Anesthesia, Burns, Sepsis, & Shock

Question 1

Infiltrative Anesthesia

Peripheral Nerve Block

IV Regional Block (Beir)

Answer 1

Infiltrative Anesthesia: local anesthesia in small area

Peripheral Nerve Block: Local near nerve to provide sensation loss to portion of body

IV Regional Block (Beir): Dilute local in limb through vein w/ tourniquet placed

Question 2

Central Nerve Blockade

Topical Anesthesia

Tumescent Anesthesia

Answer 2

Central Nerve Blockade: Local injection/infusion around CNS (spinal, epidural)

Topical Anesthesia: Diffuse through skin or mucous membrane (EMLA)

Tumescent Anesthesia: Large amount dilute local infiltrated into subcutaneous tissues (liposuction)

Question 3

Local Anesthetics - Esters

Answer 3

Rapid hydrolysis in blood by pseudocholinesterase

Procaine (shortest acting)

Tetracaine (longest acting

Question 4

Local Anesthetics - Amides

Answer 4

Metabolized in liver

Lidocaine - intermediate-acting

Bupivacaine - long acting

Question 5

Epinephrine Vasoconstriction Benefits

Answer 5

Prolong surgical anesthesia

Decreases peak serum levels anesthesia - can use higher dose

Intravascular marker

Decreases site bleeding

Question 6

Local Anesthesia Toxicity and Treatment

Answer 6

Dizziness, tinnitus to nystagmus, somnolence (neuro) to arrhythmias and CV collapse

Stop drug

ABCs

20% Intralipid (Liposyn) 1.5 mg/kg bolus 0.25 mL/kg/min

Cardiopulmonary bypass

Question 7

Cellular Changes with Burns

Answer 7

ICF influx of sodium and water

ECF influx of potassium

Get membrane function disruption and sodium pump failure

Question 8

Burn Shock

Answer 8

Myocardial depression

Metabolic acidosis

Question 9

Hematologic Burn Changes

Answer 9

Increased hematocrit

Increased blood viscosity

Anemia due to rbc disruption

Question 10

Shock Triad

Answer 10

Pump failure

Decreased peripheral resistance

Hemorrhage

Question 11

Hemorrhagic Shock

Answer 11

Increased heart rate, contractility with blood shunted to trunk and sodium and water reabsorbed

Tachycardia, NARROW pulse pressure, cool clammy skin

NS bolus

Question 12

NS bolus for hemorrhagic shock in peds

Answer 12

20 mL/kg

Question 13

Cardiogenic Shock

Answer 13

Abnormal cardiac function

Acute MI has >50% fatality

HOTN with increased peripheral resistance

Weak pulse, clammy skin, AMS, anuria

Vasopressors if needed

Question 14

Septic Shock

Answer 14

Induced HOTN from sepsis

Inadequate perfusion despite adequate resuscitation

Lactic acidosis, oliguria, acute AMS

Usually gram negative or TSS

Wide pulse pressure

Question 15

Neurogenic Shock

Answer 15

MC cause is spinal cord injury - vasomotor regulation fails

Blood pools in dilated capacitance vessels

Never from an isolated head injury - find other cause

Warm skin on PE

Question 16

Shock Treatment Keys

Answer 16

Never use colloids in septic shock - cause pulmonary edema

Only use vasopressors if septic or cardiogenic shock or if CVP shows normovolemia with continued hypovolemia presentation