Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anaesthesia > Anaesthesia I and II > Flashcards

Anaesthesia I and II Flashcards

1
Q

What are the 11 points of airway assessment?

A 
Dentition
Mouth open (3/finger or 3cm)
Neck movement (>90 degree)
Thyro mental (7cm)
Jaw protrusion
Laryngoscopy (same pt state?)
Cricoid present
Short neck
BMI
Defect/injury
Mallanpati
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the mallanpati score?

A

1: sp, fp, uv
2: sp, fp, base of uv
3: sp only
4. Only hard pallet

3&4 indicate difficult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the ultimate aim of an airway assessment?

A

Can we ventilate
Can we intubate
Can we crico

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the signs of a difficult bag mask?

A 
Beard
Obese
Thin
No teeth
Physical defect
Small jaw
Apnoea/snoring
Mallanpati 3&4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the cormack and lehane system?

A

1: full cord view
2: cords partially covered by epiglottis
3: epiglottis only
4: pharynx only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Cooks modified classification of laryngoscopy?

A

2a: posterior glottis
2b: aretynoids only
3a: epiglottis - can lift
3b: epiglottis - fixed

2b/3a: restrictive - bougee
3b/4: difficult - advanced technique

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are signs of difficult LMA insertion?

A

Limited mouth open
Oral masses
Large tongue
Reduced neck flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are signs of a difficult cricothyroidotomy?

A 
Obese
Neck mass
Deviated trachea
Reduced neck movement
Radiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe cricoid pressure.

A 
C6 level
Full ring occluded oesophagus
Other hand behind neck (lateral, unstable)
30-40N
Reduce insufflation and aspiration
Might hinder view
(Sellicks manoeuvre)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the risks of cricoid pressure?

A

Oesophageal rupture
Cspine instability
Bruise
Reduced view

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is BURP?

A

Backward
Upward
Rightward
Improve view by manipulation neck cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the ASA system?

A

Health status

1: fit and well
2: mild disease
3: function limiting disease
4: severe/life threatening
5: die without surgery
6: brain dead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are cardiopulmonary function tests?

A

METs: measure energy cost - normal is 6 (jog)

TUG: sit to stand, walk 3m and return - <10s

Cardiopulmonary exercise testing: cycle or treadmill with increasing resistance until must stop - graphs gases and stats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is FEV1 and FVC?

A

FEV1: forces expiratory volume in 1 second

FVC: total expiration volume after maximal inhale

FEV1/FVC = 80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is FRC and CC?

A

FRC: amount of gas remaining in lungs after expiration

CC: volume of gas in lungs at which small airways start to collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What factors increase closing capacity?

A

Age
Disease
Smoking
Supine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is hypertension and hypotension?

A

> 140/90
Vessel damage/aneurysm

<90/60
Brain injury/stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is MAP?

A

Mean arterial pressure
Sys+(2xdia) / 3

Normal is 60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the Glasgow coma score for eyes?

A

(4)

1: none
2: open to pain
3: open to voice
4: spontaneous open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the Glasgow coma score for verbal?

A

(5)

1: none
2: incomprehensible sounds
3: inappropriate words
4: confused
5: orientated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the Glasgow come score for motor?

A

(6)

1: none
2: extension to pain (decerebrate)
3: flexion to pain (decorticate)
4: withdraw from pain
5: localise to pain
6: obey commands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the Glasgow coma score?

A

Conscious state
Score 3-15

<13 poor

E4V5M6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is AVPU?

A 
Patient response
Alert
Voice
Pain
Unresponsive

Patient can respond via eye, verbal or motor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the 7 factors of neurovascular assessment?

A 
Pain
Pallor
Pulse
Parasthesia
Paralysis
Poikilothermia
Pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the positives for oxygen therapy?

A 
Increase reserve
Reduce effort and strain on heart, energy
Increase perfusion/circ
Increase healing
Reduce anaerobic - lactate
Assist with sedated/opioid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the cons of oxygen therapy?

A 
Dries airway
Free radicals damage tissue
Increase atelectasis due to wash out of N which remains in the alveoli 
Bad with laser
High cost
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How much oxygen is inspired and expired normally?

A

21% in

18% out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the FiO2 for nasal prongs?

A

25-45%
1-6L

Dries nostrils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the FiO2 for Hudson mask and with reservoir bag?

A

40-60%
6-10L

Reservoir bag contains valve which prevents CO2 entry
60-95%
6-max L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is a Venturi mask?

