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142 Cards in this Set
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Georgia AA
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Special category Type B(specialist) PA
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What is ACT?
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Anesthesia Care Team
-collective group of properly rained and credentialed professionals involved in certain aspects of anesthesia care under the direction of the MDA |
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What does an AA do?
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-assist pre-anesthetic assessment
-assist in various preoperative tasks -administer and maintain anesthesia -placement and interpretation of monitoring devices -initiate and est. advance life support techniques -provides recovery room care -participates in other tasks assigned by supervising attending |
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AA credentialing body
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NCCAA
National Commission for Certification of AA's |
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Can AA's perform regional and place invasive moniors?
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Yes, but depends on institution
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Who created the concepts of AA's
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1960's- Gravenstein, Steinhaus, and Volpitto
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Purpose of AA creation
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alleviate shortage determined by task analysis study
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AA Scope of Practice
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"Responsibility and immediate care of patient must remain within the province of the anesthesiologist"
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1st 2 AA programs
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Emory and Case- 1969
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Regulatory pracice
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-licensed
-licensure created by legislation that is enacted into state law -better defines and anchors AA practice |
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Delegatory practice
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expressed in either statute or recognized by board of medicine that grants physician authority to delegate tasks
-remain ultimately responsible -assures qualification |
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regulatory states
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alabama
dc florida georgia kentucky missouri new mexico ohio oklahoma south carolina vermont north carolina |
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delegatory states
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colorado
michigan new hampshire texas west virginia wisconsin |
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AA program length v. CRNA program length
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24-28 months v. 24-36 months
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didactic hours and clinical hours
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AA didactic= 600
CRNA didactic= 450 AA clinical hours= 2600 CRNA clinical hours = 800 |
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exam questions for certification
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AA- over 200 questions
CRNA- 90-160 CBT |
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CME to keep cert
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40 hours every 2 years
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certifying exam fee
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1475
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CDQ exam application fee
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825
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late CDQ fee
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1475
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cert. reinstatement fee
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100
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registration processing fee
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75
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CME registration fee
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220
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Health Care professionalism factors
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1. work ethics
2. clinical autonomy 3. self-regulation |
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Work ethics
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1. self-sacrifice
2.. self-effacement 3. compassion 4. integrity 5. confidentiality |
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self-effacement
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clinical judgment should not be affected by differences between providers and patients, such as class, gender, and race, which can introduce irrelevant and destructive bias into clinical judgment and practice
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compassion
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constant awareness of patients pain and suffering
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Clinical Autonomy
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1. Knowledge
2. communication 3. clinical skills 4. judgment |
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communication
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decorum: appropriate behavior/conduct-how you address people
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Self-regulation
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1. unique to health professionals
2. entrance control 3. professional standing 4. hold each other accountable |
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Professionalism according to Hatem
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Respect compassion and integrity: responsiveness to needs of patients that supersedes self interest; accountability to patients, society and the profession; and commitment to excellence and ongoing professional development
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Professionalism according to Epstein
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Being aware of one's own mental processes, listening more attentively, becoming flexible, and recognizing bias and judgments, thereby acting with principles and compassion
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Student expectations
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1. create a map to clearly define outcome objectives
2. conventional course texts 3. use in-course assessments/observations 4. multiple judgments by many observers |
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Perceptions formed solely from your appearance
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1. your professionalism
2. your level of sophistication 3. your intelligence 4. your credibility |
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AAAA
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American Academy of Anesthesiologist Assistants
-est. and maintain the standards of the profession -represents the interests of the profession -initiate and cultivate relationships with other organizations www.anesthetist.org |
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ASA
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1905
$25 Student membership $225 educational member -sponsorship from two active ASA members |
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Surgery before anesthesia
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Hey saw- make aperture in the skull to relieve pressure on the brain
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early compounds of anesthesia
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mandragora
black nightshade poppies (egyptians) coca(incans) refrigeration alcohol and herbs phlebotomy compression |
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Introduction of Ether
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Jan. 1842
william E clark ether soaked rag for tooth removal March 1842-crawford long |
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Birth of Anesthesia
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Wells and his epic fail with N2O, 1844-1845
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Nitrous Oxide Intro
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Priestly in 1772.
