ANZCA Anaesthesia Technician study flash cards
Provide the knowledge to pass the registration exam
What are the signs of an air embolism?
Decreased CO2
Tachypnoea
Decreased oxygen saturation
Hypotension
Tachycardia
ECG changes
‘Pulmonary wheel murmur’
Pulmonary oedema may develop later
Altered mental status if awake
Cardiopulmonary collapse
What should you do in the event of an Air Embolism?
Call for help
Identify a hands-off leader and delegate roles
Turn FiO2 to 100% and stop any nitrous oxide use
Stop the source of air entry
Inform the surgeon to flood surgical field
Use ETCO2 to monitor progression
What are the main risks for air embolism?
Operative field above the heart
Spinal surgery
Sitting craniotomy
Large bore IV access
Rapid infusions
C section
Gas insufflation procedures
Head up during central line
RRT, ECMO, Bypass
What are the signs of anaphylaxis?
Severe grade reaction
Hypotension
Bronchospasm
High peak airway pressure
Decreased or lack of breath sounds
Tachycardia
Urticara
Cardiac arrest
What should you do in the event of a suspected anaphylaxis ?
Call for help
Identify a hands off team leader
Turn FiO2 to 100% and consider reducing anaesthesia depth
Adrenalin bolus of 20-100mcg IV repeat 1-2 minutes
OR
Adrenalin IM 0.5mg every 5 minutes as needed
Remove potential causative agents
Secure the airway with ETT
Ensure large bore IV access
Give 2L fluid bolus and elevate legs
If no pulse or systolic BP <50 start CPR and follow PEA algorithm
Obtain and continue with anaphylaxis box cards
What is the IM adrenalin dose for adults?
0.5mg [0.5ml of 1:1000]
Repeat every 5 minutes as needed
What is the IM adrenalin dose for children?
10mcg [0.01ml/kg] of 1:1000
[min dose 0.1ml]
[max dose 0.5ml]
Repeat every 5 minutes as needed
What should you next consider with a suspected anaphylaxis ?
Adrenalin infusion +/- any other vasopressor
Salbutamol +/- magnesium if bronchospams
Arterial line, central line, blood gases
Tryptase levels test 1 / 4 / 24 afters
Can the operation continue?
Referral to ICU
Main causes of anaphylaxis?
Antibiotics
Muscle relaxants
Chlorhexidine
Latex
Colloids
Patient blue
What do you do in the event of an unstable bradycardia?
Call for help and the resuscitation trolley and attach defib pads
Identify a hands off leader and delegate roles
Turn FiO2 to 100%
Stop surgical stimulation
Give atropine 600mcg IV repeat up to 3mg
If atropine ineffective start either adrenalin infusion or transcutaneous pacing
Confirm pulse present if no pulse start CPR and follow cardiac arrest aystole/PEA algorithm
What are the signs of bradycardia?
HR <50bpm with hypotension
Acutely altered mental state
Shock
Ischaemic ECG or acute heart failure
What are the signs of bronchospasm?
Persistant increased peak airway pressure
Wheezing
ETCO2 slowly increasing slope
What should you do during a bronchospasm emergency?
Call for help
Identify a hands off leader and delegate roles
Turn FiO2 to 100%
Examine patients chest for wheeze and air entry
Consider other differentials [aspiration, anaphylaxis, ARDS acute respiratory distress syndrome]
Deepen anaesthesia with sevoflurane
Use neuromuscular blocker and consider intubating if LMA
Start drug treatments
Review and adjust ventilator settings [volume control]
What drugs are given during bronchospasm?
Salbutamol inhaled 8-12 puffs
Salbutamol IV bolus 250mcg [100mcg/ml]
Magnesium
Adrenalin
Ketamine
Sevoflurane
What are some additional steps to consider during a bronchospasm?
ICU review and advice
If concerned about aspiration pass suction catheter down ETT
If haemodynamically unstable may have tension pneumothorax, gas trapping or anaphylaxis
Arterial line and serial ABG’s
Chest X-ray / scan
What are the signs of Cardiac Arrest – asystole / PEA?
Non-shockable pulseless cardiac arrest
What should you do in the event of an asystole / PEA?
Call for help and the resuscitation trolley
Identify a hands off leader and delegate roles
Turn FiO2 to 100% and turn off anaesthesia
Start CPR and encourage high quality chest compressions
Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]
Secure airway with ETT and ventilate RR 8
Confirm capnography
Attach defibrillator pads in case of change to shockable rhythm
Review reversable causes 4H’s 4T’s
Pulse and rhythm check every 2 minutes
Use ETCO2 to assess CPR quality
What drug do you give for an adult cardiac arrest?
Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]
What are the 4 H’s of a cardiac arrest cause stand for?
Hypovolemia/ Haemorrhage
Hypoxia
Hyper/hypokalaemia / metabolic disorders
Hyper/hypothermia
What are the 4 T’s of a cardiac arrest cause stand for?
