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3B GH > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

what is the triad of types of drugs used in anaesthesia

A

anaesthesia
analgesia
muscle relaxation

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2
Q

name the main opoid antag

A

naloxone

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3
Q

how do you change the dose when changing from oral morphine to parenteral & why

A

oral - need twice as much, because only half is absorbed due to 1st pass metabolism by the liver

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4
Q

oxycodone + morphine, what is the diff in strength

A

oxycodone is 1.5X more potent than morphine

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5
Q

Mx of opoid induced resp depression

A

call for help
ABC bag and mask ventilate?
IV naloxone

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6
Q

when using morphine, what comorbidities should you be wary in & how could you get around the problem

A

renal failure

use oxycodone

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7
Q

Why will patient wake up about 10 mins after induction dose of propofol IV when the half-life in the body is about 2 hours?

A

high cardiac output to the brain at first, then moves to fat stores

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8
Q

local anaesthetic toxicity effects

early Sx & major effect

A

tinnitis, tingling round lips, agitation
CNS - fits
CV - CV collapse, VF

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9
Q

why do local anaesthetics sometimes include adrenaline

A

reduce bleeding (vasoconstrictor)

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10
Q

Mx of local anaesthetic toxicity

A 
stop injecting LA
call for help
ABC
benzos for fit
intralipid
CPR
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11
Q

contraindications to NSAIDs

A

asthma, renal impairment, platelet

dysfunction, gastric irritation

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12
Q

give the 3 main antiemetic classes and an example of each

A

5HT3 antagonists - e.g. ondansetron
Antihistamine agents - e.g. cyclizine
Antidopaminergic agents - e.g. metoclopramide

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13
Q

side effect of too much midazolam

A

apnoea

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14
Q

antag for benzos

A

flumazenil

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15
Q

60 yr old come for revision knee replacement, seen regularly in chest clinic with COPD, BMI 31.5. How will you assess his respiratory status?

A

acute - recent RTIs? admissions? ITU? ABx/steroids? home O2?
activity level
peak flow/spirom, sats, resp rate
O/E: hyperexpanded chest, clubbing, wheeze, CO2 retention flap?

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16
Q

60 yr old come for revision knee replacement, seen regularly in chest clinic with COPD, BMI 31.5. How can breathlessness be objectively classified? outline tool used in pre-op assessment

A

medical research council [MRC] breathlessness scale

  1. no SOB except strenuous exercise
  2. SOB when hurrying on level / walking up hill
  3. walks slower than others, stops after 1 mile/ 15 mins
  4. stops for breath 100 yrds/ few mins
  5. too breathless to leave house/ on dressing
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17
Q

how can you globally assess functional status

A

measurement of exercise tolerance before surgery [METS]

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18
Q

60 yr old come for revision knee replacement, seen regularly in chest clinic with COPD, BMI 31.5. Given this is elective surgery, what measures can be taken to ensure mr jones is in his best physicl condition pre-op?

A 
don't admit any earlier than you need to! [HAP]
optimise BMI
physical fitness
optimise COPD control [chest clinic RV]
smoking cessation
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19
Q

60 yr old come for revision knee replacement, seen regularly in chest clinic with COPD, BMI 31.5.
His wife mentions he snores. what’s the relevance +how could you assess furhter?

A

snoring = mild airway obstruction, may be difficult to intubate
ask about previous anaesthesia/ problems. Examine [mallampati]

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20
Q

60 yr old come for revision knee replacement, seen regularly in chest clinic with COPD, BMI 31.5. Also snores. He wants a GA, what do you think?

A

spinal more appropraite given COPD, BMI, snoring, and op site

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21
Q

what should be done about a patient’s regular oral steroids when he is going to theatre for a knee replacement?

A

give extra steroids (IV hydrocort) as body unable to make own to combat stress of op, due to adrenal suppression

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22
Q

60 yr old male goes for knee replacement with combined spinal epidural. How do you manage thromboprophylaxis with an epidural?

A

LMWH 4 hrs after epidural e.g. enoxaparin

[risk of epidural haematoma]

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23
Q

pulmonary oedema Mx

A 
furosemide
GTN
morphine [senation of breathlessness]
O2
sit patient up
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24
Q

high urea leads to what dangerous complication

A

encephalopathy

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25
Q

17 yr old presents with LOC.

A: groaning, no stridor
B: spont breathing, RR 20, chest clear
C: HR 105, BP 75/50, CR 4s

what are you concerned about and what action can you take?

A

^HR, low BP, long CR

fluid bolus 500ml saline over 15 mins

26
Q

eyes open to pain, groans + withdraws arm when you try to cannulate. what is the GCS?

A

8

27
Q

Pt given IM loraz due to agitation. After 5 mins, no eye opening, no movement, no speech. what do you do?

A

call for help/ resus team

ABCDE

28
Q

Pt given IM loraz due to agitation. After 5 mins, no eye opening, no movement, no speech.

on ABCDE assessment, the airway is obstructed and sats are 89% despite 15L non-rebreathe. What do you do next?

