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AP I > Anesthesia & Surgical Complications* > Flashcards

Anesthesia & Surgical Complications* Flashcards

1
Q

What are some conditions that would require prolonged intubation?

A 
Epiglottitis
Localized edema
RLN damage
Hemodynamic Instability
Bleeding
Prolonged obtundation
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2
Q

___________ problems, which occur in ___% of PACU patients, are the most frequently encountered serious complication in PACU

A

Respiratory

1.9

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3
Q

what are the 3 most common respiratory problems in PACU?

A

Airway obstruction
Hypoventilation
Hypoxemia

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4
Q

what are some common causes of airway obstruction?

A 
Posterior displacement tongue*
Secretions 
Laryngospasm
Glottic edema
Vomitus
Blood in airway
External pressure on trachea
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5
Q

in a Partial vs. complete obstruction you will see what?

A

Paradoxical chest movement

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6
Q

what are some corrective measures for airway obstruction?

A

Oxygen supplementation
Jaw thrust, head tilt
NAW (preferred) or OAW

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7
Q

what are some corrective measure for laryngospasm?

A

PPV and jaw thrust

0.1 mg/kg or 10-20 mg of succinylcholine

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8
Q

how is hypoventilation defined?

A

Generally defined PaCO2 > 45 mmHg
Common after anesthesia
Significant > 60 mmHg or pH < 7.25

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9
Q

what are some indicators of hypoventilation?

A 
Somnolence
Airway obstruction
Slow RR
Tachypnea w/shallow breathing
Labored breathing
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10
Q

what are some potential complications resulting from hypoventilation?

A

Respiratory acidosis = HTN, tachypnea, and cardiac irritability = cardiac depression

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11
Q

Most common respiratory problem that occurred in PACU

A

hypoventilation

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12
Q

what are some causes of hypoventilation?

A

Depressant effects of anesthetic agent(s)*
residual paralysis
splinting due to pain

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13
Q

how is hypoxia defined?

A

Hypoxia PaO2 < 60 mmHg

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14
Q

What are some signs of hypoxia?

A

Early signs: Restlessness, tachycardia, cardiac irritability

Late signs: Obtunded, bradycardia, hypotension, and cardiac arrest.

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15
Q

what are some causes of hypoxia

A 
Intrapulmonary Shunting:
Pulmonary atelectasis
Parenchymal infiltrates
Pneumothorax (CVP?)
Etiology:
Prolonged intraoperative hypoventilation
Endobronchial intubation
Lobar collapse from obstruction
Pulmonary aspiration
Pulmonary edema
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16
Q

What are some treatment options for hypoxia?

A 
oxygen therapy
Diuretics = fluid overload
Bronchodilators = bronchospams
PEEP/CPAP = atelectasis
Cardiac optimization
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17
Q

Most common GI complication in PACU is ________

A

PONV

18
Q

what are the three most common circulatory problems in PACU?

A

Hypotension
Hypertension
Arrhythmias

19
Q

what are the primary and secondary causes of post-op HTN

A

Primary causes:
Noxious stimulus
Endotracheal intubation
Bladder distension

Secondary causes:
Hypoxemia
Hypercapnea
Metabolic acidosis
Elevated ICP
Vascular volume overload
20
Q

4 Abnormal ECG Requiring Tx

A

Ventricular Tachycardia
Ventricular Fibrillation
SB/Asystole
ST w/hemodynamic instability

21
Q

ST segment depression or elevation is measured relative to what?

A

baseline

22
Q

what are some treatment options for ventricular tachycardia?

A 
Defibrillation:
-Electrical (DC) 200,300,360 J (EXTERNAL)
Anti dysrhythmics: 
-Amiodarone
-Lidocaine ?
23
Q

what is the most common dysrhythmia associated with cardiac arrest?

A

ventricular fibrillation

24
Q

hyperkalemia is treated with what?

A

calcium
insulin
HYPERventilation
sodium bicarbinate

25
Q

which rhythm can you not shock?

A

ventricular asystole…….ok, you can, but it won’t do any good.

26
Q

how does hyperkalemia effect the EKG?

A

increases the T wave then begins to widen the QRS complex. Finally, the EKG begins to morph into a “sine” wave

27
Q

what are the neuromuscular signs of hyperkalemia in an awake patient?

A

Paresthesias
Weakness, respiratory insufficiency
Flaccid paralysis (doesn’t sound fun)
Mental confusion

28
Q

disturbance of which ion is responsible for malignant hyperthermia?

A

Ineffective uptake of calcium by SR or

Inappropriate release of intracellular Ca+2

29
Q

what are the triggering agents for malignant hyperthermia?

A 
Inhalational anesthetics (except N2O)
Succinylcholine
30
Q

Malignant Hyperthermia Signs

A 
Hypermetabolic state muscles
Hyperthermia (40-43 C)
HYPERCARBIA (Increased EtCO2)*
TACHYCARDIA
Increased Cardiac Output
Anaerobic metabolism
Masseter muscle spasm
31
Q

treatment for malignant hyperthermia

A 
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)
32
Q

what are some other common places for injury?

A 
Airway injury
Dental Damage 
Positioning
Peripheral Nerve Injury
Awareness
Eye injury
Cardiopulmonary arrest after spinal
Allergic reactions
Aspiration
33
Q

ischemic optic neuropathy is associated with what position?

A

prone

34
Q

venus air embolism is most often associated with which position?

A

sitting

35
Q

What is alopecia?

A

bald spot from having too much pressure on one area for too long

36
Q

which drugs are most likely to ellicit and allergic reation?

A

nm blockers

37
Q

most errors are the result of what?

A

human error

38
Q

what is a critical incident?

A

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.

39
Q

human error accounts for what percentage of all critical incidents?

A

68%

40
Q

most major errors occur in what patient population?

A

ASA I (59%)

AP I (8 decks)

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