Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ALS > Anaesthetics and Acute Care > Flashcards

Anaesthetics and Acute Care Flashcards

1
Q

Malignant Hyperthermia

A

Hyperpyrexia and muscle rigidity following anaesthetic

RF - AD susceptibility (excessive Ca2+ release from SR)

Causes - halothane, suxamethonium

Inv - ^CK, contracture tests

-> dantrolene (prevents calcium release)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute Limb Ischaemia

A

Causes - thrombus (atherosclerosis) or embolus (AF, recent MI)

= pale, pulseless, painful, paralysis, paresthesia or perishingly cold

Inv - handheld arterial doppler, ABPI

-> A-E, IV opioids, IV UH, vascular review, thrombolysis/ embolectomy/ angioplasty/ bypass/ amputation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Compartment syndrome

A

Raised pressure within a closed space, compromises tissue perfusion, necrosis

Causes - supracondylar and tibial shaft fractures

= excessive pain on movement (incl passive), use of breakthrough analgesia, paralysis of the muscle group, pallor, may still have pulses

Inv - intercompartmental pressure (>40mmHg to diagnose), normal XR

-> fasciotomy, IV fluids for myoglobinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Wallaces Rule of Nines

A

Each of the following represents 9% TBSA

Head and neck
Each arm
Each anterior leg
Each posterior leg
Anterior chest
Posterior chest
Anterior abdo
Posterior abdo
Palms = 1%

Lund and Browder chart is more accurate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Organophosphate Poisoning

A

Inhibition of acetylcholinesterase (^nicotinic and cholinergic), farmers

= Dumbels
Defecation
Urination
Miosis (small)
Bradycardia, v BP
Emesis
Lacrimation
Salivation, sweating

-> atropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ecstasy OD

A

= agitated, anxious, confused, ataxia, hyperthermia, rhabdomyolysis, ^HR, ^BP, v Na

-> supportive, may use dantrolene for temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Ethylene Glycol

A

Alcohol used as coolant/ antifreeze

= three stages
1 - alcohol intoxication symptoms
2 - metabolic acidosis (high anion gap)
3 - AKI

-> fomepizole (alcohol dehydrogenase inhibitor), haemodialysis if refractory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

LSD

A

Synthetic hallucinogen, potent psychoactive compound

= variable, impaired judgement, amplifies current mood, withdrawn, drug-induced psychosis, may get palp, dry mouth, tremor, ^HR, ^BP, mydriasis, fever, resp arrest

-> calm then, benzos, anti-psych

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Methanol Poisoning

A

Due to formic acid build up

= alcohol symptoms + blindness

-> fomepizole, haemodialysis if fails, folinic acid (v eyes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Paracetamol OD

A

RF - increased hepatotoxicity if taking cyp inducers, malnourished (acute alcohol may protect)

-> activated charcoal if present <1hr, N-acetylcysteine infused over 1hr

Acetylcysteine if
- staggered OD
- above treatment line (100 at 4hrs, 15 at 15hrs)
- 8-24hrs had >150mg/kg
- >24hrs with jaundice/ hepatic tenderness/ ^ALT

Comp - anaphylactoid reaction (stop, restart at slower rate, non-IgE mediated mast cell release)

Prog - pH <7.3 at 24hrs for liver transplant (KCH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Salicylate OD

A

= hyperventilation (resp centre stim), tinnitus, sweating, n+v, seizures

Inv - mixed respiratory alkalosis and met acidosis

-> charcoal <1hr, urinary alkalinisation (IV sodium bicarb), haemodialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tricyclic OD

A

E.g., amitriptyline, clomipramine, dosulepin, imipramine

= anti-Ach early (mydriasis, blurry), arrhythmias, seizures

Inv - ABG (met acidosis), ECG (sinus tachy, broad QRS, ^QT)

-> IV bicarb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Opioid OD

A

E.g., morphine, buprenorphine, methadone

= runny nose, pinpoint pupils, drowsy, watering eyes, yawning, needle tracks

-> naloxone in acute OD, methadone/ buprenorphine for opioid detox

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

LA Toxicity

A

-> IV 20% lipid emulsion

Adrenaline can be added to prolong the duration of action at the injection site, permits higher dose of LA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Beta-blocker OD

A

= v HR, v BP, HF, syncope

-> atropine if brady, glucagon if resistant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Carbon monoxide poisoning

A

High affinity for Hb and myoglobin, left-shift of oxygen dissociation curve

= headache, n+v, vertigo, confusion, subjective weakness, pink skin, fever, arrythmia, coma, death

Inv - falsely high sats, ABG/VBG, carboxyhaemoglobin levels (<3% normal, <10% smokers), ECG

