Term
| WHAT IS THE PROCESS OF CLINICAL ASSESSMENT THAT PRECEDED THE DELIVERY OF ANESTHESIA CARE FOR SURGERY AND NOR NON-SURGICAL PROCEDURES? WHAT TYPES OF PATIENTS RECEIVE THIS? |
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Definition
| PREOPERATIVE ASSESSMENT. ANYONE WHO RECEIVES ANESTHESIA GETS A PREOP EVAL. |
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Term
| WHAT IS THE GOAL OF THE PREOP EVAL? |
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Definition
| TO OBTAIN PERTINENT INFO REGARDING THE PATIENT'S CURRENT AND PAST MEDICAL HX AND TO FORMULATE AN ASSESSMENT OF THE PATIENTS INTRAOPERATIVE RISKS. |
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Term
| INADEQUATE PREOPERATIVE PLANNING AND INCOMPLETE PATIENT PREPARATION ARE COMMONLY ASSOCIATED WITH WHAT? |
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Definition
| ANESTHETIC COMPLICATIONS. PREOPERATIVE EVALUATION GUISED THE ANESTHETIC PLAN. |
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Term
| WHAT SHOULD YOU INFORM THE PATIENT DURING THE PREOP EVAL ABOUT? |
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Definition
| INFORM THE PATIENT OF THE ANESTHETIC PLAN. ALSO INFORM THEM OF THE RISKS ASSOCIATED WITH ANESTHESIA |
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Term
| THE PURPOSE OF THE PREOP EVAL IS TO IDENTIFY PATIENTS WHOSE OUTCOMES WILL LIKELY BE IMPROVED BY IMPLEMENTATION AT A SPECIFIC MEDICAL TREATMENT. GIVE AN EXAMPLE. |
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Definition
| A DIABETIC PATIENT IN WHICH INSULIN IS NEEDED TO CORRECT HYPERGLYCEMIA. |
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Term
| WHAT IS ONE OF THE MOST IMPORTANT THINGS TO INFORM PATIENTS IN PREOP EVAL? |
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Definition
| INFORM OF THE RISKS OF ANESTHESIA. |
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Term
| HOW MANY SIGNATURES DO YOU NEED FOR EMERGENCY CONSENT? |
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Definition
| 2 PHYSICAN SIGNATURES. A CRNA DOESN'T COUNT. |
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Term
| WHAT SHOULD BE ASSESSED IN EVERY PATIENT DURING THE PREOP EVAL? |
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Definition
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Term
| WHAT PROVIDES THE BASIS FOR AND DIRECTION OF THE PATIENT INTERVIEW AND ASSESSMENT? |
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Definition
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Term
| WHAT 5 TYPES OF HISTORIES NEED TO BE TAKEN IN THE PREOP EVAL? |
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Definition
| MEDICAL HX, SURGICAL HX, DRUG HX, ANESTHETIC HX, SOCIAL HX |
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Term
| WHAT IS THE FORMULA FOR PACK YEARS? WHAT # OF PACK YEARS SMOKING EQUATES TO AN INCREASED RISK OF PERIOPERTIVE COMPLICATIONS? |
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Definition
| PACK YEARS= NUMBER OF PACKS PER DAY MULTIPLIED BY NUMBER OF YEARS. 20 PACK YEARS ARE ASSOCIATED WITH INCREASE RISKS |
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Term
| WHAT IS AN ABSOLUTE CONTRAINDICATION TO NEUROAXIAL BLOCKADE? |
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Definition
| SEVERE AORTIC STENOSIS OR SEVERE MITRAL STENOSIS |
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Term
| WHAT SHOULD BE PERFORMED PREOPERATIVELY IN EVERY PATIENT, REGARDLESS OF THE PLAN OF ANESTHETIC MANAGEMENT? |
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Definition