Tension pnumothorax
Tamponade
Thrombosis – pulmonary, coronary, air, fat
Toxins [beta blocker, Ca2+ channel blocker, local anaesthetic, drug error]
How do you treat hyperkalaemia?
Sodium bicarbonate
Insulin actrapid
Calcium chloride
What is the paediatric dose of adrenaline for a cardiac arrest Asystole/PEA
Adrenaline 0.01mg/kg of the 0.1mg/ml concentration
Max dose 1mg
Repeat every 3-5 minutes
What are the steps to take during a Cardiac arrest VF / VT
Call for help and the resuscitation trolley
Identify a hands off leader and delegate roles
Turn FiO2 to 100% and turn off anaesthesia
Start CPR and encourage high quality chest compressions
Defibrillate at 200J then recommence CPR
Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]
After 3rd cycle consider giving amiodarone 300mg IV
Secure airway with ETT and ventilate RR 8
Confirm capnography
Attach defibrillator pads in case of change to shockable rhythm
Review reversable causes 4H’s 4T’s
Pulse and rhythm check every 2 minutes
Use ETCO2 to assess CPR quality
What are the Defibrillator Instructions?
Attach defibrillator pads to patient in the appropriate way
Select energy 200J and press charge
Once charged stop CPR and assess rhythm
If shock advised ensure all staff stand clear of bed
Pressure shock and immediately restart CPR
What are the non-shockable rhythms?
Asystole/ PEA/ Sinus rhythm/ SVT/ AF/ PVC
What are the shockable rhythms?
VF / VT
What are the Starting steps to take with an unanticipated difficult airway?
Call for help and the difficult intubation trolley
Identify a hands off leader and delegate roles
Turn FiO2 to 100% at high gas flows
Use Vortex approach
Ensure good neuromuscular relaxation and consider TIVA
One person to watch oxygen saturation, declare if <90%
Ask hands off leader to count and say airway attempts
What are the get ready for CICO steps in an uninticpated difficult airway?
Open FONA [front of neck access] kit on the side of the anaesthesia machine for scalpel and or needle technique
Contact ENT senior surgeon to help
What are the steps to take during a CICO event during an unanticipated difficult airway?
Declare CICO if oxygen saturations <90% or rapidly falling and all 3 lifeline best effort attempts not successful
Options are WAKE UP or FONA
For wake up ensure muscle relaxant reversal is complete
What are the signs of an unanticipated difficult airway?
Unsuccessful intubation and oxygenation attempts under optimized conditions
What are the initial steps should you take during a haemorrhage?
Call for help and ask for blood warmer or rapid infuser +/- cell saver
Identify a hands off leader and delegate roles
Turn FiO2 to 100% and consider reducing anaesthesia depth
Confirm source control attempted by surgeon ask if help is needed
Get large bore IV access x 2
Give fluid bolus and vasopressors to maintain organ perfusion
Blood request
What are the signs of High airway pressures?
Persistant increased peak airway pressure >40cmH20
Hypoxaemia
Inadequate ventilation
What steps should you take during a high airway pressure event?
Call for help and ask surgeons to stop stimulation
Identify a hands off leader and delegate roles
Turn FiO2 to 100%
Consider TIVA
Exclude ligh anaesthesia or inadequate relaxation
Switch to manual ventilation
Disconnect LMA/ETT from circuit and squeeze bag to assess if the problem is with the airway, breathing or circuit
If pressure is normal now problem is with the airway or breathing
If pressure is still raised problem is with the circuit
Ensure HME filter checked/excluded
What steps should you take if its an airway problem during a high airway pressure event?
Review position, check patency by passing suction catheter, consider change of device
What steps should you take if it’s a breathing problem during a high airway pressure event?
Review cause by examination
Listen to chest
Consider ultrasound or chest X-ray
What steps should you take if it’s a circuit problem during a high airway pressure event?
Ventilate with AMBU bag
TIVA
Review circuit
What common problems could cause a circuit to create high airway pressures?
Blocked HME filter
Water in circuit
Kinked/compressed
Valves sticky
What can cause airway or breathing problems?
Anaphylaxis
Aspiration
Abnormal anatomy
Bronchospasm
Blocked or displaced LMA/ETT
Inadequate depth of anaesthesia
Inadequate muscle relaxation
Malignant hyperthermia
Pneumothorax
Pulmonary oedema
atelectasis
What is atelectasis?
The collapse of part or all a lung
Caused by a blockage of the air passages [bronchus or bronchioles]
What are the signs of hypotension?
Unexplained drop in blood pressure refractory to initial treatment
Why is the solution SAGM added to RBC?
{Sodium
Adenine
Glucose
Manitol}
It extends the shelf life of RBC up to 42 days of increased functional viability
What steps should you take during a hypotension emergency?
