Anaesthetics and Intensive Care Medicine (Quesmed) Flashcards
What are the 7 causes of Airway Compromise?
Angioedema
Anaphylaxis
Thermal injury
Neck Haematoma
Wheeze
Surgical Emphysema
Reduced Consciousness
What is the 4 step approach to Assessing a C-Spine Injury?
ABCDE Approach
Full Mobilisation until C-Spine is Cleared
Detailed History and Examination
Imaging as required
What are the 5 NEXUS Criteria needed to determine whether a C-Spine Injury is unlikely?
Normal Level of Alertness
No Evidence of Intoxication
No Painful Distracting Injury
No Focal Neurological Injury
Absence of Midline Cervical Tenderness
If all of the above Criteria are met, C-Spine may be cleared and Imaging may not be required
If the C-Spine cannot be cleared clinically, proceed with Imaging (CT, not plain Xrays as Xrays have limited value here)
What is the 4 step management of a C-Spine Injury?
Airway management while in full in-line Stabilisation
(Maintain Neutral Neck Position- Do Not use Head Tilt/ Chin Lift Manouevre. Instead use aa Jaw Thrust if Required)
Application of an Appropriately Sized Semi-rigid Collar
Secure Head with Blocks and Tape
Secure patient with full in-line Stabilisation
What signs after a surgery are considered abnormal?
Hypotension and Tachycardia are considered abnormal and are a sign of Shock, which may be due to a post-operative bleed
A Mild Pyrexia is common in the 48 hours after a Procedure
What are the 4 signs of a Cluster Headache?
A Unilateral headache that is typically worse around the Eye- occuring in Clusters over time
A Bloodshot or Teary Eye
Vomiting
Rhinorrhoea
What are the 2 Risk Factors for a Cluster Headache?
Middle Aged Men
Alcohol and Smoking
What is the 2 (2,2) step management of a Cluster Headache?
Treatment of a Cluster Headache is with 100% Oxygen and Sumatriptan
Prophylactic Treatment includes Verapamil and Steroids
What is Compartment Syndrome?
It most commonly develops after Limb Trauma where Muscle Swelling and Inflammation leads to an Increase in Pressure in the Muscle Compartment
This is a limb-threatening condition that needs to be diagnosed and treated quickly as the increase in pressure can cause a Loss of the Blood Supply to that Limb and Subsequent Ischaemia
What are the 5 signs of Compartment Syndrome?
Severe Pain, particularly on the Passive Flexion of the Toes
Pallor
Paralysis of the Limb
Pulselessness
Paraesthesia
What is the 3 step management of Compartment Syndrome?
Urgent Fasciotomy
Analgesia
Fluids
What is Delirium tremens?
It is a rapid onset of Confusion Precipitated by Alcohol Withdrawal. It usually develops 72 hours after Ceasing Alcohol Intake and can last for several days
What are the 5 signs of Delirium tremens?
Confusion
Hallucinations (visual and tactile (such as Formication- sensation of Insects crawling on or under the skin))
Sweating
Hypertension
(Rare) Seizures
What is the 5 step management of Delirium tremens?
Chlordiazepoxide
Fluids
Anti-emetics
Pabrinex
Refer to Local Drug and Alcohol Liaison Team
What 7 drugs should be stopped before a Surgery? And how long should they be stopped for?
- Clopidogrel should be stopped 7 days before the surgery
- Warfarin should be stopped 5 days before the surgery and patients should be on Low Molecular Weight Heparins instead until the Night before
- ACE Inhibitors should be stopped the day before
- Insulin should be held on the day of the surgery (only the short-acting preparations)
- Sulfonylureas should be held on the day of the surgery (due to the risk of Hypoglycaemia)
- Metformin can be given as normal for Short Procedures. For Longer Procedures, where patients are not Eating or Drinking for several days, Metformin should be held and Variable-rate Insulin should be Prescribed
- The Pill should be stopped 4-6 weeks before Surgery and restarted at least 2 weeks after Surgery. This reduces the Risk of Deep Vein Thrombosis (DVT)
What is Epidural Anesthesia (where is it injected)? What are the 3 risks? And how is it monitored?
It is the injection of a Local Anaesthetic to the Epidural Space around L2-3 or L3-4 at the Vertebral Level
3 Risks-
- Maternal hypotension, which results in Foetal and Maternal Distress
- Risk of Dural Puncture (which results in a severe Postural Headache)
- Epidural Haematoma
Monitoring-
- CTG (Cardiotocography) monitoring of the foetus’ heart rate is recommended.
