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142 Cards in this Set

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