A

manage the airway: head tilt, chin lift, jaw thrust. Guedel, LMA. Bag and mask ventilate. Til anaesthetist arrives to intubate

29
Q

what is a rapid sequence induction

A

intubation method used in emergency when airway is compromised to avoid aspiration [pt unlikely fasted]

30
Q

PMH of AF, IHD, HTN. DH: atenolol.

likely ECG changes?

A

old ischaemia e.g. Q waves
no P waves, irregularly irregular rhythm
bradycardic from atenolol

31
Q

what are METS?

A

measure, of exercise tolerance before surgery

32
Q

why is it important to check U+E pre-surgery

A

theatre blood loss > AKI

clearing of drugs given

33
Q

when might you consider doing a pre-op echo

A

Q waves, previous HF, ankle/pulm oedema

34
Q

pt on simvastatin, bendrofulmethiazide, ramipril, atenolol, warf, GTN. which drugs need to be stopped pre-surgery?

A

warf - stop 5 days pre-op

omit morning ramipril [need RAAs working]

35
Q

what Hb would you transfuse?

A

7/8

36
Q

what Ix do you want to do to guide your Mx in what appears clincally to be an acute MI

A

ECG
trop
CXR
ABG

37
Q

how do you manage a Pt with acute MI and CXR showing widespread alveolar shadowing, fluid in horizontal fissure, bilat effusions. ?

A

furosemide IV

38
Q

pt’s ABG shows met acidosis following an MI. The lactate was high suggesting he’s not perfusing his tissues due to cardiogenic shock. How can you increase blood getting to peripheral tissues?

A

IV nitrates [peripheral vasodilation]

39
Q

risks for Diabetics undergoing surgery

A

^risk of post-op infection
cardiac complications
risk of DKA post-op
gastroparesis - aspiration

40
Q

how do you manage an insulin dependent diabetic for morning surgery list?

A 
1st on list to reduce fasting
usual insulin night before
omit morning
resume insulin when resume food
consider sliding scale
41
Q

how do you manage a tablet treated diabetic for morning surgery list?

A

if poor control - treat as insulin-dependent [consider sliding scale]

omit long-acting sulfonyureas only [glibenclamide] - 2/3 days before [hypo risk].

omit morning drugs + take once eating e.g. with lunch

42
Q

briefly describe how you set up a sliding scale for surgery for a diabetic pt

A

insulin in saline, infusion that can be run at variable rate according to their BMs
run alongside fluids: saline with glucose + KCl

43
Q

starvation rules for theatre and 1 exception

A

clear fluids 2 hrs
food 6 hours

not in CS [ketosis bad for baby]

or emergency surg

44
Q

what happens if a patient with type 1 DM omits their insulin?

A

hyperglycaemia > DKA

45
Q

how do you manage a pt who’s on a sliding scale post-surgery and is now unconsious with a BM of 1.8

A 
ABCDE
stop sliding scale/insulin
glucogel between teeth
200ml 10% glucose over 15 mins
/glucagon IM/IV
[200ml OJ if can swallow]
46
Q

3 criteria for diagnosis of DKA

A

acidaemia
hyperglyc
ketonaemia/uria

47
Q

how often do you measure blood gucose and ketones in DKA

A

hrly

48
Q

PT Has large coffee ground vomit and is now moribund. you examine him using ABCDE and find his sats to be 89%, what could be causing this?

A

hypovolaemic shock -> not perfusing tissues with O2

may have aspirated

49
Q

imediate mx of large upper gi bleed

A 
ABCDE
O2
fluid bolus
ABG
take bloods for group+save/crossmatch, FBC, U+E
[transfuse]
emergency endoscopy
blankets, bear hugger, fluid warmer
50
Q

what fluids should you not use in fluid resus and why

A

glucose - water drawn into extravasc space + excreted

51
Q

how do you treat DIC?

A

treat underlying

fresh frozen plasma [platelets + clotting factors]

52
Q

pt with massive upper GI bleed, goes into DIC. What blood products do you give?

A

FFP
cryoprec
Red cells

53
Q

how much will one unit of blood raise the Hb by?

A

10-15

54
Q

how do you define massove haemorrhage

A

loss of entire blood vol within 24 hrs
or 50% in 3 hrs
or >150ml/min

55
Q

complications of massive transfusion

A 
TRALI [Transfusion-related acute lung injury]
low platelets
low Ca2+
low clotting factors
overloading
hyperkalaemia
hypothermia
haemolysis-jaundice
transfusion rn-SIRS
56
Q

what are sepsis, severe sepsis and septic shock?

A

sepsis = generalised SIR to infection
severe sepsis = organ dysn, low BP
septic shock = inadequate organ perfusion, ^lactate, refractory hypoTN

57
Q

how do you manage an acutely ill patient who is hypotensive and not responding to multiple fluid challenges

A

noradrenaline

or Metaraminol

58
Q

differentials for 28 yr old with sudden onset dyspnoea

A 
asthma
LRTI
pneumothorax
F body
valve disease
MI
cardiomyopathy
arrhythmia
anaphylaxis
panic attack
59
Q

types of shock

A

distributive [septic]
cardiogenic
hypovolaemic
neurogenic [spinal - damage to sympathetic chain]

60
Q

what Ix.s might you specifically do for a patient presenting with an unusual pneumonia

A

atypical serology [urine, sputum]

HIV test

3B GH (16 decks)

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