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Term
| PREOPERATIVE LAB IS NOT RECOMMENDED IN ALL PATIENTS, WHY? |
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Definition
| IT IS EXPENSIVE. NOT RECOMMENDED WHEN PATIENTS ARE FIT AN ASYMPTOMATIC. THE LABS SHOULD BE GUIDED BY H&P. A H&H SHOULD BE DRAWN FOR ANY PATIENT WITH INCREASE RISK OF SIGNIFICANT BLOOD LOSS. |
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Term
| IF YOU HAVE A PREGNANT PATIENT THAT IS ABOUT THE HAVE SURGERY IN 1ST TRIMESTER WHAT SHOULD YOU PLAN TO DO? |
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Definition
| TRY TO DELAY THE SURGERY UNTIL THE 2ND TRIMESTER |
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Term
| WHAT KIND OF DRUGS MAY BE GIVEN AS A PREMEDICATION TO DECREASE AIRWAY SECRETIONS BUT IT IS NOT GIVEN FOR PREVENTAION OF ASPIRATION? |
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Definition
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Term
| HOW MANY CLASSIFICATIONS ARE THERE IN THE ASA (AMERICAN SOCIETY OF ANESTHESIOLOGISTS? |
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Definition
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Term
| DESCRIBE CLASS I CLASSIFICATION. |
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Definition
| WHEN THERE IS NO ORGANIC, PHYSIOLOGIC, BIOCHEMICAL, OR PSYCHIATRIC DISTURBANCE. THESE ARE HEALTHY PATIENTS EXCEPT FOR THE CONDITION THAT HAS NECESSITATED SURGERY. |
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Term
| WHAT DOES THE ASA CLASSIFICATION REPRESENT? |
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Definition
| IT REPRESENTS A REFLECTION OF THE PATIENS PREOP STATUS. ASA CLASSIFICATION REMAINS INDEPENDENT ON THE PROPOSED SURGICAL PROCEDURE. WHICH MEANS A TYPE OF SURGEY DOESN'T PLACE A PT IN A PARTICULAR CLASSIFICATION. IT ALSO DOESN'T REPRESENT AN ESTIMATE OF ANESTHESIA RISK. |
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Term
| DESCRIBE ASA CLASS 2 AND GIVE EXAMPLES. |
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Definition
| MILD TO MODERATE SYSTEMIC DISTURBANCE. EX INCLUDE HEART DISEASE, UNCONTROLLED DM, CHRONIC BRONCHITIS, AIDS, HIGH CHOLESTEROL, SMOKING, EXTREME AGE, ETC... KEEP IN MIND IF YOU HAVE SEVERAL OF THESE TOGETHER THEN IT CAN BE CLASSIFIED AS CLASS 3. |
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Term
| DESCRIBE ASA CLASS 3. GIVE EXAMPLES. |
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Definition
| SEVERE SYSTEMIC DISTURBANCES THAT LIMITS ACTIVITY. EXAMPLES INCLUDE HEART DISEASE THAT EFFECTS MOBILITY, VASCULAR COMPLICATIONS, PREVIOUS MI. |
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Term
| DESCRIBE ASA CLASS 4. GIVE EXAMPLES. |
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Definition
| SEVERE SYSTEMIC DISTURBANCE THAT IS LIFE THREATENING. EX. MI, DIALYSIS, CHF, ADVANCED PULM, HEPATIC, OR RENAL DYSFUNCTION |
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Term
| DESCRIBE ASA CLASS 5. GIVE EXAMPLES. |
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Definition
| MORIBUND PATIENT UNDERGOING SURGERY AS A RESUSCITATIVE EFFORT, DESPITE MINIMAL CHANCE FOR SURVIVIAL. EX. INCLUDE A SUBDURAL BLEED IN WHICH THE PATIENT HAS HAD THE BLEED FOR A WHILE ALTHOUGH THEY ARE TAKING PATIENT TO SURGERY TO TRY TO EVACUATE IT. THESE PATIENTS ARE NOT EXPECTED TO SURVIVE WITHOUT THE OPERATION. |
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Term
| DESCRIBE ASA CLASS 6. GIVE EXAMPLES. |
