Anesthesia & Surgical Complications* Flashcards by Wesley Hall

What are some conditions that would require prolonged intubation?

Epiglottitis
Localized edema
RLN damage
Hemodynamic Instability
Bleeding
Prolonged obtundation

How well did you know this?

Not at all

Perfectly

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

Respiratory

1.9

How well did you know this?

Not at all

Perfectly

what are the 3 most common respiratory problems in PACU?

Airway obstruction
Hypoventilation
Hypoxemia

How well did you know this?

Not at all

Perfectly

what are some common causes of airway obstruction?

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

How well did you know this?

Not at all

Perfectly

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

Paradoxical chest movement

How well did you know this?

Not at all

Perfectly

what are some corrective measures for airway obstruction?

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

How well did you know this?

Not at all

Perfectly

what are some corrective measure for laryngospasm?

PPV and jaw thrust

0.1 mg/kg or 10-20 mg of succinylcholine

How well did you know this?

Not at all

Perfectly

how is hypoventilation defined?

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

How well did you know this?

Not at all

Perfectly

what are some indicators of hypoventilation?

Somnolence
Airway obstruction
Slow RR
Tachypnea w/shallow breathing
Labored breathing

How well did you know this?

Not at all

Perfectly

what are some potential complications resulting from hypoventilation?

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

How well did you know this?

Not at all

Perfectly

Most common respiratory problem that occurred in PACU

hypoventilation

How well did you know this?

Not at all

Perfectly

what are some causes of hypoventilation?

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

How well did you know this?

Not at all

Perfectly

how is hypoxia defined?

Hypoxia PaO2 < 60 mmHg

How well did you know this?

Not at all

Perfectly

What are some signs of hypoxia?

Early signs: Restlessness, tachycardia, cardiac irritability

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What are some treatment options for hypoxia?

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

How well did you know this?

Not at all

Perfectly

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%)