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EHAAT sign off > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

What are the aims of the PHEA SOP? (2)

A
  1. To provide safe and effective anaesthesia for all critically ill/injured patients pre-hospital
  2. Ensure pre-hospital standards meet those in hospital and those set out by the Association of Anaesthesia pre-hospital guidelines
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2
Q

What are the objectives of the PHEA SOP? (3)

A
  1. Define indications
  2. Describe procedure
  3. Describe failed intubation procedure
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3
Q

What are the indications for PHEA? (6)

A
  1. Actual/impending airway compromise
  2. Ventilatory failure
  3. Unconsciousness for protection of airway and ventilatory support
  4. Humanitarian need
  5. Agitation post TBI
  6. Anticipated clinical course
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4
Q

Describe LEMON?

A

L - ook
E -valuate (3/3/2)
M- allampati
O - bsrtuction
N - eck mobility

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5
Q

Describe AMPLE

A

A -llergies
M - edication
P -MHx
L -ast ate
E - events today

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6
Q

What is MOANs used to predict?

A

Difficulty with BVM

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7
Q

Describe MOANS

A

M- ask seal difficult
O - besity
A - dvanced age
N - o teeth
S -nores

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8
Q

What is the minimum period we should oxygenate for? (2)

A
  1. 3 mins

or

  1. 8 maximal insp/exp breaths if they are able
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9
Q

How should self ventilating patients be pre-oyxgenated? (3)

A
  1. 15L via NRB
  2. 15 L Apox nc
  3. Head up/ reverse Trendelenburg on scoop
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10
Q

Which self ventilating patients should be pre-oxygenated with BVM and PEEP valve?

A
  1. Pregnant
  2. Obese
  3. <93% SATs
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11
Q

How should patients with facial injuries be pre-oxygenated?

A

Most comfortable position and maintaining airway (usually sat up)

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12
Q

What should we ensure all patients having PHEA have set up in advance? (5)

A
  1. 2 x IV cannula
  2. Fluid running well
  3. Minimum observations - oximeter/ETC02, 3 lead, BP (on other arm to working cannula
  4. 2 x suction
  5. 2 x full oxygen cylinder
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13
Q

Which patients does EHAAT research show have increase risk of hypotension post RSI? (3)

A
  1. RR > 25
  2. Age > 70
  3. Shock index > 1
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14
Q

What type of weight should be used to calculate drug doses?

A

Estimated actual body weight

NB rocuronium should be IBW but for ease estimate actual body weight used

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15
Q

What is the RSI drug regime for:
1. Standard
2. Shocked/frail patients
3. High dose

A
  1. Fentanyl 1mcg/kg, Ketamine 2mg/kg + rocuronium 2mg/kg (max 150mg)
  2. Ketamine 1mg/kg, rocuronium 2mg/kg (max 150mg)
  3. Fentanyl 2mcg/kg, ketamine 2mg/kg, rocuronium 2mg/kg (max 150mg/kg)
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16
Q

Until what age should a MAC 4 blade be used?

A

> 12 years

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17
Q

When should we draw up adrenaline/metaraminol with regards to RSI? (2)

A
  1. Isolated TBI
  2. Frail/ low BP and medical
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18
Q

Which drugs should be discussed with consultant before use? (2)

A
  1. Thrombolytics
  2. Propofol
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19
Q

When should apnoeic oxygenation be avoid (2) and why? (1)

A
  1. Facial #s
  2. Epistaxis
    3, Can lead to pneumocephalus
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20
Q

When should we BVM ventilate during pre-oxygenation? (2)

A
  1. Low SATs
  2. Reduced GCS requiring airway adjuncts/Igel
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21
Q

What is the maximum tube length as per the SOP

A

Should be less than 23cm at the teeth

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22
Q

What factors in pregnancy lead to a more difficult RSI? (4)

A
  1. Increased mucosal friability
  2. Larger breasts
  3. Increased gastric scecretions
  4. Decreased functional residual capacity
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23
Q

What should we do in order to attempt positioning for RSI in pregnancy? (2)

A
  1. Ramp 20-30 degrees
  2. Left lateral tilt if visibly pregnant
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24
Q

What must we do when considering RSI in children?

A

D/w consultant on call

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25
Q

Down to what age should we use a MAC 2?

