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What test is used to diagnose corneal abrasion?
Fluoroscein with Wood's Lamp
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T or F, the cornea has an excellent blood supply?
False, there is no blood supply
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What is the most common injury after GA?
corneal abrasion
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What factors increase likelihood of corneal abrasion?
Long surgery, head and neck surgery, prone and lateral positioning
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When should the anesthetist tape the patient's eyes?
When the pt can't protect their eyes, so with GA and deep sedation.
With GA should tape eyes right after induction
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What is lagopthalmus? Why do we care?
Inability to fully close eye lid
Patients need extra precautions to make sure eye lid is fully closed before taping
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What is Bell's Phenomenon?
Protective eye reflex, eye moves up and out when threatened
This reflex is abolished under GA
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What are strategies to protect the eyes?
- -Tape them COMPLETELY shut after loss of lid reflex
- -Assess integrity of take periodically and after each position change
- -Retape PRN
- -Place oximeter on non-dominant hand and don't use middle or index fingers
- -Eye lube
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T or F, during GA the anesthetist should frequently do eye assessments to monitor anesthetic depth?
F, it's unnecessary as there are other ways to monitor depth and it poses more risk than benefit
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When is eye ointment indicated?
- Cases longer than 4 hours
- Head and neck cases
- Pts with difficulty closing eyes
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What are 2 major factors leading to dental injuries?
- -Poor dentition
- -Difficult airway
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T or F, the pre-op assessment should document missing, loose, or broken teeth?
T!!!
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Dental work does not need to be documented, T or F
F!
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If the pt has a loose tooth and don't care if it gets removed with laryngoscopy, is it ok to proceed?
No, if the anesthetist feels the tooth is likely to come out, a dental consult is needed to remove the tooth
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We are able to promise the patient that no damage will occur to their grill?
F! Pt needs to be aware that damage is possible.
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Is a post-operative dental exam necessary?
Yes, need to assess for damaged or missing teeth
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We don't need to use bite blocks because pts are under GA and won't be biting the tube, T or F?
F! Always insert a soft bite block (gauze) and document it
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What do you do if you damaged the teeth?
Document it, save dislodged pieces, get CXR if suspect aspiration, call risk management
-As SRNAs we need to tell preceptor and Sue (!)
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What's the most common cause of hemoptysis?
Bronchitis
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What are the components of the physical exam of the chest?
- Inspection
- Palpation
- Percussion
- Auscultation
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What does inspection involve?
Resp rate, depth, and pattern
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What are we assessing with palpation?
Chest expansion, vocal fremitus (increased over areas of consolidation), pleural friction rub
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What sound should we hear when percussing a normal lung?
Resonance
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What is a hyperresonant sound indicative of?
COPD
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What is a dull sound indicative of?
Consolidation or pleural effusion
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What is the normal lung sound heard on auscultation?
Vesicular
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Where are bronchial breath sounds heard?
Best heard over trachea, also over an area of consolidation
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What pts should have PFTs?
-Lung surgery patients
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What is the #1 most common restrictive lung disease?
Obesity
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When is a CXR indicated?
- -Pts with a h/o or clinical evidence of active pulmonary disease
- -May be routinely done in older pts
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How long should we preoxygenate a normal pt for? An obese pt?
Normal- 3-5 minutes or 3-4 VC breaths
Obese- 5 mins with a tight mask
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What is the goal of pre oxygenation?
Give O2 and get rid of N2
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What are causes of ETCO2 changes intraoperatively?
Incr CO2- hypovent, MH, sepsis, rebreathing, admin of bicarb, insufflation of CO2 during lap
Decr CO2- hypervent, hypothermia, low CO, PE, accidental disconnection or extubation, cardiac arrest, machine calibration
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