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Induction, maintenance, emergence

describe what happens in the holding area pre-op 1. ID by surgeon, nursing, and anesthesia 2. check ID band - ask pt for DOB 3. paperwork must be done before pt is moved from holding area 4. pt may receive sedation for anxiolysis 5. taken to OR via stretcher
how is pt transfered from stretcher to OR table do not let patient move until there is one person on each side and bed is locked; anesthesia must say "the bed is locked"; pt moves themselves to table; DOCUMENT!! Nurse places safety straps and padded arm rests (45*)
explain how monitors are placed before start of procedure BP cuff; place face mask near pts face to preoxygenate; place SPO2, EKG, BP, BIS, temp
what airway equipment do you need set up before induction place airway equipment at head of bed: ETT, laryngoscope handle and blade, oral airway and tongue depressor, suction
describe the proper order of steps for induction inject induction agent (propofol, barb, etomidate, high dose opioid, etc.); hold mask gently, check for loss of lid reflex; tape eyes closed; mask ventilate patient
if you are unable to ventilate the patient what should you do change patient head position; change arm position; place oral/nasal airway
after you know you can mask ventilate patient, describe the sequence of events for intubation inject neuromuscular blocking agent; wait until effect (PNS); intubate; confirm with proper methods (listen, ETCO2, condensation in tube, airway compliance when bagging)
after intubation; describe the proper steps to finish place patient on ventilator and turn vent ON; lower O2 flows, turn on VAA; secure the ETT; insert esophageal stethoscope; insert soft airway if needed; check pt final position; HIGH FIVES ALL AROUND!!!
an anesthetic must consist of ...(5) 1. unconsciousness/hypnosis/sedation 2. analgesia (pain) 3. amnesia (memory) 4. hemodynamic stability 5. control of movement
what is general anesthesia induction of a state of unconsciousness with the absence of pain
anesthesia performed under general occurs in 4 stages (Guedel stages of anesthesia) analgesia; excitement; surgical plane; anesthetic crisis
describe stage 1 of guedel analgesia: patient experiences analgesia but remains conscious and able to communicate
describe stage 2 of guedel excitement: pt may go bat-shit (delirium) and become violent; BP increases and becomes irregular; RR incr; may vomit or laryngospasm; effects may be bypassed by premedication and punching him in the face; avoid noxious stimuli
describe stage 3 of guedel surgical stage: in which surgery can be performed; RR is regular; constriction of pupils; stopping of involuntary movement; loss of vocalization
describe usual pupil size and reaction to light for each stage of guedel 1. normal 3-4mm; moderate constriction to light (1-2 mm) 2. normal 3-4 mm; pinpoint to light 3. normal moderate constriction 1-2 mm; no change to light 4. dilated/blown; no change to light
stage 3 of guedel is divided into how many planes 4
describe stage 3, plane 1 of guedel light anesthesia - pt has a lid reflex; swallowing and airway reflexes intact; regular respirations and good chest movement
describe stage 3, plane 2 of guedel loss of blink reflex; pupils are fixed in one position; respiratory rate is regular (comfortable for surgery)
describe stage 3, plane 3 of guedel loss of chest movement, and ab muscles; shallow and assisted breathing
describe stage 3, plane 4 of guedel no chest movement, and diaphragmatic breathing; deep surgical anesthesia
describe stage 4 of guedel anesthetic crisis; respiratory arrest, circulatory collapse, death
what are the generally accepted induction dosages for the average adult in proper induction sequence 1. versed 1-2mg 2. fentanyl 50-100 mcg 3. lidocaine 100 mg 4. propofol 150-200 mg 5. succs 160 mg or roc 50 mg
will you see all stages of guedel nope - some of the stages can occur quickly and may not all be observed
in what guedel stage can ventilation occur (after loss of lid reflex) stage 3, plane 2
what is the dose, onset and duration of rocuronium 0.4-1.2 mg/kg, onset 45s-3m, duration 25-30m
what is the dose, onset and duration of vecuronium 0.1 mg/kg, onset 1-2m, duration 45m
what is the dose, onset and duration of succs 1-2 mg/kg, onset 45s, duration 3-5m
when is the right time to intubate? 1. establish neuromuscular blockadge (0/4 on TOF) 2. adequate depth of anesthesia to blunt hemodynamic response 3. hemodynamic status must be maintained (BP/HR/sats) 4. BIS level ~ 60
what type of injuries can occur with arm positioning ulnar nerve and bracheal plexus injuries
what injuries can occur with oral airways and mask ventilation oral airway can cause pressure on mucosa; mask ventilation can cause pressure necrosis and nerve damage
what are the goals during maintenance phase analgesia; unconsciousness; skeletal muscle relaxation; control o sympathetic response; balance medication while maintaining hemodynamics and vital functions
what are 4 considerations of fluid management during maintenance 4-2-1 rule; hourly maintenance; blood loss; urine output
when preop planning of maintenance plan, what things should you consider VAA vs. TIVA; narcotics?; NMBD?
when should you be planning emergence before induction
what criteria must pt meet before giving reversal at least 1 twitch present on TOF to give reversal
what is the dosage for neo and glyco 0.035 - 0.07 neo 7 mcg/kg glyco usually ends up being 1cc:1cc
what the doses for toradal and zofran toradal 30 mg IV/IM for pain; zofran 4 mg IV for PONV
what is the criteria for extubation MACawake; adequate spontaneous respirations; Vt > 7-10 cc/kg; sats > 95%; NIFs > 20 cmH2O; follows commands - open eyes, hand grasp and release, head lift > 5 seconds
what are indications for RSI: full stomach, pregnant, GERD, trauma, difficult airways, you're on call, its after 5pm, you need to poop, they just delivered the chinese food, etc.
when should cricoid pressure be applied during RSI while NMBD (succs) is being injected
should you mask ventilate during RSI noooooo yo
what are ways to maintain temperature regulation in the OR bear hugger; foam noses on breathing circuit to maintain warmth and humidity; fluid warmer; IV line underneath bear hugger; warm the room (peds); warm blood products
what can be damaged in lower extremities from poor positioning femoral, obturator and sciatic nerve injuries in lower extremities
what type of head rest maintains neutral position shea head rest
who is ultimately responsible for positioining in the OR YOU the anesthetist
what are the most common types of positioning supine, prone, lateral, lithotomy
what does edentulous mean no teeth you f'in hillbilly
how do you get mac ratio mac awake / mac
potent anesthetics have a mac ratio of 0.3-0.4 (des, sevo, iso)
weak anesthetics have a mac ratio of 0.6 (N2O)
what are the most common VAAs used for inhalational induction sevo, halo
when would you use mask induction (inhalational induction) peds, newborns, special needs adults and children; developmentally normal children, adults, anxious adults
what are sedative hypnotic INDUCTION doses for propofol, pentothol, etomidate, ketamine, versed and fentanyl according to his screwed up ppt that doesnt match the book propofol 1.5-2.5 mg/kg Na TPL 1-1.5 mg/kg etomidate 0.3 mg/kg ketamine 2-4 mg/kg versed 0.07-0.15 mg/kg (0.1-0.4 mg/kg in book) fentanyl 50-100 mcg/kg
does emergence go through guedel steps in reverse order? si
Created by: rwilson