Call for help and the resuscitation trolley
Identify a hands off leader and delegate roles
Turn FiO2 to 100% and consider reducing the anaesthesia depth
Check pulse, BP, ECG and equipment
If Bradycardia, Tachycardia or Cardiac Arrest see specific checklist
Open IV / Pressurised fluid bolus / consider blood products
Optimize venous return with Trendelenburg positioning / low PEEP
Vasopressor treatment
Mild hypotension - phenylephrine, ephedrine, metaraminol
Severe / refractory – adrenaline, noradrenaline or vasopressin
Identify cause of hypotension
What additional steps should be taken during a hypotension emergency?
Arterial line
CVC
ABG
Hourly urine output monitoring
Consider echo
Referral to ICU
What surgical events can cause a hypotension emergency?
Mechanical / surgical manipulation
Insufflation during laparoscopy
Retraction and vagal stimulation
Vascular compression
Can sepsis cause a hypotension emergency event?
Yes
What are the signs of hypoxia?
Low oxygen saturation <92% or cyanosis
What should you do during a hypoxia emergency?
Call for help
Identify a hands-off leader and delegate roles
Turn FiO2 to 100% at high gas flows
Confirm ETCO2 capnography and morphology
Confirm pulse oximeter position and patient colour
Hand ventilate and assess patient / circuit
Check;
Airway – Examine device +/- suction tube, laryngoscopy
Breathing – chest sounds, movement and lung compliance
Circulation – blood pressure, pulse and rhythm
Circuit – HME filter, tubing, one-way valves, anaesthesia machine
Depth and relaxation
What size are the connectors for a breathing circuit?
15mm and 22mm
Why is a breathing circuit corrugated?
Less prone to kinking and increased flexibility
What are the signs of laryngospasm?
Sustained closure of the vocal cords resulting I the partial or complete loss of the patients airway
What steps should you take during a laryngospasm emergency?
Call for help
Identify a hands off leader and delegate roles
Turn FiO2 to 100% at high gas flows
Stop any stimulation
If has LMA remove and clear airway using suction if needed
Apply mask, jaw thrust and CPAP 30Cm H20
+/- Oropharyngeal airway
Deeping anaesthesia using propofol
Relaxation using IV suxamethonium
Plan to intubate if sats are <92%
Can laryngospasm break with sufficient time and hypoxia?
yes
Does ongoing laryngospasm increase the risk of negative pressure pulmonary oedema, bradycardia, cardiac arrest and aspiration?
yes
What is the intubation dose of propofol for adults?
1-2mg/kg
What is the intubation dose for suxamethonium IV?
2mg/kg
What is the intubation dose for suxamethonium IM?
4mg/kg
How much propofol do you give to break a laryngospasm event?
20% of an induction dose 0.25-0.5mg/kg
What are the signs of local anaesthetic toxicity?
Sudden alteration in mental status
Tonic clonic seizure
Arrhythmias or cardiovascular collapse
Sinus bradycardia
Conductional blocks
Asystole
Ventricular tacharrthymias
What’s steps should you take for a local anaesthetic toxicity emergency event?
Stop giving the local anaesthetic
Call for help and the resuscitation trolley and intralipid
Identify a hands off leader and delegate roles
Turn FiO2 to 100%
Assess airway, breathing, circulation and treat accordingly
If haemodynamically unstable consider intralipid
Hyperventilation may be helpful
Treat seizures with propofol
What is the immediate bolus dose of 20% intralipid during a local anaesthetic emergency event?
1.5mg/kg over 1 minute [100ml for 70kg]
If remains unstable Repeat 2 more doses at 5-minute intervals max
What is the infusion dose of 20% intralipid?
15ml/kg/hr [1000ml/hr for 70kg]
If remains unstable double infusion rate
Is propofol a substitute for intralipid?
No
What can trigger a Malignant Hyperthermia?
Volatile anaesthetic agents
Suxamethonium
What are the signs for malignant hyperthermia?
Unexpected increase in ETCO2
Unexplained tachycardia
Unexplained tachypnoea
Arrhythmias
Prolonged masseter muscle spasm after suxamethonium
Hyperthermia is a late sign
What steps should you take during a Malignant hyperthermia emergency?
Call for help and the MH box / Trolley
Identify a hands off leader and delegate roles
Remove precipants
Stop volatile anaesthesia and start TIVA
Hyperventilate with 100% oxygen at high flow of 15L/min
Consider changing soda lime if quick and easy
Do not waste time changing the circuit, machine or filter if event is actively happening
Start dantrolene
Obtain and continue with the MH box cards
What are additional consideration steps to take during a MH event?
IV access, central line, arterial line
Blood tests every 30 minutes
Temperature probe and commence active cooling
Catheter – urine output aim should be 2ml/kg/hr
Discuss with ICU
How do you prepare the dantrolene?
20mg vial mixed with 60mls sterile water
What is the bolus dose of dantrolene?
2.5mg/kg [60kg = 8 vials]
How long after immediate treatment of dantrolene should you consider giving another repeat bolus?
10 minutes if still symptomatic
How does dantrolene work?
