers

What level of amperage can cause fatal fibrillation?

  • 1 mA
  • 10 mA
  • 100 mA (correct)
  • 200 mA

    • What does the oLIM predict regarding current flow?

  • It predicts potential current flow and when current exceed 2-5 milliAmps and sets an alarm. (correct)
  • It stops current flow when it exceeds a certain amperage
  • It predicts current flow is always safe under 2 milliAmps.
  • It does not monitor current flow.

    • What should you do if an airway fire occurs?

  • Stop the flow of O2
  • Remove the airway
  • Put out the fire
  • All of the above prioritizing stopping the flow of O2 (correct)

    • What conditions increase the risk of intraoperative fire? (Select all that apply)

    <p>Open oxygen</p> Signup and view all the answers

    What are the preferred fire extinguishers used in the Operating Room (OR)?

    <p>CO2 extinguishers</p> Signup and view all the answers

    Which of the following items is part of the mandatory airway setup? (Select all that apply)

    <p>2 Laryngoscopes</p> Signup and view all the answers

    match the drug to the proper syringe size

    <p>phenylephrine, succs = 10 cc rocuronium, ephedrine, lidocaine, succs = 5 cc propofol = 20 cc atropine, versed, glycopyrrolate, fentanyl = 3 cc</p> Signup and view all the answers

    What percentage deviation from baseline typically indicates hypotension or hypertension?

    <p>20%</p> Signup and view all the answers

    What is the first sign of hypotension?

    <p>Low ETCO2</p> Signup and view all the answers

    Why does bradycardia occur during hypertension?

    <p>Increased baroreceptor sensitivity</p> Signup and view all the answers

    What types of beta-blockers should be administered to treat intraoperative hypertension?

    <p>Short-acting (e.g. esmolol)</p> Signup and view all the answers

    When should you treat bradycardia with atropine instead of glycopyrrolate?

    <p>Atropine is preferred in cases of acute bradycardia due to vagal stimulation.</p> Signup and view all the answers

    If anticholinergics are ineffective at treating bradycardia, what is the next medication to be used?

    <p>Epinephrine</p> Signup and view all the answers

    You've administered a sedative to a patient prior to laryngoscopy and cannot ventilate. What should you do next?

    <p>Attempt airway repositioning</p> Signup and view all the answers

    After repositioning the head, if you still can't ventilate, what should you do next?

    <p>Insert an airway adjunct</p> Signup and view all the answers

    After placing an airway adjunct, and you still can't ventilate, what should you do next?

    <p>Initiate a 2-person ventilation technique</p> Signup and view all the answers

    If you still cannot ventilate the patient using a two-person technique, what should you do next?

    <p>Insert a supraglottic airway (SGA)</p> Signup and view all the answers

    What are the treatments for laryngospasm? (Select all that apply)

    <p>Positive pressure ventilation up to 60 cmH2O</p> Signup and view all the answers

    How can laryngospasm be prevented?

    <p>All of the above</p> Signup and view all the answers

    ETCO2 may be gone in severe bronchospasm

    <p>True</p> Signup and view all the answers

    Which of the following are treatments for severe bronchospasm? (Select all that apply)

    <p>Albuterol</p> Signup and view all the answers

    What are the implications of hypothermia? (Select all that apply)

    <p>Increased cardiac strain</p> Signup and view all the answers

    What is the initial sign of malignant hyperthermia?

    <p>elevated ETCO2</p> Signup and view all the answers

    What effects do increased PEEP and PIP have on blood pressure?

    <p>Decrease blood pressure due to increased intrathoracic pressure</p> Signup and view all the answers

    What is the typical hemodynamic consequence of stimulation of the carina and bladder distension?

    <p>Hypertension</p> Signup and view all the answers

    What is the hemodynamic consequence of prolonged tourniquet time?

    <p>Hypertension due to accumulation of metabolic waste</p> Signup and view all the answers

    Which of the following is commonly seen during intubation and emergence from general anesthesia?

    <p>Hypertension</p> Signup and view all the answers

    In cases of mild to moderate bronchospasm, how should the anesthetic be titrated to alleviate symptoms?

    <p>Deepen anesthetic</p> Signup and view all the answers

    If difficulties are anticipated in managing the airway after induction, what type of airway management technique should be performed if no other contraindications exist?

    <p>Awake intubation</p> Signup and view all the answers

    What is the common cause of an unanticipated difficult airway?

