Moderate Sedation Technique questions and answers graded A+

What permits early discovery of potential problems of moderate sedation? What does this allow to be instituted? What have many states enacted? - Answer--monitoring of appropriate physiological functions of a patient -corrective measures to be instituted at a time to effectively prevent serious complications -regulations governing the use of GA and parenteral sedation What do monitoring devices deliver? What does the device do without the warning system? What is the norm for outpatient surgery? What do many techniques and devices available for? - Answer--audible or visual signal -simply measures -non invasive measures -monitoring CNS, respiratory system, CV system and temperature What are ten ideal characteristics of an ideal monitoring device? - Answer-1. safe 2. reliable 3. noninvasive 4. easily interpreted display 5. easily calibrated 6. stable 7. portable 8. easily integrated with other monitors 9. no technical aid required 10. inexpensive What are five things that preoperative monitoring include?When should these values be recorded? - Answer--blood pressure, heart rate and rhythm, respiratory rate, temperature, height and weight -at baseline and at a non-threatening time What is measured with the pulse? What is the frequency of assessment directly related to? What requires continuous monitoring? What are two ways they can be measured? - Answer--heart rate and rhythm -depth of anesthesia -sedation and general anesthesia -manually and electronically What are six accessible arteries for pulse determination and their location? Which two are monitored most frequently? - Answer--radial - ventrolateral wrist -brachial - medical anteecubital fossa -carotid - groove between SCM and trachea -labial - upper lip -facial - antegonial notch of mandible -superficial temporal - anterior to tragus of the ear -radial and brachial What do palpable pulses reveal? In what locations? - Answer--minimum systolic blood pressure -radial 80 mmHg, brachial 70mmHg, carotid 60mmHg What does blood pressure reflect? When should it be determined? What pressures should raise a red flag?How can you measure it? How is manual BP obtained? - Answer--CV status of the pt -routinely -systolic greater than 150 or diastolic greater than 100 -manual or electronic -stethoscope and sphygmomanometer (blood pressure cuff) For a manual blood pressure, where should the cuff be placed? What should you palpate? When should you inflate the cuff until? When do you deflate the cuff? What does the first sound represent? What represents the diastolic pressure? What will a small cuff do? What will a large cuff do? - Answer--upper arm proximal to the antecubital fossa -radial pulse -until the radial pulse disappears and inflate 20-30 mmHg beyond that point -while osculating the brachial artery -systolic pressure -when the sounds become muffled -falsely elevate the BP -decreases the BP What do automatic BP monitoring provide? How can you directly monitor blood pressure? What method is the most accurate? Who is this method reserved for? - Answer--systolic, diastolic, mean pressures, and HR -invasive arterial line -invasive arterial line-high risk during GA What does an EKG provide? What type is often used? What is it usually used for? - Answer--means of monitoring heart rate and rhythm and recognizing dysrhythmias -lead II opposed to a full 12 lead EKG -GA or high cardiac risk pts undergoing conscious sedation How important is monitoring respiration? What do most drugs do? What is usually observed before CV changes? What is associated with significant morbidity and mortality? - Answer--equal or greater importance than monitoring the CV system -depress the respiratory system more than the CV system -breathing alterations -unrecognized respiratory depression, hypoxia, and hypercarbia How can respiratory adequacy be crudely monitored? What does chest movement not guarantee? What is the primary cause of cardiac arrest during sedation? Why is observing mucous membrane color not reliable? What may rubber dam placement do? What should you always remember to do? - Answer--monitor rate, observing chest rise and fall, observing color of skin and mucous membranes or inflation/deflation of reservoir bag -air exchange -ischemia of the heart secondary to respiratory arrest or obstruction -bc hypoxia precedes cyanosis -may mask visible symptoms of respiratory depression -look, listen, feelWhat are three types of monitors for respiration? - Answer-1. precordial or pre tracheal stethoscope (custom fit earpiece, wireless and blue tooth earpieces, REQUIRED for GA) 2. esophageal stethoscope (used for GA) 3. pulse oximetry (indirect monitor) What does monitoring breath sounds and respiratory rate NOT