Anesthesia and Surgical Complications P2 Flashcards
What rhythm is the worse thing for heart patients with CAD and why?
Sinus tachycardia because of increased myocardial demand for O2 so treat immediately!
ST segment depression is examined _____ to baseline.
relative
What rhythm
- has a QRS > 0.12
- strangely shaped
- MAY have inverted t-wave
PVC
What do PVCs generally indicate?
electrolyte imbalance
- hypokalemia
- hypomagnesemia
- myocardial ischemia
What rhythm is indicated by >3 consecutive PVCs > 100 bpm <200 bpm
Ventricular tachycardia
Is QRS preceded by a P wave in ventricular tachycardia?
NO
sustained VT often degenerates to v. fib
Ventricular tachycardia medical emergency associated with _______ and low cardiac output.
hypotension
What is first treatment for ventricular tachycardia?
defibrillation at 200, 300, 360 J
antidysrhythmics: amiodarone, 100mg lidocaine
What rhythm is characterized by quivering, pulseless ventricular movements > _____ bpm
300 bpm
ventricular fibrillation
What is the most common dysthythmia associated with cardiac arrest?
ventricular fibrillation
What has occasional P wave, no QRS?
How do you treat this rhythm?
ventricular asystole
GIVE EPI
CANNOT SHOCK THIS RHYTHM!
What is normally the iatragenic (of or relating to illness caused by medical examination or treatment) cause of ventricular asystole?
HYPERkalemia
- K-penicillin
- potassium sparing diuretics (too good at sparing K)
- ACE inhibitors
- NSAIDS
- renal failure
- OLIGURIA
- Causes for hyperkalemia (6)
What is expressed in a hyperkalemia ECG?
Peaked t-waves
Arrhythmias
heart block
DELAYED CONDUCTION
ventricular standstill
peaked T waves
decreased P waves
prolonged PR interval
sine wave
hyperkalemia
What are neuromusclular effects from hyperkalemia? (4)
- Paresthesia
- weakness, respiratory insufficiency
- flaccid paralysis
- mental confusion
How do you treat hyperkalemia? (5)
- Give Ca to drive K into the cells
- Give insulin with D5W to treat high insulin
- Hyperventilate
- Sodium bicarb
- Lasix
What rare inherited myopathy is characterized by:
- ineffective uptake of calcium by sarcoplasmic reticulum
- inappropriate release of intracellular Ca
malignant hyperthermia
Malignant hyperthermia is unapparent until these agents are administered: (2)
inhalational anesthetic
Succx
1st signs of malignant hyperthermia: (3)
- increased CO or HR
- HYPERCARBIA
- TACHYCARDIA
- Hyperthermia
- MASSETER MUSCLE SPASM
- Metabolic acidosis
- Hyperkalemia from muscle breakdown
by the time you see temp increase, already going down bad pathway
Treatment for malignant hyperthermia?
- stop triggering agent
- cancel procedure
- 100% OXYGEN
- DANTROLENE 2 MG/KG Q 5 MIN
Dantrolene mixed with _____ saline and given every ____ minutes.
cold
5
How do you prepare a machine for malignant hyperthermia patient?
- Take agents out of line
- 10L flows–leave on for hours
- change absorbent
- first case of day
What are other surgical complications?
- AIRWAY INJURY #1
- dental damage
- alopecia
- corneal abrasion
- AIR EMBOLISM (sitting position)
- ulnar nerve injury
- 0.2-0.4 % awareness
What injury can result from being in prone position?
ischemic optic neuropathy
blindness
Most common allergic reaction:
muscle relaxant allergy
What are most common human errors?
- unrecognized breathing circuit disconnect
- mistaken drugs
- airway mismanagement
- anesthesia machine misuse
- fluid mismanagement
- IV line disconnect
A human error or equipment failure that could have led or did lead to an undesirable outcome ranging from _____ to ______.
Definition of critical incident
- increased length of hospital stay
- death
What accounts for majority of errors besides human error?
- equipment failure
- disconnection
