Brainscape's Knowledge GenomeTM

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


See full index

4 - Med > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

What is a fistula ?

A

an abnormal connection between 2 epithelial surfaces

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

what is a hernia ?

A

protrusion of a viscus/art of a viscus through a defect of the wall of containing cavity into an abnormal position

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

What is diathermy ? what are the two types ?

A

high frequency electrical current to cut tissues of cauterise small vessels
- monopolar or bipolar diathermy

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

What are the general two types of sutures ? describe a bit

A
  • absorbable: slowly absorbed + disappear over time (good for tissues that heal well)
  • non-absorbable (stay in place for long time to support other tissues)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the WHO surgical checklist ? what is the aim ?

A

aim to reduce post op complications + mortality
- contains 19 questions
- done before induction of anaesthesia, before first incision, before patient leaves theatre

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

name some things in the HWO surgical checklist ?

A
  • patient identity
  • allergies
  • operation to be performed
  • Risk of bleeding
  • count number of needles/sponges
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What processes need to be done before a patient undergoes surgery ? (7)

A
  • Pre-op assessment
  • consent
  • bloods (plus group and save/cross match)
  • patient fasting
  • med changes
  • VTE risk assessment
  • Ensure patient understands procedure/outcomes (consent)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is done in the pre-op assessment ? (5)

A
  • establish if patient is fit to undergo procedure
  • explore comorbidities
  • anaesthetic risk
  • frailty status
  • cardio/resp fitness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is ASA grading ? how many levels are there ? describe a bit

A

ASA1: normal healthy
ASA5: moribund (will not survive 24 hrs)
- grade to describe current fitness before undergoing anaesthesia/surgery

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

What is DASI ? what does it stand for and what does it indicate ?

A

Duke Activity Status Index
- scoring tool that estimates function capacity (asks about activities)
- higher value => higher functional status

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

What is a MET ? what does it stand for and explain ?

A

Metabolic equivalent
- ratio of working metabolic state to resting metabolic rate
- 1 MET is energy you spend sitting at rest (4 METS => activity takes 4x the energy than at rest)

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

What are patients with IHD at a higher risk of ?

A

increased MI risk preoperatively so ensure continue BB

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

What tests do you generally do for everyone pre-op ? (5)

A
  • U+E
  • FBC
  • finger prick bood glucose
  • group + save
  • MRSA screening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When would you do ECG pre-op ? (4)

A
  • > 55
  • poor exercise tolorance
  • prev MI
  • if suspected CVD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When would you do an echo pre-op ?

A
  • suspected heart murmur
  • suspected HF
  • suspected poor LV function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is group + save ?

A

send off sample to establish blood group

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

what is crossmatching ?

A

taking unit of blood off shelf and assigning to patient

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

what happens if patient is MRSA positive ?

A

this is no contraindication to surgery
- patient gets put to end of case list

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

what are the surgical fasting rules ?

A
  • > 6 hrs no food
  • NMB >2hrs pre-op for clear fluids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why NBM for surgery ?

A

make stomach empty to prevent gastric contents refluxing into oropharynx => aspirated into trachea => aspiration pneumonitis, pneumonia => morbidity/mortality

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

When would you check HbA1c pre-op ?

A

if known diabetic

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

Which meds should be continued on the day of surgery ? (10)

A
  • ACEI
  • Abx
  • BB
  • Digoxin
  • Statin
  • Bronchodilators
  • PPI
  • Steroids
  • Levodopa
  • Anticonvulsants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Should a BB block be taken on morning of surgery ?

A

yes, continue including day of surgery as this reduces cardiovascular risk

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

which meds need to be stopped earlier in advance of surgery (week tie frame) ?

A
  • COCP/HRT (4 weeks pre-op and start 2 weeks post op)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How old to give consent in the UK ?

A

> 16 yrs can give valid consent
if <16 then need to show hillock competence
- if <18 yrs and refusing life saving surgery then talk to parent + senior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What and when Abx prophylaxis given ?

A

IV prophylaxis 30 min pre op (co-amox)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the 4 levels of sedation ? at what point may airway intervention be required ?

A
  • minimal
  • moderate
  • deep (airway intervention make be required at this point)
  • GA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

why is tight glycemic control important in a diabetic patient undergoing surgery ?

