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AP1 Final > Anes. Surgical Complicaitons > Flashcards

Anes. Surgical Complicaitons Flashcards

1
Q

In regards to the difficult airway algorithm, what is the first thing to consider with an unsuccessful intubation of a patient that has been inducted?

A

call for help

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2
Q

In regards to the difficult airway algorithm, what should you do if face mask ventilation is not adequate?

A

consider/attempt LMA

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3
Q

In regards to the difficult airway algorithm, what should be done if an LMA is not feasible?

A

Emergency non-invasive airway ventilation

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4
Q

What are examples of emergency non-invasive airway ventilation techniques?

A

rigid bronchoscope

esophageal-tracheal combitube

transtracheal jet ventilation

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5
Q

IIn regards to the difficult airway algorithm, if non-invasive airway is unsuccessful what is the next step?

A

invasive airway access — (i.e. surgical/percutaneous tracheostomy or cricothyrotomy.

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6
Q

what are some clinical presentations that may prove for a difficult intubation?

A

MAL 3 or 4

thyromental distance < 6 cm

loud snoring

small mouth (opening < 3 cm)

limited ROM

obesity

neck pathology (mass, scar, radiation therapy)

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7
Q

What are some examples of conditions that would necessitate a contiued intubation?

A

epiglottitis

localized edema (angioedema)

Recurrent larangeal nerve damage

Bleeding

Hemodynamic instability

Obtundation due to Anes. drugs

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8
Q

What is the the most frequently encountered serious complication in PACU?

A

respiratory problems (i.e. airway obstruction, hypoventilation, hypoxemia)

hypoventilation (most common)

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9
Q

What are some common causes of airway obstruction?

A

posterior displacement of tongue

secrections/fluids (blood, vomit)

laryngospasm

pressure on trachea (ie. bleeing in the neck)

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10
Q

what is the quickest and easiest way to correct an airway obstruction?

A

jaw thrust, head tilt

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11
Q

You have an obese patient that reports a history of snoring and use of CPAP, what measure might you take prevent airway obstruction after extubation?

A

Nasal airway

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12
Q

what sign/symptom would indicate an airway obstruction?

A

paradoical chest movements (i.e. guppy breathing)

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13
Q

You’ve just extubated you’re patient, you place the anesthesia mask on to confirm the 3 Cs. They are not present, even after a jaw thrust/head tilt. What could be the problem?

A

laryngospasm

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14
Q

What dose of succinylcholine should be used to break the laryngospasm?

A

0.1 mg/kg or 10-20 mg (0.5-1 ml)

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15
Q

How is hypoventilation generally defined in regards to PaCO2?

A

PaCO2 > 45 mmHg

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16
Q

what is considered significant hypoventilation?

A

PaCO2 > 60 mmHg pH < 7.25

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17
Q

What are common signs and symptoms of hypoventilation?

A

Somnolence

Airway obstruction

Slow RR

Tachypnea w/shallow breathing

Labored breathing

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18
Q

In regards to acid base balance what does hypoventilation cause?

A

respiratory acidosis

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19
Q

what are symptoms of respiratory acidosis?

A

HTN

tachypnea

cardiac irritability (cardiac depression)

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20
Q

what are possible causes of hypoventilation in regards to the Anes. drugs?

A
  1. too much narcotic
  2. residual paralysis
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21
Q

What can be done to correct too much opioid?

A

Narcan

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22
Q

What are the cons of using Narcan

A

Pain HTN crisis pulmonary edema myocardial ischemia

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23
Q

What is considered hypoxia?

A

PaO2 < 60 mmHg

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24
Q

what are the ealry signs of hypoxia?

A

restlessness tachycardia cardiac irritability

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25
Q

what are late signs of hypoxia?

A

obtunded bradycardia hypotension cardiac arrest

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26
Q

what can be used to confirm hypoxia?

A

SpO2 Arterial blood gas (ABG)

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27
Q

what are some causes of hypoxia?

A

hypoventilation R-L shunting intrapulmonary shunting

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28
Q

What are examples of intrapulmonay shunting?

A

pulmonary atelectasis parenchymal infiltrates pneumothorax

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29
Q

what most often causes intrapulmonary shunting

A

decreased FRC

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30
Q

what are other causes of intrapulmonary shunting?

A

Prolonged intraoperative hypoventilation Endobronchial intubation Lobar collapse from obstruction Pulmonary aspiration Pulmonary edema

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31
Q

On chest x-ray where should the tip of the ETT be?

A

T2-T4

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32
Q

What is depth of tube position, in reference to teeth?

A

male - 23 cm female - 21 cm

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33
Q

what level is the carina at?

A

generally T6 but can be T5-T7

34
Q

what are treatments for hypoxia?

A

oxygen therapy

bronchodilators (if bronchospasm)

diuretics (if fluid overload - pulm edema)

PEEP/CPAP (if atelectasis)

cardiac optimization

35
Q

What type of patient would you be cautious with when providing O2 therapy for hypoxia?

A

pts with obstructive airway disease (COPD)

36
Q

what is the most common GI complication in the PACU?

A

PONV

37
Q

what are some common etiologies of PONV?

A

Autonomic afferents from GI/mediastinum

Vestibular component CN 8

Visual/cortical stimuli

Chemoreceptor trigger zone

38
Q

what are the most common circulatory complications in PACU?

A

Hypotension

Hypertension

Arrhythmias

39
Q

In regards to resolving cirulatory complications, what should you always consider when thinking about causes?

A

respiratory disturbances (i.e. hypoxia causes hypotension)

40
Q

What is considered hypotension?

A

30 % difference in baseline

41
Q

What are common etiologies of hypotension?