-> 100% high-flow oxygen via a non-rebreather mask for at least 6hrs, hyperbaric oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Antidotes:

BNZD
Lithium
Iron
Cyanide
Lead

A

BNZD - Flumazenil if severe (GABA ant, risk of seizures)

Lithium - volume resus if mild, haemodialysis if severe

Iron - desferrioxamine

Cyanide - hydroxocobalamin

Lead - penicillamine, calcium edetate, dimercaprol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pain Management

A

Analgesic Ladder

1 - non opioid
2 - weak opioids e.g., codeine, tramadol
3 - strong opioids e.g., morphine, oxycodone

Post Op:
Patient controlled analgesia - IV morphine infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pain Physiology

A

Nociceptors detect pain, two fibres to transmit the signal

C Fibres - small diameter, slow and dull

A delta - myelinated, larger, sharp and localised

Enter the CNS up the ST tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Post-Op Pyrexia

A

0-5 days:

Atelectasis
Cellulitis
UTI
Physiological (systemic inflam, <24hrs)
Blood transfusion

5+ days

Pneumonia
VTE
Wound infection
Anastomotic leak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Propofol

A

GABA agonist

Use: maintaining sedation on ITU, total IV anaesthesia and daycase surgery

Positives
Anti-emetic properties
Rapid induction
Rapidly metabolised

Negatives
Pain on injection
Hypotension – myocardial depression

22
Q

Sodium Thiopentone

A

GABA agonist

Use: rapid sequence of induction

Positives - Very quick onset

Negatives - myocardial depression, laryngospasm, cant use as maintenance and no analgesic properties

23
Q

Ketamine

A

NMDA antagonist

Use: induction of anaesthesia

Positives - useful in trauma/ haem instability as little myocardial depression, strong pain relief

Negatives - disorientation, hallucination, nightmares

24
Q

Etomidate

A

GABA potentiator

Use: induction in hemodynamic stability

Positives - less hypotension caused

Negatives - primary adrenal suppression if prolonged (can’t use for maintenance), myoclonus, sig post-op vomiting, no analgesia

25
Q

Fluranes

A

Isoflurane, desflurane, sevoflurane

Use: induction and maintenance of anesthesia

MOA - combination of GABA, glycine and NMDA

Negatives - myocardial depression, malignant hyperthermia, hepatotoxic (halothane)

26
Q

NO

A

NMDA, nACh, 5-HT3, GABA and glycine receptors

Use: maintenance of anesthesia and analgesia (e.g. during labour)

Avoid in Pneumothorax

27
Q

Tracheo-Oesophageal Fistula

A

RF - prolonged mechanical ventilation, traumatic intubation

= air leak and recurrent pneumonias secondary to aspiration

28
Q

Methaemoglobinaemia

A

Hb that has been oxidised from fe2+ to fe3+, tissue hypoxia as Fe3+ cannot bind oxygen

Causes - (congenital) Hb variants, NADHm reductase deficiency, (acquired) sulphonamides, nitrates e.g., poppers, sodium nitroprusside, primaquine, aniline dye

= chocolate cyanosis, SOB, headache

Inv - normal pao2 but v sats

-> IV methylene blue, ascorbic acid if def

29
Q

Curlings Ulcer

A

Peptic stress ulcer, acute gastric erosion linked to burns, ^children, ^duodenum

= bloody vomit, ^HR, v BP

30
Q

Metformin and surgery

A

Day before - normal

Day of - only change if TDS, omit lunchtime dose

31
Q

Sulfonylureas and surgery

A

Day before - normal

Morning op - omit OD dose or omit morning dose if BD

Afternoon op - omit all doses

32
Q

GLP1, DPP4 and SGLT2

A

GLP1 (-tides) and DPP4 (-gliptins) - normal

SGLT2 (-flozins) - omit on the day

33
Q

Once and Twice Daily Insulin

A

Once daily (Lantus, Levemir) - decrease by 20% on day before and day of

Twice daily (Novomix 30) - 50% morning of dose, rest normal

*If poorly controlled (Hba1c >69) then use VRII

34
Q

Drugs to stop before surgery

A

Clopidogrel (^bleeding) - stop 7d before elective surgery
HRT (^VTE) - stop 4wks before
ACE inhibitors/ furosemide (exacerbate hypotension periop) - omit on the day

Betablockers confer protection against major adverse cardiac events and should be continued

Diabetes - target HbA1c <69, first on operating list

35
Q

Anaphylaxis doses

A

<6 months = 100-150mcg
6 months - 6 years = 150mcg
6-12 = 300mcg
12yrs+ = 500mcg

Repeat every 5mins, IM anterolateral aspect of middle 1/3 of thigh (vastus lateralis)