What are the 7 signs that suggest a patient may require fluid resuscitation?
Systolic BP<100mmHg
Heart Rate >90bpm
Capillary Refill>2s
Cool Peripheries
Respiratory Rate>20
NEWS>/=5
Dry Mucous Membranes
What is the 4 step approach to Fluid Resuscitation?
Identify the cause of Fluid Deficit and respond appropriately
Fluid bolus of 500ml Crystalloid over<15 minutes
Reassess using ABCDE Approach
Further Fluid Boluses (up to 2,000ml) may be required
What are the 5 daily fluid requirements?
25-30mL/kg/ day of Water
1 mmol/kg/day of Sodium
1 mmol/kg/day of Potassium
1 mmol/kg/day of Chloride
50-100g/ day of Glucose to limit Ketosis
What are Crystalloid and Colloid Fluids?
Crystalloid Fluid- Solution containing small molecules (Sodium, Chloride)
Colloid Fluid- Solution containing larger molecules (Albumin)
What is the composition of 0.9% Sodium Chloride (Saline) Fluid, 0.18% Sodium Chloride/ 4% Glucose, 0.45% Sodium Chloride/ 4% Glucose, 5% Dextrose and Hartmann’s?
0.9% Sodium Chloride-
- 154mmol/L of Sodium and 154%mmol/L of Chloride
0.18% Sodium Chloride/ 4% Glucose-
- 31mmol/L of Sodium, 31mmol/L of Chloride and 222mmol/L Glucose
0.45% of Sodium Chloride/ 4% Glucose-
- 77mmol/L of Sodium, 77mool/L of Chloride and 222mmol/L Glucose
5% Dextrose-
- 278mmol/L Glucose
Hartmann’s-
- 131mmol/L of Sodium, 5mmol/L of Potassium, 111mmol/L of Chloride and 29mmol/L of HCO3-
What are the 4 types of Fluid suitable for Resuscitation and which 2 should not be used for Resuscitation and why?
Suitable
- Saline (0.9% NaCl)
- Hartmann’s Solution
- 4-5% Human Albumin Solution- if Severe Sepsis
- Blood- if Severe Haemorrhage
Fluids not suitable for Resuscitation-
- Dextrose (Does not stay in the Intravascular Compartment)
- Gelofusine (Risk of Anaphylaxis)
What is the 4 step approach to using Fluids to Resuscitate patients?
Use 500ml of the Fluid of Choice, or 250ml if Cardiac Disease or if the patient is Old (due to the Increased Risk of Pulmonary Oedema secondary to Excessive Fluid Resuscitation)
This should be given over <15 minutes
This can be repeated if Needed
If the patient fails to respond after 2L of Fluid, they should be considered Non-Fluid Responsive and immediate help should be sought (they may require Blood Pressure Support)
What is Lactic Acidosis seen as in an ABG?
Raised Anion Gap, Metabolic Acidosis
What are the 7 causes of Type A (Tissue Hypoxia) and 5 causes of Type B (Abnormalities in the Metabolism of Lactate) Lactic Acidosis?
Type A-
- Shock
- Hypoxia
- Acute Mesenteric Ischaemia
- Limb Ischaemia
- Severe Anaemia
- Seizures
- Vigorous Exercise
Type B-
- Diabetic Ketoacidosis
- Cancer
- Liver Disease
- Inborn Errors in Metabolism
- Drugs (Metformin (impairs liver metabolism of Lactate) and Aspirin)
What are the 16 signs of Local Anaesthesia Toxicity?
Hypotension
Hypertension
Tachycardia
Sinus Bradycardia
Ventricular Arrhythmias
Asystole
Shivering
Tinnitus
Subtle Tremors of Face and Extremities
Restlessness and Agitation
Seizures
Numbness or Tingling around the Mouth
Vertigo and Dizziness
Decreased Consciousness
Respiratory Depression
Apnoea
What is the 5 step management of Local Anaesthesia Toxicity?
Stop administering the Local Anaesthetic
ABCDE approach including the ECG monitoring
Lipid Emulsion (20% Intralipid) 1ml/kg every 3 minutes up to a dose of 3mL/kg
Initiate Lipid Emulsion Infusion at a rate of 0.25ml/kg/min
Maximum Dose= 8ml/kg
