Brainscape's Knowledge GenomeTM

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


See full index

Anaesthesia > Anaesthesia IV Week 6-12 > Flashcards

Anaesthesia IV Week 6-12 Flashcards

1
Q

What is the “cover” from

Cover abcd stand for?

A 
Circulation, colour, capnography 
Oxygen delivery, analyser, oximeter
Vaporiser, ventilator
ETT, eliminate machine 
Review monitor and equipment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the “abcd” in cover abcd stand for?

A

Airway
Breathing
Circulation
Drugs

Be aware of air and allergy

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

What does “a swift” from a swift check stand for?

A 
Air embolism, anaphylaxis, air in pleura, awareness
Surgeon, sepsis
Wound, water intoxication
Infarct, insufflation
Fat syndrome, full bladder
Trauma, tourniquet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does “check” from a swift check stand for?

A 
Catheter (IV, chest drain), cement 
Hypo/hyperthermia, hypocalcaemia 
Embolus, endocrine
Check
K+, keep patient asleep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is cover abcd and a swift check for?

A

Diagnostic aides
Cover abcd should be used whilst scanning
A swift check can help to eliminate and diagnose problems

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

What is “scare”?

A

Scan: routine checking per 5min using cover abcd
Check: when suspect something not right
Alert/ready: recognise a problem looks so call for help
Emergency: full response

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

What increase risks of bronchospasm?

A

Infection
Smoking
asthma

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

What might cause a laryngospasm?

A

Suctioning
Surgical stimulus
Secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is “isbar”?

A

Identify: who, where, role
Situation: what happening, diagnosis, operation
Background: clinical details
Assessment: what problem is
Recommendation: what required, risks, assign responsibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why are air embolisms common in neuro surgery?

A

Veins in cranium held open

If in sitting position (head above heart) air may be entrained

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

What are causes of air embolisms?

A 
Entrainment in vessels 
Unprimed lines
Insufflation 
Entrainment in lines
Pressure bags
Long bone surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the symptoms of an air embolism?

A 
Low ET CO2
Low sats
Low BP
High HR
ECG changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the treatment of air embolisms?

A

Call for help
Inform surgeon: irrigate, lower site, soaked swabs, entry point
100% oxygen
Stop nitrous
Consider CPR
Left side down to prevent travel to ventricles
Aspirate with CVL or hyperbaric chamber

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

What problem does an air embolism impose?

A

Too much air in the ventricles means the heart cannot pump properly
Most air is removed by lungs
Left lateral keeps air in RA
Problem with babies who have PDA as can then reach left heart and go to brain

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

What are the symptoms of anaphylaxis?

A 
Low BP
Bronchospasm
High pressure
High HR
Urticaria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the treatment of anaphylaxis?

A

Help
Stop causative agent
100% o2 airway?
Arrest? - CPR algorithm
Adrenaline 50-100mcg IV 1:10000 (0.5mg 1:1000 IM) repeat 5 minutely
Rapid infuse fluids
Also: adrenaline infusion (0.4mcg/kg/min), neb adrenaline, inotrope, salbutamol, trytase testing, extra lines, steroid and antihistamine

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

What are the common causes of anaphylaxis?

A 
Latex
AB
Relaxant
Chlorhexidine
Colloid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the times for trytase testing?

A

1 hour
4 hour
24 hour

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

What are the symptoms of a pneumothorax?

A 
Resp distress or difficult to ventilate
Tracheal deviation
High HR
Low BP
Neck vein distension
Misplaced apex beat
Reduced sound on one side
Low sats 
Unilateral chest rise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the treatment of a pneumothorax?

A

Help
100% oxygen
Nitrous off
Insert large IV into the 2nd intercostal space of the mid clavicular line
Or 5th intercostal space of the mid Axillary line

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

What might cause of pneumothorax?

A 
Trauma
Nearby nerve blocks
Central lines
Surgical causes 
CPR 
Traumatic intubation
Drains
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the symptoms of fat embolism syndrome?

A 
Neurological changes
Respiratory distress
Low sats
Low BP
Arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the problem with water intoxication?

A

Circulatory overload

Electrolyte disturbance such as hyponatraemia

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

What is bradycardia and the treatment?