first used in 1846-"letheon" at Mass general. |
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Term of Anesthesia
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Oliver Wendell Holmes-1846
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Disadvantages of Ether
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Flammability
prolonged induction/emergence high incidence of n/v |
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Intro of Chloroform
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1847- James Simpson from Scottland, John Snow popularized it
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John Snow
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Developed the concept of the MAC
-Developed stronger understanding of anes. physiology -Developed better anes. apparatus -fabricated first closed circuit device |
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Anes. Record
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Codman v. Harvey Cushing
Friendly competition |
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NIOSH
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National Institute for Occupational Safey and Health
-responsible for ensuring workers have a safe working envir. -makes standards |
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OSHA
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Occupational Safety and Health Administration
-responsible for enacting job health standards by investigating violations and enforcing standards |
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Hazards of Anes. Gases
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1967-Vaisman-anes gases may be harmful
1971-Cohen and ER nurses miscarriage 1972- knill-jones-increased spontaneous abortions/ birth defects 1973- Corbett- increased incidence of cancer in CRNAs in Michigan |
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NIOSH response to studies
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1977- recommendations for standards, exposure, and scavenging practices
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Trace anes gases
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-increased risk of spontaneous abortions
-decreased fecundabiliy |
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Physical Hazards
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-Trace anes gases
-lifting heavy weights -greater than 46 hour work weeks -changing work shifts |
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Trace Gas Hazard: Cancer
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Buring- increased cancer in female anes. personel
-cervical -lymphoma -leukemia No changes in male cancer rates |
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Chemical Hazards
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Methylmehacrylate
-exposre should be less than 8 hours Halothane (hepatitis) -Latex-13-16% sensitivity in anes |
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Radiation Hazards
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-diagnostic radiographs
-fluoroscopy -radiation therapy -PACU Precautions -lead aprons and shields -dosimeters -maintaining distance E=1/d^2 |
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Laser Hazards
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-thermal burns
-eye injury -electrical hazards -fire and explosions Laser plumes can contain viral DNA |
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Error in Anes. Management
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64% contributed to fatigue
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Transmission of Infectious Agents requires:
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-source
-stable pathogen -adequate numbers -infectivity of agent -appropriate vector -portal of entry |
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Respiratory Infection Hazards
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Aerosoliaztion
Self Innoculation |
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Aerosolization
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Small particles aerosolized by coughing
-influenza -measles -rhinovirus -TB |
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Self Inoculation
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Direct oral, nasal, or conjuctival exposure
-rhinovirus -resp. syncital virus |
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Influenza
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easily transmitted
36k deaths, 200k hospitalized resp. isolation precautionsm shed for 5 days |
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Classifications of Influenza
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-hemagglutinin H1-16
-Neuroamidase N1-9 -Avian Flu H5N1 -H3N2 Rx resistance 91% of flu viruses are resistant to antivirals |
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Rubeola
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Measles
-aerosol transmission highly infective-90% households maculopapular rash and koplicks spots -fever and 3 C's -30%immunosupressed |
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Rubella(paramyxoviridae)
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German measles
-most adults immune -miscarriages, 1st trimester -birth defects -health care workers at increased risk |
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Mumps(epidemic parotitis)
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-infection by airborn droplets
-painful swelling salivary and parotid glands -orchitis -symptoms not severe in children |
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Respiratory Syncytial Virus
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-most important cause of serious lower resp. disease
-60% of infants -100% 2-3 yr olds -self innoculation -prevalent nov-may -viable on a surface for 6 hours -shed virus for 7 days kids w/ asthma can hae this chronically |
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Rhinovirus
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-most common viral infective agents in humans
-transmission: self-inoculation and/or aerosolized particles -over 110 serological types - responsible for 50% of all cases of common cold |
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Herpes Virus
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Varicella-zoster