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Definition
| PATIENTS UNDERGOING ORGAN PROCUREMENT PROCEDURES. |
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Term
| DESCRIBE CLASS E. GIVE EXAMPLES. |
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Definition
| EMERGENCY SURGERY IS REQUIRED. EX. DISSECTING AAA. |
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Term
| DESCRIBE ASA CLASS VE. GIVE EXAMPLES. |
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Definition
| A PATIENT WHO IS ACTIVELY BLEEDING AND NEEDS EMERGENCY SURGERY. |
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Term
| WHAT HAS EMERGED AS THE MOST COST EFFECTIVE AND CONVENIENT MEANS OF PATIENT PREPARATION? |
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Definition
| A PREANESTHESIA ASSESSMENT CLINIC (PAC). |
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Term
| IS PULMONARY ASPIRATION OR ASPIRATION PNEUMOITIS CONSIDERED PNEUMONIA? |
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Definition
| NO. ALTHOUGH ASPIRATION CAN LEAD TO PNEUMONIA. |
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Term
| DURING THE EVALUATION PROCESS WHAT SHOULD BE ALWAYS EVALUATE REGARDING INGESTION OF FOOD? |
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Definition
| IDENTIFY PATIENTS WHO ARE AT RISK OF ASPIRATING GASTRIC CONTENTS INTO THE LUNGS AND DEVELOPING ASPIRATION PNEUMONITIS |
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Term
| WHAT ARE THE 3 COMPONENTS OF PULMONARY ASPIRATION? |
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Definition
| 1) MOVEMENT OF CONTENTS FROM THE STOMACH TO THE PHARYNX. 2) MOVEMENT OF CONTENTS FROM THE PHARYNX TO THE LUNGS. 3) CONTENTS ARE CAUSTIC AND CAUSE TIDDUE INJURY (ASPIRATION PNEUMONITIS). |
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Term
| DESCRIBE SILENT VERSUS SYMPTOMATIC ASPIRATION. |
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Definition
| SILEN ASPIRATION THERE IS NO DISRUPTION OF PHYSIOLOGIC PARAMETERS. WITH SYMPTOMATIC ASPRIATION LUNG INJURY IS PRESENT. THE PATIENT MAY COUGH AND/OR AUDIBLE WHEEZE. |
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Term
| DEVELOPMENT OF PNEUMONIA, WITH SUBSEQUENT VENTILATION PERFUSION ABNORMALITIES DEPENDS ON WHAT THINGS? |
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Definition
| 1) TYPE OF ASPIRATE 2) VOLUME OF ASPIRATE 3) THE PATIENT'S COMORBID CONDITIONS. THE TYPE OF ASPIRATE CAN BE CONTAMINATED, ACIDIV VS ALKALINE, OR PARTICULATE VS NONPARTICULATE. |
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Term
| NAME THE 3 IDENTIFIED ASPIRATION SYNDROMES. |
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Definition
| CHEMICAL PNEUMONITIS (MENDELSON'S SYNDROME, MECHANICAL OBSTRUCTION, OR BACTERIAL INFECTION |
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Term
| WHAT DOES NONACIDIC (ALKALINE) FLUID ASPIRATE DO TO THE LUNGS? |
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Definition
| IT DESTROYS THE SURFACTANT. IT CAUSES ALVEOLAR COLLAPSE AND ATELECTASIS. ALSO CAUSES HYPOXIA. DESTRUCTION OF LUNG ARCHITECTURE AND THE LATE INFLAMMATORY RESPONSE ARE NOT AS GREAT AS IN ACID ASPIRATION. |
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Term
| WHAT DOES THE ACIDIC FLUID ASPIRATE DO? |
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Definition
| DESTRUCTION OF LUNG ARCHITECTURE AND RESULTS WITH LATE INFLAMMATORY RESPONSE. |
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Term
| WHAT MAY HAPPEN WITH PARTICULATE FOOD MATTER ASPIRATE? |
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Definition
| CAUSES BOTH PHYSICAL OBSTRUCTION OF THE AIRWAY AND A LATER INFLAMMATORY RESPONSE RELATED TO THE PRESENCE OF A FOREIGN BODY. ALTERNATING AREAS OF ATELECTASIS AND HYPEREXPANSION MAY OCCUR. IF ACID IS MIXED WITH THE PARTICULATE MATTER, DAMAGE IS OFTEN GREATER AND THE CLINICAL PICTURE WORSE. |
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Term
| WILL THE PT BECOME HYPOXIC AND HYPERCAPNIC DIRECTLY AFTER PARTICULATE FOOD MATTER ASPIRATE? |
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Definition
| THE END RESULT IS HYPOXIA AND HYPERCAPNIA ALTHOUGH AFTER ASPIRATION PTS BECOME TACHYPNEIC WHICH CAUSES HYPOCAPNIA. THEREFORE PTS BECOME HYPOCAPNIA PRIOR TO HYPERCAPNIA. |
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Term
| WHAT IS ASPIRATION PNEUMONITIS ALSO KNOWN AS? |
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Definition
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Term
| MENDELSON'S CONCLUSION OF 2 TYPES OF ASPIRATION. WHAT ARE THEY? WHAT ARE THEY RESULTED BY? |
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Definition
| ASPIRATION OF SOLID FOOD CAUSING LARYNGEAL OR BRONCHIAL OBSTRUCTION. OR ASPIRATION RESULTING IN DIRECT ACID INJURY TO THE LUNG AND PRODUCES THE "ASTHMALIKE" SYNDROME KNOWN AS ASPIRATION PNEUMONITIS. THE RESUL FROM PREEXISTING DISEASE, AIRWAY MANIPULATION, COMPROMISE OF PROTECTIVE REFLEXES. |
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Term
| IS EVERY ASPIRATION PNEUMONITIS ASSOCIATED WITH PNEUMONIA? |
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Definition
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Term
| DESCRIBE ASPIRATION PNEUMONITIS. |
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Definition
| A CHEMICAL INJURY. INGESTION OF HIGHLY ACIDIC OR PARTICULATE ASPIRATE MAY CAUSE SEVERE RESPIRATORY DAMAGE WITHOUT AN INFECTIONS COMPONENT. MAY DEVELOP PNEUMONIA OVER TIME DUE TO THE SEVERITY OF THE INJURY AND PROLONGED RESPIRATORY SUPPORT. |
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Term
| WHAT IS THE MOST COMMON CAUSE OF ASPIRATION PNEUMONITIS? WHEN IS IT THE GREATEST? WHAT 3 THINGS ARE IT CHARACTERIZED BY? |
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Definition
| OCCURS WHEN NORMAL PROTECTIVE REFLEXES (SWALLOWING, COUGHING, GAGGING) FAIL. MOST COMMON SETING FOR DEPRESSION OF REFLEX PROTECION ARE THE INDUCTION AND EMERGENCE PHASES OF ANESTHESIA. IT IS CHARACTERIZED BY pH, VOLUME, AND GASTRIC MATERIAL ASPIRATED. |
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Term
| A GASTRIC FLUID VOLUME OF _____ AND A pH LESS THAN ____, TRADITIONALLY HAVE BEEN SIGNIFICANT INDICATORS OF RISK OF ASPIRATION SEQULAE. |
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Definition
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Term
| THE _______OF ASPIRATE CORRELATES WITH THE SEVERITY OF PULMONARY DAMAGE. |
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Definition
| VOLUME. THE pH OF GASTRIC FLUID IS CONTROVERSIAL. |
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Term
| WHAT IS THE BARRIER PRESSURE? |
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Definition
| DIFFERENCE BETWEEN LES (LOWER ESOPHAGEAL SPHINCTER) AND INTRAGSTRIC PRESSURE. |
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Term
| A DECREASE IN LES TONE WILL CAUSE AN ____ RISK OF ASPIRATION. |
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Definition
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Term
