Anesthesia
24%of exam
Physiology
18%of exam
Monitoring + Intervention
35%of exam
Care Considerations
14%of exam
HandoffTransferEducationPsychosocialDevelopmentDischarge
Professional Practice
9%of exam
StandardsSafetyEthicsDocumentationPrivacyCollaboration
Quick Facts
- Exam
- CPAN
- Sponsor
- ABPANC
- Focus
- Phase I PACU
- Questions
- 185 MCQ
- Scored
- 140 scored
- Pretest
- 45 unscored
- Time
- 3 hours
- Pass
- 450 scaled
- Scale
- 200-800
- Vendor
- PSI
- Eligibility
- RN + 1200 hours
MH Clues
EtCO2 climbs before temperature scares.
EtCO2RigidityAcidosisDantrolene
MH vs Fever
MH
- Rising EtCO2
- Rigidity
- Dantrolene now
Fever
- Slower onset
- Infection workup
- Antipyretics
EtCO2 drives urgency
Techniques
- General
- Unconscious airway support
- Regional
- Nerve distribution block
- Local
- Site-specific anesthesia
- Moderate sedation
- Purposeful response
- MAC
- Anesthesia-monitored sedation
- TIVA
- IV anesthesia only
- Neuraxial
- Spinal/epidural block
- Peripheral block
- Extremity analgesia
LAST Clues
Mouth rings, ears ring, seizures start.
PerioralTinnitusSeizureLipid
LAST vs Anaphylaxis
LAST
- After local
- Seizure/collapse
- Lipid therapy
Anaphylaxis
- Allergen exposure
- Bronchospasm/hypotension
- Epinephrine
Trigger identifies pathway
Agents + Reversal
- Volatiles
- MH triggers
- Succinylcholine
- MH trigger
- Propofol
- Rapid hypnotic
- Ketamine
- Dissociative analgesia
- Opioids
- Respiratory depression
- Benzodiazepines
- Sedation/amnesia
- Naloxone
- Opioid reversal
- Flumazenil
- Benzo reversal
- Sugammadex
- Rocuronium reversal
- Neostigmine
- Cholinesterase inhibition
Spinal vs Epidural
Spinal
- Single injection
- Rapid dense block
- Hypotension risk
Epidural
- Catheter possible
- Segmental dosing
- Hematoma watch
Speed vs titration
Block Complications
- Interscalene
- Phrenic palsy
- Supraclavicular
- Pneumothorax risk
- Cervical plexus
- Horner syndrome
- Neuraxial opioid
- Delayed depression
- High spinal
- Hypotension/apnea
- Epidural hematoma
- Neuro emergency
- LAST
- Seizures/collapse
- Tourniquet pain
- Regional breakthrough
Hypoxia vs Delirium
Hypoxia
- Check airway
- Assess SpO2
- Ventilate/oxygenate
Delirium
- After oxygenation
- Reorient calmly
- Find causes
Oxygen first
Respiratory
- Hypoventilation
- CO2 retention
- Obstruction
- Noisy effort
- Laryngospasm
- Closed glottis
- Bronchospasm
- Wheezing resistance
- Atelectasis
- Collapsed alveoli
- Aspiration
- Gastric contamination
- OSA
- Opioid sensitivity
- Pneumothorax
- Unilateral sounds
- NPPE
- Post-obstruction edema
Circulation
- Hypovolemia
- Tachycardia/hypotension
- Bleeding
- Trend drains
- Shock
- Poor perfusion
- MI
- ST changes
- Mobitz II
- Pacing risk
- Hypertension
- Pain/hypoxia/full bladder
- Embolism
- Sudden hypoxemia
- Aortocaval
- Left tilt
Neuro + Endocrine
- Delayed emergence
- Drugs/metabolic/neuro
- Delirium
- Hypoxia first
- Stroke
- Time-sensitive escalation
- ICP rise
- Midline/head up
- Hypoglycemia
- Altered mentation
- DKA
- Polyuria/acidosis
- Hypocalcemia
- Tetany signs
- Hyperkalemia
- Wide QRS
Temperature + Fluids
- Hypothermia
- Shivering/O2 demand
- Normothermia
- Active warming
- MH
- Hypermetabolic crisis
- Acidosis
- Ventilate/perfuse
- Citrate toxicity
- Low ionized calcium
- AKI
- Urine trend
- Fluid bolus
- Hypovolemia response
- Blood products
- Massive loss
PACU First Look
Airway, breathing, circulation before comfort.