Dantrolene directly interferes with muscle contraction by decreasing calcium in muscle cells
preventing electrical impulses traveling to muscles and preventing muscle contractions
What complications can MH cause?
Acidosis – treat with hyperventilation, sodium bicarbonate
Arrhythmias
Disseminated intravascular coagulation [DIC] -abnormal blood clotting
Hyperkalaemia – high potassium levels in blood
Hyperthermia – cold fluids, ice
Hypotension – fluid bolus, vasopressor
Cardiovascular collapse and cardiac arrest
What are the signs of unstable tachycardia?
Shock
Syncope – loss of consciousness
Severe heart failure
Myocardial ischaemia [obstructed blood flow to heart]
Altered mental status
Heart Rate > 150 BPM
Mean arterial pressure <65
What are the signs of stable tachycardia?
Mean arterial pressure >65 and no adverse features
What steps should you take with a tachycardia emergency?
Call for help and the resuscitation trolley
Identify a hands off leader and delegate roles
Turn FiO2 to 100%
Stop surgery and perform DRABCDE review
Identify any reversible causes and tailor treatment to patient
What steps should you take with an unstable tachycardia emergency?
If conscious use gentle sedation
Cardioversion with synchronised shock
Review rhythm and confirm cardiac output
If problem persists repeat cardioversion up to 3 times
Amiodarone 300mg IV over 10-20 minutes
What steps should you take with a stable tachycardia emergency?
Review rhythm and check underlying causes
Arterial line and bloods
Consider drug treatment
Seek expert help from cardiology or ICU
How to set up a cardioversion with synchronised shock
Apply pads and select DEFIB
Select 50-150J energy
Press SYNC button
Check SYNC success – confirm marking ^ on R waves
Charge and deliver shock safely
If synchronisation not possible use high energy unsynchronised shocks
What is SVT?
Supraventricular tachycardia
What is PEA?
Pulseless electrical activity
When is amiodarone given and what dose?
After third shock for VF and VT that is unresponsive to shock delivery, CPR and vasopressor
300mg
How can you raise concerns of ideas during the crisis?
Your input may be crucial
Probe – make observation or ask clarifying question
Alert – suggest problem and offer possible alternative
Challenge – address person using their name, directly question plan or decision
Emergency – get their attention – say you must listen. Give direct order to avoid immediate harm to patient
What should your checks be during any crisis?
Oxygen delivery FiO2, FGF, bellows or bag moving
Airway – ETT or LMA patent
Breathing – Sats ETCO2 waveform, tidal volumes and rate
Circulation – Rate, rhythm, ischaemia, BP, Peripheries
Depth – MAC or TIVA value, BIS or entropy
Surgery – ask how is the operation going? Review blood loss
What does BCIS stand for?
Bone cement implantation syndrome
What are the patient signs of BCIS?
Hypoxia
Hypotension
Or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion
What are the 7 layers of tissue to cut through for a c-section?
Skin
Subcutaneous fat
Fascia
Muscle
Peritoneum
Uterus
Amniotic sac
What are the preliminary checks before starting a level 2 machine check?
Wash hands
Check bulk gas warning lights and medical gas alarm panel
Turn machine + monitor on
Check machine is plugged into a UPS
Check service dates on machine and patient monitor
Check scavenging is on, and ball float is in the green zone
Depress condenser drain
Check machine moves freely
Attack circuit and gas sampling line
Check sampling line and d-fend are clean and free of defects
Confirm gas analyser registers 21% +/- 3% oxygen
Check low oxygen alarm is set to 21%
Check Aladdin cassettes are full and ports are closed and locked in vaporiser bay and correct agent is identified on the ASD
Check AMBU bag
What does UPS stand for?
Uninterruptible power supply
What level should you replace the emergency reserve oxygen cylinder on the back of the anaesthetic machine?
<5000 kPa
Residual Current Device
An electrical device that monitors current leakage and shuts off if excess, unexpected current is detected
Line insulation Monitor
An electrical device that monitors a decrease in electrical resistance and alerts to any change
True or False: a small current may be sufficient to induce ventricular fibrillation
True
True or false: body protection is sufficient protection from micro shock
False
True or false: micro shock requires a conducting pathway to the heart
True
True or false: macro shock cannot cause ventricular fibrillation
False
True or false: Cardiac protection is sufficient protection from both micro shock and macro shock
True
An operating theatre should be equipped with electrical ________ protection
Cardiac
What is the size of the cylinder on our anaesthetic machines?
Size E
What is the pin index for medical air
1, 5
What is the pin index for oxygen?
2, 5
What is the pin index for nitrous oxide?
3, 5
What is the pin index for cardon dioxide
1, 6
What is the pin index for Entonox?
7
What cylinder has blue and white shoulders?
Entonox
What cylinder has black and white shoulders?
Medical Air
What cylinder has white body and white shoulders?
Oxygen
What cylinder has blue body and blue shoulders?
Nitrous oxide
What is the name for the combination of nitrous oxide and oxygen?