A 
Fixed conc mask
Based on Bernoulli principle (^speed decreases pressure so more space)
Entrains gas via Venturi effect 
Dial % and FR
Up to 90%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Define hypoxia.

A

<94%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the 9 symptoms of hypovalaemia?

A 
>15% loss
Low systolic
High diastolic then low
High HR
Capillary refill >2s
High RR 
Low urine
Pale/cold
Reduced alert: anxious, confused, reduced conscious
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is a PCA?

A 
Push button, lockout or basal rate
Need IV and fluid
One way valve on fluid line to prevent opioid travelling and bolusing 
O2 and pulse ox
Additives: clonidine, naloxone, antiem 
Normal rate: 1ml, 5min, 12ml/hr max
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the steps of an incorrect count?

A 
Recount
Inform team
Search
Magnet?
X-ray
Close
Inform patient, document
Incident form and refer patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the minimum count items in an emergency?

A

Swabs
Sponges
Sharps

Incident form
Complete count ASAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What must purposely retained items have?

A

X-ray detectable
Well documented
Hand over

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the practitioners assurance act 2003?

A

Protect public by having mechanisms to ensure competence and fitness of practitioner

Mechanisms:
Valid qualification
Annual registration 
Practise within SOP
Ongoing education
Tribunal for discipline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the HDC Code of Health and Disability services consumer rights regulations 1996 for?

A

Promote and protect rights

Pt rights vs provider responsibilities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the 10 patient rights under the HDC Code of Health and Disability services consumer rights regulations 1996?

A 
Respect (privacy, culture)
Fair treat (no discrim, no coercion)
Dignity and independence 
Proper standards (care, skill, quality)
Communication (in way pt understand, fair enviro, Qs)
Info (risk/ben, options, result)
Consent/decision (accept/refuse)
Support
Teaching/research
Complaint
40
Q

What are the three aspects of the treaty?

A

Partnership
- working with to develop

Participation
- involved at all levels

Protection
- ensure level care, safe guard concepts

41
Q

What are the 12 points of the Privacy Act 1994?

A 
Purpose: necessary, relevant
Source: from pt or reasonable 
Collection: pt aware and consent
Manner: lawful, fair
Storage: protect from loss, others
Access: pt allowed
Correction: attach statement
Accuracy: regular check/update
Retention: no longer than needed
Limit use: primary purpose only
Limit disclosure: can't give to others
Unique ID: not unless needed for org
42
Q

What are the exceptions to the privacy act?

A 
If patient can't consent
If secondary purposes relate to the consent
If urgent care is needed
If it lessens public risk
If it is known public information
43
Q

Who monitors the privacy act?

A

The privacy commissioner

Monitors, develops and investigates issues

44
Q

What drug acts relate to technicians?

A

Medicines act

  • only give under direct supervision
  • follow direction

Misuse of drugs act
- only give under direct supervision

45
Q

What is important about the theatre layout?

A

Double door to keep privacy, separate areas and maintain environment

Dirty - exit
Clean - entry

46
Q

What are the different areas of restriction in the theatre block?

A

Unrestricted: public access
Semi: peripheral support area, storage, limited access, special attire
Restricted: OR, strict access and attire

47
Q

What are the conditions of the theatre environment?

A 
Laminar flow from centre ceiling out
20-24.4 degrees (comfort, microbes)
Positive pressure (air out only)
55% humid (spark, humid)
20 air change per hour (3 fresh; other recycled - filtered, warmed)
Scavenging to remove gases
48
Q

What is an RCD?

A

Residual current device

Cut power if leak detected
Compares active to neutral line

49
Q

What’s a LIM?

A

Line isolation overload monitor

On all critical equipment
Alarm and display leaked current
Does not cut power

50
Q

What is a UPS?

A

Uninterrupted power supply

Back up hospital battery comes on if power cuts out
For essential equipment

51
Q

What is body protected and cardiac protected?

A

Body - for procedures where skin is compromised
Uses RCD and LIM

Cardiac - for procedures where a conductor is near the heart
Uses RCD, LIM and equipotential earth

52
Q

What is micro and macro shock?

A

Micro
10-100micro amp
When electrodes near heart

Macro
Large current through skin
Fibrillation occur at 100mA

53
Q

What are the methods to manage a spill?

A 
Stop work, turn off risky equipment, ventilate area, report 
Turn on PPE 
Contain spill using kit medium
Collect spill in bucket
Label and take to unit 
Ensure workplace safe before resuming
  • incident form
54
Q

What are the 8 pieces of equipment in a spill kit?