| AN INCREASE IN INTRAGASTRIC PRESSURE WILL CAUSE AN ____ RISK OF ASPIRATION. |
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Definition
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Term
| A DECREASE IN BARRIER PRESSURE WILL CAUSE AN _____ RISK OF ASPIRATION. |
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Definition
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Term
| WHAT HAPPENS WITH GASTRIC EMPTYING IN RELATION TO TRAUMA? |
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Definition
| AFTER A TRAUMA GASTIC EMPTYING IS DELAYED. IF YOU ATE AT 12 AND TRAUMA HAPPENED AT 2 THEN YOUR NPO TIME WAS 2 HRS. WITH TRAUMA PATIENTS YOU MAY HAVE A DELAY IN GASTRIC EMPTYING UP TO A WEEK AFTER INJURY. |
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Term
| WHAT TYPES OF PRESSURES CAUSE ACTIVE VOMITING OR GAGGING? |
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Definition
| SUDDEN ONSET OF HIGH INTRAGASTRIC PRESSURE IS ASSOCIATED WITH RELAXATION OF BOTH THE LOWER AND UPPER ESOPHAGEAL SPHINCTER MECHANISMS. |
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Term
| WHAT PRESSURE FAILS AS A RESULT OF REFLUX? |
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Definition
| BARRIER PRESSURE. THE BARRIER PRESSURE IS THE DIFFERENCE BETWEEN LES PRESSURE AND INTRAGASTRIC PRESSURE. |
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Term
| IF EMERGENCY SURGERY IS PERFORMED HOW MANY FOLDS IS THE RISK FOR ASPIRATION INCREASED? |
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Definition
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Term
| DESCRIBE GASTRIC EMPTYING RATES IN OBESE PATIENTS. |
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Definition
| OBESE PATIENTS HAVE THE SAME GASTRIC EMPTYING RATE AS NONOBESE PATIENTS FOR LIQUIDS. SOLIDS EMPTYING MAY ACTUALLY BE FASTER IN OBESE THAN NONOBESE PATIENTS. |
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Term
| HOW DOES PROGESTERONE MAKE A PT AT RISK FOR ASPIRATION? |
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Definition
| PROGESTERONE CAUSES RELAXATION OF THE GES AND IMPAIRS GASTRIC EMPTYING; DECREASE IN LES TONE. EVEN IF THEY ARE ONLY A FEW WEEKS PREGNANT THEY ARE STILL AT RISK FOR ASPIRATION R/T INCREASE IN PROGESTERONE. |
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Term
| WHAT AGE POPULATION IS AT RISK FOR ASPIRATION? |
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Definition
| EXTREMES IN AGE LIKE NEONATES, PREMIE BABIES, AND THE ELDERLY |
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Term
| NAME THE 4 STAGES WHEN YOU ASPIRATE. |
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Definition
| 1) ASPIRATED SUBSTANCE CAUSES IMMEDIATE DAMAGE TO THE LUNG RESULTING IN TISSUE DAMAGE. 2) PARASYMPATHETIC RESPONSE THAT LEADS TO AIRWAY CLOSURE AND A DECREASE IN LUNG COMPLIANCE RESULTING IN ATELECTASIS WITHIN MINUTES. 3) 1-2 HOURS AFTER INJURY, AN INTENSE INFLAMMATORY REACTION OCCURS CHARACTERIZED BY PULMONARY EDEMA AND HEMORRHAGE. 4) 24 HOURS AFTER THE INSULT, SECONDARY INJURIES RESULT FROM DEPOSITS AND NECROSIS OF ALVEOLAR CELLS |
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Term
| WHAT IS THE HALLMARK SIGN FOR ASPIRATION PNEUMONITIS? |
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Definition
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Term
| WHY SHOULD WE ONLY DEEP SUCTION FOR PARTICULATE MATTER? |
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Definition
| DEEP SUCTION CAN CAUSE MORE TRAUMA. |
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Term
