AAPD - Sedation Quiz

AAPD - Sedation Quiz What level of sedation is anxiolysis? - ✔✔Minimal Sedation What level of sedation is conscious sedation? - ✔✔Moderate Sedation What level of sedation is analgesia? - ✔✔Moderate to Deep How much o ...

AAPD - Sedation Quiz What level of sedation is anxiolysis? - ✔✔Minimal Sedation What level of sedation is conscious sedation? - ✔✔Moderate Sedation What level of sedation is analgesia? - ✔✔Moderate to Deep How much of delay is the pulse oximeter? - ✔✔6-12 seconds Is reflex withdrawal a purposeful response? - ✔✔No, must be acommanied by another response (pushing away) Duration is long or short? Choral Hydrate - ✔✔Long Duration is long or short? Pentobarbital - ✔✔Long Duration is long or short? Phenothiazine - ✔✔Long Level of sedation for anatomic airway abnormalities or extreme tonsillar hypertrophy - ✔✔Consult recommended Level of sedation for extreme tonsillar hypertrophy - ✔✔Consult recommended When is it preferatble to have 2 or more adults accompany children for sedation? - ✔✔Child is still in car safety seats Complications facilities most be prepared for - ✔✔Airway obstruction, hypoventilation, hypoxemia, apnea Consequence of unmanaged airway - ✔✔CV: hypotension, cardiopulmonary arrest Documentation before sedation - ✔✔1. Informed consent, 2, Instructions and Information NPO before elective surrgery: Clear liquids - ✔✔2 hours Minimum NPO before elective surrgery: Breast Milk - ✔✔4 hours Minimum NPO before elective surrgery: Infant Formula - ✔✔6 hours Minimum NPO before elective surrgery: Nonhuman Milk - ✔✔6 hours Minimum NPO before elective surrgery: Light Meal - ✔✔6 hours Minimum Immobilization device requirements - ✔✔No airway obstruction, chest restriction, exposed hand or foot, monitoring, monitoring Example of medications that may inhibit cytochrome P450 - ✔✔St. John's wort Example of medications that may inhibit cytochrome P450 - ✔✔Echinacea What may Kava do to sedatives? - ✔✔Increase the effects What does Kava effect? - ✔✔Potentiates GABA inhibitory neurotranmission How does Valerian produce sedations? - ✔✔Modulates GABA neurotransmission and receptor funtion Example of medications that may inhibit cytochrome P450 - ✔✔Erythromycin Example of medications that may inhibit cytochrome P450 - ✔✔Cimetidine Sedation medication that processed through cytochrom P450 - ✔✔Midazolam Components of Health Evaluations: 1 - ✔✔Age and Weight Components of Health Evaluations: 2 - ✔✔Health History Components of Health Evaluations: 3 - ✔✔Review of Systems: Caridac, Pulmonary, Hepatitic funcion Components of Health Evaluations: 4 - ✔✔Vital Signs: HR, BP, Respiratory Rate, Temp Components of Health Evaluations: 5 - ✔✔Physical examination: airway evaluation Components of Health Evaluations: 6 - ✔✔Physical status: ASA classification Components of Health Evaluations: 7 - ✔✔Medical home contact information Components of Health History: 1 - ✔✔Allegies, adverse drug reaction Components of Health History: 2 - ✔✔Medication/drug hisootroy (OTC, herbal, illicit) Components of Health History: 3 - ✔✔Relevants diseases, phyical abnormalities, neurologic impairment, airway (apnea, snoring) Components of Health History: 4 - ✔✔Pregnancy Status Components of Health History: 5 - ✔✔Summary of previous relavent hospitilizations Components of Health History: 6 - ✔✔History of sedation/GA and complications Components of Health History: 7 - ✔✔Relevant family hx (esp. anethesia) Components of Health History: 8 - ✔✔Prescriptions- copy if RX written, not to be administered withoue benefit of direct supervision by medical personnel Normal Pulse Rates: <1 y.o. - ✔✔100-160 bpm Normal Pulse Rates: 1 - 10 yr - ✔✔60-140 bpm Normal Pulse Rates: 10+ yr - ✔✔60-100 bpm Normal Pulse Rates: Well conditioned athleted - ✔✔40-60 bpm Time of Documentation: Health Evaluation - ✔✔At time of sedation (before sedation Time of Documentation: Instructions and care instruction - ✔✔Before sedation Time of Documentation: Informed consent - ✔✔Before sedation Time of Documentation: Prescription - ✔✔At time of sedation Time of Documentation: Sedation Record - ✔✔During treatment Documnation during treatment:1 - ✔✔Time out Documnation during treatment:2 - ✔✔Drugs administeried (name, route/site, dosage, effect), oxygen & inhalation medications (%, duration) Documnation during treatment:3 - ✔✔Level of consciouness/responsiveness + Vitals (BP, HR, RR, O2) Documnation during treatment:4 - ✔✔Adverse Documnation after treatment: - ✔✔Level of consciouness/responsiveness + Vitals (BP, HR, RR, O2at room air) Simple evaluation tool to use after discharge - ✔✔Ability to remain awak for >20min in quiet environment Acronym for sedation perparation/set up - ✔✔SOAPME SOAPME: S - ✔✔Suction (size appropriate, functioning SOAPME: O - ✔✔Oxygen (adequate supply, flow) SOAPME: A - ✔✔Airway management tools (size appropriate) SOAPME: P - ✔✔Pharmacy (antagonist ans basic drugs of emergency life support) SOAPME: M - ✔✔Monitors (functioning - e.g. oximeter, BP) SOAPME: E - ✔✔Equipment or durgs (special for a particular case, e.g. defibrilator) Yankuer type suction - ✔✔Yankuer.jpg Practiioner qualifications for moderate sedation: 1 - ✔✔Competent to proivde monitoring and manage complications to deep sedation Practiioner qualifications for moderate sedation: 2 - ✔✔Bag-vavle mask ventilation Practiioner qualifications for moderate sedation: 3 - ✔✔PALS training (required) Practiioner qualifications for moderate sedation: 4 - ✔✔Regular skill reinforcement (strongly encouraged) Is PALS Training Required for Moderate Sedation? - ✔✔Yes Minimum ariway skill required for Moderate Sedation - ✔✔Bag-vavle mask ventilation, PALS Is PALS Training Required for Moderate Sedation? - ✔✔Yes Is skill reinforcement required for Moderate Sedation? - ✔✔No but strongly encourgaed Support personnel qualifications for moderate sedation: 1 - ✔✔Pediatric basic life support Support personnel qualifications for moderate sedation: 2 - ✔✔Specific assignments in event of emergency Support personnel qualifications for moderate sedation: 3 - ✔✔Current knowledge of emergency cart invintory Is support personnel required for moderate sedation - ✔✔Yes Duties of support personnel in moderate sedation - ✔✔Monitor phyiologic parameters, assis in supporitiave or resuscitation measure May support personnel assist in moderate sedation? - ✔✔Yes - in interriptible patient-related tasks of shor duraction Pracitioners should/must/or encourages to review or practice emergency drills? - ✔✔Should Monitoring/Documentation for Moderate sedation Requirements: 1 - ✔✔Baseline Vitals or documentation why can't get Monitoring/Documentation for Moderate sedation Requirements: 2 - ✔✔Drugs used (details), vitals (time based) Monitoring/Documentation for Moderate sedation Requirements: 3 - ✔✔Vitals: Oxygen and heart rate (shall be monitored continuously) Monitoring/Documentation for Moderate sedation Requirements: 4 - ✔✔BP and RR (shall be monitored intermittently) Monitoring/Documentation Moderate sedation: Restraint Recommendations - ✔✔No airway obstruction, chest restriction, exposed hand or foot, monitoring, monitoring Monitoring/Documentation Moderate sedation: After procedure requirements 1 - ✔✔Functioning Sunction Apparatus Monitoring/Documentation Moderate sedation: After procedure requirements 2 - ✔✔>90% oxygen delivery, positive pressure ventilation What % of oxygen delivery is required for pt receiving moderate sedation? - ✔✔>90% Is a bag vale mask considerted positive-pressure ventilation? - ✔✔Yes How long must a patient stay awake before discharge? - ✔✔20 min in quiet environment True or False? The state abd risks of deep sedation is less than general anestheisa - ✔✔False - they are indistinguishable Personnel qualifications for deep sedation: 1 - ✔✔At least one trained in Pediatric Advanced Life Support (Required) Personnel qualifications for deep sedation: 2 - ✔✔Skilled in airway management and