    <p>Lingual tonsil hyperplasia</p> Signup and view all the answers

    LEMON = Look, Evaluate 3-3-2, Mallampati, Obstruction, Neck Mobility

    <p>True</p> Signup and view all the answers

    If an invasive airway approach fails in a Can't Intubate, Can't Ventilate (CICV) situation, what is an alternative intervention?

    <p>Extracorporeal membrane oxygenation (ECMO)</p> Signup and view all the answers

    You've induced a patient and are unable to ventilate after placing an SGA. What intervention should you prepare to perform while pursuing alternative intubation approaches?

    <p>Prepare for a cricothyrotomy</p> Signup and view all the answers

    What are the disadvantages of awake intubation? Select all that apply.

    <p>Increased risk of bronchospasm</p> Signup and view all the answers

    In awake intubation, spontaneous ventilation is maintained

    <p>True</p> Signup and view all the answers

    Patient cooperation is essential to perform an awake intubation.

    <p>True</p> Signup and view all the answers

    What types of medications are commonly used in awake intubation? (Select all that apply)

    <p>Local anesthetics</p> Signup and view all the answers

    What is a complication of benzocaine use?

    <p>Methemoglobinemia</p> Signup and view all the answers

    Lidocaine and mepivacaine are noted for having a ___ onset of action.

    <p>rapid</p> Signup and view all the answers

    Which local anesthetic is noted for its longer duration of action?

    <p>Bupivacaine</p> Signup and view all the answers

    Which local anesthetic is noted for its rapid onset and can be used in all areas of the tracheobronchial tree?

    <p>Lidocaine</p> Signup and view all the answers

    Which anticholinergic drug does not cross the blood-brain barrier or placenta and is noted to have a longer duration of action?

    <p>Glycopyrrolate</p> Signup and view all the answers

    Which anticholinergic is noted to cause less tachycardia but can cause sedation, amnesia, and euphoria?

    <p>Scopolamine</p> Signup and view all the answers

    What are the three anatomical areas where local anesthetic (LA) should be placed for awake intubation?

    <p>Nasopharynx, Pharynx/Base of Tongue, Larynx/Trachea</p> Signup and view all the answers

    From which cranial nerve do the recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) arise?

    <p>Cranial Nerve X (Vagus)</p> Signup and view all the answers

    What nerve provides sensory information from the area above the vocal cords?

    <p>Internal branch of the SLN</p> Signup and view all the answers

    What nerve provides sensory information from the area below the vocal cords?

    <p>Recurrent laryngeal nerve</p> Signup and view all the answers

    Which muscle does the external branch of the superior laryngeal nerve (SLN) innervate?

    <p>Cricothyroid</p> Signup and view all the answers

    What is the motor innervation of the recurrent laryngeal nerve (RLN)?

    <p>Laryngeal muscles except the cricothyroid muscle</p> Signup and view all the answers

    At what stage of general anesthesia is laryngospasm most likely to occur?

    <p>Stage 2: Excitement/Delirium</p> Signup and view all the answers

    What is the sensory innervation of the glossopharyngeal nerve in relation to the airway?

    <p>Posterior 1/3 of tongue, rostral epiglottis, pharynx</p> Signup and view all the answers

    Which nerve provides sensory information about the larynx?

    <p>Recurrent Laryngeal Nerve (RLN)</p> Signup and view all the answers

    Which nerve provides sensory information about the vocal cords and dorsal epiglottis?

    <p>Internal Branch of the Superior Laryngeal Nerve</p> Signup and view all the answers

    Which of the following correctly describes the Greater and Lesser Palatine Nerves? (select 2)

    <p>They are branches of the Trigeminal Nerve.</p> Signup and view all the answers

    What areas does the Anterior Ethmoidal Nerve innervate and what cranial nerve is it a branch of?

    <p>Nares and anterior 1/3 of nasal septum</p> Signup and view all the answers

    What nerves must be anesthetized to target the pharynx and base of the tongue?

    <p>Glossopharyngeal and Superior Laryngeal Nerve</p> Signup and view all the answers

    Which artery should CRNAs be cautious of when performing an invasive oral approach to anesthetizing the nasopharynx?

    <p>Sphenopalatine artery</p> Signup and view all the answers

    Where is local anesthesia placed to anesthetize the pharynx and base of the tongue?

