What are special populations?
They present with physical and psychological unique challenges like stress, body temperature, and loss of intravascular fluids
A patient is considered a ..... if she is between birth and the age of 12
Pediatric
What do they class a patient first 28 days of life outside the womb
A neonate
A child less than 6 months old cannot .......
Shiver
Because a child less than 6 months old cannot shiver what are the repercussions?
They are at risk for hyperthermia, bradycardia, and acidosis
At what age are tears produced
2-3 months of age
What genitalia changes by 1 year of age in a male
Testes descend
What overwhelming feeling do most pediatric patients feel
Anxiety, due to separation from parents.
Can lead to a feeling of abandonment
What is the role of the circulating surgical tech when a pediatric patient is on the table
They should stand nearby to assist the anesthesia provider by holding the mask on the face of the child, holing their hands or arms and making sure the room is kept very quiet
What critical parame4ters should be monitored for a pediatric patient
Temperature, urine output, cardiac function, and oxygenation
What is the primary means of monitoring temperature in the OR
Skin temperature
What is the most effective way of maintaining temperature in the OR
Keeping extremities wrapped and covered
Due to contamination what is the route least used in the groin region
Saphenous vein
What is the standard for monitoring oxygenation for all age groups
Measure the arterial blood gases (ABG's)
What are the two most common sorts of shock seen in all age groups
Septic shock and hypovolemic shock
What is septic shock
A life-threatening illness characterized by hypotension, impaired organ function and/or failure, and metabolic abnormalities
What is hypovolemic shock
A state of decreased blood volume; more specifically, decrease in volume of blood plasma. It is thus the intravascular component of volume contraction, but, as it also is the most essential one, hypovolemia and volume contraction are sometimes used synonymously
In neonates Hypovolemic shock results in
Decrease venous return that lowers cardia output that leads to tissue perfusion and lactic acidosis
In infants what is the most common cause of hypovolemic shock
Dehydration
Septic shock is normally caused by ......
Gram-negative bacteria
This can result from peritonitis, intestinal perforation, UTI's, and Upper respiratory Infection (URI)
What are the reasons for insensible water loss, mainly in the OR
Water loss through the skin and lungs caused by overhead radiant heaters and phototherapy
What is the initial sign of postoperative infection
Fever
What are the most common sites of preoperative infections
Lungs, surgical wound, urinary tract, and vascular access sites
Three important side effect differences in children vs adults for antibiotics
Sulfonamides, Chloramphenicol, and Tetracycline
What is kernicterus
Excess of bilirubin in the blood
Children vs adults-Sulfonamides
Bactum or Septa, are associated with increased incidents of kernicterus in neonates. This should not be given to newborns
Children vs adults-Chloramphenicol
A synthetic form of antibiotic that is associated with the cause of "gray" syndrome, infants skin turns grey from drug toxicity
Children vs adults-Tetracycline
Causes staining and hypoplasia of the enamel of the developing teeth, therefore should not be administered to children
What is the number one cause of death in 1-15 year olds
Accidents
What is the best treatment for a child having breathing problems
Intubate immediately by placing an uncuffed endotracheal tube
What is Pneumothorax
Accumulation of air in the pleural cavity
Why must bleeding be brought under control
To prevent hypovolemia
What is the most common bone fracture
The clavicle - usually a result of a shoulder dystocia (in labor and delivery this is normally because the shoulders of the baby are stuck behind the pubic bone, or they are too big for delivery)
What is the term for a patient whose body weight is 100 pounds greater than ideal body weight
Obese
In obese patients what issues do anesthetic personnel face
Higher doses of anesthetic agents are required due to their large uptake of adipose tissue. Recovery time is increased, and poor blood supply slows the elimination of these agents
Obese patients are prone to.....
Increased incidences of postoperative wound infections
Patients who are obese are high risk for......
Coronary artery disease due to hypertension and diabetes
In obese patients what aids in ventilation?