| WHAT DRUG AND DOSE CAN INHIBIT NEUTROPHIL RESPONSE AFTER ASPIRATION? |
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Definition
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Term
| WHEN ARE ANTIBIOTICS NEEDED AFTER ASPIRATION PNEUMONITIS? |
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Definition
| IF FEVER OR INCREASE IN WBC GREATER THAN 48 HRS. |
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Term
| HOW MANY HOURS SHOULD YOU BE NPO FOR CLEAR LIQUIDS? BREAST MILK? INFANT FORMULA? NON HUMAN MILK? LIGHT MEAL? FRIED OR FATTY FOODS? |
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Definition
| 2 HOURS FOR CLEAR LIQUIDS. 4 HOUR FOR BREAST MILK. 6 HOURSE FOR INFANT FORMULA. 6 HOURS FOR NON HUMAN MILK EX. SOY MILK. 6 HOURS FOR A LIGHT MEAL EX. (CRACKER OIR TOAST W/O BUTTER). 8 HOURSE FOR FRIED OR FATTY FOODS. PULP JUICES ARE NOT CONSIDERED CLEAR LIQUIDS AND ARE 6 HRS. ALCOHOL IS NOT A CLEAR LIQUID DIET. |
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Term
| WHAT ARE THE ROLES OF PHARMACOLOGICAL AGENTS AIMED AT? |
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Definition
| REDUCING GASTRIC VOLUME, INCREASING GASTRIC pH, AUGMENTING (INCREASE) LOWER ESOPHAGEAL SPHINCTER (LES) TONE |
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Term
| DURING A MONITORED RSI IT IS OKAY TO USE POSTITIVE PRESSURE VENTILATION AS LONG AS YOU DO WHAT? |
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Definition
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Term
| WHAT IS A GOOD AIRWAY PRESSURE TO BE LESS THEN WHEN PERFORMING POSITIVE PRESSURE VENTILATION DURING A MODIFIED RSI? |
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Definition
| <15. IN ORDER TO PREVENT GASTRIC INSUFFLATION, EVERY EFFORT SHOULD BE MADE TO VENTILATE THE LUNGS AT THE LOWEST PRESSURE POSSIBLE. |
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Term
| WHAT TYPE OF PATIENTS TYPICALLY DEVELOP PNEUMONIA AFTER ASPIRATION? |
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Definition
| LESS THAN HALF OF ALL ASPIRATIONS LEAD TO PNEUMONIA, WHICH OCCURS MOST OFTEN IN PATIENTS WHO ASPIRATE INFECTED MATERIAL OR WHO ARE IMMUNOCOMPROMISED. |
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Term
| PATIENTS WHO ASPIRATE BUT DO NOT DEVELOP SYMPTOMES WITH ___ HRS CAN BE DISCHARGED. |
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Definition
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Term
| WHAT DOES REGLAN DO TO THE BARRIER PRESSURE? |
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Definition
| IN INCREASES IT BY INCREASING THE TONE OF THE LES. |
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Term
| WHAT DOES SODIUM CITRATE WITH CITRIC ACID (BICITRA) DO? |
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Definition
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Term
| WHAT IS THE ONSET AND DURATION OF BICITRA? |
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Definition
| ONSET OCCURS WITHIN 15 MINUTES AND DURATION OF ACTION IS 1-3 HOURS. ALTHOUGH CITRATE PREPARATIONS MAY LAST UP TO 6-7 HOURS, SOME PATIENT WILL ALSO EXPERIENCE A REBOUND INCREASE IN GASTRIC ACID PRODUCTION, SO IF SURGERY IS DELAYED MORE THAN 1 HR AFTER CITRATE ADMINISTRATION, IT MAY BE PRUDENT TO REPEAT THE DOSE. |
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Term
| HOW DOES LIDOCAINE HELP AFTER ASPIRATION? |
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Definition
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