Entonox
What is the Bodox seal made of?
Neoprene
True or false – serial number is engraved on the medical gas cylinder BODY
True
True or false – owner identification is not engraved on the medical gas cylinder BODY
False
True or false – tare weight is engraved on the medical gas cylinder BODY
True
True or false – test pressure is on the medical gas cylinder SHOULDER LABEL
False
True or false – dangerous goods classification is listed on the medical gas cylinder SHOULDER LABEL
True
True or false – the gas content is not listed on the medical gas cylinder SHOULDER LABEL
False
True or false – manufacturers perform a visual endoscopic examination of cylinders
True
True or false – Manufacturers do not perform impact test on cylinders
False
True or false -tensile strength and/or bending tests are performed by the manufacturer
True
What are cylinders traditionally made of?
Molybenum Steel
After how many years of use must a cylinder be tested?
5
True or false – cylinder’s ability to not be flattened will be tested
True
Plasmalyte is ______ compared to body water
Isotonic
Sodium chloride 0.9% is ______ compared to body water?
Isotonic
0.45% sodium chloride is ______ compared to body water?
Hypotonic
What is the adult blood volume per kg in mls?
70
What is the paediatric blood volume per kg in mls?
80
True or false – hypotonic fluids might be used to treat diabetic ketoacidosis
True
True or false – Hypertonic fluids are not used in treatment of oedema
False
True or false – Albumin must be given through a pump set?
False
Fresh frozen plasma is used to treat coagulopathies and what other purpose?
increase circulating volume
Untreated haemorrhage or dehydration could lead to which of the 4H’s and 4T’s
Hypovolaemia
True or false – platelets are stored in the fridge
False
What is the micron size range for a blood filter?
170-200
Who is the universal blood donor?
O Negative
What does SAGM stand for?
Saline, adenine, glucose and mannitol
Who is the universal blood recipient?
AB positive
Who is the universal plasma donor?
AB
Who is the universal plasma recipient?
O
In normal use, how many units of blood should be given through a blood filter?
4
true or false – in a massive transfusion, it is acceptable to give more units than 4 through a filter
True
Can rhesus positive blood be given to rhesus negative patients?
No
What blood products should not be given in the same line as RBC’s
Platelets
A haemolytic transfusion reaction causes destruction of what?
Haemoglobin
What is the adult cardiac arrest adrenaline dose? Include units
1mg
What is the adult anapahylaxis adrenaline dose? Include units
0.5mg
What is the paediatric cardiac arrest adrenaline dose? mcg/kg
10 mcg/kg
What is the paediatric amiodarone cardiac arrest dose? mg/kg
5 mg/kg
What is the energy dose for paediatric defibrillation? J/kg
4 J/Kg
What is the energy dose for adult defibrillation?
200J
What is the intralipid bolus dose in ml/kg?
1.5ml/kg
Stridor is associated with inspiration or expiration?
Inspiration
Wheeze is associated with inspiration or expiration?
Expiration
true or false – albumin is included in the massive transfusion protocol
False
Which emergency causes tachycardia, hypotension, urticaria and bronchospasm?
Anaphylaxis
Which emergency causes visual disturbances, confusion, bradycardia and hypotension?
Local toxicity
What emergency causes tachycardia, tachypnoea, hypotension, and hyperkalaemia?
Malignant hyperthermia
Which medication can be used to increase potassium uptake in malignant hyperthermia, reducing hyperkalaemia?
Insulin
Which medication can be given to reduce metabolic acidosis in malignant hyperthermia?
c
True or false – nitrous oxide is a triggering agent for malignant hyperthermia
False
Which blood test is used to confirm anaphylaxis after the incident?
Tryptase
When should tryptase be taken after an anaphylaxis event?
A - Immediately and after 24 hours
B- 1 hour, 4 hours and 24 hours
C - Immediately, 2 hours and 6 hours
D - When I can be bothered doing a blood gas
B
MTP box 1 contains what?
A) 4 RBC, 4 FFP
B) 2 RBC, 2 FFP
C) 4 RBC, 4 FFP, 3 Cryo
D) 4 RBC, 4 FFP, 1 Platelets
B
MTP box 2 contains what?
A - 4 RBC, 4 FFP, 3 Cryo
B - 2 RBC, 2 FFP
C - 4 RBC, 4 FFP, 1 Platelets
D - 4 RBC, 4 FFP
A
MTP box 3 contains what?
A 2 RBC, 2 FFP
B 4 RBC, 4 FFP, 1 Platelets
C 4 RBC, 4 FFP, 3 Cryo
D 4 RBC, 4 FFP, 1 Cryo
B 4 RBC, 4 FFP, 1 Platelets
Which boxes are repeated in an MTP?
A - 1 & 2
B - 3 & 4
C - 1 & 4
D - 2 & 4
B
What are the 4 H’s related to an emergency?
Hypovolemia,
Hypoglycaemia/Hyperkalaemia,
Hypo/Hyperthermia,
Hypoxia
What are the 4 T’s related to an emergency?