A

Reduce post op infection + cardiac complications risk

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

how to manage a diabetic patient on insulin ? when have last insulin dose ?

A
  • make them first on the list to minimise fasting time
  • give all usual insulin the night before surgery (if Am then omit morning dose)
  • variable rate IV insulin infusion (VRIII/sliding scale) to achieve normoglycemia (fluid should be prescribe to run with the VRIII)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How to manage a diabetic patient on only tablet treated diabetes ? when take last meds ? except which one ? why ?

A

normal meds night before
- except long acting sulphonylureas (cause prolonged hypos when fasting)

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

How to deal with a patient on warfarin undergoing surgery ? peri op? post op ?

A
  • Im major surgery stop the warfarin (inverse with vit K)
  • consider bridging with heparin
  • post op: give LMWH until INR is therapeutic (as warfarin is initially prothrombottic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

how to manage a patient on long term steroids undergoing surgery ?

A

may not be able to handle the stress of surgery due to HPA supression
- extra corticosteroid over required (if patient >2 weeks >5mg/d): give hydrocortisone before induction and immediately after surgery

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

What helps enhance recovery post-operatively ? (5)

A
  • good prep (healthy diet + exercise)
  • minimally invasive surgery
  • adequate analgesia
  • good nutritional support
  • early mobilisation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What causes post-op nausea and vomiting (PONV) ? (4)

A
  • surgical procedure
  • anaesthetic
  • pain
  • opioids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

PONV RF ? (5)

A
  • Female
  • motion sickness
  • non-smoker
  • post op opiates
  • younger age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is given to help with PONV ? (3)

A

prophylactic antiemetics (ondansetron (5HT-3), dexamethasone, cyclazine)

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

what is TPN ? how is it given ? why this way ?

A

food given through IV infusion (given through central line due to thrombophlebitis risk)

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

TPN complications ? (3)

A
  • sepsis
  • thrombosis (=> PE or SVC obstruction)
  • refeeding syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is used to screen for malnourished patients ?

A

MUST score
(Malnutrition universal screening tool)

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

name some common post-op complications ? (10)

A
  • anaemia
  • atelectasis
  • infection
  • wound dehiscence
  • urinary retention
  • DVT/PE
  • Sepsis
  • ACS
  • Delirium
  • AKI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

post op anaemia - when do you start oral iron ? when blood transfusion ?

A

always do FBC to assess haemoglobin
- <100g/l: start oral iron
- <70-80 g/l: blood transfusion

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

in what % of surgical patients does DVT occur in ?

A

25-50%

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

DVT prevention in a patent undergoing surgery ? holistic approach

A
  • Stop COCP
  • mobilise early
  • LMWH for high risk patients (enoxaparin)
  • compression stockings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

DVT treatment ?

A
  • calculate wells score (>2 => DVT likely so do D-dimer + USS)
  • LMWH (enoxaparin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Cause of swollen legs (bilateral oedema) (2)

A
  • increased venous pressure (RHF)
  • reduced intravascular oncotic pressure (low albumin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

In what conditions should you avoid NSAIDs ?

A

avoid in asthma, renal impairment, heart disease, stomach ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are the 2 main anaesthesia types ? describe a bit

A
  • General (making the patient unconscious): patient is intubated/supraglottal airway device, breathing supported by ventilator
  • regional: blocking feeling to isolated area of the body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what is pre oxygenation ? what is the aim ?

A

period of several minutes where patient receives 100% oxygen
- have oxygen reserve for period where los consciousness + successfully intubated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

when might anxiolytics be needed pre-op ? what drug ?

A

if anxious, LD, neurodivergent
- diazepam, midazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is rapid sequence induction/intubation ? when done ? what is the risk ?

A

fain airway control in emergency
- bigger aspiration risk: so position patient more upright, cricoid pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what are some indications for gaseous induction ? (3)

A
  • Patient request
  • Difficult IV access
  • children
51
Q

what is the triad of general anaesthesia ?

A
  • Hypnosis (make patient unconscious)
  • Muscle relaxation (block neuromuscular junction from working => relax/paralyse muscles)
  • Analgesia (pain relief)
52
Q

What drugs are used for the hypnosis part of GA ? IV ? inhaled ?

