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Acute and Critical Care > Anaesthetics CBD topics > Flashcards

Anaesthetics CBD topics Flashcards

1
Q

A to E interventions of a bleeding patient

A

A - Clear visible secretions with suction. Maintain airway with manoeuvres or support (Guedle)
B - 15L of oxygen with a non-rebreathable mask.
C - 2x large bore cannulas. 250ml of WARM normal saline STAT. IV PPI to decrease gastric acid levels (high acid inhibits platelet aggregation and clot formation).
D - Blood sugars. GCS score.
E - urgent endoscopy.

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2
Q

Types of hypoxia

A

Hypoxic hypoxia - aspiration
Anaemia hypoxia - haemorrhage (low O2 dissolved in blood)
Histotoxic hypoxia - cyanide poisining
Stagnant hypoxia - septic shock

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3
Q

Bloods in haemorrhage patient

A

FBC, U+E, LFT, Clotting screen, Group and save.

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4
Q

What fluids are not used in massive haemorrhage

A

Ones containing glucose/dextrose. Hypertonic so goes into cells rather than stays in plasma and does not rehydrate whole body.

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5
Q

Problems with over fluid resuscitation

A

Pulmonary oedema.
Could dislodge clots
Electrolyte imbalance (hypernatraemia with normal saline or hyperkalaemia with Hartmann’s).
Aim for MAP of >65, Systolic BP of >90mmHg, HR of 100bpm.
Don’t raise BP too rapidly as won’t support stopping the bleed.

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6
Q

Definition of disseminated intravascular coagulation

A

Systemic activation go coagulation pathways leading to consumption of platelets & coagulation factors and also microthrombi from fibrin deposits. Results in end organ damage, thombocytopenia and bleeding

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7
Q

Causes of DIC

A 
GI haemorrhage
Placenta abruption
Amniotic fluid embolism
Large aortic aneurysms
Major trauma
Severe liver failure
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8
Q

Blood test results in DIC

A

PT (extrinsic and common coagulation pathways) - increased
Platelets - decreased
Fibrinogen - decrease
D-dimer (Evidence of plasmin-mediated biodegradation) - increased

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9
Q

Treatment of DIC

A

Treat cause.
4 units of red blood cells.
4 units of fresh frozen plasma (leave 30mins to thaw)
1 unit of platelets
Keep patient warm with warming fluids and warming blanket.
1g of tranexamic acid IV followed by 1g after 3hrs.
Can use Cryoprecipitates instead of FFP.

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10
Q

Rise in Hb with 1 unit of blood

A

1g/dl

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11
Q

Complications of massive transfusion

A

Hyperkalaemia due to cell lysis from circulatory overload.

Transfusion-related acute lung injury

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12
Q

Components of optimising pre-surgery

A

Stop smoking (aim for 6-8weeks pre-op or at least 24hrs)
Control any co-morbidities (DM, HTN, COPD)
Optimise Hb
Weight loss via nutrition and exercise.
Reduce alcohol intake.

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13
Q

Symptoms and risk factors of obstructive sleep apnea

A 
Snoring during the night followed by periods of no breathe then rewatching breathe then snoring again. 
Daytime tiredness
High blood pressure
High BMI
High neck circumference
Over 50
Male
Irritable
Poor concentration
Low libido
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14
Q

Treatment of Obstructive sleep apnoea

A

CPAP

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15
Q

Investigations of OSA

A

Polysynography and sleep studies.

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16
Q

Steroids use in surgery patients

A

If low steroid prescription e.g. 10mg of prednisolone - take meds as usual.
If >10mg and minor operation - oral morning dose or IV 25-50mg Hydrocortisone at induction and resume oral dose after operation.
If >10mg and major operation - IV 25-50mg Hydrocortisone at induction and 2 days of IV TDS hydrocortisone then resume oral meds.

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17
Q

Thromboprophylaxis in epidurals

A

Low molecular weight heparin.
Give dose then wait 12hrs before administering epidural. Wait 12hours after last dose before removing catheter and then a further 4 hours before next dose of LMWH.
MRI ASAP if signs of haematoma!

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18
Q

Management of hypoglycaemia

A 
Img of IV glucagon
or
50mg of oral glucose
or
50ml of 10% dextrose IV
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19
Q

Management of paracetamol overdose

A

n-acetylcysteine.

150mg/kg over first 1 hour –> 50mg/kg over next 4 hours –> 100mg/kg over next 16 hours.