Tension pneumothorax,
Tamponade,
Thrombosis,
Toxins
What does DRSABCD stand for?
Check for DANGER
Check for a RESPONSE
SEND for help
Check the AIRWAY
Check for BREATHING
Start CPR
DEFIBRILLATION
What does VIE stand for?
Vacuum Insulated Evaporator
What are 3 safety features of a Bulk Gas?
Colour coded Pipelines
Non-interchangeable screw thread hose
Colour coded wall connectors
Gas pressure and contents visible on the front of the machine
Second stage regulators: control pipeline pressure surges
Continuous Positive Airway Pressure, Propofol and Suxamethonium is textbook treatment for what emergency?
A - Bronchospasm
B - Laryngospasm
C - Difficult intubation
D - Anaphylaxis
B
Bronchospasm may be treated with:
A -Salbutamol via ETT or IV
B - Adrenaline
C - Volatile anaesthetics (increased MAC)
D - All the above
D
What are the 4 tests done on a reserve cylinder?
Internal endoscopic exam
Impact, Bend, and flattening test
Pressure test at 22000kPa
Tensile test: Strips cut and stretched
What are 5 labels on the reserve cylinder?
Name, Chemical and symbol
Substance identification number
Batch number
Hazards warning and safety instructions
Max contents (Litres)
Pressure
Cylinder size code
Storage and Handling
Filing date, shelf life and expiration date
What are 5 safety features of a flowmeter on the anaesthetic machine?
Gas knobs are colour coded for each gas
Oxygen knob is positioned on the left and is fluted and larger than the other knobs as it will now be easily recognised.
Oxygen is the last gas to be added to the common gas manifold
One knob for each gas
Each knob is calibrated for that specific gas
Doesn’t allow N2O to be given without O2
O bobbin will rise with N2O: anti-hypoxic device
Does not allow oxygen to have a concentration of less than 25% when giving N2O
What are 4 safety features of a vaporiser?
Colour coded
Vapour specific
Specific key filling port
Ani-spill/antipollution cap on bottles
Bottles only opens when full inserted into the vaporiser
Content window
Interlock system
Magnetic coding
What does MAC stand for?
Minimum alveolar concentration
What does APL stand for?
Adjustable Pressure limiting valve
What are 5 safety features of an anaesthetic machine?
Anti-static wheels
Colour coded pipeline
Recessed oxygen flush with spring loaded activation
Cover on the on/off switch to prevent accidental on/off
Anti-Hypoxic device
Oxygen failure alarm/nitrous cut off
Universal connectors for a breathing system are 22mm and 15mm
Scavenging has a different connector to breathing system which is 30mm
Back-up power supply
High pressure relief valve which prevents high airway pressure
What are the 5 must haves of monitoring during anaesthesia?
SpO2
EtCO2
Oxygen analyser
Agent Analyser
Ventilator alarms
What are the 10 patient rights?
Right to be treated with respect
Right to fair treatment and freedom from discrimination
Right to dignity and independence
Right to service of an appropriate standard
Right to be listened to and understood
Right to receive information: benefit and risks of treatment
Right to make informed choice
Right to support
Right to teaching and research
Right to complain
What is involved in the ‘Sign in’?
Confirm surgeon available
Before induction of anaesthesia, confirm with patient: Identity, Site and side, Procedure, Consent
Site marked or not applicable
Does the patient have: Known allergies, Difficult airway or aspiration risk, Risk of >500 ml blood loss recorded.
Anaesthesia safety checklist completed
Check and confirm prothesis/ special equipment to be used
What is involved in the ‘Sign out’
Verbally confirm with the team after final count:
The name of the procedure recorded
That instrument, needle, sponge, and other counts are correct
How the specimen is labelled (including patient name)
The plan for ongoing VTE prophylaxis
Whether there are any equipment problems to be addressed
Postoperative concerns/plan for recovery and management of this patient
What is CO2 measured in?
kPa and mmHg
What is side stream CO2?
Connected to adapter at patient end
Small increase of dead space
Time delay
Moisture trap
What is Mainstream CO2?
Sample chamber positioned within patient’s gas stream
Increased dead space
Heated to prevent condensation
No time delay
What are 7 features of an Endotracheal tube?
Radio opaque lines
Single use
Latex free
Sterile
Anatomical shape
Internal diameter on tube
Outer diameter on tube
Pilot balloon with self-seal valve
Low-pressure, high-volume cuff
Depth in CM
Black line to position vocal cords
PVC clear
15mm connector
Murph’s eye
Left bevelled edge
Five common causes of anaphylaxis?
Latex
Colloid
Antibiotics
Muscle relaxant
Chlorhexidine
Patient blue
sugamadex -[likelihood appears to be dose-related]
What are 5 symptoms of anaphylaxis?