A
  • IV: propofol, ketamine, thiopental sodium
  • Inhaled: sevoflurane
53
Q

Why is propofol a good GA drug ? what do you have to be careful about once its been drawn up ?

A
    • its used for GA + induction plus has anti-emetic effects
  • once opened, use or discard due to risk of bacterial growth
54
Q

What do you need to be sure of before you give muscle relaxants ?

A

need to know that ventilation is possible

55
Q

What are the two different types of muscle relaxants ? give an example of each ?

A
  • depolarising (suxamethonium)
  • non-depolarising (rocuronium/atracurium)
56
Q

How to depolarising muscle relaxants work ?

A

partial agonist for Ash so causes initial fasciculation’s through depolarisation => paralysis by blocking them

57
Q

how do non-depolarising muscle relaxants work ?

A

competitive antagonists (compete with Ach at NMJ) => no fasciculations

58
Q

is it depolarising or non-depolarising muscle relaxants that can be easily reversed ? how is this done ?

A

non depolarising
- their action can be reversed by anticholinesterases which act to increase ACh in NMJ

59
Q

what is usually used as analgesia in surgery. give examples

A

opiates
- fentanyl, alfentanyl, remifentnyl morhpine

60
Q

what is TIVA ? what is usually used ?

A

total intravenous anaesthesia
- typically propofol + remifentanyl (ultra short acting opioid)

61
Q

When is the patient extubated after surgery ?

A

patient regains consciousness => extubated when start breathing for themselves
(muscle relaxant needs to have worn off)

62
Q

what are some risk of GA ? (+intubation) (7)

A
  • post op N&V
  • accidental awareness
  • aspiration
  • dental injury
  • anaphylaxis
  • MI/stroke
  • malignant hyperthermia
63
Q

What is malignant hyperthermia ? what inheritance

A

rare autosomal dominant condition: hyper metabolic response to anaesthesia precipitated by volatile agent (halothane, suxamethonium)
- 1 degree temp rise every 30 mins

64
Q

how is malignant hypertension treated ?

A

dantrolene (skeletal muscle relaxant)

65
Q

what is PEEP ? what stand for ?

A

Positive end-expiratory pressure
- is useful adjunct to mechanical ventilation: allows pressure to be exerted at end of expiration to prevent atelectasis => increase SA for gas exchange

66
Q

What is Rapid sequence induction (RSI) ? how different to normal

A

in emergency setting (unlikely fasted)
- pre-oxygenate to 100%, apply cricoid pressure, induction agent (propofol) + quick acting muscle relaxant (suxamethonium) and then longer acting (rocuronium)

67
Q

What are peripheral nerve blocks ? and how do they work ? is patient awake ?

A

regional anaesthesia (patient remains awake)
- local anaesthetic injected around specific nerves => area distal to nerve is anaesthetised

68
Q

what is spinal anaesthetic ? into what space ? name a drug used for this ?

A

central neuroaxial anaesthesia (spinal): regional anaesthesia
- local anaesthetic (bupivicaine) injected into CSF (sub arachnoid)
- causes numbness + paralysis below injection level (check with cold spray)

69
Q

at what vertebral level is spinal injected ?

A

L3/4 or l4/5 level

70
Q

What is epidural anaesthesia ? explain how it is done ? which vertebral level ?

A

insert catheter into epidural space + inject local anaesthetic => diffuse through to surrounding tissues + spinal cord
- L3/4 comments site

71
Q

epidural adverse effects ? (6)

A
  • headache (if dural puncture)
  • hypotension
  • motor weakness in legs
  • nerve damage
  • infection
  • haematoma
72
Q

name some local anaesthetic agents ? (3)

A
  • lidocaine
  • prilocaine
  • bupivicaine
73
Q

through what anatomy is an endotracheal tube inserted ?

A

inserted through mouth => pharynx => larynx => vocal cords => trachea

74
Q

name some supraglottic airway devices ?

A
  • LMA
  • I-gel
75
Q

what type of airway device are guedels ? where do they go ?

A

oropharyngeal airway device: inserted into the oropharynx

76
Q

what are the 4 plans for unanticipated difficulty with intubating a patient (A-D)

A

Plan A: laryngoscopy + tracheal intubation
Plan B: supraglottic airway device
Plan C: face mask ventilation
Plan D: cricothyroidotomy

77
Q

What are arterial lines ? what are they used for ? what not ?