A

6 months

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26
Q

Below 6 months of age what type of laryngoscope could be considered?

A

Miller if experience allows

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27
Q

Aside from the tube size, what other size should be confirmed during the RSI checklist in paeds?

A

Igel size

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28
Q

What should be done in a paeds RSI to try and reduce the dead space? (3)

A
  1. Compress catheter mount
  2. Paeds filter
  3. Paeds ventilator circuit if TV <250ml
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29
Q

What is more important to ensure we have done post RSI in children compared to adults?

A

OG tube to decrease gastric volume and increase ventilation

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30
Q

What additional drug should be drawn up during a paeds RSI and at what dose?

A

Atropine
20mcg/kg

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31
Q

Outline the DOPESSS pneumonic

A

D - isplacement of tube
O - bstruction of tube
P - TX
E - quipment failure
S - pasm
S - ynchrony
S - tacking

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32
Q

What are the 30 sec drills?

A

S - uction
L - arygneal manipulation
I - nsert blade fully and withdraw
P - ositioning
D - eclare

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33
Q

How many attempts should be made to intubate?

A

2 attempts 1 operator + 1 additional attempt by another operator

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34
Q

If unable to intubate outline the next steps in order (3)

A
  1. Igel (size 4 standard)
  2. BVM with OP/NP
  3. Surgical airway
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35
Q

What size ETT should be used in surgical airway?

A

6mm cuffed

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36
Q

What is the minimum time rocuronium should last?

A

30 mins

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37
Q

What should be handed over in terms of RSI when arriving at hospital? (3)

A
  1. Grade view
  2. Tube size
  3. Last time muscle relaxant given
38
Q

What are the aims and objective of the ventilation SOP? (4)

A
  1. Ensures staff are familiar with ventilator checks for the Oxylog 3000 plus
  2. Review the ventilators used by PHC staff
  3. Detail procedure for checking ventilators
  4. Provide a brief overview of patient ventilation
39
Q

What tidal volume should be aim formed under normal conditions?

A

6-8ml/kg

40
Q

What minute volume should we aim for under normal conditions?

A

70ml/kg

41
Q

What is our standard ventilator setting?

A

VC-CMV (volume control, continuous mandatory ventilation)

42
Q

When should pressure control ventilation be considered? (2)

A
  1. Paediatrics <50kg
  2. Significant lung pathology
43
Q

What is the standard initial setting for peak inspiratory pressure according to the ventilation SOP?

A

40 cmH2O

44
Q

What is the standard initial PEEP setting according to the ventilation SOP?

A

5cm H2O - compensates for ETT

45
Q

How is the Oxylog 3000 plus described in the ventilation SOP? (3)

A

Time cycled
Volume controlled
Pressure controlled

Ventilator

46
Q

When should we switch from an adult to a paeds ventilator circuit?

A

TV < 250ml

47
Q

What is the battery life of an Oxylog 3000 Plus?

A

7.5 hours

48
Q

What range of Fi02 can the Oxylog 3000 Plus deliver?

A

40-100%

49
Q

What settings should we start with if we wish to deliver pressure control ventilation (PC-BIPAP)

A

Start with peak inspiratory 15-20cmH20 and then titrate to desired TV

50
Q

What changes may need to be made if using a ventilator whilst CPR ongoing?

A
  1. Pmax will need to be increased
51
Q

If the ventilator isnt delivering good enough tidal volumes during cardiac arrest what should be done?

A

Switch to BVM

52
Q

What button must we make sure if on whenever we are using the ventilator?

A

HME compensation is on ‘yes’

53
Q

When checking the EEAST DSAs oxygen supply for transfer, what must we check? (3)

A
  1. Both 02 valves switched on (access via door on drivers side of truck )
  2. Oxygen levels sufficient between the 2 cylinders
  3. The correct cylinder is selected via the switch
54
Q

What much oxygen is in a F cylinder?

