ca exam 1 combo set

You are in the OR and infectious body fluids have come into contact with you. What do you do?

1. Immediately clean area with soap and water

2. Flush your eyes if necessary

3. Contact your supervisor immediately

4. Follow ALL recommendations made by employee health

•Immediate blood samples for HIV, Hepatitis B and C

•Test patient if possible

•Need permission from patient for HIV testing

5. Follow up blood samples to determine need for treatment

6. Notify the program office

Examples of Clean vs Sterile

Sterile: wrapped in green or blue - indicate surgical field

clean: LMA or laryngoscope blades

Sterile

◦Sterilized and wrapped utilizing sterile techniques: Everything on the surgical field, Surgical towels, instruments, gloves

◦Anesthesia items that will enter vasculature: Needles, syringes, catheters, IV tubing

clean

◦Clean when wrapped

◦Anesthesia items that will enter nose or mouth: Reusable LMAs, laryngoscope blades

Insurance company is requesting records from doctor. Is it necessary to obtain pt approval beforehand?

yes

What does HIPAA stand for

Health Insurance Portability and Accountability Act

What does HIPAA do

Rules that govern the use and disclosure of protected health information (PHI)

Who does HIPAA cover?

◦Healthcare providers

◦Healthcare facilities

◦Business Associates

◦Person/entity that performs certain functions involving PHI and a covered entity

Who gets HIPAA permitted use

Public health and safety

Medical examiners

Law enforcement

When was HIPAA introduced?

1996

Things to consider due to HIPAA

•Where you speak w/ patients

•Who else is present

•Introduction & permission

•Do not share patient info/access charts unless directly related to patient care!

What is considered PHI

- Names

- Geographic subdivisions smaller than a state

- Birth dates, age of patients if > 89 years

- Phone numbers, email addresses

- SSN, MRN, health plan numbers, account numbers

- Biometric identifiers (fingerprints, voiceprints)

- Photographs of the face or other identifying objects (tattoos)

- Any other unique identifying number, characteristic, or code

Best security practices

- Do not share passwords

- Use strong passwords

- Log off computer when finished

- Destroy all PHI in shredder or locked disposal box

- Do not leave PHI sitting out

- Do not send PHI over unsecured email system

- Do not leave PHI messages on voicemail

- Password protect personal electronic devices with PHI

Social media posts rule

Social media posts that contain patient information - even if it does not include identifiable information - violates the HIPAA Privacy Rule!

Do not remove these things from the OR

◦Schedule

◦Labels

◦Charts

What does OSHA stand for

Occupational Safety and Health Administration

What does OSHA do

establishes and enforces safety standards for the workplace (for employees)

all bodily fluids are

potentially infectious

equipment that must be clean

blood pressure cuff, ECG leads, pulse ox, monitor cables, machines, and hands

Standard Precautions

gloves, eye protection, mask, gown when needed

Gown is necessary for

contact isolation patients, sterile procedures, and cases where bodily fluid will be flying

How to prevent infection

•HANDWASHING!

•Always wear gloves

•Proper use of line ports

•Follow protocol for placing lines

•Use eye protection

•Proper capping and disposal of sharps (Never recap or reuse needles)

•Proper OR dress: Scrubs, hair coverings, sleeves, jewelry, Mask disposal

JCAHO comes by to

to assess if healthcare organizations meet specific patient safety and quality of care standards

possibly infectious diseases

HIV/AIDS, heptatitis, TB, MRSA

what are the two most prevenlant blood borne diseases

Heptatitis B and HIV

"background" color on biohazard

red/orange

proper use of ports

•Maintain caps on stopcocks

•Clean ports with alcohol prior to use

Single dose vials

- generally without preservative

- Discard remainder of contents after case

- Draw up full amount when possible

Multi-dose vials

- have preservative

- Date and initial every vial when opened

- Wipe vials with alcohol before each use

- Discard remainder at end of day

What to do if you suspect an infection control issue

Alert preceptor/attending -> notify clinical coordinator -> communicate w/ program

Alert preceptor/attending -> go to OR desk -> complete incident report -> go to OR manager -> proceed to ER for evaluation