A

cannula inserted into artery: can measure BP in real time + ABG smiles taken
- drugs never given through art line

78
Q

what are central venous catheter (CVC)

A

long tube with several lumens inserted in large vein

79
Q

what is PICC line ?

A

peripherally inserted central Catheter
- inserted in peripheral vein (arm) and inserted until tip is in central position (vena cava or RA)

80
Q

What is acute vs chronic pain ?

A

acue pain (new onset of pain) vs chronic (>3 months)

81
Q

what is pain threshold ?

A

the point at which a sensory input is reported as painful

82
Q

what is allodynia ?

A

it is where pain is experienced with sensory inputs that don’t usually cause pain

83
Q

describe the general pain pathway ? how is pain detected and communicated ?

A

pain receptors (nociceptors) at end of nerve detect damage/potential damage to tissue => transmitted along afferent nerve (primary afferent nociceptor) => CNS up spinal cord in spinothalamic/reticular tract => brain interprets as pain

84
Q

What is neuropathic pain ?

A

pain is caused by abnormal functioning or damage of sensory nerves

85
Q

briefly describer WHO analgesic ladder ?

A
  • step 1: non-opioid (paracetamol, NSAIDs)
  • step 2: weak opioids (codeine, tramadol)
  • step 3: strong opioids (norphine, oxycodone, fentanyl, buprmorphine)
86
Q

NSAID SE ? (5)

A
  • gastritis with dyspepsia
  • stomach ulcers
  • asthma exacerbation
  • HTN
  • renal impariemtn
    (prescribe PPI to reduce GI SE)
87
Q

NSAID contraindications ? (5)

A
  • asthma
  • renal impairment
  • heart disease
  • stomach ulcers
  • uncontrolled HTN
88
Q

Opioid SE ? (5)

A
  • constipation
  • skin itching
  • N&V
  • altered mental state
  • resp depression
89
Q

what is multimodal analgesia ? why good ?

A

using many analgesic types to reduce SE profile of each by avoiding higher doses

90
Q

what are APACHE and SAPS scores for ?

A

scoring system to predict mortality at admission to ICU

91
Q

why need good nutritional support post surgery ?

A

they are in hypermetabolic state and have increased nutritional requirements

92
Q

what is ventilator associated lung injury ? what can it lead to ?

A

from mechanical ventilation => over-inflating alveoli (volutrauma) => pulmonary oedema + hypoxia => fibrosis, infection, cor pulmonale

93
Q

what is ventoliar associated pneumonia ? how to avoid ?

A

due to increased risk of bacteria aspiration to lungs
- so put bed at 30 degree angle + good mouth cleaning

94
Q

what is critical illness myopathy ?

A

muscle wasting + weakness of resp muscles => difficult weaning mechanical ventilation => reduced QOL

95
Q

what is ABG used for ? what does it show ?

A

to assess patents for resp failure + monitoring in ICU
- give info about acid-base balance, blood gases, bicarb, lactate, haemoglobin, electrolytes

96
Q

normal ABG pH range ?

A

7.35 - 7.45

97
Q

normal ABG PaO2 range ?

A

10.7 - 13.3 KPa

98
Q

normal ABG PaCO2 range ?

A

4.7 - 6.0 KPa

99
Q

normal ABG HCO3- range ?

A

22 - 26 mmol/L

100
Q

normal ABG base excess range ?

A

-2 to 2

101
Q

normal ABG lactate range ?

A

0.5 - 1 mmol/L

102
Q

what is type 1 vs type 2 resp failure ? describe blood gas findings

A

type 1 (1 affected): low PaO2 + normal PaCO2
type 2 (2 affected): low PaO2 + high PaCO2

103
Q

describe the ABG findings in resp acidosis ?

A

low pH + high PaCO2 (patient is retaining CO2)

104
Q

what would raised bicarb in resp acidosis mean ?

A
  • bicarb: produced in kidneys + acts as a buffer (slow compensatory mechanism so increased bicarb indicates chronically retain CO2 - like COPD)
105
Q

describe ABG findings in resp alkalosis ? caused by ?

