Anaesthetics Flashcards
Anaphylaxis
Urticaria, angiodema, wheeze, hypo
Conservative - remove source, escalate
Medical - 0.5ml of 1 in 1000 adrenaline IM, wait 5 mins then again
Refractory if no response in 2 doses, call anaesthetics ?IV adrenaline, intubation
Burns
if inhalational, anaesthetic review
A to E
be aware of circulatory shock
rule of 9s for TBSA
fluids 2-4ml x weight x TBSA
cool tap water, clean saline, wrap loose clingfilm, analgesia
refer to burns service later
acute lung injury, rhabdo, AKI, electrolytes, shock
Types of shock
Hypovolaemic - either haemorrhagic or D&V, burns, dehydration
Cardiogenic - poor cardiac output due to MI, valvular, PE, arrythmia
Distributive - usually vasodilation - sepsis, anaphylaxis, neuro
Obstructive - within circulation - massive PE, tension pneumo, tamponade, dissection
Oxygen delivery
Nasal cannula 24-30 o2, flow max 4l
Hudson 30-40 o2, flow max 10l
Non-rebreathe 70 o2, flow max 15l
Ventuuri masks
blue 24 o2 and 2-4l
white 28 o2 at 4-6l
yellow 35 o2 at 8-10l
red 40 o2 at 10-12l
green 60 o2 at 12-15l
Cannula colours
Grey 16
Green 18
Pink 20
Blue 22
ASA grading
- Normal healthy patient
- Mild systemic disease (e.g. asthma)
- Severe systemic disease
- Severe systemic disease that is a constant threat to life
- Moribund patient, not expected to survive without the operation
- Declared brain-dead patient – organ removal for donor purposes
Pre-op questions
previous anaesthetic + reactions
allergies and intolerances
medications (coag, platelet, HTN)
PC + PMH (management of conditions)
diabetes, gord, c-spine problems
fasted for 6 hours, no water for 2 hours
Pre-op ECG
> 80 y/o
60y/o and surgical severity >3
Cardiovascular or renal disease
VTE prophylaxis
Enoxaparin 20mg SC if low risk
40mg SC if high risk
Unfractionated heparin in renal impairment
Antiemetics
Cyclizine - ENT, some post-op but no HF
Metoclopramide - chemo, radio, not bowel obstruction or Parkinson’s
Ondansetron - first line for post-op, chemo, Parkinson’s
Doxylamine - pregnancy