HSV 1 and 2 Cytomegalovirus |
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Varicella-Zoster
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Chicken pox and shingles
communicable 1-2 days before and lasts 5-6 days after -study showed that healthcare workers over 36 had VZV antibodies, whereas 7.5% younger population was susceptible |
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Herpes Simplex
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Type 1= oral lesion, adenopathy, fever
-self inoculation or direct contact -encephalitis -ocular- blindness |
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Herpetic Whitlow
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herpes inoculation of fingers/hand
-severe urticaria, erythema, and neuralgia site of infecion - often associated with fever, malaise, and lymphadenopahty -prevented by gloves when in contact with oral secretions -Dx Tzanck's Test |
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Cytomegalovirus
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CMV
-Usually occurs during childhood -40-90% adults have anitbodies -transmitted via direct contact -serious sequelae in pregnant women -primary or recurrent cmv infection during pregnancy results in fetal infection 2.5% (10% congential CMV syndrome) |
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Hep B
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3.5% prevalence
seroconversion up to 30% sexual contact, needles, perinataly 5% chance fetus of HBV mother will be infected. |
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Hep C
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-Leading cause of chronic liver disease in US
-9K new cases per year -Prevalence HCV in US is about 3% -60% HCV infected patients will have chronic hepatitis/cirrhosis Seroconversion=1.8% |
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TB
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USE BACTERIAL FILTER btwn anesthesia circuit and airway
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Principle Routes of Blood born infections
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-Percutaneous contact
-mucosal contact -non-intact skin exposure |
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Fluids documented to be infectious
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Blood
Blood products CSF Amniotic Plueral -Pericardial -Peritoneal -Synovial -Inflammatory exudates |
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Hand washing
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THE SINGLE MOST IMPORTANT ACTION IN PREVENTION OF THE SPREAD OF INFECTION
-minimum time of 15 seconds -rinse well to remove all soap |
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anticipate spraying or splashing of fluids?
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mask
eye protection gowns |
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MRSA
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Methicillin-resistant staphlococcus aureus
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VRE
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Vancomycin-resistant enterococci
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Clostridium Difficle
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overgrown pop= watery smelly shit
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Precautions for MRSA, VRE, C. Difficle
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Hand washing, gown and gloves, similar to contact precautions but more obsessive
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Droplet precautions
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Wear a mask within 3 feet of patients with:
Mumps, german measles, streptococcus, meningococcal |
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Disposal of Contaminated Materials
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Linen=blue bag
Needles and sharps=red reusable sterile gowns=green |
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NIOSH-95 MASK
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Use for TB
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Key Elements for Postexposure Management
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1. wound management
2. exposure reporting 3. evaluation of transmission risk 4. Serological testing 5. Considerations of PEP |
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Cleaning
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removal of foreign material
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Antiseptic
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chemical germicide used on living tissue
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Disinfectant
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chemical germicide for use on non-living items
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Sterile
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completely free of all microorganisms
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Sterilization
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process that results in probability of microorganism survival less than 1:1,000,000
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High Level Disinfectant
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Kills fungi, viruses, and vegetative baceria-except endospores
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Intermediate-Level Disinfection
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kills fungi, non small or nonlipid viruses, and bacteria-except endospores
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Low-Level Disinfection
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Kills fungi, some viruses (lipid/medium size) and bacteria-except TB and endospores
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Equipment requiring sterility
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any item that will enter or contact any body area that is normally sterile must be sterile at time of use
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Items requiring high level disinfectant
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any item that comes in contact with mucus membranes, but would not penetrate body surface mus be washed and cleaned with high-level disinfectant-LARYNGOSCOPES AND BRONCHOSCOPES!