A

raised pH + low PaCO2 (when patient has high resp rate)

106
Q

patient has resp alkalosis. what would low PaO2 indicate ? what would normal PaO2 indicate ?

A

normal PaO2: hyperventilation (anxiety)
low PaO2: PE

107
Q

describe ABG findings for metabolic acidosis ? caused by ? (4)

A

low pH + low bicarb
- caused by raised lactate, raised ketones, renal failure, low bicarb)

108
Q

describer ABG findings for metabolic alkalosis ? caused by ?

A

high pH + raised bicarb
- caused by loss of H+: vomiting, or from kidneys (due to increased aldosterone activity due to conns syndrome, liver cirrhosis, HR, loop diuretics)

109
Q

describe resp support form least to most invasive ?

A
  • oxy therapy
  • high flow nasal cannula
  • non-invasive ventilation
  • intubation + mechanical ventilation
  • extracorporeal membrane oxygenation (ECMO)
110
Q

What is acute resp distress syndrome ?

A

acute onset of collapsing alveoli (atelectasis), pulmonary oedema, reduced lung compliance, fibrosis of lung tissue ( after >10 days)

111
Q

benefits of prone position in patients with acute resp distress mx ? (4)

A
  • reduced compression of lungs by other organs
  • improve blood flow to lungs
  • clears secretion
  • improves oxygenation
112
Q

what is a benefit to Venturi masks ?

A

can be used to deliver exact concentrations of oxygen (useful in COPD)

113
Q

What is CPAP ? used for what ?

A

continuous positive airway pressure (CPAP)
- constant pressure added to lungs to keep airway expanded (adds PEEP
- used in OSA

114
Q

what is non-invasive ventilation ? what BiPAP

A

full face mask to blow air forcefully into lungs + inflate them
- BiPAP involves cycle of low + high pressure (cycle between IPAP + EPAP)

115
Q

what is mechanical ventilation ?

A

ventilator machine moves air in + out of lungs (patients require a level of sedation)
- ETT or tracheostomy is required

116
Q

what is ECMO ? describe it

A

Extracorporeal membrane oxygenation: most extreme resp upport
- blood is removed from body, passed through machine, gas exchange, pump back into body

117
Q

What is preload ? after load ?

A
  • preload: amount that heart muscle is stretched when filled with blood before contraction
  • afterload: resistance that heart must overcome to eject blood from LV
118
Q

what is MAP ? explain it a bit

A

mean arterial pressure is average BP throughout entire cardiac cycle (systole and diastole)

119
Q

what can cause low MAP ? (2) what does this cause ?

A

low MAP may be due to low CO or low SVR => poor tissue perfusion => hypoxia, anaerobic resp, lactate

120
Q

what is often used to estimate preload ?

A

central venous pressure (CVP)

121
Q

what do inotropes do ? name some positive and negative ones ?

A

alter contractility of heart
- positive inotropes => increase contractility => increase CO + MAP (adrenaline)
- Negative inotropes: BB, CCB, flecanide

122
Q

what are vasopressors ? affect on MAP ? name some ? (4)

A

cause vasoconstriction => increase SVR => increase MAP
- noradrenaline, vasopressin, adrenaline, metaraminol

123
Q

indications for acute dialysis ? (5)

A

AEIOU
- acidosis
- Electrolyte abnormalities (esp treatment resistant hyperkalaemia)
- intoxication (certain med overdose)
- Oedema (severe + unresponsive oedema)
- Uraemia (with sx like seizures + unconsciousness)

124
Q

What causes Obstructive sleep apnoea (OSA)

A

caused by collapse of the pharyngeal airway => apnoea apisods

125
Q

what tool can be used to screen for OSA patients ? (2) describe it

A

STOP-BANG
- Snoring
- Tired
- Observed
- blood Pressure
- BMI
- Age
- Neck circumference
- Gender

Hepworth sleepiness scale (assess sx of sleepiness associated with OSA)

126
Q

what is the relevance of OSA to peri-op care ? how to manage this ? management post op ?

A

sedation + opioids + anaesthesia => increased risk of upper airway collapse => increase risk of post-op complications
- Mx: minimise surgical stress, reduce duration of surgery, consider regional/local, anticipate difficult intubation
- post op mx: minimise opioid use, continuously monitor O2, CPAP after surgery

4 - Med (12 decks)

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