cardiopulomonary resuscitation Personnel qualifications for deep sedation: 3 - ✔✔One person whose only responsibility is to observe vitals, airway patency, ventilation and administer or direct drug administration May support personnel also assist in deep sedation? - ✔✔At least one person whose only responsibility is to observe vitals, airway patency, ventilation and administer or direct drug administration What does intranasal drug administration considered equivalent to? Oral, Transdermal, or IV - ✔✔IV - bypasses the liver Does a conscious sedation permit allow for intranasal delivery? - ✔✔No - intranasal is considered paraental Monitoring/Documentation for Moderate sedation: Equipment - ✔✔Moderate sedation recommendations + Readily Available: ECG monitor, AED Monitoring/Documentation for Moderate sedation Requirements: 1 - ✔✔Vascular Access - IV line shold be in place or someone readiy able to palce one Monitoring/Documentation for Moderate sedation Requirements: 2 - ✔✔Same as moderate but O2 and HR should be documented every 5 min Monitoring/Documentation for Moderate sedation Requirements: 3 - ✔✔Precordial or capnograph encouraged Monitoring/Documentation for Moderate sedation Requirements: 4 - ✔✔Drugs administeried (name, route/site, dosage, effect), oxygen & inhalation medications (%, duration) Monitoring/Documentation Deep sedation: After procedure requirements - ✔✔Same as moderate Capnography - ✔✔Expired CO2 monitoring Is capnography required? - ✔✔No - it is encouraged, particurly if other means of monitoring is limited True/False: Capnography are prone to false positive so cannot be used to detect complete airway obstruction/apnea - ✔✔False - True for fals positive but accurate in detecting obstruction Tru/False: Use of patient stimulators is not recommended - ✔✔False - It is encouraged to better train medical professional to respond more appropriately and effectively to rare events What are risk do conventional monitoring devices (ECG, pulse ox) pose during MRI? - ✔✔Thermal injury - if wires coild What alternative montiroing methods are there for MRI? - ✔✔Capnography What is minimum oxgene flow rate during nitrous oxide delivery? - ✔✔25% True/False: Nitrous oxide delivery must cover the mouth and nose. - ✔✔TRUE True/False: Nitrous oxide delivery must be used in conjunction with a calibrated and functional O2 analyzer. - ✔✔TRUE What is the maximum of nitrous oxide to be considered minimal sedation? - ✔✔50% - when used alone. Tru/False: Local anesthetics do not considered sedatives when used only with nitrous oxide. - ✔✔True - even though they have sedative properties. Nitrous oxide to be used to achieve moderate or deep sedation? - ✔✔Yes - riske occurs at > 50% or when used in combination with other medications Procaine: Ester or Amide - ✔✔Ester Chloroprocaine: Ester or Amide - ✔✔Ester Tetracaine: Ester or Amide - ✔✔Ester Lidocaine:Ester or Amide - ✔✔Amide Mepivaciane: Ester or Amide - ✔✔Amide Bupiacaine: Ester or Amide - ✔✔Amide Levobupicaine: Ester or Amide - ✔✔Amide Ropivacine: Ester or Amide - ✔✔Amide Articaine: Ester or Amide - ✔✔Amide Procaine: Max dose with Epi (mg/kg) - ✔✔6 (Dental)/ 10 (medical) Chloroprocaine: Max dose with Epi (mg/kg) - ✔✔12 (Dental)/ 20(medical) Tetracaine: Max dose with Epi (mg/kg) - ✔✔1 (Dental)/ 1.4 (medical) Lidocaine:Max dose with Epi (mg/kg) - ✔✔4.4 (Dental)/ 7.0 (medical)/ 3-5 for IV regional anestheis Mepivaciane: Max dose with Epi (mg/kg) - ✔✔4.4 (Dental)/ 3.0 (medical) Bupiacaine: Max dose with Epi (mg/kg) - ✔✔1.3 (Dental)/ 3.0 (medical) Levobupicaine: Max dose with Epi (mg/kg) - ✔✔2 (Dental)/ 3.0 (medical) Ropivacine: Max dose with Epi (mg/kg) - ✔✔2 (Dental)/ 3.0 (medical) Articaine: Max dose with Epi (mg/kg) - ✔✔7 (Dental) When epinephrine is not used, local anesthetic doses should be increased or decreased? - ✔✔Decreased In infants <6 months, doses of amides should be decreased by what % - ✔✔30% A 2% concentration solution contains how many mg/mL? - ✔✔20.0mg/mL