Term
List the steps (in order) of the
AIRWAY FIRE PROTOCOL |
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Definition
1) STOP ventilation
2) PULL Endotrachial Tube
3) TURN OFF oxygen & disconnect circuit
4) EXTINGUISH fire w/ saline
5) VENTILATE with face mask (and reintubate)
6) ASSESS airway damage w/ bronchoscopy &
ABG's
7) ASSESS oropharynx & face
8) consider BRONCHIAL LAVAGE & STEROIDS
9) obtain CXR |
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Term
List four general safety tips that should be enforced when laser is being used. |
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Definition
1) Place warning signs outside the room indicating a laser is in use.
2) All staff & the patient should have eye protection.
3) Matte-finished insturments should be used because they reduce beam dispersion ("hey doc, I'm ur CRNA today & I'm concerned u might not be using matte-finished instruments....")
4) Place laser in standby mode-(when its not being used of course!) |
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Term
Can u think of any Anesthesia Safety Tips related to fire safety???
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Definition
-Watch your volatile agents-they can potentiate a fire!
-You may need to utilize a balancing technique.
-Consider short acting muscle relaxants!
-Take into consideration the length of the case. |
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Term
What are the FOUR most frequently performed ear
surgeries?? |
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Definition
-Tympanoplasty
-Mastoidectomy
-Stapedectomy
-Myringotomy w/ tube insertion |
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Term
Name the most common pediatric ear surgery. |
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Definition
Myringotomy w/ tube insertion |
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Term
Why are PE (pressure equalizing) tubes placed? |
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Definition
1) Chronic serous otitis media
2) Recurrent otitis media |
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Term
What is the manifestation of chronic serous otitis? |
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Definition
Fluid build up in the middle ear |
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Term
Define recurrent otitis media. |
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Definition
More than 6 episodes of ear infections in a given year
(untreated it can lead to permanent hearing loss) |
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Term
Children w/ recurrent otitis media may exhibit what? |
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Definition
delayed speech or a speech impediment
(that will resolves when they can hear!) |
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Term
Many children will present on antibiotics, Why?? |
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Definition
-URIs are frequently seen in children w/ CHRONIC OTITIS
-the intervals between URIs may be brief (so its not unlikely to see a URI free child)
**TREATMENT w/ PE tubes will resolve the URI**
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Term
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Definition
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Term
What is the cause for a possible delay in emergence during myringotomy w/ PE tube placement? |
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Definition
the operation is SHORT less than 10 min!!
Sedative premeds or intraop opiods may outlast the surgery |
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Term
When would you try to get an IV access on a child? |
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Definition
After he/she is masked to sleep (DUH!) |
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Term
Describe the problem w/ nitrous oxide & middle ear surgeries. |
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Definition
Nitrous oxide is 34 times more soluble than nitrogen.
Nitrouse enters air-filled cavities (middle ear) more rapidly than nitrogen can be absorbed by the blood.
This causes an increase in middle ear pressure.
Since there is a problem w/ the middle ear pathology the normal venting of the pressure through the Eustachian tubes into the nasopharynx doesn't occur. |
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Term
Sooo, can you use Nitrous in kids getting PE tubes? |
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Definition
YES!!!!!
Because the operation is short (& nitrous related pressure takes some time to develop)
The PE tubes will equalize the pressure |
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Term
Your masking your kid, things look good, oh crap when do I turn off the gas? |
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Definition
During the 2nd ear PE tube placement
(This will help facilitate emergence or spontaneous ventilation & make your surgeon happy (: |
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Term
Name FOUR techniques you can use as a CRNA to help with postoperative pain control. |
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Definition
1) NASAL FENTANYL (1-2 mcg/kg)
2) DEMEROL IV
3) RECTAL FENTANYL
4) TYLENOL SUPPOSITORIES (15 mg/kg) |
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Term
Being the excellent CRNA that you will be, when is the best time to give the nasal fentanyl? |
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Definition
In between the ear tubes (afterall that is where the nose is located LOL) |
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