OR dress code

•Pull back hair

•Limited/no jewelry: can have a wedding band, watch

•No perfume/cologne

•Scrubs to and from hospital

•Neck lines and midriffs

•Clean and trim fingernails: No polish or acrylics

•No long sleeve shirts under scrubs

•Appropriate shoes

•Wash scrubs after each use

The OR will have these people

- Surgeon and team: PA, first assist, resident, med student, etc

- Scrub technician

- Circulator nurse

- Anesthesia technician

- Radiology technician

- Orderly

- Board runner: Anesthesia/OR charge nurse

How to introduce yourself in the OR

Introduce yourself when you first get in the room

•First name, last name, Anesthesiologist Assistant student

•Write it on OR board and/or chart

Equipment that must be free of contamination

•Blood pressure cuff

•ECG leads

•Pulse oximeter

•Other monitor cables

•Temp, a-line, etc

•Machine

When should you Clean up your workspace/anesthesia machine

between cases

What to keep in mind when giving a patient a vasoactive drug or high concentrated narcotic (regarding stopcock)

Always give it at the port closest to patient (not just any random port on the line), do not want the drug to linger in any other tubing bc small amounts can make big significant changes

Luer lock

-pressed in by SYRINGE
-do NOT puncture with needle
-more info: standardized connectors that securely join small-scale fluid fittings making leak-free connections. can be found on needles, syringes, catheters, etc

Medical definition of anesthesia

LOSS OF SENSATION and USUALLY OF CONSCIOUSNESS

WITHOUT loss of vital functions

artificially produced by the administration of one or more agents that BLOCK THE PASSAGE OF PAIN IMPULSES along nerve pathways TO THE BRAIN

(multimodal)

4 types of anesthesia

General, regional, MAC, and local

Two types of regional anesthesia

Peripheral and neuraxial blocks

ASA definition of general anesthesia

Drug-induced LOSS OF CONSCIOUSNESS during which patients are not arousable, even by painful stimulation

What problems OFTEN come with general anesthesia?

-Impaired ability to independently maintain ventilitory function

-Require assistance maintaining a patent airway

What MAY occur/be required with general anesthesia?

-positive pressure ventilation MAY BE required

-cardiovascular function MAY BE impaired

What is often a biproduct of volatile anesthetics?

Shapid breathing (shallow/rapid breathing)

Describe minimal sedation anxiolysis

- Responsiveness: normal response to verbal stimulation

- Airway: unaffected

- Spontaneous ventilation: unaffected

- Cardiovascular function: unaffected

Describe moderate sedation/analgesia (conscious sedation)

- Responsiveness: purposeful response to verbal or tactile stimulation

- Airway: no intervention required

- Spontaneous ventilation: adequate

- Cardiovascular function: usually maintained

Describe deep sedation/analgesia

- Responsiveness: purposeful response following repeated or painful stimulation

- Airway: intervention may be required

- Spontaneous ventilation: may be inadequate

- Cardiovascular function: usually maintained

Describe general anesthesia

- Responsiveness: unarousable even with painful stimulus

- Airway: intervention often required

- Spontaneous ventilation: frequently inadequate

- Cardiovascular function: may be impaired

4 categories of depth of sedation

minimal sedation anxiolysis

moderate sensation/analgesia (conscious sedation)

deep sedation/analgesia

general anesthesia

4 characteristics to describe depth of sedation

responsiveness

airway

spontaneous ventilation

cardiovascular function

What are the two methods of induction for general anesthesia

IV agent (e.g. propofol) or inhalational agent (e.g. sevoflurane)

What IV agent is used for general anesthesia?

Propofol

Name an inhalational agent used in general anesthesia

sevoflurane

What kind of case usually uses inhalational agent induction?

