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13 Cards in this Set
- Front
- Back
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General anesthesia monitoring includes?
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ECG- 5 lead
Blood pressure q 5 at a min./ q 2.5 at induction O2 sat ETCO2 Inspired O2 SM 6-10 lpm Temperature- must in Peds PNS- if you are paralyzing Gas anaylzer- end tital measurements usually |
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Pre-case machine and monitor check
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set alarm parameters
alarms volumes > radio |
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Pre-op preparation
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H&P
Meds Labs – i.e. glucose monitoring Observations of patient Technique |
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Precordial stethoscope placement
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Adults – supraclavicular notch or apex of the lung
Children – left side of chest |
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ventilation considerations
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Ventilatory volumes and flows
Patient’s ventilatory drive Apnea Resp muscle strength Compliance and Resistance Vent Pressures |
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WHAT FACTORS AFFECT RELIABILITY OF PULSE OXIMETRY CAUSING A FALSE LOW?
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methylene blue
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Clinical Conditions Causing Decreased EtCO2?
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Hyperventilation
Hypothermia Impaired Pulm circulation (ie air embolism) Shock Air Embolism Contamination…by room air |
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Clinical Conditions Causing Increased EtCO2?
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Hypoventilation
Hyperthermia Increased Metabolic Rate (malignant hyperthermia) IV Sodium Bicarb Rebreathing Exhausted CO2 absorbent(will change color; dry and hard) Faulty breathing circuit valves Tourniquet Release (release of CO2 from extremity) |
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When do we monitor temperature?
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General – Intermittently or continuously monitored and recorded
Always on children! |
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What factors affect temp?
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Room temp (cold)
Length of surgery Surgical Prep Fluid Replacement Irrigation Fact: Lose 1–5 C in core temp in 1st hour |
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Urine output monitoring?
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Direct Monitoring - Not every case
Usually if case > 4 hrs (healthy) Cases with large fluid shifts, patient hemodynamically unstable.. 0.5ml/kg/hr – 1ml/kg/hr |
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Giving a Break/ Leaving
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Report
Review the monitors together Document the exchange |
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When giving break or leaving..what to do in report?
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Patient status (ASA, pathophysiology)
Procedure and course of surgery Anesthesia plan, course and problems ( eg. Hypotension, bronchospasm) Meds and last time of dose Fluid, blood, urine status Airway (difficult intubation, tube size) Any other important or unusual aspects |