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Chlorine
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Hypochlorite- most widely used of the chlorine disinfectants
1:100-1:1000 effective against HIV 1:5-1:10 effective against hep 1:10 for blood spills |
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Hydrogen peroxide
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25%-35%-effective surface cleaner and safe for rubber and plastic
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Sterilization types
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steam, chemical, gas, liquid, radiation, plasma
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Steam sterilization
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Autoclaving
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Autoclaving
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quick, cheap, effective with no residues
-kills everything with pressure and temp. |
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Min. Autoclaving times
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15 min @ 121 C
10 min @ 126 C 3.5 min @ 134 C -confirmed by indicator strip -used to sterilize metal instruments, laryngoscopes |
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Aseptic technique for medication
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alcohol swab to rubber septum or neck of glass ampule
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Use of syringes
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-single patient use
-used syringes discarded after use or at end of case\ -unused syringes should be stored in a clean area to avoid contamination by used syringes and equipment |
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Latex allergy-high risk groups
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-70% of latex allergies in health care personnel
-multiple surgical procedures(spina bifida, congential genitourinary tract anomalies) -History of hay fever, rhinitis, asthma, eczema -food allergies (avocado, kiwi, banana, chestnuts, stone fruit) |
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For patients with Latex allergy
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-schedule them as first surgery of the day
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Overall goal of preop assessment
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decrease perioperative morbidity/mortality
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Purpose of PreOp
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-Choose care plan to follow
-Obtain informed consent -Educate pt about anesthesia -Make pre-operative care more efficient and less expensive -obtain information |
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Basic Patient Information
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Age
Dates: Preop and surgery Surgery planned and surgeon patient identification |
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patient identification
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name, DOB, MRN
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Patient Vitals and Rx Rxn
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Baseline BP, pulse, rr, height, weight, body temp, known drug allergies
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ASA 1
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Healthy, no smoking, no or very minimal drinking
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ASA 2
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Smoker, more than minimal drinking, pregnancy, obesity, well controlled diabetes, well controlled hypertension, mild lung disease
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ASA 3
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Diabetes, poorly controlled HTN, distant history of MI, CVA, TIA, cardiac stent, COPD, ESRD, dialysis, ejection fraction below 40%
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ASA 4
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Recent history of MI, CVA, TIA, cardiac stent, ongoing cardiac ischemia, ejection fraction below 25%
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ASA 5
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Aneurism, intracranial bleed, ischemic bowel,
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ECG
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over 50 years old
DM over 40 years CV, PVD disease renal disease, smoker over 40 pack years, lupus |
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CXR
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Debilitating asthma or COPD
Cardiothoracic procedures Cancer, over 40 pack year smoker |
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Pregnancy Test
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Pregnancy might complicate surgery
Uncertain status |
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Normal Hgb Levels
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Male: 13-17.5 g/dl
Female: 12-16 g/dl |
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Normal Hct levels
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Male: 39-49%
Female: 36-45% |
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Plts levels
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150-450 x 10^3
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WBC levels
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4.5-11 x 10^3
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Platelet and Coagulation studies
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abnormal values associated with bleeding, anticoagulation Rx, Hepatic disease, EtOH, abuse,
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Coagulation levels
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PT- 10-14 sec (vit k, extrinsic)
INR 0.9-1.1-international ratio aPTT 20-40 seconds |
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Liver function
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Hx hepatitis exposure, hepatic disease, EtOH abuse, certain Rx
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Normal Liver values
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ALT 0-40 IU/L
AST 7-40 IU/L Ammonia 10-50 mol/L Bilirubin(total) 0.2-1.0 mg/dl Bilirubin (conj) 0-0.2 mg/dl |
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Alk Phosphatase ALP
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Male: 38-126
Female: 70 -230 U/L |
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Sodium
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135-145 mEq/L
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Potassium
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3.5-5.3 mEq/L
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Chloride
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95-105mEq/L
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CO2
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20-29 mEq/L
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BUN-blood urea nitrogen
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10-26 mg/dl
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creatinine
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0.6-1.3 mg/dl
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Glucose
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70-115 mg/dl
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NPO
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Non per os
pts with less than 25 ml gsatric contents with a ph over 2.5 -increased risk for pulmonary aspiration syndrome |
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when to expect a full stomach
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recent meal
pregnancy, regardless of NPO Bowel obstruction septic shock morbid obesity parkinsons achalasia trauma |
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Preop Fasting guidelines
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Clear liquids-minimum 2 hours
Breast Milk- 4 Infant formula- 6 non-human milk-6 light solid foods- 6 |
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Communication problems?
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language barrier
vocal cord paralysis laryngectomy cerebral involvement |
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Smoking history
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Predisposes pts to
-COPD -Emphysema -Current O2 requirements Infections -bronchitis -recent URI -chronic infections Sleep apnea asthma |