20
Q

Management of hyperkalaemia

A

10mg of nebulised salbutamol
10ml of 10% calcium gluconate IV
10units of insulin e.g. ACTRAPID + 50ml of 50% glucose.

21
Q

Scale for OSA

A

EPWORTH SLEEPINESS SCALE

22
Q

Scale to assess breathlessness

A

MRC dyspnoea scale

23
Q

How to assess a patient’s functional capacity

A

MET - metabolic equivalent of a task.
1 MET is the basal metabolic oxygen consumption at rest (about 3.5ml/kg/min).
Hoovering, gardening, jogging etc.

24
Q

Fasting periods pre-op

A

6 hours no food

2 hours no clear liquids

25
Q

Where should a DM patient be on the theatre list

A

At start to reduce period of starvation

Stop metformin in morning of surgery

26
Q

Components of GCS and max score

A 
Eye opening response (4)
Verbal response (5)
Motor response (6)
27
Q

Scoring of eye opening response in GCS

A

Spontaneously = 4
To speech = 3
To pain = 2
No response = 1

28
Q

Scoring of verbal response in GCS

A 
Orientated in time and place = 5
Confused = 4
Inappropriate words = 3
Incomprehensible words = 2
No response = 1
29
Q

Scoring of motor response in GCS

A

Obey commands = 6
Moves to localised pain = 5
Flexion withdrawal from pain = 4
Abnormal flexion withdrawal (spastic) from pain = 3
Abnormal extension withdrawal (rigid) from pain = 2
No response = 1

30
Q

Causes of hypoglycaemia

A 
EXPLAINS H
EXogenous- alcohol, insulin
Pituitary insufficiency
Liver failure
Addison's disease
Islet cell tumours (insulinoma)
Infection (severe sepsis)
Non-pancreatic neoplasms (IGF secreting tumours)
Hypothyroidism
31
Q

Diagnosis of hypoglycemia BM levels

A

<2.2

or <4 in a known DM patient

32
Q

Blood tests for assessing synthetic liver function

A

INR and Albumin (show liver abilities to synthesis products)

LFTs show cell damage.

33
Q

Causes of drowsyness

A 
Decreased perfusion to brain due to hypotension
Drugs e.g. opioids
Dehydration 
Hypoglycemia
Pain
34
Q

Name some components of pre-op assessment

A 
From history:
Co-morbidities and how they are managed
Drug history and ALLERGIES
Exercise tolerance 
Hx of anaesthesia/surgery
FHx of malignant hyperthermia.

Assessments to be made:
ASA score
Malpati airway score

Ix:
ECG

35
Q

Specific conditions to ask about in pre-op

A 
Obstructive sleep apnoea
GORD
Asthma
Epilepsy
Issues with cervical spine
36
Q

Some anaesthetic side effects you can council a patient on

A 
Post-op nausea and vomiting.
Confusion
Dizziness
Bladder problems
Nerve damage
(there are lots this is just a few)
37
Q

What drugs should an anaesthetist be aware of as may need bridging/stopping etc etc

A 
Steroids
Warfarin
Metformin and insulin
COCP (bridge to POP to reduce DVT risk)
ACE inhibitors.
Diuretics
38
Q

Risk factors for post op n+v

A 
Patient = Female, Hx of travel sickness, non-smoker.
Operative = laparotomy, gynae, abdo, neuro, ENT
Anaesthesia = opiates, volatile agents, dehydration (not enough fluids)
39
Q

Name some meds for post-op n+v

A

Intra-op = ondansetron, dexamethasone.
Post-op = cyclizine.
Acupuncture point on wrist.

40
Q

Where is local anaesthetic + adrenaline not used

A

Peripheral areas e.g. toes, ears, penis, fingers. Causes vasoconstriction.

41
Q

What does the % of a local anaesthetic mean

A

gram of drug per 100ml. 1% = 1g/100ml.

42
Q

How to work out mean arterial pressure

A

diastolic BP + (1/3 of SBP-DBP)

43
Q

If you socially drink or smoke what ASA grade can you NOT be

A

ASA1.

Automatically at least a 2

44
Q

Name a form of non-invasive ventilation and describe how it helps?

A

Bi-level positive airway pressure (BiPAP).
Delivers differing pressure depending on inspiration and expiration.
Used in T2RF (COPD exacerbation).

45
Q

Name a mechanism for fixed positive airway pressure?

A

Continuous positive airway pressure (CPAP).
Not a form of ventilation but helps keep airway open allowing greater oxygen delivery.
Used in T1RF (acute pulmonary oedema) or chronically for OSA.

Acute and Critical Care (2 decks)

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