A 
<40bpm
Help
100% oxygen (volatile off?)
Exclude hypoxia in children 
Stop surgical stimulus
Atropine 0.6mg 
If remain: adrenaline or transcutaneous pacing 
Consider CPR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the treatment of hypoxia?

A 
Help
100% o2 - confirm on analyser
Ensure circulation remains 
Hand ventilate
Check equipment 
Auscultation of chest
Consider: suction catheter, reintubate, F/O look, X-ray, ABG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the treatment for hypotension?

A 
Help
100% o2 - volatile down
Check pulse and equipment
Head down 
Open fluids - pressure
Vasopressors
Consider CPR 
Find the cause
More IV access
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the symptoms of laryngospasm?

A 
Strider
Inspiratory obstruction
Tracheal tug
Paradoxical breathing
Low sats
Low HR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is strider and paradoxical breathing?

A

Strider: abnormal high pitched inspiratory noise

Paradoxical: chest moves inward on inspiration instead of out

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

What is the treatment of laryngospasm?

A 
Help
100% o2
Jaw thrust/chin lift
Peep/CPAP
Deepen anaesthetic
Check airway clear
Sux/atropine and intubate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is considered a high airway pressure and what’s the treatment?

A 
>40cmh2o
Help
Inform surgeon - stop stimulus
100% o2
Manual ventilation
Check equipment
Check airway: suction Cath, et position, auscultation 
Bronchospasm: salb + adren
Pulm oedema: GTN + peep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the progressive symptoms of local anaesthetic toxicity?

A 
Tingling of lips and mouth
Ringing in ears
Confusion
Seizure
ECG changes
Cvs collapse - arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the treatment of LA toxicity?

A 
Stop LA
Help
100% o2 
Consider intubation 
Treat seizure
Control cvs - CPR or drug therapy 
Give intralipid!!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How is intralipid used during LA toxicity?

A

20%
Bolus: 1.5ml/kg over one minute
Infusion: 15ml/kg/Hr (0.25ml/kg/min)

If still unstable 5min after bolus, repeat bolus every 5 min up to 3 times and double the infusion rate

Maximum 12ml/kg cumulative dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the early symptoms of MH?

A 
Prolonged massater spasm with sux 
High ETco2
High RR
High HR
Arrhythmia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the developing symptoms of MH?

A 
0.5 degree increase in temperature every 15min
Respiratory and metabolic acidosis
High potassium
Sweating
Cvs instability 
Low sats and mottled skin
Muscle rigidity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the late symptoms of MH?

A

Cola urine - myoglobinuria
High CK
Coagulopathy
Arrest

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

What is the treatment of MH?

A 
Help
Stop trigger agents - remove
Switch to TIVA 
MH box - task cards (Dantrolene is priority)
100% o2, hyperventilate, FGF>15 with vapor free filters
Insert additional lines
Swap fluids to cold saline 
Ice pack body
Swap soda lime 
Treat other factors 
Investigations 
Dantrolene mixing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the dose of dantrolene?

A

2.5mg/kg IV bolus every 10-15min and repeat up to 30mg/kg

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

What drugs are used to treat the other factors?

A

Acidosis: sodium bicarbonate

Potassium: insulin in dextrose

Arrhythmia: amiodarone, lignocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Who is susceptible to MH?

A

Family history
Diagnosed MH
Raised Creatine kinase
Rare muscle disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How is the anaesthetic machine prepared for a known MH case?

A

Should be first on list
Remove vaporisers and sux -
Flush circuit for 90sec using 15L/min on the ventilator with test lung attached
Insert vapor free filters
Replace all consumables while still maintaining a flush of 15L/min
Keep FGF above 10L/min for first 90 minutes of the case

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the aims of haemorrhage treatment and other drugs which could be considered?

A

MAP > 50
Laboratory goals

Other drugs:
Calcium
Insulin for high potassium
Tranexamic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the treatment of cardiac arrest?

A

Help
100% o2
Start CPR
Attach defibrillator (200J)
Assess the rhythm
Shockable: 1mg adren after second shock and every second cycle, amiodarone 300mg after third shock
Non-shockable: adrenaline 1mg and repeat every second cycle
During CPR: achieve airway, attach capnography, IV access

44
Q

What are the 4H and 4T?

