Anaesthetics Flashcards
assessment scale of n+v
0 = no n or v 1 = n only 2 = v once 3 = v more than once
Mx of n+v in intracranial tumours
dexamethasone
mechanism and use of metoclopramide in n+v
D2-antagonist (anti-dopaminergic)
- prokinetic/promotes bowel motility
- 1st line in low risk chemo induced n+v
mechanism and use of ondansetron in n+v
5HT3 antagonist
- chemotherapy induced nausea (high risk pts)
mechanism and use of cyclizine in n+v
anti-histamine
- inner ear induced nausea
mechanism and use of haloperidol in n+v
typical antipsychotic
- used in palliative care n+v
rating pain scale
0 = no pain rest, no pain movement 1 = no pain rest, slight pain movement 2 = slight pain rest, moderate pain movement 3 = pain at rest, severe pain movement
1st step in WHO pain ladder
pain score 0-1
non-opioid e.g. paracetamol 1g 6hrly
2nd step in WHO pain ladder
pain score 1-2
non-opioid
+
mild opioid (e.g. codeine or tramadol)
3rd step in WHO pain ladder
non-opioid
+
strong opioid (e.g. morphine)
how is oramorph usually given
10mg/5mls
what is MST
modified release morphine
- given bd
dose of breakthrough analgesia
1/6th of total daily dose of morphine
standard PCA prescription
1mg morphine bolus / 5 min lockout
conversion codeine to morphine
divide by 10
conversion morphine to oxycodone
divide by 2
order for opening airway
head tilt chin lift jaw thrust oropharyngeal airway nasopharyngeal airway laryngeal airway (guedel)
what airway device is not used in patients with GORD
laryngeal airway
- poor control against gastric reflux
(use endotracheal tube)
when is nasopharyngeal airway contraindicated
BOS #
how to size an oropharyngeal airway
between incisor teeth and angle of mandible
how long should warfarin be with-held for pre-op
5d
what is INR target pre-surgery for someone on warfarin
<1.5
if INR high in someone on warfarin pre-op, what do u give
oral vit K
when do u restart warfarin post op
on the same day of the procedure, if there is no bleeding
normal urine output
0.5ml/kg/hr
for a 70kg man - daily water requirement
2000-2500ml/day
daily Na requirement
1-2 mmol/kg
daily K requirement
1-2 mmol/kg
Na, K, Cl and Ca levels in plasma
Na - 135-147
K - 3.5-5
Cl - 92-109
Ca - 1.9-2.3
contents of 0.9% saline
Na 154 Cl 154 K 0 Ca 0 Lactate 0
contents of 5% glucose
Na 0 Cl 0 Ca 0 K 0 Lactate 0
used for pure dehydration
contents of hartmann’s
Na 131 Cl 110 K 5 Lactate 29 Ca 0
contents of colloid
Na 154 Cl 154 K 0 Lactate 0 Ca 0
what 3 things should be considered when prescribing fluids
- basal requirements
- existing deficit
- predicted losses
when are maintenance fluids given
if pt isnt drinking enough
must match daily requirements of Na, K and water over 24h
replacing fluid loss - how is this given
as a stat bolus - hartmanns
presentation paracetamol overdose
non-specific
- vomiting
- fever
- ringing in ears
- unconsciousness
what is the toxic metabolite of paracetamol and what detoxifies it
NAPQI
detoxified by glutathione
when to do paracetamol OD blood test
4h - if 100% paracetamol at this time they get Tx
how long does paracetamol take to be absorbed - what things affect this time
30mins
substances that delay gastric emptying - opiates, alcohol
when checking paracetamol level, what also always gets checked
aspirin level
Mx paracetamol Od
N-acetylcysteine (Parvolex)
- replenishes glutathione
- gvien in 3 stages
Mx opiate OD
naloxone
Mx TCA OD
sodium bicarbonate
presentation TCA OD
large pupils tachy urinary retention arrhythmia hypotension dry skin
If pt having seizures in TCA OD, what do u give
lorazepam + muscle relaxant + barbituate infusion
Mx BZD OD
flumazenil
why is flumazenil only given in iatrogenic OD
flumazenil can cause seizures which are then untreatable.
Mx tetanus
IVIG
prophylaxis following injury:
Mx if tetanus immune status complete and any wound
none required
prophylaxis following injury:
Mx if tetanus status inadequate and clean wound
none required
prophylaxis following injury:
Mx if tetanus status inadequate and tetanus prone site
immediate reinforcing dose of vaccine
prophylaxis following injury:
Mx if tetanus status inadequate and high risk tetanus prone site
immediate reinforcing dose of vaccine + IVIG at diff site
prophylaxis following injury:
Mx if no immune tetanus status and clean wound
immediate reinforcing dose of vaccine
prophylaxis following injury:
Mx if no immune tetanus status and tetanus prone site
immediate reinforcing dose of vaccine + IVIG at diff site