A

decreased venous return

LV dysfunction

excessive arterial vasodilatation

42
Q

what are examples of decreased Venous Return

A

Hypothermic venoconstriction (shivering)

hypovolemia,

third spacing,

postop blood loss,

43
Q

what are examples of LV dysfunction?

A

Pneumothorax, (pushing on heart)

cardiac tamponade,

fluid overload,

CAD,

valvular disease,

dysrhythmias

44
Q

What are examples of excessive arterial vasodilatation

A

Neuraxial procedures,

adrenergic blockade venodilators,

sepsis,

allergic rxn

45
Q

What are primary causes of HTN

A

Noxious stimulus (surgical incision)

Endotracheal intubation

Bladder distension

46
Q

What are 2nd causes of HTN

A

Hypoxemia

Hypercapnea

Metabolic acidosis

Elevated ICP

Vascular volume overload

47
Q

Which arhythmia is extremely common in PACU

A

sinus tachycardia

48
Q

Common causes of Arrhythmias

A

HIS DEBS

hypoxia

ischemia

sympathetic stimuli

drugs

elecrolyte disturbances

bradycardia

stretch

49
Q

which lead is commonly used for detection of cardiac dysrhythmias ?

why?

A

a. lead II
b. paralles P wave vector

50
Q

what is arrhythmia is Ominous sign of severe hypoxemia ( more common in OR)

A

sinus brady ( < 60 bpm)

trx required when hemodynamicly unstable (i.e. b/p change > 30%)

51
Q

what is the worst arrhythmia for a patient with CAD?

A

Sinus Tach. (> 100 bpm)

52
Q

What are common medications used to trx ST in the OR?

A

b - blockers (esmolol - metoprolol)

53
Q

what happens to QRS in regards to a PVC?

A

wide QRS ( > 0.12 s)

strange shape

54
Q

what are some common causes of PVCs

A

hypokalemia

hypomagnesemia

Myocardial ischemia

55
Q

what is considered V. Tach?

A

> 3 consecutive PVCs

rate 100 - 200 bpm

wide QRS (not proceded by P wave)

56
Q

when does V. tach often become V. fib?

A

> 30 beats of sustained VT

57
Q

what happens to cariac output with V. Tach?

A

decreases (low B/P)

58
Q

What is the defibrillation trx for V. tach?

A

200 J

300 J

360 J

59
Q

What anti-dysrhythmics are used for V-tach

A

amiodarone

lidocaine?

60
Q

what’s most common dysrhythmia associated with sudden cardiac arrest?

A

v. fib

61
Q

what arrhythmia has quivering, pulseless ventricular movements but has a rate of > 300 bpm

A

V. Fib (can be course or fine)

62
Q

what is the iatagenic cause of asystole?

A

hyperkalemia

63
Q

what is lab value for hyperkalemia?

A

> 5.0 mEq/L

64
Q

You’re in the middle of a surgery that requires labs to be done, a CMP reveals hyperkalemia. What should you do first?

A
  1. STAT recheck of K
65
Q

What are causes of psuedohyperkalemia?

A

hemolysis

leukocytosis

thrombocytosis

66
Q

What are examples of excess K intake

A

K supplements

K penicillin

stored blood

salt substitutes

clay

67
Q

What are causes of translocation of K from ICF to ECF

A

succinylcholine

catecholamine deficiency states

hyperosmolality

b-blockers

acidosis

aldosterone antagonists (diuretic - spironlactone)

68
Q

what decreased excretory capacity contribute to hyperkalemia?

A

renal failure & renal tubular disease

oliguria

K-sparing diuretics

ACE inhibitors

NSAIDS

hypoaldosteroneism

69
Q

What are ecg findings that indicate hyperkalemia

A

peaked T waves

decreased P waves,

prolonged PR interval wide QRS,

sine wave

70
Q

what are cardiovascular clinical features of hyperkalemia? (other than ecg wave form changes)

A

Arrhythmias
Heart block
Delayed conduction
Ventricular standstill

71
Q

what are neuromuscular clinical features of hyperkalemia?

A

Paresthesias
Weakness, respiratory insufficiency
Flaccid paralysis
Mental confusion

72
Q

what complication is a rare inherited myopathy characterized by
Ineffective uptake of calcium by SR or
Inappropriate release of intracellular Ca+2

A

Malignant Hyperthermia

73
Q

what are triggers for malignant hyperthermia

A

Inhaled anesthetics (EXCEPT N2O)

succinylcholine

74
Q

What are the signs of malignant hyperthermia

A

Hyperthermia (40-43 C)
Hypercarbia (Increased EtCO2)*
Tachycardia
Increased CO

75
Q

What type of metabolism is associated with the hypermetabolic state of the muscles in Mailgnant hyperthermia?

A

Metabolic acidosis
Cellular hypoxia
Rhabdomyolysis ( Hyperkalemia, Myoglobinemia )
Cardiac/Renal failure

76
Q

what is the first thing you do to treat malignant hyperthermia? Then what?

A

a. halt administration of trigger

100 % O2,

ice packs irrigate stomach (if open),

art line (ABG &enzyme monitoring),

77
Q

what medication can be used to treat Malignant hyperthermia?

A

Dantrolene 2mg/kg q 5 min (max 10 mg/kg)

78
Q

what are some safe anesthetic agents for Malignant hyperthermia?

A

Barbiturates
Etomidate
Droperiodol
NDMB - (roc, vec)
Anticholinesterases (neostigmine)
Local Anesthetics
N2O
Antihistamines
Catecholamines and sympathomimetics

79
Q

What is the most common peripheral nerve injury

A

ulnar n.

80
Q

what is a human error or equipment failure that could have led (if not discovered or corrected in time) or did lead to an undesirable outcome, ranging from increased length of hospital stay to death.

A

critical incident

81
Q

what is the most common type of critical incident

A

human error

AP1 Final (3 decks)

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