A 
Hypoxia
Hypovalaemia
Hyper/hypokalaemia other metabolic disorders
Hyper/hypothermia
Tension pneumothorax
Tamponade
Toxins
Thromboembolism
45
Q

What is post resuscitation care of a cardiac arrest?

A 
Reevaluate abcde 
12 lead ECG
Treat cause
Paed: Reevaluate oxygen and ventilation
Adult: aim for 94-98% O2, normocapnia and normoglycaemia 
Target temperature management (cool)
46
Q

What is the symptoms of aspiration?

A 
Laryngospasm
Obstruction
Bronchospasm
Crackles
Hypo ventilation
Dyspnoea
Low sats
47
Q

What is the treatment of aspiration?

A 
Help
Intubate
Suction, 100% o2, peep
Bronchoscope and lavage
Bronchodilator 
X-ray
48
Q

What should be done if the patient is regurgitating?

A 
Place head down
Suction
Cricoid
Gentle CPAP bag mask
Intubate
49
Q

What are the symptoms of a bronchospasm?

A 
High pressure
Low sats
Wheeze
Low tv 
High co2
50
Q

What is the treatment of bronchospasm?

A 
Help
100% o2
Stop any stimulation
Deepen
Check tube or intubate 
Adren or salbutamol
Find and treat cause
51
Q

What might cause a bronchospasm?

A

Anaphylaxis
Irritation
Aspiration

Differential: pneumothorax, oesophageal intubation, too light

52
Q

What is asthma?

A

Reversible airflow obstruction
Smooth muscle construction
Inflamed bronchial wall
Increased mucus production

53
Q

What is COPD?

A

Chronic bronchitis or emphysema
Obstruction of airflow
Non reversible
From prolonged exposure to irritant
Narrowing from inflammation, scar tissue and multiplying epithelial cells
Reduced elasticity causes collapse on expiration causing gas trapping
Enlarged mucus glands and reduced cilia function creates cough and mucus plugs

54
Q

What is chronic bronchitis?

A

A productive cough on most days for over 3 years
Inflamed bronchi

Productive cough for more than 3 months each year for 2 consecutive years

55
Q

What is emphysema?

A

Dilatation and destruction of alveolar which weaken and rupture causing reduced surface area for exchange

Alpha1 anti trypsin deficiency: allow WBC to attack lung tissue

56
Q

What are common COPD irritants?

A

Smoking
Occupational hazards
Pollution
Repeated infections

57
Q

What is a pink puffer?

A 
Emphysema
Thin
Breathless
High RR
Hypoxic
Barrel chest
Pursed lips
58
Q

What is a blue bloated?

A 
Bronchitis
Overweight
Poor respiratory effort
Hypoxic - blue
Peripheral oedema
Co2 retention
59
Q

What is Cor pulmonale?

A

Enlargement of right heart from lung disease

High pressure in lung vessels means difficult to pump here therefore it backs up in the right heart so it works harder

60
Q

What are normal blood gases?

A

Ph 7.35-7.45
O2 85-100 mmHg
Co2 35-45
Be +3/-3 mmol/L

61
Q

What are the anaesthetic considerations for COPD?

A 
Pre optimise (neb)
Avoid H1 drugs
Not for SV
Not ideal to lie flat
RV failure? 
Suction catheter
Extubate awake
62
Q

What affects do anaesthetic have on the respiratory system?

A 
Low FRC (quick hypoxia)
Low Cc (collapse before end expiration - gas trap)
Atelectasis
V/q mismatch 
Reduced pharyngeal tone
Increased secretions 
Low MV
Infection risk
63
Q

What is rheumatoid arthritis?

A 
Autoimmune inflammatory 
More common females
Reduced movement due to joint swelling, pain and stiffness
Chronic pain 
Symmetrical
64
Q

What are the articular problems with rheumatoid arthritis?

A

Temporomadibular: mouth opening reduced
larynx obstructed by nodules
Atlantoaxial subluxation: neck motion limited, movement may compress cord

65
Q

What are the non articular problems with rheumatoid arthritis?

A 
Cardiac: CAD, HD, aortic regurgitate
Resp: pleural effusion, reduced chest compliance 
Chronic anaemia - monitor 
Neuropathy, dry eye, cord compression
Immunosuppressants!! 
Renal failure
DI
66
Q

What is diabetes mellitus?

