Anaesthetics Flashcards
What are the 4 causes of shock?
Cardiogenic
- MI
- Arrhythmia
Hypovolaemic
- Haemorrhage
- Endocrine (addisonian crisis, DKA)
- Burns, diarrhoea
- Third spacing (pancreatitis)
Obstructive
- PE
- Tension pneumothorax
Distributive
- Sepsis
- Anaphylaxis
- Neurogenic
Give 5 ways of assessing hypovolaemic shock on examination
Increased capillary refil time
Decreased blood pressure (loss of peripheral pulses)
Inspection: cold clammy skin
tachycardia
Decreased JVP
What is the sepsis 6?
Give high flow oxygen
Take blood cultures
Give IV antibiotics
Give an IV fluid challenge
Measure lactate
Measure urine output
Give ten investigations to carry out pre-op (major operation)
FBC U+Es LFTs Clotting Group and save CXR Abdominal X-ray ECG Echo Sickle cell testing (ethnicity)
Respiratory testing:
-PEFR, Spirometry, cardiopulmonary exercise testing
When can pre-operative assessments occur?
NCEPOD 1 (Emergency)
- Within 1 hr
- Resus at same time as pre-op (AAA, trauma etc)
NCEPOD 2 (Urgent)
- Within 24hrs
- ASAP after resus
- Irreducible hernia, intussusception, major fractures, etc)
NCEPOD 3 (Scheduled)
- Within 3 weeks
- Early operation but not life threatening (e.g. malignancy)
NCEPOD 4 (Elective)
- At time convenient for patient and doctor
- Cholecystectomy, joint replacement
When do you group and save or cross match pre-op?
If the anticipated blood loss is < 15% of total blood volume and
the Hb>13 gm/dl, group and save the sample.
If the anticipated blood loss is > 15% of total blood volume
then cross matched blood should be available for peri-operative
period.
How do you predict difficult intubation (not Mallempti’s classification)
Wilson Risk Sum is a scoring system to predict difficult intubation. It includes following
five risk factors.
- Obesity
- Restricted head and neck movements
- Restricted jaw movements
- Receding mandible and
- Buck teeth.
Why do patients require oxygen post operatively?
Post op opiate sedation reduces respiratory drive
Increased oxygen consumption due to shivering (volatile agent S/E or recovery from intraoperative hypothermia)
Restricted Ventilation post operatively
Increased metabolic rate post anaesthesia
In a patient with large abdominal surgery how long should they receive oxygen for and why?
72 hours
Promote wound healing
Restricted Ventilation due to pain
What are the main signs of upper airway obstruction in the unconscious patient?
Stridor Increased RR Use of accessory muscles Seesaw breathing Cyanosis Decreased breath sounds Tachycardia Tracheal tug
Why is it important to treat pain post operatively?
Pain causes an increase in the sympathetic response of the body with subsequent rises in
heart rate, cardiac work and oxygen consumption.
Prolonged pain can reduce physical
activity and lead to venous stasis and an increased risk of deep vein thrombosis and
consequent pulmonary embolism.
In addition, there can be widespread effects on gut and
urinary tract motility which may lead, in turn, to postoperative ileus, nausea, vomiting
and urinary retention.
These problems are unpleasant for the patient and may prolong
hospital stay.
What is the general steps in reducing delirium in patients?
-orientation and ensuring patients have their glasses
and hearing aids
-Reduce noise (ear plugs in ICU)
- promoting sleep hygiene
- early mobilisation
- pain control
• prevention, early identification and treatment of
postoperative complications
- maintaining optimal hydration and nutrition
- regulation of bladder and bowel function
- provision of supplementary oxygen, if appropriate.
What are the types of pain?
Nociceptive
- Somatic
- Visceral
Neuropathic
What are the causes of delirium?
Hypoxia
Drugs (opiates, sedatives, anaesthesia)
Urinary retention, constipation
MI, stroke
Infections
Alcohol withdrawal
Electrolyte abnormalities
Hypoglycaemia
Frailty comes into play
Lack of sleep
Dehydration
How might delirium manifest?
Agitation Confusion Attempts to discharge Aggression Irritability