Difficult/noisy breathing
Wheeze/Persistent cough
Swelling of the face and tongue
Swelling/tightness in the throat
Difficulty talking
Persistent dizziness/ loss of consciousness
Abdominal pain and vomiting
Hives, welt and body redness/rash
Hypotension
What are the signs and symptoms of Local Anaesthetic Toxicity?
Tingling on the lips and fingers, metallic taste, ringing in the ears, confusion, and dizziness
Convulsions and loss of consciousness
Hypotension, bradycardia, and respiratory arrest
What are the early signs and symaptoms of Malignant hyperthermia?
Prolonged muscle spasm after Suxamethonium
Tachycardia
Tachypnoea in a spontaneous breathing patient
Increased CO2
Cardiac arrhythmias
What are the Developing Signs and Symptoms of Malignant hyperthermia?
Rapid increase in temperature (0.5 degrees every 15 minutes)
Respiratory and metabolic acidosis
Hyperkalaemia
Profuse sweating
Decrease SpO2
Mottled skin
Cardiac instability
Muscular rigidity
What are the Late Signs and Symptoms of Malignant hyperthermia?
Cola coloured urine
Increase CK serum
Coagulopathy
Severe muscle ache
Cardiac Arrest
What is the definition of Decontamination?
Process of removal of unwanted matter or infectious tissue on an object or area
What is the definition of Disinfection?
Process of elimination of all or many micro-organisms not including spores
What is the definition of Sterilisation?
Process of elimination of all micro-organisms including spores
What is the definition of Contact precautions?
To prevent transmission of infectious agents which are spread by direct or indirect contact with a patient, their environment, or patient care items
What is the definition of Droplet precautions?
Prevent transmission of infectious agents which are spread by close respiratory or mucous membrane contact with respiratory secretions
What is the definition of Airbourne Precautions?
Prevent transmission of infectious agents that remain infectious over long distances when suspended in the air and are transmitted person to person by inhalation of airborne particles
What are 4 methods of sterilisation?
Autoclaving
Ionising radiation
Dry heat
Ethylene oxide
What is Moment 1 in the 5 Moments of Hand Hygiene?
Before patient contact
When: before approaching and touching a patient
Why: To protect the patient from harmful germs on your hands
What is Moment 2 in the 5 Moments of Hand Hygiene?
Before performing a procedure
When: Immediately prior to performing a procedure
Why: To protect the patient from harmful germs, including their own from entering their body
What is Moment 3 in the 5 Moments of Hand Hygiene?
After procedure or exposure to bodily fluid
When: Immediately are procedure or exposure of bodily fluid and after removal of gloves
Why: to protect you and the health care environment against harmful patient germs
What is Moment 4 in the 5 Moments of Hand Hygiene?
After patient contact
When: Immediately after touching the patient and touching patient surroundings once leaving the patient’s side
Why: to protect you and the health care environment against harmful patient germs
What is Moment 5 in the 5 Moments of Hand Hygiene?
After contact with patients’ surroundings
When: immediately after contact with objects that have been in the same area as the patient, even if you have not touched the patient
Why: to protect you and the health care environment against harmful patient germs
What does TACO stand for and what is it?
Transfusion Related Circulatory Overload
Pulmonary oedema primarily caused by volume excess
Symptoms = acute respiratory distress, cough, pink sputum, decreased SpO2, nausea, pulmonary oedema, raised CVP.
What does TRALI stand for and what is it?
Transfusion Related Acute Lung Injury
Repaid onset of excess fluid in the lungs.
Symptoms = acute respiratory distress, fever, bilateral infiltrates on chest
What is Acute Haemolytic Transfusion Reaction
AHTR
A life-threatening reaction to receiving a blood transfusion that results from the rapid destruction of donor red blood cells by host antibodies (Can be delayed)
HELLP
Haemolysis Elevated Liver Enzyme and Low Platelets
HME
Heat, Moisture Exchange
ESBL
Extended Spectrum Beta-Lactamase
IPPV
Intermittent Positive Pressure Ventilation
LIM
Line Isolation Monitor
PEEP
Positive End Expiratory Pressure
THJR
Total Hip Joint Replacement
VSD
Ventricular Septal Defect
MI
Myocardial Infarction
RIC
Rapid Infusion Catheter
SAH
Subarachnoid Haemorrhage
TEG
Thromboaelastogram
LMWH
Low Molecular Weight Heparin
EUA
Examination under Anaesthesia
CSE
Combined Spinal Epidural
CLAB
Central line Associated Bacteraemia
ITM
Intrathecal Morphine
IVC
Inferior Vena Cava
ASA
American Society of Anaesthesiologist
DAS
Difficult airway Society
GIK
Glucose, Insulin, Potassium
AAA
Abdominal Aortic Aneurysm
ACF
Activated Charcoal filters
FiO2
Fraction Inspired Oxygen
MRSA
Methicillin Resistant Staphylococcus Aureus
PCA
Patient controlled Analgesia
RAE
Ring, Adair, Elwyn
TIVA
Total Intravenous Anaesthesia
VT
Ventricular Tachycardia
PPE
Personal Protective Equipment
MUA
Manipulation under Anaesthesia
NOF
Neck of Femur
OSA
Obstructive Sleep Apnoea
What is the relationship between standard preacautions and infection control?