A

Insulin stimulates glucose uptake into cells
Type 1: immune mediated, IDDM, pancreas doesn’t produce insulin, deficiency, Tx: insulin
Type 2: NIDDM, cells don’t respond to insulin or not enough is produced, resistance, Tx: diet, exercise, oral, insulin

67
Q

What are the systemic complications of DM?

A

CAD, PVD, poor circulation, HTN, IHD
Neuropathy, autonomic neuropathy - vessels can’t constrict to compensate - hypotensive easily
High infection risk
Kidney failure, high creatinine
Retinopathy
Delayed gastric emptying, reflux (RSI)
Thickened soft tissues: limited joint mobility syndrome - DI

68
Q

Why is Hartmans solution not ideal in DM?

A

Contains lactate which is converted to glucose in the fasted state which could Potentiate hyperglycaemic state

69
Q

What are the symptoms of DM?

A 
Weight loss
Thirst (polydypsia)
Polyuria (frequent urine)
Polyphagia ( hunger)
Blurred vision
Headache
Fatigue
Reduced healing
70
Q

What is diabetes insipidus?

A

Deficiency of pituitary hormone ADH which regulates kidney function. Creates thirst and increased urine

71
Q

What is gestational diabetes?

A

Development of high blood sugar during pregnancy. Foetus creates higher need and hormones may disrupt normal insulin. Mother has higher risk of developing T2DM later in life

72
Q

What are the rules with insulin/dextrose infusions?

A 
Deliver through same line
Fluid through volumetric pump
Insulin through syringe driver
Anti reflux valve on glucose line to prevent bolus of insulin
Check regularly
73
Q

What is hypoglycaemia and the treatment?

A

<4mmol/L
Cause brain death
50ml of 50% glucose IV
1mg glucagon IM/IV

74
Q

Why is potassium added to DM regimes?

A

Dextrose/insulin can cause low potassium levels so needs replacing. Usually added to dextrose bag

75
Q

What is DKA?

A

Diabetic ketoacidosis
Not enough insulin to use glucose so fat gets metabolised for energy which produces poisonous ketones
Fluid shifts to ECF
Caused by missed insulin, infection, first presentation of DM

76
Q

What are the symptoms and treatment of DKA?

A 
Reduce alertness
High RR
Fruit breath
Nausea and vomiting
Dehydration

Insulin and fluid; add potassium later

77
Q

What is obesity?

A

> 30 kg/m2

78
Q

How is BMI calculated?

A

Weight/height2

79
Q

What are the systemic effects of obesity on the cardiac system?

A 
High blood volume
High CO, SV, BP 
CAD, IHD, HTN 
Atherosclerosis 
LV hyper trophy
80
Q

What are the systemic effects of obesity on the respiratory system?

A 
High oxygen consumption from more tissue and supporting muscles
High CO2
Low FRC and CC
Low compliance
Osa
81
Q

What are other systemic effects of obesity?

A 
High abdominal pressure
More gastric acid
High aspiration risk
Low liver function
Likely NIDDM
DI
Poor IV access 
Increased infection
82
Q

What pharmacology effects so obese patients pose?

A

Changed Vd due to less water and more fat
Higher plasma cholinesterases
Lipophilic drugs have a higher Vd and duration - anaesthetic
LA in central blocks need reduced dose as less space (more fat)
LA and GA drugs based on ideal weight

83
Q

What is PVD?

A

Circulation disorder caused by narrowing, blockage or spasms in blood vessels.
From athersclerosis/plaques
Reduce flow and O2 to tissue
Can be functional: no damage to structure, change from other factors eg temp
Organic: changed structure - plaque

84
Q

What are the anaesthetic considerations for PVD?

A 
60% will have CAD
Difficult to manage BP as hardened vessels are less compliant - art line
Cardiac events/stroke risk - invos or RA
Optimise pre op
DVT care 
Pressure area care 
5 lead ECG? 
Warming
85
Q

What ventilator settings can help with COPD?

A

Change I:E

Peep

86
Q

What is osa?

A

Frequent episodes of apnoea during sleep
>5/hr or >30/night
10 seconds is apnoea

87
Q

What is preeclampsia?

A

Condition of pregnancy
Symptoms: HTN, oedema, proteinuria
Can cause seizures and coagulopathy

Treatment: hypotensives and bed rest, deliver baby in unstable

88
Q

What might cause a PPH?