A 
Absorbent
Respirator
Goggles
Gauntlet glove
Plastic apron
Large plastic bag
Bucket
Neutraliser
55
Q

What is sterilisation?

A

Complete destruction of all microbes and spores
Must decontaminate first
Correct method for equipment

56
Q

What is disinfection?

A

Process of destroying microbes on non-living object; spores remain

(Antiseptic does the same but on living tissue)

57
Q

What is decontamination?

A

Removal of bio burden and contaminants

Must occur first!

58
Q

What is autoclave?

A

Steam and pressure
121 degrees
15psi
15min

Cheap, non-toxic, quick, enviro friendly

59
Q

What is dry heat?

A

Hot air
160-170 degrees
2 hour

Item must be heat stable - glass

60
Q

What is ethylene oxide?

A 
Chemical/biocide
Delicate items
500mg/L
58 degrees
40% humid
4 hour

High cost, long time, toxic
Need bio indicator

61
Q

What is ionising radiation, UV light and U/S wave?

A

IR
High energy EM waves disrupt DNA eg a teddy

UV
Waves penetrate surface only

US (decontamination)
In solvent tank, waves vibrate liquid to remove debri

62
Q

What are the 5 disinfectant factors?

A 
Correct time
Correct conc
Temp
pH
Relevant to microbe

Must decontaminate first!!

63
Q

What are 8 important factors for storage of equipment?

A 
Room temp
Good ventilation
Secure
Clean
Well
Ventilated
Dry
No sunlight
Above ground level
64
Q

What are the 5 moments of hand hygiene?

A 
Before pt contact
After pt contact
Before a procedure
After body fluid exposure
After leaving pt surroundings
65
Q

What is diathermy?

A

Mono: current from device to electrode pad
Bi: both electrodes mounted on device

Pad: large, hairless, flat, non-bony, close to site, not through heart

66
Q

What are safety concerns or features of diathermy?

A 
Bi is safer and ok for use with pacemaker
Heat up internal metal work
Patient touching metal may burn
Poor pad contact - burn
Electrical fault
Fire risk
High current
Microshock risk
67
Q

What are the layers from skin to subarachnoid space?

A 
Skin
Subcutaneous tissue
Supraspinus ligaments
Interspinus ligaments
Ligamentum flavum
Epidural space
Dura mater
Arachnoid mater 
Subarachnoid space
68
Q

What is a spinal injection?

A

One off injection into subarachnoid space
Placed below L2 - ideally L3/4 to avoid spinal cord

Continuous spinal anaesthesia with a catheter is possible

69
Q

What is the spinal needle?

A

26G pencil point
Atraumatic tip to side
Clear hub to see CSF
Stylet to avoid tissue core occlusion and strengthen shaft

Quinke: cutting bevel

70
Q

Describe the spinal space.

A

Subarachnoid space
Inject at L3/4
Spinal cord ends L1 in adult and L3 in infants
Iliac crests indicate L4 (Tuffier’s line or intercristine)

71
Q

What LA is used in spinals?

A

Bupivicaine 0.5%
Isobaric (plain)
Hyperbaric (heavy) with 8% glucose
Hyperbaric can produce a higher block by positioning the patient accordingly

72
Q

What are the contraindications to a spinal anaesthetic?

A 
Hypotensive problems eg aortic stenosis, hypovalaemia
Back surgery
Neurological disease
Systemic sepsis
Local sepsis
Anticoagulant use
73
Q

What are common complications of spinal anaesthesia?

A 
Hypotension
Bradycardia
Total spinal
Urinary retention
Nerve damage
PDPH
Infection - abscess 
Bleeding - haematoma
74
Q

What is the cause of a PDPH?

A

Caused by leaking CSF
causing pressure to drop and the brain to sink
Proportional to needle gauge and number of punctures
Less likely with atraumatic needle
24-48hr post procedure
Pain worse on standing, maybe absent in the morning and return on moving
Usually front with neck stiffness

75
Q

What’s an epidural?

A

Placement of catheter into epidural space
Up to 3 days
Analgesia via top ups, continuous infusion or PCEA
Anywhere along vertebral column

76
Q

Describe the epidural space.

A

Aka extradural

Potential space

77
Q

How is an epidural placed?

A 
Position patient 
Locate anatomy
(Ensure IV; foetal monitor)
Insert needle until resistance met
Connect roulsen syringe and continue insertion until loss of resistance
Introduce 4-5cm of catheter 
Check for blood/CSF
Test dose
Secure
78
Q

What is an epidural test dose?

