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Year 3 Conditions > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

What do preoperative investigations depend on

A

Patient medication and comorbidites
Severity of surgery
Elective or emergency

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2
Q

Scoring systems for health of patient pre surgery

A

ASA

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3
Q

ASA scoring

A

1- healthy
2- minor systemic condition that enables them to walk up 2 flights of stairs
3- major systemic disease that is a threat to life
4- major disease that is constant threat to life
5- patient wont make it oast 24 hours

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4
Q

Scoring system for risk to patient of surgery

A

POSSUM

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5
Q

How does possum score work

A

Use patient physiological and operative variables to give risk of mortality or morbidity of surgery. This then determines what sort of mid operative monitoring is done or where the patient needs to be monitrored after surgery. For example if mortality rate over 5% then would end up post operatively on ICU

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6
Q

What to do with diabetes perioperatively

A

Ensure Hba1c is well controlled

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7
Q

What to do pre operatively with HTN

A

Check most recent at GP as before surgery very high, if over 160/80 need to treat

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8
Q

What to do intra-operatively with HTN

A

Keep within 20% of their normal

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9
Q

What to do with IHD pre operatively

A

Make sure no recent deterioration and is well controlled. If has been a change then refer to cardiology or do ECG to check for anomaly

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10
Q

What to do with IDH intra operatively

A

Check for HR and BP constantly

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11
Q

What to do with IHD post operatively

A

Consider taking to HDU

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12
Q

What to do with asthma or COPD perioperatively

A

Ensure taking medication and no exacerbating symptoms or signs recently

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13
Q

What is INR range for surgery perioperatively

A

Less than 1.5

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14
Q

What should be considered with anticoagulants

A

Why are they taking it

Should they be stopped?

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15
Q

What needs to be done to optimise SCD patients for surgery

A

Haematology review

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16
Q

What should be done peroperatively for SCD patients

A

Ensure good care so warm, hydrated, analgesia and infection free

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17
Q

What is criteria for suitability for day stay surgery

A

Social- patient consent and is there suitable care situation at home
Medical- fitness and are they stable chronically
Surgical- mobile?, complication risk needs monitoring?

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18
Q

Why do NBM pre surgery

A

Reduce risk of aspiration as paralysed swallowing reflex

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19
Q

Usual guidance on ceasing fluid and food

A

Food 6 hours

Water 2 hours

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20
Q

What to include when recording on controlled drug register

A

Dose
Form of administration
Strength
Instalment prescription

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21
Q

Whats included on instalment prescription

A

Amount of medicine per instalment

Interval between instalments

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22
Q

What is another name for oropharangeal airways

A

Guedel

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23
Q

How to do sizing of oropharyngeal airways

A

Side of mouth to angle of mandible

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24
Q

Who do you use bag-mask-valves in

A

Apnoeic patients

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25
Q

What FiO2 can be achieved in bag mask valves

A

60-90

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26
Q

What does supraglottic device look like

A

A cobra

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27
Q

What are 3 aiway adjuncts we need to know

A

Endotracheal tubes
Supraglottic device
Bag mask valves

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28
Q

What are the 5 steps to safer surgery

A 
Briefing
Sign in
Time out
Sign out
De brief
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29
Q

What is done in briefing in 5 steps to safer surgery

A

All the team meet to introduce themselves, discuss order and each persons role

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30
Q

What is done in sign in in 5 steps to safer surgery

A

Lead by anaesthetist to patient pre any anaesthetic
Confirm patient details, the procedure and the side
Check allergies
Prophylaxis

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31
Q

What is done in time out in 5 steps to safer surgery

A

Lead by surgeon pre incision
Check anaesthetic side all fine and details
All equipment sterile

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32
Q

What is done in sign out in 5 steps to safer surgery

A

Lead by anaesthetist where do equipment check to see if any left in body, prescriptions and any prophylaxis given

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33
Q

What should be considered for VTE prophylaxis

A

Their mobility
Risk factors such as cancer, prophylaxis
Bleeding risk

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34
Q

What is the WHO pain ladder

A

Determies level of pain relief given post operatively

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35
Q

3 tiers to WHO pain ladder

A

Step 1- non opioid
Step 2- weak opioid
Step 3- strong opioid

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36
Q

What enables you to move up WHO pain ladder

A

Increasing or persisting pain

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37
Q

What anti emetics are given alongside pain relief

A 
Ondensatron
Prochlorperazine
Cyclizine
Dexamethasone
Metoclopramide
38
Q

Dose and administration of ondensatron

A

4-8mg TDS

PO IV

39
Q

Dose and administration of cyclizine

A

50mg TDS

PO IV

40
Q

Dose and administration of dexamethasone

A

4-8mg

PO/slow IV/IM

41
Q

Dose and administration of metoclopramide

A

10mg TDS

PO IV

42
Q

Dose and administration of propchlorperazine

A

12.5mg BD

IM

43
Q

SEs ondensatron

A

Bradychardia

Long QT

44
Q

SEs cyclizine

A

Tachycarida

Anti-cholinergic

45
Q

SEs dexamethasone

A

Hyperglycaemia

Perineal burning

46
Q

SEs metoclopramide

A

Extrapyramidal SEs

47
Q

SEs prochlorperazine

A

Extrapyramidal SEs

Long QT

48
Q

Aim of temperature control in anaesthesia

A

36C

49
Q

What is always given for heat control if surgery over 30mins

A

Bair hugger

50
Q

Methods used to warm up patients

A

Bair hugger
Warming IV fluids
Heat moisturiser exchangers

51
Q

Method of warmth control for very long surgeries

A

Warming IV fluids

52
Q

What is effect anaesthesia on temp control

A

Makes you colder

53
Q

What is management of severe bronchospasm outside of theatre

A 
Start high flow O2
Salbutamol nebulisers
Hydrocortisone
Ipatropium bromdie
Theophylline
Magnesium
54
Q

Pnemonic for control of severe bronchospasm

A

OSHITM

55
Q

How would you treat a tension pneuomthorax

A

16 gauge needle decompression in 2ics MCL

56
Q

Resp emergencies need to be aware of in anaesthetics

A

Asthma attacks
Hameo/pneumothorax
Anaphylaxis
Foreign body aspiration

57
Q

Anaphylaxis triggers

A 
Stings
Nuts
Foods
Antibiotics
Anaesthetic drugs
Contrast media
58
Q

Recognising anaphylaxis ABC

A 
Airway
SOB and swallowing
Stridor
Hoarse voice
Breathing
Wheeze
Confusion from hypoxia
SOB- tachypnoea
Accessory muscle involvement
Circulation
shock signs
Tachycardia
Hyoptension
Loss of conciousness
Can arrest
59
Q

What is main management of anaphylaxis

A

Adrenaline

Then supportive measures such as airway establishment, O2, hydrocortisone, IV fluid and chlorphenamine

60
Q

When should you give blood transfusion

A

Tranfusion guideline

61
Q

Post operatively what scores do you use to monitor recovery and if theyre getting worse

A

NEWS

62
Q

Early warning signs of detioration of patient

A

Tachycardia
Hypotensive
HR above SBP

63
Q

How to define SIRS

A 
2 of 
Temp out of 36-38
HR above 90
RR above 20 or Pa CO2 below 4.3kPa
WBC abnormal
64
Q

What is common after surgery

A

SIRS

65
Q

What are indications for ABG

A 
Interpret oxygenation levels
Assess resp derangements
Assess metabolic derangements
Acid base status
Assess lactate
CO poisoning
66
Q

Contraindications to ABG

A 
Local infection
Distorted anatomy 
Presence of fistulas
Peripheral vascular disease
Severe coagulopathy
Recent thrombolysi
67
Q

What can lead to errors with ABG measurements

A

Presence of air in sample
Venous as opposed to arterial blood
Improper heparin amount
Delay in transportation

68
Q

Complications of ABG

A 
Haematoma
Nerve damage
Arteriospasm
Aneurysm
Syncope vasovagal
69
Q

What are goals of oxygen therapy

A

Relieve hypoxaemia
Prevent CO2 accumulation
Reduce work of breathing such as CPAP
Ensure adequate clearance of secretions and limit effects of hypothermia

70
Q

Oxygen delivery methods

A

Nasal cannula
Hudson facemask
Venturi
Non-rebreather

71
Q

When do you nasal cannulae

A

Non-acute setting

Mild hypoxia

72
Q

What FiO2 are nasal cannulae

A

24-30

73
Q

Flow rate of nasal cannulae

A

1-4

74
Q

FiO2 venturi

A

24-60

75
Q

FiO2 hudson facemask

A

30-40

76
Q

Flow rate hudson

A

5-10

77
Q

Flow rate of venturi

A

Fixed depending on colour

78
Q

What oxygen therapy preferred in COPD

A

Venturi

79
Q

Who are non-rebreather mask used for

A

Apnoeic

80
Q

Flow rate of non rebreather

A

15

81
Q

FiO2 of non rebreath

A

60-90

82
Q

What is purpose of non-rebreather

A

Stop breathing expired air

83
Q

What are 2 non-invasive modes of ventilation

A

CPAP

BiPAP

84
Q

Who do you use CPAP for

A

Type 1 RF in order to splint open airways

85
Q

What is CPAP

A

continuous positive air pressure that occurs all the time

86
Q

What is device used for CPAP

A

Tight fitting mask

87
Q

What is BiPAP

A

Bilevel positive airways pressure

88
Q

How does BiPAP work

A

High positive pressure on inspiration and lower positive pressure on expiration

89
Q

Who do you use BiPAP for

A

T2 RF such as COPD exacerbation

90
Q

Treatment for anaphylaxis

A

IM adrenaline

Year 3 Conditions (33 decks)

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