Pediatrics

Mechanical ventilation for general anesthesia

ETT

Spontaneous/assisted ventilation for general anesthesia

NC, Mask, LMA

General anesthesia typical flow

See the patient in pre-op, make plan

Set up room

Patient to room, move to OR bed, apply monitors

Induction

Bag mask ventilate

Intubation (ETT (pt placed on ventilator), lma placement (self ventilate, SV))

Assess vitals

Patient positioned

Surgery (maintenance)

Emergence

Patient regains consciousness

Extubation/removal of LMA

Transport to PACU/ICU/day surgery

Describe process of applying monitors to patients

Start with blood pressure (set to AUTO 2.5-3ish minutes)

Pulse ox, EKG, ETCO2

Temprobe when patient is asleep

How many ports are we looking for on nasal cannula?

2 ports so we can both attach capnography and oxygen

What is TIVA?

total intravenous anesthetic

Inhalational agents for induction

Sevoflurane

Isoflurane

Desflurane

IV agents for induction

Propofol

Ketamine

Etomidate

Supplemental agents

Narcotics

Neuromuscular blockers (paralytics)

Hemodynamic drugs (vasopressors/vasodilators)

Reversal agents

Goals of general anesthesia maintenance

amnesia, analgesia, skeletal muscle relaxation, hemodynamic control

Do patients have to be conscious for it to qualify as regional anesthesia?

No, patients can be unconscious in regional anesthesia cases

Neuraxial regional anesthetic techniques

Spinal

Epidural (e.g. Caudal)

Epidural block

Anesthetic is injected into the epidural space, which is the area between the spinal cord and the dura mater (outer layer of the spinal cord)

Spinal block

Anesthetic is injected directly into the subarachnoid space, which contains cerebrospinal fluid and surrounds the spinal cord.

Caudal block

type of regional anesthetic that uses an injection of local anesthetic into the sacral epidural space, near the tailbone

Peripheral nerve blocks can anesthetize these areas

upper extremity, lower extremity

What is a bier block?

intravenous regional anesthesia, a technique used to provide temporary pain relief in an arm or leg

Describe the bier block process

- Place and secure small IV catheter on the dorsal hand

- Exsanguinate the arm with an Esmarch bandage (drain blood from arm)

- Inflate tourniquet

- inject local anesthetic through catheter

Upper extremity block locations

cervical plexus, brachial plexus, forearm

Brachial plexus blocks

Interscalene, supraclavicular, infraclavicular, axillary

What does an interscalene brachial plexus block affect?

shoulder/distal extremity (shoulder/clavicle/upper arm)

What does a supraclavicular brachial plexus block affect?

Entire arm

What does an infraclavicular brachial plexus block affect?

elbow, forearm, hand

What does an axillary brachial plexus block affect?

elbow, forearm, hand

Forearm blocks

median, ulnar, radial

What does a median forearm block affect?

Palm

What does an ulnar forearm block affect?

Dorsal AND palmar hand

What does a radial forearm block affect?

Dorsal

Lower extremity block locations

femoral, saphenous, sciatic, popliteal, ankle

Femoral block effect

Anterior - medial thigh, knee

Saphenous block effect

Medial below the knee

Sciatic nerve block effect

foot and lower leg

Popliteal nerve block effect

foot and ankle

Ankle block effect

foot

Describe MAC

- Maintains consciousness

- Spontaneously breathes with supplemental oxygen

- surgeon may administer local anesthetic

- ASA monitoring still applies

- May need to offer verbal encouragement

- Varying levels of sedation, analgesia, and anxiolysis

If the patient loses consciousness and the ability to respond purposefully in MAC,

this is now a general anesthetic, irrespective of airway instrumentation

MAC goals

- Diagnose clinical problems during procedure

- Administer sedatives, analgesics, hypnotics, and other meds

- psychological support

- physical comfort

- support vital functions

Prep for case/setup

Research case the night before

Machine check

Airway set up

Drug set up

Stocking if necessary

DAMMITS

Drugs, Airway, Machine, Monitors, IV, Tape/Tank/Table/Transfusion, Suction

Induction agent pantone color

Yellow

Benzodiazepine and tranquilizer pantone color

Orange

Benzodiazepine Antagonist pantone color

orange with white diagonal stripes

Muscle relaxant pantone color

Red

Relaxant antagonist pantone color

Red with white diagonal stripes

Narcotics pantone color

Blue

Narcotic Antagonists pantone color

Blue with white diagonal stripes