A

1360 L

55
Q

What are the aims and objectives of the analgesia + sedation SOP? (4)

A
  1. To ensure all patients receive timely and effective assessment of pain, delivery of analgesia and where necessary, procedural sedation
  2. Describe PHC analgesia and sedation drugs
  3. Describe the specific indication and proper use of each drug
  4. Analgesia is important on humanitarian grounds and also to meet clinical endpoints essential to the resusitation philosophy of the service
56
Q

What does the analgesia/sedation SOP policy state about how these drugs should be delivered? (3)

A

Should be:
- diluted
- delivered IV
- titrated to effect

57
Q

Which analgesia can be given IM according to the SOP? (3)

A
  1. Fentanyl
  2. Morphine
  3. Ketamine
58
Q

What is the label colour for?
1. Ketamine
2. Morphine
3. Fentanyly
4. Midazolam

A
  1. Yellow
  2. Blue
  3. Blue
  4. Orange
59
Q

What is the analgesic dose of ketamine IV?

A

0.1mg/kg then 5-20mg bolus

Up to 0.5mg/kg in severe pain

60
Q

What is the analgesic dose of ketamine IM?

A

1 mg/kg

61
Q

What is the ketamine dose for procedural sedation IV?

A

0.5mg/kg followed by 10-20mg bolus

62
Q

What is the IM dose of ketamine for sedation?

A

5mg/kg

63
Q

What two concentrations do we carry of ketamine?

A
  1. 200mg/20ml PFS = 10mg/ml
  2. 500mg/10ml vial = 50mg/kg
64
Q

What does the analgesia SOP suggest for morphine analgesic dose?

A

2mg bolus followed by 2mg aliquots

65
Q

What dose the analgesia SOP state about analgesic dose fentanyl IV?

A

25mcg bolus IV followed by 25mcg aliquots

66
Q

What is the dose of IN fentanyl?

A

1.5mcg/kg (max initial dose 100mcg) followed by a further 0.75-1.5mcg/kg second dose after 10 mins if needed

67
Q

What strength fentanyl dose we carry?

A

500mcg/10ml PFS = 50mcg/ml

68
Q

What is the sedation SOP state is the recommended doses for midazolam IV in adults? (2)

A
  1. 2mg
  2. 1mg if frail
69
Q

What is the recommended dose of midazolam as an adjunct to ketamine to prevent emergence?

A

1-2mg

70
Q

What is the recommended midazolam dose IV for maintenance of anasthesia?

A

0.5-1.0mg bolus

71
Q

How do we draw up an adrenaline infusion post ROSC?

A
  • Use 50ml syringe
  • Add 10ml 1 in 10,000 adrenaline to 40ml normal saline = 20mcg/ml
  • discard 10ml to allow syringe to fit in driver
72
Q

At what rate should we set a post ROSC adrenaline infusion?

A

10-33ml/hr

73
Q

What infusion should we use to maintain anaesthesia in an unstable patient who is 70kg

A

Ketamine
1mg/kg/hr
=70mg/hr
= 7ml 200mg/20ml ketamine/hr

74
Q

What rates should be used for a ketamine infusion?

A

0.5 - 2.0 mg/kg/hr

start 1mg/kg/hr

75
Q

What infusion should be used to maintain anaesthesia in a stable patient?

A

Midazolam/fentanyl

76
Q

How should we draw up an midazolam/fentanyl infusion?

A
  1. Midazolam 10mg/10ml syringe
  2. Add 5ml 500mcg/10ml fentanyl (250mcg)
  3. Add 5ml normal saline
77
Q

What rate should we start a midazolam/fentanyl infusion?

A

0.1ml/kg/hr

78
Q

What is the maximum rate for a midazolam/fentanyl infusion?

A

0.3ml/kg/hr

79
Q

What rate should a midazolam/fentanyl infusion for a 70kg patient be started at?

A

7ml/hr

(0.1ml/kg/hr)

80
Q

What are the concentrations of midazolam and and fentanyl in our infusions?

A

0.5mg/ml midazolam
12.5mcg/ml fentanly

81
Q

How much dead space is there in a paeds HME filter?

A

25ml

82
Q

How much dead space is there in an adult HME filter?

A

66ml

83
Q

What is dead space?

A

The proportion of ventilated air that does not take part in gas exchange

84
Q

What is the calculation for anatomical dead space?

A

2ml/kg

85
Q
A
86
Q

What is the TV below which we should switch to a paeds HME filter?

A

Less than 150ml

87
Q

Minimum TV achievable of the oxylog ventilator?

A

50ml

88
Q

How is shock index calculated?

A

HR / SBP

89
Q

What shock index is associated with increased mortality?

A

> 1.0

90
Q
A

EHAAT sign off (7 decks)

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