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1. Develop response plans for the most likely respiratory and cardiovascular emergencies to occur post-operatively.
2. Communicate the regulatory issues and standards driving changes in post-anesthesia practice today.
3. Assess strategies to identify concerns early on in the patient following surgery.
4. Evaluate the key elements involved in related malpractice cases.
5. Appraise how the medications used during surgical cases can present challenges afterwards when the patients admit to the floor.
6. Formulate effective documentation samples for emergent post-op patient cases.
7. Analyze why certain populations pose unique challenges post-operatively to be able to anticipate needs.
8. Plan for emergent interventions for patients with known or unknown sleep apnea.

Critical Elements in Perianesthesia Care

• Co-existing disease process and anesthesia
• Levels of sedation and advantages/ disadvantages (conscious sedation, MAC, general)
• Intubation techniques and equipment (standard versus emergency)
• Differentiating spinal and epidural blocks
  • Safe management of catheters
  • Emergency identification and management of complications
  • Regional nerve blocks (Neck, upper and lower extremity, eyes)
• Identifying potential emergencies and complications resulting from regional blocks
  • Horners syndrome
  • Pneumothorax, vertebral artery injection
  • Hematoma and intravascular injection

Anesthetic Medication Complications

• Pharmacokinetics and pharmacodynamics
• Benzodiazepines
• Opioids
• Induction agents
• Inhalation agents and physiology
• Depolarizing and non-depolarizing muscle relaxants
• Acetylcholine receptor competitive antagonists
• Antiemetics
• Common emergency medications in the perianestheisa setting

Post-operative Complications with Clinical Application (Real Life Case Studies)

• Modulation of pain
  • Pharmacologic and non-pharmacologic methods to employ
  • Physiologic complications from pain
• Local Anesthetic Systemic Toxicity (LAST)
  • Signs and symptoms (early and late)
  • Treatment algorithm
  • Post-op Nausea and Vomiting (PONV):
  • Risk factors, medication management, prophylaxis, rescue therapy
  • Hypothermia: Heat loss physics, delayed awakening, warming interventions
  • Perform a focused yet thorough physical assessment (systems review)

Respiratory Emergent Complications (Real Life Case Studies)

• Airway obstruction: Upper and lower
• Pharyngeal muscular weakness
• Laryngospasm vocal cord paralysis
• Airway edema
• Other airway emergencies:
  • Postoperative cervical hematoma
  • Foreign bodies
  • Residual effects of anesthesia
  • Pharmacologic reversal
  • Compromised oxygen exchange
  • Bronchospasms
  • Non-cardiogenic pulmonary edema
  • Hypoventilation and hypoxia
  • Pulmonary embolism
  • Pseudeocholinesterase deficiency
  • Atelectasis
  • Aspiration
  • Pneumothorax
  • Emergency tracheotomy

Obstructive Sleep Apnea Airway Emergent Complications (Real Life Case Studies)

• Physiology of OSA
• Comorbidities of concern
• Diagnosis
• Planning for treatment
• Emergency interventions
• Effects on airway management and ventilation
• Implications for care across the perianesthesia setting

Cardiovascular Emergent Complications (Real Life Case Studies)

• Pulmonary edema
  • Fluid overload
  • LV failure
  • MV dysfunction
• Hypertension and hypotension
• Postoperative dysrhythmias
• Myocardial infarction
• Hypervolemia and hypervolemia

Neuropsychiatric Emergent Complications (Real Life Case Studies)

• Emergence delirium/excitement
• Somnolence
• Visual disturbances
• Intraoperative awareness
• Malignant hyperthermia

Post-operative Urinary Retention Concerns

• Risk factors to heighten awareness
• Evaluation and the latest in treatment

High Risk Populations: Tips to Reduce Potential Complications

• Obese patients
• Pediatric patients
• Obstetric patients
• Geriatric patients

Michael Greco, DNP, CRNA, CPAN, CAPA is a certified registered nurse anesthetist, a certified post-anesthesia nurse and a certified ambulatory perianestheisa nurse who currently practices at The New York Presbyterian Medical Center in New York City. He has provided anesthesia care for cases ranging from outpatient ambulatory care to complex open-heart cases. He has also covered labor and delivery services as well as serving as a PACU liaison. His extensive experience in the perianesthesia/critical care arena has not been limited just to the hospital setting. As a past critical care staff educator, Michael had the opportunity to take his skills to the sky and educate flight attendants around the continental US and South America through his involvement with the American Airlines AED program. Recently, he received an honorary discharge from the US Army after serving ten years in the reserves as a nurse anesthetist. Michael has had the opportunity to present to and empower nurses and anesthesia providers not only nationally, but internationally as well.

