Anesthesia/Emergencies Flashcards
What is the dose of fentanyl?
What is the onset of action?
1-2 mcg/kg IV
OAA: 3-6 mins
How do you treat a opioid overdose? What’s the dose?
Narcan (naloxone): competitively binds at mu receptor
Generally give 0.4 mg IV/IM
Adult dose: 0.1-0.3 mcg/kg
Peds dose: 0.005-0.01 mg total
You have to give it every 2-5 mins and monitor the patient closely because it has a shorter half life than most opioids
How does respiratory depression occur in sedation? How do you diagnose it?
primary stimulus to respiratory centers in the brain stem which control respiration is an increase in CO2 in the bloodstream. Anesthestic drugs suppress the response to rising CO2. Diagnosed by looking for decreased RR/depth, pallor, orthostatic hypotension.
How do you treat chest wall rigidity?
Narcan (0.4 mg IV/IM) and succinylcholine (1 mg/kg), ventilatory support
Why does acute adrenal insufficiency happen? Describe the pathophysiology
The adrenal glands are located on top of the kidneys and produce corticosteroids and catecholamines. The corticosteroids provide resistance to stress, maintain vascular reactivity, increase plasma glucose and control metabolism of carbohydrates, proteins, and fats. When exogenous corticosteroids are prescribed in large doses longer than several days, the glands can become suppressed and lose much of their ability to respond to stress.
For us, that can result in weakness, fatigue, tachycardia, and hypotension as a result of surgical stress. When the patient is exposed to surgical stress, the adrenal gland is unable to provide adequate corticosteroids to maintain vascular reactivity and the blood pressure falls. The patient should be placed in the Trendelnburg, IV fluids given rapidly and hydrocortisone given to augment the inadequate cortisol production of the adrenal glands.
Define angina
Crushing pain in the chest caused by blockage of the coronary arteries. The pain can radiate to such areas as the arms or the mandible. In unstable angina, there are fatty deposits of atherosclerotic plaques which build up on the inside of the blood vessels of the heart. Eventually a blood clot forms and the blood vessel becomes plugged further. Occlusion of the artery reduces the blood flow and therefore oxygen supply to the heart muscle which results in the patients clinical symptoms. Progressive occlusion of the coronary arteries leads to acute coronary syndrome
Define acute coronary syndrome – myocardial infarction
ACS develops because fatty deposits (atherosclerotic plaques) within the coronary artery walls. Eventually a blood clot may form which totally occludes the artery and causes death or necrosis of the area of the myocardium supplied by the artery. This produces heavy, squeezing chest pain which does not respond to 2 doses of nitroglycerin. Chest pain is not the only thing they feel, patients in fact can have no chest pain, but exhibit nausea, weakness, anxiety, cardiac dysrhythmias.
Define allergic reaction
Union of antigen and antibody that causes release of chemical mediators. When an allergen enters the body, certain white blood cells make antibodies which attach to mast cells. Allergens can be virtually any foreign substance from pollen to latex in medical gloves. Then when the same allergen enters the body again, the allergen becomes attached to two adjacent antibodies on a mast cell and allergic chemicals such as histamine are released.
How does epi work in an allergic reaction?
Stabilizes mast cells
Beta2 activity dilates the constricted bronchioles
Alpha activity causes vasoconstriction in the edematous laryngeal tissues
Additional tx:
Benadryl combats the histamine induced components
Decadron given to counteract swelling in tissues of the airway, throat, lips, eyelids
Define bronchospasm
Constriction of the terminal bronchioles which lead to the alveoli. This causes the flow of oxygen containing air bronchioles to alveoli to be blocked. You’ll see impairment of respiratory exchange, inspiratory/expiratory wheezing; resistance to ventilation.
What is the definition of bradycardia?
Bradycardia is defined as a heart rate less than 60 beats per minute. However, not all bradycardia requires treatment. There are many young healthy patients/athletes that have rest pulse rates of 40/50. Normally there is a balance between sympathetic (the accelerator) and the parasympathetic (the brakes) nerve supply to the heart. The treatment for bradycardia is to administer atrophine which interrupts the vagal parasympathetic nerve supply therefore taking the foot off the brakes. You can also increase the sympathetic response with epinephrine similar to pressing the accelerator.
Define tachycardia
Pulse greater than 150 caused by excessive adrenergic stimulation. This can be caused by increased stimulation of the SA node, or another focus in the atria or ventricle. There are different types depending on the QRS complex (narrow vs wide). They are typically caused by extreme anxiety, pain, and hypoxia. The common tachycardias with narrow QRS complex include sinus tachycardia, SVT, a-fib, a flutter. Common tachycardias with wide QRS complex include monomorphic V-tach, polymorphic V-tach/v-fib, and torsades de pointes. With any dysrhythmia it is important to assess whether the patient is stable or unstable.
What is the difference between defibrillation and cardioversion?
Defibrillation is the asynchronous delivery of energy, such as the shock is delivered randomly during the cardiac cycle. Cardioversion — Cardioversion is the delivery of energy that is synchronized to the QRS complex.
Define v-fib
Ventricular fibrillation there are multiple rapidly firing ectopic foci in the ventricles without any input from the SA node. The ventricles literally “quiver” and there are no purposeful contraction which can effectively pump blood
Define unstable V-tach
First of all, treatment is the same as it is for V-fib. In unstable ventricular fibrillation, a ventricular pacemaker has assumed control of the heart and the ventricles are contracting so rapidly that refilling is not possible and the pulse is lost.