Placing the patient in reverse Trendelenburg's position to expand total lung volume
What is reverse Trendelenburg's position
A body position in which the trunk and head are elevated above the pelvis and lower extremities
Three most common complications after gastric bypass or gastroplasty
Abdominal catastrophes, internal hernia, and acute gastric distention
What is an Abdominal catastrophes
A torsion/twist of the abdominal contents
What is an internal hernia
Protrusion of an internal organ into a retroperitoneal fossa or a foramen (congenital or acquired) in the abdominal cavity
What is an acute gastric distention
Bloating of the stomach when air is pumped into it
What often indicates peritonitis
Acute respiratory failure
What is often found in patients that are obese, resulting in the gall bladder being removed
Gall stones
What affects the normal metabolic and physiological processes of a patient with diabetes
Anesthesia
What is the most common preoperative complication with a diabetic patient
Increase rate of infection
What should be postponed in the first trimester, if possible
Surgical procedures
Why should surgical procedures be postponed in the first trimester
Increased chances of spontaneous abortion, if need be they should be performed in the second trimester when the fetus is more stable
What can stimulate pre term labor
Vasopressors and neostigmine (reversed muscle relaxation)
What decreases the uterine tone and aids in preventing uterine contractions
Halogenated agents
What should be placed under a pregnant patient when placing them in the supine position
A small rolled sheet or pad under the right hip to slightly laterally shift the uterus to the left
What position should be used on a pregnant patient in a supine position
Trendelenburg position with the OR table tilted 30 degrees to the left to aid with venous return, in turn taking the weight of the vena cava
Name some autoimmune diseases
Multiple Sclerosis, lupus erythematosus, and rheumatoid arthritis
What opportunistic diseases have been seen more frequently since the arrival of AIDS
Kaposi's sarcoma, severe psoriasis rash of the body
Pneumocystis carinil pneumonia (PCN)
What is a common complication when a patient has Kaposi's sarcoma
Multiple internal and external lesions
How will IV placement be difficult doe to Kaposi's lesions
Candidiasis Skin patches may cover large areas of normal skin, veins may be used up due to repeated sticks previously
In a study of AID's patients requiring abdominal surgery what are the four clinical syndromes that require clinical intervention
1. Peritonitis secondary to cytomegalovirus infection
2. Non-Hodgkin's lymphoma of the GI track resulting in an obstruction or bleeding
3. Kaposi's sarcoma lesions in the GI tract
4. Mycobacterial infection of the retro peritoneum or spleen
In an isolation patient wearing of protective attire is mandated by the .......
OSHA blood borne pathogens final rule
In an isolation patient who addresses the wearing of a respirator
CDC
In an isolation patient who should be notified of precautions to reduce the risk of transmission of
All personnel including pre op room, anesthesia, PACU personnel, and pre op holding
In geriatric patients what special considerations are taken into account
Preoperative assessment and planning in scheduled elective surgeries.
What is associated with geriatric patients and emergency surgeries
Higher mortality rates
What does the "Golden hour" mean
It refers to reaching the trauma victim and providing treatment within the first hour following injury, this is critical to the patients outcome
Level I trauma center
Can meet all needs required for treating trauma patients, including qualified personnel and on a 24hr basis
Level II trauma center
Can treat seriously injured or ill patients, but does not have all the resources available at a Level I facility
Level III trauma center
Most often a community or rural hospital in an area that does not have a Level I or II facility. Patients are stabilized and transported to a Level I or II hospital
What are three important factors when considering the resulting injury from various forces
1. Velocity of the injuring force
2. Flexibility of the tissue
3. Shape of the injuring force
What is the number one organ injured in an MVA
Spleen
In preservation of evidence what clothing considerations should be made
Remove clothing by cutting along the seams and around a bullet or stab wound holes. Shape of the hole can provide vital evidence.
In preservation of evidence what considerations should be made for bullets
They should be carefully handled as lead will easily scratch. They SHOULD not be handled with metal forceps or clamps. Surg tech places it on a clean gauze and hands of to the circulator for placing in an evidence cup
What is a central venous catheter
A catheter placed into a large vein in the neck(internal jugular vein), chest (subclavian vein or axillary vein) or groin (femoral vein
What is enterocolitis
An inflammation of the digestive tract, involving enteritis of the small intestine and colitis of the colon.
What is intra-arterial measurement
Monitors the blood pressure real-time
What is Kinematics
Motion of points, bodies (objects) and systems of bodies (groups of objects)
What is a splenectomy
A surgical operation involving removal of the spleen
What is a splenomegaly
An enlargement of the spleen
What is torticollis
Dystonic condition defined by an abnormal, asymmetrical head or neck position