Michael received his Doctor of Nursing Practice degree from The University of Alabama, his Masters in Nurse Anesthesia at SUNY Health Science Center at Brooklyn, and his undergraduate BSN training at Niagara University. He is dedicated to nursing education and has completed a research study on adult learning. He currently holds an academic appointment at Columbia University as a professor in the graduate Nurse Anesthesia program. His current research interests include anesthetic management of cardiac electrophysiology patients as well as computer-mediated distance education. He is a member of Sigma Theta Tau, American Association of Nurse Anesthetists and American Society of Perianesthesia Nurses. Utilizing his minor in theater arts, Michael has appeared on National TV on the Jerry Lewis Telethon, on TLC's Trauma Life in the ER, and has done voice over work for local and national television commercials.

Disclosures:

Financial: Michael Greco is receiving a fee for speaking at this educational activity.

Nonfinancial: Michael Greco has no relevant nonfinancial relationships to disclose.

For U.S. and Canadian customers, a CE test is available for $9.99 USD per participant. International CE rates may vary; please contact our Customer Service at 1-800-844-8260 for more details.

Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Please note, your state licensing board dictates whether self study is an acceptable form of continuing education. Please refer to your state rules and regulations.

Certificates of Successful Completion may be emailed, faxed or mailed to participants completing the post-test/evaluation and paying the CE fee.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

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Nurses/Nurse Practitioners/Clinical Nurse Specialists - Credit Expired: 2/13/2018
No CE available for this board.

California Nurses: PESI, Inc. is a provider approved by the California Board of Registered Nursing, Provider #:17118 for 5.5 self-study contact hours.

You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Nurses: PESI, Inc. is an approved provider by the Florida Board of Nursing. Provider #: FBN2858. These materials qualify for 5.5 self-study contact hours.

Iowa Nurses: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 5.8 self-study contact hours.

Copies of the evaluation may be sent to the IBON. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

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Pharmacology Nurse Practitioners
This self-study program offers 120 instructional minutes of pharmacology content which is designed to qualify for 2.0 contact hours toward your pharmacology requirement.

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Physical Therapists & Physical Therapist Assistants
This self-study course consists of 5.75 clock hours of instruction that is applicable for physical therapists. CE requirements for physical therapists vary by state/jurisdiction. Please retain the certificate of completion that you receive and use as proof of completion when required.

California Physical Therapists & Physical Therapist Assistants: PESI, Inc. is recognized by the Physical Therapy Board of California as an approval agency to approve providers. This self-study lecture qualifies for 5.75 continuing competency hours.

Illinois Physical Therapists & Physical Therapist Assistants: PESI, Inc. is a Registered Physical Therapy Continuing Education Sponsor through the State of Illinois Department of Financial and Professional Regulation, Division of Professional Regulation. License #: 216.000270. This self-study course qualifies for 5.5 CE credit hours.

New York Physical Therapists & Physical Therapist Assistants: PESI, Inc. is recognized by the New York State Education Department, State Board for Physical Therapy as an approved provider for physical therapy and physical therapy assistant continuing education. This self-study course qualifies for 7.0 contact hours.

Texas Physical Therapists & Physical Therapist Assistants: This self-study activity is provided by the Texas Board of Physical Therapy Examiners Accredited Provider #2106032TX and meets continuing competence requirements for physical therapist and physical therapist assistant licensure renewal in Texas. This activity will provide 5.75 CCUs. The assignment of Texas PT CCUs does not imply endorsement of specific course content, products, or clinical procedures by TPTA or TBPTE. Full attendance is required; no partial credits will be offered for partial attendance.

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Other Professions
This self-study activity qualifies for 5.75 clock hours of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements.

Disclaimer: **Information obtained in this course should be used within your scope of practice.
**It is your ethical responsibility to report accurate hours to your licensing board.
**All self-study participants must complete and pass (80% or better) a post-test and evaluation prior to receiving a certificate of completion. If you require a copy of the test/evaluation for CE purposes, please print at the time you take the test. Or you may call our customer service department and a copy of your test/evaluation will be emailed to you. Please allow 30-45 days.

Nurses, Physical Therapists, Physician Assistants, and other Healthcare Professionals