ABA Clinical Practice & Patient Safety 2 — Questions and Answers
Question 1: A patient with suspected malignant hyperthermia (MH) crisis develops a temperature of 39.8°C, masseter spasm, and rising ETCO2. What is the FIRST priority intervention?
- Administer dantrolene 2.5 mg/kg IV
- Discontinue all triggering agents and change to a clean circuit (Correct answer)
- Apply active surface cooling measures immediately
- Obtain arterial blood gas and serum creatine kinase
Correct answer: Discontinue all triggering agents and change to a clean circuit
Removing the triggering agent (volatile anesthetics and succinylcholine) is the first step in MH management before dantrolene administration.
Question 2: Which of the following best describes the 'surgical safety checklist' Sign-Out phase according to WHO guidelines?
- Confirming patient identity, site, and consent before anesthesia induction
- Reviewing key concerns for recovery and specimen labeling before the patient leaves the OR (Correct answer)
- Verifying antibiotic administration and anticipated blood loss at incision
- Checking equipment function and team member introductions before the procedure
Correct answer: Reviewing key concerns for recovery and specimen labeling before the patient leaves the OR
The Sign-Out phase occurs before the patient leaves the OR and covers instrument counts, specimen labeling, equipment issues, and recovery concerns.
Question 3: A 70 kg patient undergoing laparoscopic surgery develops sudden hypotension, tachycardia, and decreased ETCO2 despite high airway pressures. The MOST likely diagnosis is:
- Anaphylaxis
- Tension pneumothorax
- Venous gas embolism (Correct answer)
- Pulmonary embolism
Correct answer: Venous gas embolism
Venous gas embolism from CO2 insufflation presents with sudden cardiovascular collapse and a characteristic mill-wheel murmur, with a drop in ETCO2 due to dead space increase.
Question 4: Which monitoring modality is MOST useful for detecting intraoperative awareness during total intravenous anesthesia (TIVA)?
- End-tidal anesthetic agent concentration
- Processed EEG (e.g., BIS monitor) (Correct answer)
- Entropy monitoring
- Neuromuscular blockade monitoring
Correct answer: Processed EEG (e.g., BIS monitor)
Processed EEG monitors like BIS are particularly valuable during TIVA because end-tidal agent concentration cannot be used to verify adequate depth.
Question 5: A patient receiving an epidural infusion develops sudden onset bilateral lower extremity weakness and urinary retention 12 hours postoperatively. What is the MOST urgent next step?
- Stop the epidural infusion and reassess motor block in 2 hours
- Order an emergent MRI of the spine to rule out epidural hematoma (Correct answer)
- Increase the epidural infusion rate to improve analgesic spread
- Administer IV naloxone to reverse opioid-related motor block
Correct answer: Order an emergent MRI of the spine to rule out epidural hematoma
New-onset neurological deficits after epidural analgesia require emergent MRI to rule out epidural hematoma, as delays beyond 8 hours worsen neurological outcomes.
Question 6: According to the ASA Difficult Airway Algorithm, which intervention is indicated when a 'cannot intubate, cannot oxygenate' (CICO) situation is declared?
- Reattempt direct laryngoscopy with a different blade
- Proceed with emergency surgical airway (Correct answer)
- Place a supraglottic airway and wake the patient
- Administer succinylcholine to relax the jaw
Correct answer: Proceed with emergency surgical airway
CICO is a life-threatening emergency requiring immediate emergency surgical airway (cricothyrotomy) to establish oxygenation.
Question 7: Which of the following is the MOST effective strategy to reduce catheter-associated urinary tract infections (CAUTIs) in the perioperative setting?
- Use of antiseptic-coated urinary catheters in all surgical patients
- Daily reassessment and early removal of urinary catheters when no longer needed (Correct answer)
- Routine irrigation of urinary catheters with antiseptic solutions
- Prophylactic oral antibiotics throughout catheterization
Correct answer: Daily reassessment and early removal of urinary catheters when no longer needed
The single most effective CAUTI prevention strategy is prompt removal of urinary catheters as soon as they are no longer clinically indicated.
ABA Clinical Practice & Patient Safety 2
A patient with suspected malignant hyperthermia (MH) crisis develops a temperature of 39.8°C, masseter spasm, and rising ETCO2.
What is the FIRST priority intervention?