A

Retained placenta preventing the uterus from contracting

89
Q

What is placenta previa and accretia?

A

Previa: placenta attached to wall close to or covering cervix

Accretia: placenta grows through to myometrium
Increta: grows into myometrium and muscle layer
Percreta: grows through myometrium onto surrounding structures

90
Q

What is an amniotic fluid embolism?

A

Amniotic fluid or fetal cells enter mothers circulation and cause an allergic-like response

91
Q

How does the obstetric DAS differ?

A

Maximum 2+1 attempts intubation

Maximum 2 attempts at supraglottic

It is an RSI

92
Q

How is adrenaline used in anaphylaxis and in cardiac arrest?

A

Anaphylaxis: 50-100mcg IV or 0.5mg IM

Cardiac arrest shockable: 1mg every second cycle

Cardiac arrest non-shockable:
1mg immediately then every second cycle

93
Q

How does the paediatric cardiac arrest algorithm differ?

A

2 breaths: 15 compressions

Charge to 4J/Kg

Shockable: 10mcg/Kg 2nd loop
5mg/kg amiodarone 3rd shock
Non-shockable: 10mcg/Kg immediately and every 2nd loop

94
Q

How does the paediatric algorithm for anaphylaxis differ to adult?

A

Adrenaline 10mcg/kg IM of 1:1000
Repeat 3-5 minutes
20ml/kg fluid bolus

95
Q

Draw the algorithm for CPR.

A

See notes

96
Q

What are the four classes of hypovalaemic shock?

A

1: <15%
2: 15-30%
3: 30-40%
4: >40%

97
Q

What are the signs of shock, lower airway obstruction and upper airway obstruction in anaphylaxis?

A

Shock: hypotension

Upper airway: strider, swelling

Lower airway: wheeze

98
Q

How does paediatric MTP work?

A

Ring blood bank
Ensure X match
Alpha: 0-10Kg
Bravo: 11-20Kg
Charlie: 21-45Kg
Each weight tare has different products arriving in each box with a certain volume to be given of each.
Remember tranexamic acid, warming and lab checks

99
Q

What is in each MTP box?

A 
Box1: 2xRBC, 2xFFP
Lab check, tranexamic 
Box2: 4xRBC, 4xFFP, 3xCryo
Box3: 4xRBC, 4xFFP, 1xPlate
Lab check 
Box4: 4xRBC, 4xFFP, 3xCryo
Alternate box 3&amp;4, lab check/30min
100
Q

What’s the purpose of the guardian of the box?

A 
Overseas safe management of the box
IV certified nurse/tech/MO
May be theatre coordinator 
Guardian initials box when arrived
Check pt ID on form against that on box
Select one at a time for checking
101
Q

What reversal agents are used?

A

Sug reverses vecuronium and rocuronium

Neo reverses all non-depolarises except mivacurium

102
Q

What could be some patient, equipment and machine causes of a high airway pressure?

A 
Aspiration
Spasm
Pulmonary oedema
Tension pneumothorax
Kinked tube 
Tube moved and against trachea
Tube in too far; one bronchi
Filter blocked
Tubing occluded by a FB
Run over tubing
Valve stuck
Ventilator malfunction
Pressure relief valve failure 
(Disconnect circuit, on bag, squeeze to eliminate machine and circuit)
103
Q

What are the steps of MTP?

A
  1. Massive bleeding and shock or coagulopathy
  2. Initiate 777: MTP, location. This will contact relevant ppl
    Correct forms with either emergency blood or box 1. Send via runner; wait
  3. Give 3 units of RBC
  4. Activate: Call blood bank: MTP, clinician and guardian
    Ensure X match sent
    Request each box as needed by form

Consult the additional treatment thresholds with lab results
Cancel MTP ASAP
Warming, lines, fluid, level1, testing

104
Q

What are methods of dealing with obstetric bleeding?

A

IR: balloon catheters into internal iliac vessels prior to case and inflated at time of delivery
Intrauterine tamponade with a saline filled Bakri balloon
Cross match prior
Cell salvage with care
Uterotonics
Hysterectomy
Bimanual compression of uterus

105
Q

Why is magnesium used in eclamptic patients?

A

It is used to control an initial seizure and an infusion is used to prevent any more

Anaesthesia (8 decks)

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