Anesthesiology, resp care Flashcards
what should you do if bleeding from tracheostomy site? (tracheoinnominate fistula)
- inflate tracheostomy balloon for compression
- reintubate patient using endotracheal tube
- removal of tracheostomy and finger compress innominate artery
what should you do if bleeding stopped from trach site or to confirm its a tracheoinnominate fistula
immediate fiberoptic exploration in OR- broncoscopic eval
extubate if patient has been weaned to what cm H2O PEEP
<5 cm
what should tidal volume be before extubating
<10 L/min
what should resp rate be before extubating
under 20 breaths/min
what rapid shallow breathing index be before extubating
between 60-105
which anesthesia gas can lead to ddistention of air filled spaces during prolonged anesthesia (should be avoided for intestinal obstruction)
nitrous oxide , less dense than air
ARDS diagnosis criteria
- CXR: bilaterial pulm infiltrates
- PaO2/FiO2 ratio <200
- pulm wedge pressure <18 mm Hg
best management for someone with emphysema with resp acidosis and low O2
intubate them
dopamine effects on coronary blood flow
dilates at all doses
dopamine effects on blood flow at low vs medium vs high doses
low (1-5): dopaminergic rec- vasodilates renal and mesenteric arteries
medium (2-10): B1- increase CO and BP
high (>10): alpha- peripheral vasoconstriction, shifting flow away from extremities to organs, decrease kidney funct.
if someone gets a transfusion and then has resp distress, what should you think?
TRALI- transfusion related acute lung injury
stop transfusion and ventilate
drug of choice for cardiogenic shock
dobutamine (pos inotropy and peripheral vasodilation)
treatment of post operative cholecystitis
percutaneous drainage of gallbladder
how does PEEP increase oxygenation
by increasing FRC- keep alveoli open at end of expiration-
shifts lung water from alveolar to interstitial space so more surface area for gas exchange
potential side effects from PEEP
alveolar overdistention—> barotraumas
decreased VR and CO
increased dead space ventilation–> increase minute ventilation requirements
beck triad
systemic hypotension
jugular venous distention
distant heart sounds
cardiac tamponade
cardiac tamonade on echo and swan-ganz
echo: pericardial fluid and RA collapse
swan: equal pressure across 4 chambers
pulsus paradoxus
occurs in cardiac tamponade
decrease in systolic BP by >10 mm Hg at end of inspiratory phase
major predictors of having a cardiac event during surgery
unstable angina recent MI decompensated HF significant arrhythmias severe valvular disease
what should be administered locally for removing a nail from a finger
digital block with 1% lidocaine (no epi!)
what are benefits of adding epinephrine to lidocaine?
doubles duration and increases maximal safe total dose by 1/3 by decreasing rate of absorption into blood stream
what areas can epinephrine not be added to for local anesthesia?
tissues supplied by end arteries (finger, toe, penis, ear, nose)
initial management of someone who is hypotensive and bradycardic from blunt trauma causing spinal cord injury (neurogenic shock)
1) fluid bolus
2) vasoconstrictors- dopamine, phenylephrine
initial management of air embolism in central venous catheter placement
place patient in left lateral decubitis trendelenburg
serious management of air embolism in central venous catheter placement
thoracotomy
management of suspected hemothroax
chest tube
family history of prolonged paralysis during general anesthsia. think…
pseudocholinesterase deficiency
avoid succinylcholine and mivacurium!
what provides a rough estimate of protein nutritional adequacy
serum albumin level
what is ideal respiratory quotient (RQ)
0.75-0.85
RQ < 0.7 and <1 indicates what?
<0.7: lipid diet
> 1: carb diet , which can impair weaning off ventilator
what should you give preoperatively to patients with vWD?
cryoprecipitate
extracorpeal membrane oxygenation (ECMO) service is good for irreversible or reversible pulmonary disease?
reversible
what is indicated if a patient aspirates particulate matter?
bronchoscopy
do you give prophylactic antibiotics for a patient who aspirates particulate matter?
no, only if they develop pneumonia
what is diagnostic test for ventilator associated pneumonia
> 10,000 colonies on bronchoalveolar lavage
what should you do to treat malignant hyperthermia besides dantrolene?
promptly conclude the procedure and anesthetics
hyperventilate with 100% 02 (because of O2 consump)
alkanize urine to protect kidneys from myoglobin
what is a known complication of angiography that would lead to renal failure? and what are the abnl labs?
cholesterol atheroembolism- in renal artery
*eosinophilia, microscopic hematuria, proteinuria, ESR
treatment for PE
heparin infusion (same as DVT!)
vasopressors of choice for severe sepsis or septic shock
NE and DA
