Lesson 266: PreAnesthetic Assessment of the Patient With Negative Pressure Pulmonary Edema

Course Author:

Jonathan R. Ashton, MD, Staff Anesthesiologist, Memorial Hospital of Carbondale, Carbondale, Illinois

Registration Fee: $15.00
2.0 AMA PRA Category 1 CreditsTM
available until
September 30, 2008

Please be sure to read registration information below.

 

Registration links are at the bottom of the page.

Reviewed by:

Suhail Istanbouly, MD Attending Pulmonologist, Memorial Hospital of Carbondale, Carbondale, Illinois

Review Date: May, 2007

NEEDS STATEMENT

Anesthesiologists are treating an increasingly large overweight population. The perioperative risks associated with obesity are well documented. Regional block techniques offer benefits to the patient for early ambulation and good pain control and are often part of office-based anesthesia. Locating nerves, however, may be technically difficult in the obese patient. New techniques have been described that assist in the precise location of specific tissues; the use of such techniques is rapidly becoming a standard of care. The descriptions of these methods have been identified as required knowledge for anesthesiologists.

     
CASE HISTORY

A 21-year-old African-American man was brought to the operating room for open reduction and internal fixation of his femur after he sustained a fracture when the golf cart he was driving overturned. His height was 6 ft and his weight about 300 lb. The patient was otherwise healthy and muscular, although he had been told that he snored and might benefit from sleep studies. On emergence from anesthesia, he appeared to be awakening appropriately and his trachea was extubated. Thereafter, ventilation became difficult and his oxygen saturation decreased.

   

LEARNING OBJECTIVES

At the end of this activity, the participant should be able to:

  1. Review the incidence and association of laryngospasm and NPPE.

  2. Describe the risk factors for NPPE.

  3. List the means for preventing NPPE.

  4. Discuss the signs and symptoms of NPPE and make a diagnosis.

  5. Describe the appearance of NPPE on a chest X-ray film.

  6. Recognize clinical scenarios that lead to NPPE.

  7. Describe the effects of obstructed breathing on cardiac function.

  8. Classify NPPE as noncardiogenic.

  9. Explain the added effects of hypoxia and sympathetic stimulation in the development of  pulmonary edema.

  10. Prescribe a plan for the treatment of patients with NPPE.

TARGET AUDIENCE:  Anesthesiologists

INSTRUCTIONS FOR COMPLETING THIS COURSE

The estimated time to complete this activity is 2 hours. There are two options for completing this CME activity.

Option 1: Exam Only.  This option can only be exercised by subscribers to Anesthesiology News who possess a material copy of the course.  Participants who select this option must read the article in the journal, reflect on the information presented, and then register to complete the exam and course evaluation online before September 30, 2008. (CME credit is not valid past this date.)  

To register for the exam only, click on the Register For Exam link located at the bottom of this page. DO NOT select this option if you do not possess a material copy of the CME course material.

There are ten questions in the examination and you must achieve a score of 80% or better to earn CME credit.  Following successful completion, your certificate will be immediately available online.  In addition, a historical record of  completed CME courses is maintained online in an individualized profile.  This includes copies of course certificates which can be printed at any time.

Option 2: Course Material and Exam.  All participants are eligible for this option.

You must first register for this course by clicking the "Register for Course" link located at the bottom of this page.  Course material is presented in small digestible sections followed by exam questions pertaining to the information in the segment covered.  As you read through the material on the course pages, you will occasionally be prompted to answer exam questions. 

There are several short pages of information and 10 multiple choice questions presented in this course.  You must achieve a minimum grade of 80% (8 correct answers) to receive CME credit. The exam and course evaluation must be completed before September 30, 2008. (CME credit is not valid past this date.)  

The course software does not permit you to page back from the exam questions.  You must be sure that you understand the material presented on each page before proceeding.

When you have answered the last exam question, the Course Results page will display. This page will contain your final grade and allow you to immediately view/print your Certificate if you have achieved the minimum passing score of 80%. 

Upon successful completion, your Certificate will be available at all times from your Student Control Panel.   In addition, a historical record of  completed CME courses is maintained online in an individualized profile.  This includes copies of course certificates which can be printed at any time.

The course does not need to be completed in a single online session. You can log off at any point and return to the course at your convenience.  If you wish to obtain more information regarding the features of this site, you may visit the Orientation page.  Click here to view Orientation.

REGISTRATION

The registration fee for this course is $15.00

Physicians are provided with two opportunities to complete the course presented here. 

Accreditation Statement

Mount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation: The Mount Sinai School of Medicine designates each educational activity for a maximum of 2 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

It is the policy of Mount Sinai School of Medicine to ensure objectivity, balance, independence, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Presenters must also make a meaningful disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices.

CONTACT INFORMATION

Questions regarding course content may be directed to Dr. Elizabeth Frost: ElzFrost@aol.com.

If you require technical assistance with completing this course, please contact Continuing Education Online Customer Service at 718-648-8080 or send e-mail to CEO.support6@proceo.com.

All other requests for administrative assistance should be directed to Josephine Greene in the CME office at the Mount Sinai School of Medicine : 212-241-4441 or send email to Josephine.Greene@msnyuhealth.org

CALL FOR WRITERS

If you would like to write a CME lesson in Anesthesiology News, please send an e-mail to Elizabeth A.M. Frost, MD, at ElzFrost@aol.com

Click Here to REGISTER FOR
EXAM ONLY

This option is for the examination ONLY.  No course material is provided. This option is available for subscribers of Anesthesiology News who possess a material copy of the course material.  DO NOT select this option if you do not have the course material.

Click Here to REGISTER FOR COURSE AND EXAM

This option is available for all participants. This option includes a full online text version of the course material and exam.