Ap I Exam 3: Emergence And Pacu Icu Transport

Front 1

AP I EXAM 3: EMERGENCE and PACU ICU TRANSPORT

Back 1

AP I EXAM 3: EMERGENCE and PACU ICU TRANSPORT

Front 2

What does IV or inhalational anesthetics do to the ventilatory responses?

Back 2

It blunts it. Both hypercarbia and hypoxemia.

Front 3

What is apneic threshold?

Back 3

PaCO2 where spontaneous ventilation is initiated.

Front 4

CO2 level during emergence process?

Back 4

Need to increase PaCO2

Front 5

How do you increase PaCO2?

Back 5

1. adjust RR & Vt
2. maintain FiO2 > .85 during hypoventilation (except COPD)

Front 6

What do NMB drugs do?

Back 6

Interrupt transmission of nerve impulses at NMJ of skeletal muscle.

Front 7

Succinylcholine

Back 7

Depolarize the end plate of nicotinic receptor.
1. short duration
2. depolarize end plate, then diffuses away

Front 8

Dose of succinylcholine?

Back 8

1mg/kg

Front 9

Side effects of Sux?

Back 9

1. bradycardia
2. fasciculation
3. hyperkalemia
4. myalgias
5. malignant hyperthermia

Front 10

What type of receptor does SUX act on?

Back 10

Muscurinic

Front 11

Non depolarizing NMB:

Back 11

1. inhibits cholinergic receptor
2. does NOT bind to Ach. Just block Ach receptor sites.
3. the non-depolarizers get pushed off as Ach continues to be released.
4. then non-depol get metabolized.

Front 12

Which muscle is a good monitoring neuromuscular function during intubation?

Back 12

Orbicularis oculi

Front 13

Which one is better for emergence?

Back 13

Adductor pollicis

Front 14

Which muscle is most resistant to sensitivity?

Back 14

Vocal cord

Front 15

Which is most sensitive?

Back 15

Extraocular

Front 16

ToF

Back 16

4 stimulations at 2Hz (0.5s)

Front 17

Tetany

Back 17

50-100 Hz usually 5 sec long

Front 18

Head lift greater than 5 seconds is equivalent to?

Back 18

ToF ratio > 0.7

Front 19

0 twitch is equal to percentage of receptors blocked by drug?

Back 19

99%

1 twitch: 95%
2: 90%
3: 85%
4. 75%

Front 20

The parent of a child hospitalized with acute glomerulonephritis (AGN) asks the nurse why blood pressure readings are being taken so often. The nurse's reply should be based on knowledge of which of the following?
BP fluctuations are a common side effect of antibiotic therapy
BP fluctuations are a sign that the condition has become chronic
Acute hypertension must be anticipated and identified
Hypotension leading to sudden shock can develop at any time

Back 20

Acute HTN must be anticipated and identified: Vital signs, in particular BP, provide information about the severity of AGN and early signs of complications. Acute HTN is anticipated and requires frequent monitoring for early intervention.

Front 21

Reversal is done by what type of drugs?

Back 21

ANTIcholinesterase

1. inhibits acetycholinesterase

Front 22

What are some examples of anti-muscurinic?

Back 22

Glycopyrolate or atropine

Front 23

Neostigmine

Back 23

Max is: 0.07mg/kg

Peak onset: 5-10min

Front 24

Is reversal necessary?

Back 24

1. make sure if the pt is adequately reversed.
2. if not, then use drugs

Front 25

How do you assess for adequacy of ventilation?

Back 25

1. via arterial blood gas
a. PaO2> 65 on FiO2<0.40
b. PaCO2 < 50 torr
2. ETCO2
3. SpO2: >90%

Front 26

The need for NAW

Back 26

Establish airway prior to extubation for pts that have obstructive issues:
1. obesity
2. OSA
3. Hx snoring

Front 27

OSA

Back 27

CPAP would help

Tongue is usually the tissue that causes the obstruction during sleep.

Front 28

What usually causes the arousal of OSA pts?

Back 28

Hypoxia

Front 29

Factors that increase incidence of PONV?

Back 29

1. female gender
2. hypotension
3. non smoker
4. pain/narcotic use
5. swallowed heme
6. nitrous oxide

Front 30

Mechanism of anti-emetics?

Back 30

Works on the chemotaxic trigger zone brain area.

Front 31

What receptor antagonist does Zofran act on?

Droperidol?

Back 31

Serotonin 5-HT3

Droperidol: a dopamine antagonist

Front 32

Extubation criteria

Back 32

1. airway reflexes intact
2. clinical stability
3. intact neurological function
4. normal body temp
5. normal coagulation
6. head lift
7. ToF
8. RR: 5-30
9. Vt > 5cc/kg
10. PaCO2 < 50 torr
11. Resting MV < 10L/min
12. LOC
13. muscle relaxant reversed
14. PaO2 > 65 on FiO2 < 0.40

Front 33

What are some immediate hazards of extubation?

Back 33

1. laryngospasm
2. vomiting
3. hypoxia/loss of airway

Front 34

Purpose of deep extubation?

Back 34

1. minimize tracheal stimulation
2. minimize coughing/bucking

NOTE: coughing causes increased:
1. IOP
2. ICP
3. BP
4. dehiscence

Front 35

What are the contraindications of deep extubation?

Back 35

1. difficult mask airway
2. difficult intubation
3. aspiration risk
4. airway edema

Front 36

Citeria for deep extubation?

Back 36

1. MAC 1.3
2. NMB COMPLETELY REVERSED.
3. spont. ventilation at reg. rate/rhythm
4. NO AIRWAY REFLEXES
5. 100% O2
6. lidocaine

Front 37

What should you ALWAYS do when you DEEP extubate a pt?

Back 37

Keep the oral airway in place

Front 38

What should you do AFTER you deep extubate?

Back 38

1. Suction one more time
2. place mask on pt
3. keep hand on bag
4. test for airway patency
5. help them breathe if need be

Front 39

Awake tracheal intubation criterea?

Back 39

1. pt breathing 100% O2
2. consider using OAW/NAW/bite block
3. Sx oropharynx
4. deflate cuff
5. adm PPV with bag
6. remove tube