AirwayBreathingCirculationPain
Pain vs Respiratory Depression
Pain
- Assess scale
- Multimodal options
- Reassess response
Resp depression
- Slow respirations
- Low EtCO2 alarm
- Ventilate/reverse
Breathing wins
Airway Picker
- Snoring obstruction→Jaw thrust(Open airway)
- Secretions present→Suction(Clear airway)
- Low SpO2→Oxygen(Assess ventilation)
- Hypoventilation→Ventilate(Bag-mask)
- Laryngospasm→Positive pressure(Call anesthesia)
- OSA patient→Extended monitoring(Limit opioids)
- Intubated transport→Monitor/O2/BVM(Emergency meds)
Airway Monitoring
- SpO2
- Oxygen saturation
- EtCO2
- Ventilation trend
- ABG
- Gas exchange
- Aldrete
- Phase I readiness
- Sedation score
- Arousal depth
- Extubation
- Protective reflexes
- LMA removal
- Awake preferred
- Suction
- Clear secretions
- Jaw thrust
- Obstruction relief
Emergency Picker
- Rising EtCO2→MH protocol(Dantrolene)
- Seizure after block→LAST protocol(Lipid)
- Absent sounds→Pneumothorax response(Escalate)
- Widened QRS→IV calcium(Hyperkalemia)
- Opioid apnea→Ventilate first(Naloxone)
- Anaphylaxis signs→Epinephrine(Airway/fluids)
- New neuro deficit→Stroke alert(Time matters)
Pain + PONV
- Multimodal
- Multiple mechanisms
- Opioid titration
- Pain vs breathing
- Regional analgesia
- Motor/sensory checks
- PCA
- Patient controlled
- FLACC
- Nonverbal child
- FACES
- Young verbal child
- PONV
- Hydrate/antiemetic
- P6
- Antiemetic acupressure
Pain PONV Picker
- Severe pain→Titrate analgesia(Reassess)
- Respiratory depression→Hold opioid(Ventilate)
- Regional numbness→Neurovascular check(Trend)
- Nonverbal child→FLACC(Behavior)
- Verbal young child→FACES(Self-report)
- Nausea/vomiting→Antiemetic(Hydrate)
- Complementary PONV→P6 acupressure(Adjunct)
Lines Drains Wounds
- Arterial line
- Waveform/limb perfusion
- Central line
- Never force flush
- PICC
- Check occlusion
- Chest tube
- Air leak/drainage
- JP drain
- Bulb suction
- Serosanguineous
- Expected early
- Bright red
- Active bleeding
- Milky drainage
- Chyle leak
- Wound dehiscence
- Cover/escalate
Emergencies
- MH signs
- EtCO2/rigidity/heat
- Dantrolene
- MH antidote
- LAST signs
- Neuro then cardiac
- Lipid emulsion
- LAST therapy
- Anaphylaxis
- Epinephrine/airway
- Tension pneumo
- Decompress now
- Hyperkalemia ECG
- Calcium first
- Opioid overdose
- Ventilate/naloxone
Transfer Ready
Stable trends beat one pretty number.
AirwayVitalsPainHandoff
CPAN vs CAPA
CPAN
- Phase I
- Immediate recovery
- PACU instability
CAPA
- Ambulatory phases
- Preop/Phase II
- Discharge flow
Match primary practice
Transfer Picker
- Unstable airway→Stay Phase I(Escalate)
- Stable vitals→Assess criteria(Aldrete)
- Drain change→Report trend(Before transfer)
- Discharge teaching→Written/verbal(Verify learning)
- Language barrier→Interpreter(No family)
- Cognitive impairment→Caregiver(Reorient)
- No ride→Delay discharge(Safety)
Care Transitions
- Phase I
- Immediate recovery
- Phase II
- Discharge readiness
- Handoff
- Structured transfer
- SBAR
- Situation/background/assessment/recommendation
- Transport
- Monitor/O2/airway meds
- Family presence
- Reorientation support
- Interpreter
- Language access
- Caregiver
- Home safety
- Readiness
- Vitals/airway/pain
Phase I vs Phase II
Phase I
- Airway focus
- Frequent vitals
- Unstable trends
Phase II
- Ambulation
- Oral intake
- Home readiness
Stability before discharge
Individualized Care
- Pediatric
- Developmental scales
- Geriatric
- Reserve/delirium risk
- Pregnant
- Left uterine displacement
- Autism
- Reduce stimulation
- PTSD
- Trauma-informed care
- Substance use
- Tolerance/withdrawal
- Obesity
- Airway/OSA risk
- Latex allergy
- Latex-free setup
- Cultural beliefs
- Negotiate care
Document Care
Assess, intervene, reassess, communicate.
AssessInterveneReassessCommunicate
Standards vs Policy
Standards
- External guidance
- Professional baseline
- Evidence informed
Policy
- Local process
- Facility specific
- Operational rules
Use both
Exam Blueprint
- Anesthesia
- 24%
- Physiology
- 18%
- Monitoring
- 35%
- Care considerations
- 14%
- Professional practice
- 9%
- Blueprint cycle
- 2023-2027 exams
- Scoring
- Equated scale
- Retest
- Next window
Standards + Safety
- ASPAN
- Perianesthesia standards
- ASA
- Postanesthesia standards
- ACLS
- Adult resuscitation
- PALS
- Pediatric resuscitation
- MHAUS
- MH protocol
- HIPAA
- Privacy rule
- Consent
- Clarify discrepancies
- DNR
- Required reconsideration
- Incident report
- Safety documentation
- Competency
- Observed validation
Common Traps
Pretest Items
Unlabeled ≠ Still answer all
Scaled Score
450 scale ≠ Not fixed percent
Agitation
Could be hypoxia ≠ Not just anxiety
Hypothermia
Raises oxygen demand ≠ Not benign shivering
Pulse Ox
Oxygenation estimate ≠ Not ventilation proof
Central Line
Gentle troubleshoot ≠ Never force flush
DNR Surgery
Reconsider required ≠ Not automatic suspension
Family Interpreter
Use professional ≠ Not convenience substitute
Aldrete Score
Supports decision ≠ Not sole judgment
Pain Report
Believe patient ≠ Balance sedation
Last Minute
- 1.185 questions, 3 hours
- 2.140 scored; 45 pretest
- 3.Pass is 450 scaled
- 4.Monitoring is 35%
- 5.Airway before pain control
- 6.EtCO2 detects ventilation
- 7.Volatiles and succinylcholine trigger MH
- 8.Dantrolene treats MH
- 9.LAST gets lipid emulsion
- 10.SpO2 is not ventilation
- 11.Never force central lines
- 12.Trend vitals before transfer
- 13.Use interpreter for teaching
- 14.Document assessment and reassessment
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