Refractory: 2+ doses of adrenaline, give IV fluids and consider IV adrenaline infusion

36
Q

Airway devices

A

Oropharyngeal
= easy to use, not well tolerated if awake

Nasopharyngeal
= good for v GCS or seizures, contra in basal skull fracture

Supraglottic
= used in low risk cases or if needed short time (arrest)

Laryngeal mask
= very easy, poor control against gastric reflux, used in day surgery

Only ET tube and tracheostomy protect from aspiration

Multiple facial injuries/ fractures ?cricothyroidotomy

37
Q

ASA Grades

A

1 - Healthy, no smoking, no/ minimal alcohol

2 - Mild systemic disease e.g., current smoker, social drinker, pregnancy, BMI 30-40, well controlled DM/ HTN

3 - Severe systemic e.g., poor control, COPD, BMI > 40, ESRD with regular dialysis

4 - Severe and constant threat to life e.g., MI <3m

5 - Would die without surgery e.g., ruptured AAA

6 - Brain dead

38
Q

Burns: Subtypes

A

Superficial epidermal (first degree) - red, painful

Partial thickness (second degree)
- Superficial dermal - pale pink, blistered, slow CR
- Deep dermal - white, v sensation

Full thickness (third degree) - white/ brown, painless

39
Q

Management of Burns

A

-> A-E, consider early intubation, irrigate with cold water and layer with clingfilm, just water if chemical

Superficial epidermal -> analgesia, emollients
Superficial dermal -> leave blisters intact, no creams, review in 24hrs
Circumferential -> escharotomy

40
Q

Fluids in Burns

A

Fluid resus if >15% TBSA in adults (>10% kids)

Parkland formula to calculate

% of surface area x kg x 4 = 24hr requirement
- 50% in first 8hrs, 50% in next 16hrs

41
Q

Referral in burns

A

All deep dermal and full thickness

Superficial dermal if >3% TBSA in adults or 2% in kids, or if affects hands, face, feet, flexures or genitals

All circumferential, inhalation, electrical, chemical, NAI

42
Q

Brainstem Death

A
  • No light reflex (fixed pupils)
  • No corneal reflex
  • No oculo-vestibular reflex (caloric test; eye movement when ice water into ear)
  • No cough or gagging reflex
  • No observed respiratory effort

Deep tendon reflexes are intact (monosynaptic reflex not directly controlled by the brain)

43
Q

Shockable and Unshockable

A

‘shockable’ rhythms: VF, pulseless VT

‘non-shockable’ rhythms: asystole, pulseless-electrical activity

44
Q

GCS to I+V

A

GCS < 8 indicates the patient cannot protect their own airway

-> urgent intubation and ventilation

45
Q

Trauma and Tachycardia

A

Location of traumatic haemorrhage
= the floor (external haemorrhage), chest, pelvis, long bones and abdomen (internal)

BP may be normal - exclude clinically significant bleeding before attributing tachycardia to pain alone

Beware beta blockers (no tachy response)

46
Q

Pre-op bloods (elective)

A

Minor
No routine bloods (unless ASA 3/4 and indicated)

Intermediate
ASA2 consider U&E, ECG if indicated.
ASA3+ consider FBC, coag. Yes U&Es and ECG

Major
FBC in all
ASA2+ yes U&Es and ECG. consider coag ASA3

47
Q

Muscle Relaxants

A

Depolarising NM blocker

Suxamethonium
MOA - inhibits action of acetylcholine at NMJ
**fastest onset, shortest duration
SE: generalised contraction prior to paralysis, ^K, malignant hyperthermia, v AChE, ^intra-ocular pressure, fasciculation

Non-Depolarising NM Blocker (neostigmine reverses)

Atracurium
**Duration of action 30-45mins
SE: general histamine release on administration may produce facial flushing, ^HR, v BP

Vecuronium
Degraded by liver and kidney

Pancuronium
**Onset in 2mins, duration <2hours

48
Q

Post-Op Ileus

A

Paralytic ileus, post-bowel surgery

= distention, abdo pain, n+v, no flatus

-> NBM, IV fluids, correct electrolytes

49
Q

ALS Adrenaline Doses

A

Anaphylaxis: 0.5mg so 0.5ml of 1:1,000 IM

Cardiac arrest: 1mg so 10ml of 1:10,000 IV or 1ml of 1:1000 IV

50
Q

Quinine Toxicity

A

Use - antimalarial

SE: broad QRS, ^QT, ^PR, into VT/VF, v glucose, tinnitus, visual blurring, flushing, dry skin, abdominal pain, pulmonary oedema

ALS (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions