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DAANCE 2023| 295 QUESTIONS| WITH COMPLETE SOLUTIONS
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DAANCE 2023| 295 QUESTIONS| WITHCOMPLETE SOLUTIONS
MODULE V: OFFICE ANESTHESIA EMERGENCIES
Hypoxia correct answer: deficiency in the amount of oxygen
reaching the tissues
hypoxia results correct answer: cardiac dysrhythmias, cardiac
arrest, neurologic or brain damage, and ultimately death
hypoxia adverse effects correct answer: - more rapidly in
children, elderly and those w diminished respiratory reserve;
systemic ailments like cardiac, pulmonary, sickle cell anemia or
sezieures
- aid with pre-oxygenation period prior to anesthesia
airway maintenance correct answer: -evaluation of the patients
anatomy: neck, mandible, tongue and body obesity
- short thick neck with poor flexibility is more difficult
------ Class II or higher Mallampati classification
airway obstruction correct answer: a. head position and the
tongue
b. foreign body
cause of airway obstruction- head position and the tongue
correct answer: -most often posterior positioning of the tongue
in the oropharynx
,-poor headpositioning
-loss of tone of pharyngeal muscles secondary to deep
anesthesia or sedation
prevention of airway obstruction- head position and the tongue
correct answer: correct positioning of the patients head and
mandible in head tilt-chin lift position
signs of airway obstruction correct answer: Choking, gagging,
substernal notch retraction, labored breathing, rapid pulse
initially, then decreased pulse, respiratory arrest, and cardiac
arrest
early treatment of airway obstruction-head position and the
tongue correct answer: a. 100% (O2) via nasal mask
b. place the patient in a Trendelenburg position and pack off the
surgical site
c. digital traction of the tongue with gauze, tongue forceps, a
hemostat ortongue suture
d. suction oropharynx
continued treatment of airway obstruction- head position and the
tongue correct answer: a. a nasopharyngeal airway can be
utilized in a conscious or semiconscious patient
b. in an unconscious patient an oropharyngeal airway can be
used
c. consider using an LMA, igel or other supraglottic (above level
of vocal cords) airway
d. endotracheal intubation
,Cricothyrotomy- airway obstruction- head position and the
tongue correct answer: - if an airway obstruction persists after
all conventional methods for establishing an airway have failed
- quickest and easiest
- making an opening through the thin ciricothyroid membrane
between the ciricoid and thyroid cartilages of the larynx
treatment by ciricothyrotomy correct answer: - activate EMS
1. cleanse the overlying skin
2. locate the ciricothyroid membrane by palpation
3. utilize the emergency ciricothyrotomy needle/cannula kit or a
large gauge to enter the trachea beneath the vocal cords through
the ciricothyroid membrane
4. attach the tube of the ciricothyrotomy device to an oxygen
source such as an anesthesia machine or Ambu bag and ventilate
with 100% oxygen
cause of airway obstruction- foreign bodies correct answer:
partial dentures, surgical packs or partitions and teeth
prevention of airway obstruction- foreign bodies correct answer:
preoperative removal of foreign bodies(dentures, partials, tongue
piercings etc.), effective placement of packs or partitions,
adequate suctioning and assistance an good visualization of the
field
treatment of airway obstruction- foreign bodies correct answer:
1. digital removal of the foreign body only if it can be well-
visualized- do not attempt blind finger sweeps that may push the
foreign body farther down into the airway
, 2. chest compressions if no airflow during ventilation with the
patient in s supine position. Use Heimlich maneuver is Patient is
upright
—— preferred over abdominal thrusts: more pressure develop in
chest, lower chance of puncture of organ
3. Direct laryngoscopy(removal of foreign object utilizing a
laryngoscopes) for visualization and retrieval of the foreign
body with forceps and/or suction
4. If cannot be removed and severe obstruction persists, a
ciricothyrotomy may be necessary
laryngospasm correct answer: A protective reflex of the vocal
cords that attempt to prevent passage of foreign matter, such as
blood or excessive secretions into the larynx, trachea, and lungs
Signs of laryngospasm correct answer: Partial- crowing sounds
and labored respiratory efforts
Complete- cessation of crowing sounds, suprasternal retraction,
paradoxical chest movements(rocking pattern of the chest and
abdomen)
Prevention of laryngospasm correct answer: Proper pack
placement or throat partition, changing packs and partitions
when necessary, adequate suctioning, control of secretions and
adequate anesthesia levels
Treatment of laryngospasm correct answer: Closely observe the
ventilatory status with pretracheal stethoscope, pulse oximetry
and capnography
1. Administer 100% oxygen via nasal hood
2. Establish proper head position to maintain/establish airway
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