    <p>Palatoglossal arch</p> Signup and view all the answers

    What is the landmark used in placing a SLN block?

    <p>Greater cornu of the hyoid bone</p> Signup and view all the answers

    How should the hyoid be displaced when placing a superior laryngeal nerve (SLN) block?

    <p>Medially</p> Signup and view all the answers

    Which ligament is the target in a superior laryngeal nerve (SLN) block?

    <p>Thyrohyoid ligament</p> Signup and view all the answers

    What nerve is anesthetized when placing a local anesthetic in the translaryngeal space?

    <p>Recurrent laryngeal nerve (RLN)</p> Signup and view all the answers

    Air should be aspirated before injecting LA when anesthetizing the RLN

    <p>True</p> Signup and view all the answers

    What is a disadvantage of using local anesthesia (LA) through a fiberoptic scope to anesthetize the larynx and trachea?

    <p>LA can obscure the lens of the scope</p> Signup and view all the answers

    A patient has an anticipated difficult airway but is at a massive risk of aspiration. Is an awake technique appropriate?

    <p>True</p> Signup and view all the answers

    What should be considered when an awake intubation fails and the patient is hemodynamically stable (non-emergent)?

    <p>Regional anesthesia techniques</p> Signup and view all the answers

    What are the contraindications for regional anesthesia in patients with difficult airways? (Select all that apply)

    <p>Poor airway access</p> Signup and view all the answers

    What is a disadvantage of percutaneous cricothyroidotomy?

    <p>Exhalation is passive and not able to be controlled</p> Signup and view all the answers

    What is a disadvantage of a tracheostomy?

    <p>It is not appropriate for emergent situations due to the length of the procedure.</p> Signup and view all the answers

    The upper airway must be ____ for percutaneous jet ventilation.

    <p>patent</p> Signup and view all the answers

    When is retrograde intubation indicated?

    <p>Cannot intubate, can ventilate</p> Signup and view all the answers

    In which of the following situations is retrograde intubation indicated? (Select all that apply)

    <p>Impaired visualization</p> Signup and view all the answers

    Which device is best used to assist in the extubation of a difficult airway?

    <p>Airway exchange catheter</p> Signup and view all the answers

    Which of the following medications should be included in the emergence and recovery plan of a difficult airway? (Select all that apply)

    <p>Anti-inflammatory agents</p> Signup and view all the answers

    Which of the following is NOT one of the emergence criteria for anesthesia? (Select one)

    <p>Increased heart rate</p> Signup and view all the answers

    Patients must be breathing spontaneously before extubation

    <p>True</p> Signup and view all the answers

    What is the recommended pressure to be generated during positive pressure ventilation (PPV)?

    <p>&lt;20 - 25 cmH2O</p> Signup and view all the answers

    What is the BURP maneuver used for?

    <p>To improve the laryngoscopic view by displacing the thyroid cartilage.</p> Signup and view all the answers

    What is the maximum amount of pressure used in the Sellick maneuver during RSI?

    <p>30 mmHg</p> Signup and view all the answers

    What is an alternate form of preoxygenation in the crashing patient?

    <p>8 vital capacity breaths over 60 seconds</p> Signup and view all the answers

    Patients on ACE inhibitors or ARBs are most likely to present with which intraoperative complication?

    <p>Hypotension</p> Signup and view all the answers

    Neuraxial anesthesia is most likely to result in which intraoperative complication?

    <p>Hypotension</p> Signup and view all the answers

    What is an appropriate intervention in the event of an airway obstruction?

    <p>Rigid bronchoscopy</p> Signup and view all the answers

    What are characteristics of effective teams? (Select all that apply)

    <p>Respect</p> Signup and view all the answers

    Match the appropriate ASA

    <p>ASA 1 = healthy ASA 2 = mild systemic disease ASA 3 = severe disease that is not life-threatenind ASA 4 = severe disease that is life-threatening</p> Signup and view all the answers

    What describes a patient that is ASA 5?

    <p>A patient who is not expected to survive without surgery</p> Signup and view all the answers

    How can an ASA 6 patient be described?

    <p>A patient who is declared brain dead and whose organs are being removed for donor purposes</p> Signup and view all the answers

    What is a McGrath?

    <p>A type of video laryngoscope used for intubation.</p> Signup and view all the answers

    Which video laryngoscope has an external monitor separate from the laryngoscope?