A

Checking for IV injection, spinal injection and production of a expected block

79
Q

Why choose an epidural/spinal over GA?

A

Post op atelectasis and infection reduced
Pain relief = better breathing
Reduced post op MI
Reduced hypercoagulable response
Increased mobility reduced DVT
Improves intestinal mobility so eating sooner

80
Q

What are the common complications of epidurals?

A 
Dural puncture
Headache
Nerve injury
Catheter migration
Hematoma/abscess
Respiratory depression 
Hypotension
Pruritis
Urinary retention
Motor block
IV injection
81
Q

Compare a spinal drug dose with a epidural drug dose.

A

Spinal:
3ml of 0.5% bupivicaine
0.2 morphine
10-25mcg fentanyl

Epidural:
10-15ml of 0.1% bupivicaine
50-100mcg fentanyl (2mcg/ml)

82
Q

Why might pethidine be the drug of choice for a spinal?

A

Has both opioid and LA properties so can be used as the sole drug

83
Q

How is a PDPH treated?

A

Blood patch
Seals the leak and compresses dural space thereby raising pressure
Lateral position - minimise pressure at the site
Aseptic technique
Perform epi at same or lower space
Obtain 20ml blood
Inject slowly until given or pain which doesn’t ease occurs (in back)
Rest for 2 hours

84
Q

What are the complications of a blood patch?

A 
Backache
Repeated dural puncture
Neurological deficits
Epileptiform fits
Cranial nerve damage
85
Q

What is the needle for an epidural?

A 
Touhy 
10cm needle
1cm markings
Stylet to prevent tissue core
20degree atraumatic bevel (huber) to prevent dural puncture and trauma 
Normally 18G
86
Q

What are the other components of an epidural pack?

A 
Nylon/Teflon catheter
Rounded distal end
Side ports
5cm markings (1cm between 5-15cm)
Proximal connects to lure lock and filter
0.22 micron filter
Loss of resistance syringe
87
Q

Compare a spinal block and epidural block.

A 
Spinal:
Excellent/dense block
One off/catheter
Less drug needed so less side effects 
Faster onset
Higher PDPH 
Epidural:
Patchy block
Catheter allows ongoing relief/top up 
High infection risk
Can titrate the drugs
Can block higher 
High volume used so greater risk of total spinal, toxicity if misplaced
88
Q

What is a CSE?

A

Combined spinal epidural

Touhy needle in place as per epidural
Spinal needle through - give dose
Remove spinal needle
Place epidural catheter and continue as per epidural

Gives fast onset, good block and ability to top up

89
Q

How is an IVRA placed?

A 
Measure BP
IV into non surgical limb and one into surgical limb
Apply tourniquet to limb - exsanguinate 
Inflate 50-100mmHg > systolic
Inject LA
Don't deflate for 15-20min

(If double cuff and tourniquet pain occurs; use proximal cuff to do block then change to distal cuff as this should be asleep)

90
Q

What are the contraindications of IVRA?

A

Circulation problems
Crush injury
Sickle cell disease
PVD

91
Q

What is a block needle?

A 
Short/blunt bevel for minimal nerve trauma
Lure lock
Clear hub to detect IV 
Nerve stimulator connection 
22G normally
92
Q

How is a nerve stimulator used to assist regional blocks?

A

Introduce needle to skin
Attach to stimulator
High output (1-3mA) advance until nerve stimulated
Lower output (0.2mA) until maximal stimulation with minimal mA so that tip is close to nerve (if stim <0.2 might be intraneural)
As LA injected stimulation should stop (failure to stop might be intraneural)

93
Q

What’s an insulated needle?

A

Teflon coated with exposed tip

Current passes from tip only to ensure accurate stimulation

94
Q

What is a caudal extradural block?

A

Injection into epidural space of sacral spine for a block below the umbilicus in children

Can place catheter

95
Q

What is the anatomy for a CEA?

A

Position left lateral with legs flexed
Sacral hiatus: tip of a triangle with base at posterior superior iliac spine
Sacral hiatus is also a triangle with base at sacral cornu and tip at 4th vertebra

96
Q

How is a CEA placed?

A 
Left lateral
Define boundaries
Nick the skin
22/20G cannula 60degree to skin from midpoint of sacral cornu 
Small give indicates penetration of membrane
Flatten needle then advance
Aspirate and inject LA 
Normal block 4-8hours
97
Q

Why can’t a CEA be used in adults?

A

Difficult to find space
Sacral bones fused
Adipose reduces spread so not reliable
Spinal/epidural easier and better

Anaesthesia (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions