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year 4 > Anaesthetics > Flashcards

Anaesthetics Flashcards

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1
Q

List some factors that need to be taken into account in an airway assessment.

A

Mouth opening, teeth, facial hair, neck extension, thyromental distance >/=6.5cm, obesity, jaw protrusion, mallampati score

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2
Q

What is Pain?

A

An unpleasant sensory or emotional experience associated with actual or potential tissue damage

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3
Q

What signs might indicate hypovolaemia?

A

Raised HR, RR, dropped Bp
Reduced urine output
History of poor fluid in take or fluid loss
Reduced skin turgor, cool peripheries, postural hypotension, CRT >2, dry mucous membranes

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4
Q

What is the max maintenance fluids you can prescribe?

A

100mls/hr

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5
Q

What are the daily requirements of water and Na, CL, K , glucose?

A

30ml/kg/day water
1-2mmol/L/kg/day NaCl
1 mmol/L/kg/day K
50-100g glucose per day

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6
Q

What electrolytes are in Saline and hartmanns?

A

Saline - NaCL

Hartmanns - Na, K, Ca, Cl, HCO3

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7
Q

Where is the vomiting centre?

A

Medulla oblongata
Low level stimulation - nausea
High level stimulation - vomiting

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8
Q

List some inputs to the vomiting centre.

A

Chemoreceptor trigger zone - Dopamine, ACH, serotonin, histamine
Higher cortical centres - GABA
Vestibular apparatus and cerebellum - ACH, histamine
Stomach/ intestines - ACh, Dopamine, histamine, serotonin
Raised ICP or brain mets directly putting pressure on VC

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9
Q

Where is the Chemoreceptor trigger zone and what triggers it to stimulate the vomiting centre?

A

Outside the BBB
Area postrema at the base of the 4th ventricle
Electrolyte disturbances (hyperCa, HypoNa), biochemical changes, medication (e.g. chemotherapy induced N&V)

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10
Q

Where does the dopamine antagonist Metaclopramide work and what might it be used first line for?

A

CTZ, GI tract

1st line in: Impaired gastric emptying, biochemical causes of vomiting

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11
Q

Where does cyclizine act and when might it be used first line?

A

Vomiting centre, vestibular systen

1st line in: Complete bowel obstruction, IC cause/motion sickness

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12
Q

Where does Ondansetron act and when might it be used?

A

CTZ, vagal nerve

1st line in: Chemo/radiotherapy induced N&V, opiate induced N&V, GI distension/obstruction, post-op

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13
Q

Where does the dopamine antagonist Haloperidol act and when might it be used 1st line?

A

CTZ

1st line in: Biochemical, hiccups, delirium

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14
Q

Where does Levomepromazine act and when is it used?

A

Everywhere - Dopamine, serotonin, muscarinic, histamine

Due to SE it is used 2nd line when 1st line has failed

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15
Q

Explain the vomiting reflex,

A
  1. Stimulation to the Vomiting center
  2. VC coordinates reflex throughout CN V, VII, IX, X, XII
  3. Prodrome - Hypersalavation, sweating, pallor, tachycardia
  4. Glottis closes and soft palate raises to close off airway
  5. Deep inspiration and diaphragm contracts
  6. GO sphincter and funds of stomach relax
  7. Abdominal muscles contract forcefully
  8. Anti-peristalitic waves
  9. Increased pressure forces chyme up from the stomach and out of the mouth
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16
Q

What is the triad of anaesthesia and give some examples of agents.

A

Unconsciousness - propofol (GABA agonist), ketamine & NO (antagonises NMDA)
Muscle relaxants - Recuronium, suxamethonium
Analgesia - IV paracetamol or opioids

17
Q

What drugs could you reverse the effect of the neuromuscular blockers suxamethonium or rocuronium?

A

Neostigmine or rocuronium

18
Q

List some pre-op risk scores.

A

NSQIP
SORT
POSSUM
They help calculate the risk of mortality

19
Q

What are the fasting guidelines?

A 
Food and fizzy drinks - 6 hours
Clear fluids - 2 hours
Milk - 6 hours
Breast milk - 4 hours
Chewing gum - 2 hours
20
Q

How would you define a major haemorrhage?

A

Loss of more than 1 blood volume within 24 hours
Rate >150ml/min
50% of blood volume in under 3 hours

21
Q

How might you assess nutritional status?

A

BMI
Grip strength
Tricep skin fold thickness

MUST

22
Q

Explain the physiological response to pain.

A

Pain causes release on endogenous amines - NA, adrenaline, dopamine, etc - knock on effect
Inc HR and contraction - inc myocardial oxygen demand - If CAD - Type 2 MI??
Rapid resps, shallow breathing
Reduced wound healing due to reduce blood flow to wound and reduced oxygen and blood to wound, reduced healing in hypoglycaemia due to stress response
Coagulopathy - DVT/PE

23
Q

Explain the analgesia pain ladder.

A

NSAID ± Aspirin ± paracetamol
+ Tramadol, codeine, oxycodone
+ Morphine, hydromorphone, fentanyl, methadone, buprenorphine

24
Q

What are some post-op causes of pyrexia?

A

WIND - 1-2d - pneumonia, atelectasis, aspiration
WATER - 3-5d - UTI
WALKING - 5+ - DVT/PE
WOUND - 5-7d - surgical site infection, abscess
What did I do? 7+ - line infection, sepsis, transfusion reaction, drugs

year 4 (14 decks)

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