    <p>Glidescope</p> Signup and view all the answers

    What is the target site for anesthetizing the recurrent laryngeal nerve (RLN)?

    <p>Cricothyroid membrane</p> Signup and view all the answers

    What are the contraindications for an awake intubation? (Select all that apply)

    <p>Patient refusal</p> Signup and view all the answers

    Which surgical airway technique is recommended for use in pediatric populations (less than 6 years old)?

    <p>Percutaneous jet ventilation</p> Signup and view all the answers

    What are the advantages of an awake intubation? (Select all that apply)

    <p>Decreased risk of aspiration due to airway reflexes being intact</p> Signup and view all the answers

    What are the options for extubation of difficult airways? (Select all that apply)

    <p>Awake extubation</p> Signup and view all the answers

    Study Notes

    Electrical Safety in Anesthesia

    • Amperage levels above 100 mA can cause fatal fibrillation.
    • oLIM predicts the potential risk of current flow in medical devices.

    Fire Safety

    • If an airway fire occurs, immediately remove the airway device and extinguish the flames.
    • Conditions that increase the risk of intraoperative fire include the presence of ignition sources, flammable substances, and patient’s body type (obesity).
    • Preferred fire extinguishers in the Operating Room include Class B and Class C extinguishers.
    • Mandatory airway setup items include an endotracheal tube, laryngoscope, and suction.

    Hemodynamics and Pharmacology

    • A deviation of 20% from baseline typically indicates hypotension or hypertension.
    • The first sign of hypotension is often tachycardia.
    • Bradycardia during hypertension can occur due to baroreceptor reflexes.
    • Beta-blockers such as metoprolol or labetalol are used to treat intraoperative hypertension.
    • Atropine should be used to treat bradycardia if heart rate is below 40 bpm or there are signs of hemodynamic instability, rather than glycopyrrolate.

    Airway Management in Emergencies

    • If unable to ventilate after administering sedatives, reposition the airway and reattempt ventilation.
    • If still unsuccessful, use airway adjuncts before considering alternative ventilation techniques or intubation.
    • Treatments for laryngospasm include positive pressure ventilation, administering anesthetics, or succinylcholine.
    • Preventive measures against laryngospasm include ensuring adequate depth of anesthesia and avoiding airway irritation.

    Bronchospasm Management

    • Treatments for severe bronchospasm include bronchodilators like albuterol and corticosteroids.
    • Hypothermia implications include delayed drug metabolism, increased bleeding risk, and impaired immune response.
    • Initial sign of malignant hyperthermia is an unexplained rise in end-tidal CO2.

    Intubation Techniques and Complications

    • Increased PEEP and PIP can lead to decreased blood pressure.
    • Difficult airway management techniques should include preparation for potential hyperextension or use of alternative devices.
    • If an invasive airway approach fails in a Can't Intubate, Can't Ventilate (CICV) scenario, consider emergency surgical airway techniques.
    • Patient cooperation is crucial for effective awake intubation, which maintains spontaneous ventilation.

    Local Anesthetic Administration

    • Benzocaine may cause methemoglobinemia as a complication.
    • Lidocaine and mepivacaine are known for rapid onset of action; bupivacaine has a longer duration.
    • External branch of the superior laryngeal nerve innervates the cricothyroid muscle.
    • Structures above the vocal cords are innervated by the internal branch of the superior laryngeal nerve.

    Surgical Aspects of Airway Management

    • Local anesthetics target specific areas for awake intubation: glossopharyngeal nerve, superior laryngeal nerve, and recurrent laryngeal nerve.
    • The hyoid bone should be displaced posteriorly during an SLN block.
    • Contraindications for regional anesthesia in difficult airways include patient refusal or uncooperative demeanor.

    Recovery Strategies

    • Patients must be spontaneously breathing prior to extubation; pressure during positive pressure ventilation should be controlled.
    • The BURP maneuver is used during intubation to manipulate the trachea for better visualization.
    • Recommended preoxygenation techniques include using high-flow nasal cannula or non-invasive ventilation in crashing patients.

    Management of Intraoperative Complications

    • Patients on ACE inhibitors or ARBs may present with hypotension intra-operatively.
    • Interventions during airway obstruction may include repositioning the head and utilizing back pressure.

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    Description

    This exam covers intro the OR and anesthesia set up, basic anesthesia crisis management, and airway management

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