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68 Cards in this Set
- Front
- Back
what is the basic thing you should think about for someone with nose and throat surgeries
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surgery is being done because something is wrong with the airway so adjust for what is wrong as needed.
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basic considerations for ENT surgeries
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possible alterations in patient airway
maintenance of airway sharing operative field with surgeon appropriate drugs appropriate and safe extubation |
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things that you may not be able to see when evaluating an airway but will impact airway are
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infection, FB, tracheal stenosis, vocal cord dysfunction, tumors, goiters, edema, signs of airway obstruction
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signs of airway obstruction when evaluating the airway
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snoring
apnea CPAP use large tongue extra tissue large tonsils |
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tracheal stenosis is seen in what patient populations
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neonatal babies that had trachs for a while
patients that were intubated or trached for a while |
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another thing to consider when evaluating the airway
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how will the anatomy change when the patient is induced (relaxed)
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what questions do you ask yourself when planning your airway management technique
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do you anticipate any problems with mask ventilation (OBESE)
should the patient be easy to intubate with DVL what are my back up plans? |
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because the bed is often turned away from you, it is critically important that you constantly
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assess for circuit disconnect and loss of an airway
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assessment tools you should use in ENT surgeries include
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precordial or esophageal stethoscope, capnography, and pulse ox, machine alarms
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why is airway monitoring so important in ENT surgeries
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because surgeon may move ETT either intentionally or accidentally and that you are farther from the patient and have worse access if something goes wrong
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what about the supine position in ENT surgeries
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tuck arms at side to prevent brachial plexus injuries as surgeon may move head from side to side and out of neutral position
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what about rotating the bed for surgeon access
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make sure circuit is long enough and not under tension
make sure monitor wires will accommodate rotation always disconnect circuit before moving bed hold the ETT and head when positioning patient extend IV lines |
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signs of extubation or circuit disconnect
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loss of chest rise
loss of breathsounds through precordial stethoscope loss of ETCO2 loss of airway pressures alarming machine decreasing saturation |
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signs of loss of cuff seal
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loss of airway pressures
decreasing tidal volume increasing inspiratory pressure SMELL OF GAS |
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narrowing, occlusion, or pinching of the airway tube will show up as
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rise in peak airway pressure
decrease in inhaled volume |
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Oral RAEs are used for
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cleft palate repair
tonsillectomy UPPP and eye and upper face procedures |
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UPPP stands for
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uvulopalatopharyngoplasty
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RAE stands for
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Ring Adair Elwynn
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the nasal RAE is used for
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maxillofacial surgery
some cosmetic surgeries malocclusion or cases where jaw is wired shut |
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nasal RAEs should not be used if
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cribiform plate is disrupted
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examples of special tubes for NT procedures
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anode
armored reinforced |
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read article about tubes
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read article about tubes
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anode tubes are
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armored tubes that are imbedded with a coiled wire to produce a very flexible tube that resists kinking
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anode tubes are useful when
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extreme neck flexion is required
prone cases sometimes |
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what tubes should be placed with a stylet
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anode or armored tubes
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if pt is to be vented post op, the armored tube
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should be exchanged for a regular ETT
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a problem associated with the reinforced tubes
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if tube gets bit down, will not resume normal shape, so will have narrowed airway that can cause NPPE
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what should you use with reinforced tubes
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bite block
lidocaine spray since tubes are sticky |
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laser stands for
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light amplification by stimulated emission of radiation
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4 types of lasers used in surgery
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CO2, YAG, KTP, Argon
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wavelength of CO2
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long - 10,600 nm
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wavelength of YAG
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short - 1060 nm
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wavelength of KTP
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short - 532 nm
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wavelength of Argon
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short - 488 nm
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the longer the wavelength, the greater the
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absorption by water and therefore the less tissue is penetrated
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does CO2 or YAG have a more superficial effect
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CO2
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YAG stands for
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yttrium aluminum garnet
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KTP stands for
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potassium titanyl phosphate
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a laser is
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a device capable of producing an intense beam of light that can be focused to produce precisely controlled coagulation, incision, or vaporization of tissues with minimal post op edema or pain
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color of eye protection for YAG laser
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green
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color of eye protection for CO2
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clear plastic
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color of eye protection for KTP
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orange - red
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color of eye protection for argon
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orange
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hopefully, the circulating nurse in the laser room has
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the appropriate eye protection for you
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pg 10s chart i don't think we really need to know but feel free to look it over because I'm not putting it in here
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pg 10s chart i don't think we really need to know but feel free to look it over because I'm not putting it in here
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advantages of laser surgery
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hemostatic operative environment
decreased - blood loss, edema, scarring, post op pain, recovery time, hospital stay, sick time no touch technique, potential cost savings |
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what is critical in laser surgeries
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that patients remain completely immobile
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what is common during and after laser surgery in the larynx and pharynx
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bronchospasm and laryngospasm
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hazards of lasers
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transmission of disease via inhaled particulate
misdirected laser beam cutting other internal organs or blood vessels ocular injury with energy transfer if not wearing goggles |
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in laser surgeries remember to help patient by
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protecting their eyes with saline soaked pads after taping them shut
or putting goggles on them too |
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example of disease caught from inhalation of smoke plume
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genital herpes are burned off but the particulate has been inhaled by GYN providers to result in herpetic lesions in the lungs
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risk of disease transmission from lasers is reduced by
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wearing high efficiency masks (brown)
efficient smoke evacuator systems |
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are airway fires common
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they are not uncommon
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what type of tube should you not use with a laser
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PVC ETT are highly flammable
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airway fires can be caused by
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laser or cautery use
flammable ETTs |
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2 methods of reducing flammability of ETT
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wrap tube with Merocel (a metallic foil that Gayle hasn't seen used in years)
Xomed tube - has a laser resistant coating of aluminum powder |
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even if the tube isn't burning
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it could retain heat that will burn the patients airway
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describe a laser tube
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double balloon so outer balloon is filled with a dye so you know if the cuff ruptures and it will also help put fire out
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why don't most people use laser tubes with laser surgeries
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too expensive
uses regular tube but fills cuff with saline and a little bit of blue |
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what can you do to reduce risk of airway fires
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decrease oxygen concentration to less than 40% (ideally 30%)
avoid nitrous apneic technique substitute helium for air |
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advantage of helium
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permits smaller ETT use without turbulence and high resistance because has a lower viscosity
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describe the apneic technique
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ventilate
disconnect ETT to let surgeons work reconnect and ventilate and continue to alternate with surgeon |
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what to remember with apneic technique and in general to prevent airway fires
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cuff should be fully inflated
patient should not be breathing |
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because cuff is vulnerable to puncture, you should
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inflate cuff with methylene tinted saline
color lets surgeon know it's ruptured saline absorbs the heat and may quench the fire |
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airway fire protocol
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stop ventilation
pull ETT turn off oxygen and disconnect circuit extinguish fire ventilate with mask and reintubate |
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once patient is reintubated after an airway fire, you should
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assess airway damage with bronchoscopy and ABG
assess oropharynx and face consider bronchial lavage and steroids obtain CXR |
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general safety tips for lasers and fire safety
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OR fires are closed claims
put warning signs on doors if laser in use patient and staff eye protection matte finish instruments reduce beam dispersion laser in standby mode if not in use |
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other anesthesia safety tips
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volatile agents can potentiate a fire
balanced technique is considered short acting muscle relaxants are good for table glue length of case |