Anesthesia & Surgical Complications* Flashcards
What are some conditions that would require prolonged intubation?
Epiglottitis Localized edema RLN damage Hemodynamic Instability Bleeding Prolonged obtundation
___________ problems, which occur in ___% of PACU patients, are the most frequently encountered serious complication in PACU
Respiratory
1.9
what are the 3 most common respiratory problems in PACU?
Airway obstruction
Hypoventilation
Hypoxemia
what are some common causes of airway obstruction?
Posterior displacement tongue* Secretions Laryngospasm Glottic edema Vomitus Blood in airway External pressure on trachea
in a Partial vs. complete obstruction you will see what?
Paradoxical chest movement
what are some corrective measures for airway obstruction?
Oxygen supplementation
Jaw thrust, head tilt
NAW (preferred) or OAW
what are some corrective measure for laryngospasm?
PPV and jaw thrust
0.1 mg/kg or 10-20 mg of succinylcholine
how is hypoventilation defined?
Generally defined PaCO2 > 45 mmHg
Common after anesthesia
Significant > 60 mmHg or pH < 7.25
what are some indicators of hypoventilation?
Somnolence Airway obstruction Slow RR Tachypnea w/shallow breathing Labored breathing
what are some potential complications resulting from hypoventilation?
Respiratory acidosis = HTN, tachypnea, and cardiac irritability = cardiac depression
Most common respiratory problem that occurred in PACU
hypoventilation
what are some causes of hypoventilation?
Depressant effects of anesthetic agent(s)*
residual paralysis
splinting due to pain
how is hypoxia defined?
Hypoxia PaO2 < 60 mmHg
What are some signs of hypoxia?
Early signs: Restlessness, tachycardia, cardiac irritability
Late signs: Obtunded, bradycardia, hypotension, and cardiac arrest.
what are some causes of hypoxia
Intrapulmonary Shunting: Pulmonary atelectasis Parenchymal infiltrates Pneumothorax (CVP?) Etiology: Prolonged intraoperative hypoventilation Endobronchial intubation Lobar collapse from obstruction Pulmonary aspiration Pulmonary edema
What are some treatment options for hypoxia?
oxygen therapy Diuretics = fluid overload Bronchodilators = bronchospams PEEP/CPAP = atelectasis Cardiac optimization
Most common GI complication in PACU is ________
PONV
what are the three most common circulatory problems in PACU?
Hypotension
Hypertension
Arrhythmias
what are the primary and secondary causes of post-op HTN
Primary causes:
Noxious stimulus
Endotracheal intubation
Bladder distension
Secondary causes: Hypoxemia Hypercapnea Metabolic acidosis Elevated ICP Vascular volume overload
4 Abnormal ECG Requiring Tx
Ventricular Tachycardia
Ventricular Fibrillation
SB/Asystole
ST w/hemodynamic instability
ST segment depression or elevation is measured relative to what?
baseline
what are some treatment options for ventricular tachycardia?
Defibrillation: -Electrical (DC) 200,300,360 J (EXTERNAL) Anti dysrhythmics: -Amiodarone -Lidocaine ?
what is the most common dysrhythmia associated with cardiac arrest?
ventricular fibrillation
hyperkalemia is treated with what?
calcium
insulin
HYPERventilation
sodium bicarbinate
which rhythm can you not shock?
ventricular asystole…….ok, you can, but it won’t do any good.
how does hyperkalemia effect the EKG?
increases the T wave then begins to widen the QRS complex. Finally, the EKG begins to morph into a “sine” wave
what are the neuromuscular signs of hyperkalemia in an awake patient?
Paresthesias
Weakness, respiratory insufficiency
Flaccid paralysis (doesn’t sound fun)
Mental confusion
disturbance of which ion is responsible for malignant hyperthermia?
Ineffective uptake of calcium by SR or
Inappropriate release of intracellular Ca+2
what are the triggering agents for malignant hyperthermia?
Inhalational anesthetics (except N2O) Succinylcholine
Malignant Hyperthermia Signs
Hypermetabolic state muscles Hyperthermia (40-43 C) HYPERCARBIA (Increased EtCO2)* TACHYCARDIA Increased Cardiac Output Anaerobic metabolism Masseter muscle spasm
treatment for malignant hyperthermia
Halt administration triggering agent Cancel procedure 100% Oxygen Dantrolene 2mg/kg q 5 min (max 10 mg/kg) Pack groin, axilla, neck ice Irrigate stomach bladder iced solution Insert arterial line for ABG and enzyme monitoring (CPK, myoglobin, glucose, etc)
what are some other common places for injury?
Airway injury Dental Damage Positioning Peripheral Nerve Injury Awareness Eye injury Cardiopulmonary arrest after spinal Allergic reactions Aspiration
ischemic optic neuropathy is associated with what position?
prone
venus air embolism is most often associated with which position?
sitting
What is alopecia?
bald spot from having too much pressure on one area for too long
which drugs are most likely to ellicit and allergic reation?
nm blockers
most errors are the result of what?
human error
what is a critical incident?
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.
human error accounts for what percentage of all critical incidents?
68%
most major errors occur in what patient population?
ASA I (59%)