provide? What is an accurate analysis of breathing effectiveness? What does this require? What does pulse oximetry provide? - Answer--accurate assessment of ventilatory efforts -monitoring of arterial blood gases (o2 and co2) -invasive monitors -simple noninvasive assessment of arterial oxygenation What does pulse oximeter measure? How is it expressed? What is oxygen saturation? What is pulse oximetry based on? - Answer--oxygen saturation of arterial blood -percentage -amount of oxygen carried, compared with the total capacity of the hemoglobin -assumption that hemoglobin exists in two principle states: oxygenated (HbO2) and reduced (Hb) How is arterial oxygen saturation (SaO2) defined? What does the oximeter measure? What is oxyhemoglobin measured at? What is reduced hemoglobin measured at? How are these used? - Answer--ratio of HbO2 to total hemoglobin (HbO2 + Hb) --> SaO2 = HbO2/HbO2 + Hb -absorption of selected wavelengths (660 and 940 nm) of light passing through living tissue (fingertip or earlobe)-940 nm -660 nm relative percentages of these two are calculated and SaO2 is determined What is the measure of Co2? How can these levels be monitored? What principles do they use? What do the devices monitor? In what type of patients are these monitors less accurate in? What are they required for? - Answer--capnography -non invasive monitors -infrared absorption -levels of inspired and end tidal CO2, providing visual displays as a percentage or in mmHg -non-intubated pts -all moderate/deep sedations required by iowa code as of Jan 1, 2014 What is temperature not usually as critical for? When is it important to detect an elevated temp? Why is intraoperative temperature monitoring important? - Answer--CV or respiratory parameters -pre op -to prevent hypothermia and detect hyperthermia What does moderate sedation allow? What increases as depth of sedation increases? What must you sole rely on once unconsciousness occurs? What equipment is needed for moderate sedation? - Answer--communication w/ patient and appropriate response to commands -need for more sophisticated monitoring devices -monitoring to assess pt's status-IV supplies, appropriate monitors, emergency supplies What are any practitioners administering any type of anesthesia required to be? What is a sedation permit in Iowa required for? What is required for administration of moderate to deep sedation? - Answer--familiar with state code and requirements for additional licensure or training prior to administering sedation -administering sedation beyond minimal sedation or nitrous -ACLS certificaiton What do auxiliary staff need to be trained in and capable of? Who needs to be present for sedative drugs to be given? Why is this important? - Answer--BLS and be able to help manage common emergencies associated with sedations -qualified staff -emergencies and medico-legally What needs to be documented pre operatively? When should this be completed? What is a significant medico-legal issue? - Answer--pt ID -physical ID (mallampati, heart/lung exam) -baseline vitals (HR, BP, SaO2 room air) -NPO, pregnancy status -IV placement, quality of infusion -review meds, medical hx for any changes -staff present -escort -before starting the procedure -timely documentationWhat are the ASA pre op fasting guidelines for: clear fluids ingestion of breast milk ingestion of infant formula or non human milk a meal What do clear fluids include? - Answer--2 hrs -4 hrs -6 hrs -8 hrs -water, fruit juice w/out pulp, carbonated beverages, clear tea, electrolyte solutions, black coffee, no more than 8 oz for pts >13 years of age What is an escort? How long are they required to stay? What needs to happen before treatment can proceed? - Answer--responsible adult must accompany every sedation patient to the appointment -duration of the tx and take the pt home -the escort must be spoken to What intraoperative documentation must be completed? What needs to be documented through recovery time? - Answer--drugs administered and wasted (both dose and time) -vital signs (continuous monitoring of HR, BP, O2, ECG rhythm documented in intervals of 5-15 min) -beginning and end times of procedures - times must correlate with times on the monitors -vitals What must you document post operatively? What else do you need to document? - Answer--that they were stable enough to discharge-discharge status (who, when, how) and verify by practitioner that the record is accurate (signature, electronic signature) What are the first 7 steps prior to administering sedation? - Answer-1. review hx, meds, etc 2. review consent and instructions 3. verify NPO and escort 4. place monitors and record baseline vitals 5. secure IV access 6. position patient 7. supplemental O2 administered via nasal cannula