Universal precautions are in place to prevent infections and contamination
Following standard precautions, we can minimise infection spreading which allows for better infection control
Define microshock
A small electric current passing directly through the heart and directly sending the patient into ventricular fibrillation
Define macroshock
Larger electrical current passes through the body
What is the formula for estimating the size of both cuffed and uncuffed ETT for a paediatric patient?
Cuffed – age/4 + 3.5
Uncuffed age/4 + 4
What is ROSC?
Return of spontaneous circulation
Generally detected by arterial pulse palpation and end tidal CO2 monitoring
What is the triad of anaesthesia
Amnesia
Analgesia
Muscle relaxation
What is sodalime composed of?
94% calcium hydroxide
5% sodium hydroxide
1% potassium hydroxide
What is the flow rate of a 14g cannula?
Just gravity - 250ml/min
Pressurized – 380ml/min
What is the flow rate of a RIC line?
1000ml/min
What are some examples of colloid substances?
RBC
Albumin
FFP
What are some crystalloid fluids
Heartmans
Sodium Chloride
Plasmalyte
Dextrose saline
manitol
Do crystalloids have high or low cell permeability?
High
Do colloids have high or low cell permeability
Low
What temperature is FFP stored at?
-30’C
What temperature is RBC stored at?
2- 6’C
What are the signs and symptoms of a blood transfusion reaction?
Increased temperature
Hypotension
Tachycardia
Anaphylaxis
Elevated ventilation pressure
List fractionated blood products available;
Plasma
Cryoprecipitate
Platelets
Immunoglobins
Albumin
Irradiated and leuko depleted red blood cells
What are leukocytes and what is their main purpose?
White blood cells
Main immune system cell
Name a depolarising muscle relaxant;
Suxamethonium
Name non-depolarising muscle relaxants;
Rocuronium
Vecuronium
Atricurium
What are the 5 R’s of drug administration?
Right drug
Right patient
Right dose
Right route
Right time
What are some induction agents?
Propofol
Thiopentone
Etomidate
What medications can provide analgesia?
Fentanyl
Alfentanil
Remifentanil
Morphine
Paracetamol
Parecoxib
What are some antiemetics?
Ondansetron
Dexamethasone
Define a half-life regarding medications;
It is the time taken for half of the drug to be broken down by biological processing
Define agonist;
Is a chemical that binds to a receptor on a cell to cause activation thus causing a response
Define antagonist;
A chemical substance that binds to and blocks the activation of receptors on cells preventing a biological response
Define toxicity;
Chemicals or drug concentrations are at such high levels in the body that they can damage organs and tissues
Define bioavailability;
The rate and extent to which the rate a drug is absorbed and reaches circulation
IV administration has a bioavilability of 100%
State CVC insertion sites
Internal jugular
Subclavian vein
Femoral vein
Why are patients in Trendelenburg for an internal jugular central line insertion?
To prevent causing an air embolism
To increase the cross sectional area of the jugular vein
What pressure should a tourniquet be set to?
Inflated to above 100mmHg above systolic pressure for lower limbs
Inflated to above 50mmHg for upper limb
What are some complications associated with tourniquet use?
Post tourniquet syndrome – 2-4 hours afterwards of muscle stiffness, weakness, paleness, joint stiffness and tingling sensation are experienced
Ischemia – necrosis
Pressure sores
Nerve damage
Compartment pressure syndrome
Define scatter regarding radiation;
Radiation that spreads out in different directions from a radiation beam when it encounters an object or tissue
What are three methods of radiation protection/
Time
Distance
Shielding
Expand the acronym LASER
Light
Amplification
Stimulated
Emission
Radiation
What items can contain latex in operating theatres?
Some surgical gloves
Some catheters and other tubing
Sticky tape or electrode pads
What items can contain chlorhexidine in operating theatres?
Skin antiseptic wipes
Hand gels and hand wash solutions
Surgical skin disinfectants
Pre-surgery wash sponges and wipes
Lubricant preparations
Central venous lines
Surgical dressings and mesh
Mouth wash
Regarding paediatric airways what is the position of the larynx, is it more anterior or posterior?
Anterior
What is the normal heart rate range for a child?
70-160 BPM
List four methods of heat loss;
Conduction
Convection
Radiation
Evaporation
Why do children have a difficult time regulating their temperature?
They have thin skin and less body fat
High body surface area to volume ratio and loose heat quicker
They have a high metabolic rate which consumes more oxygen and energy
They are not as developed to develop shivering/vasoconstriction/piloerection/sweating.
Outline the guidelines for fluid maintenance relating to body weight in paediatric anaesthesia;
0-10kg = 4ml/kg/hr
10-20kg = 2ml/kg/hr
> 20kg = 1ml/kg/hr
4-2-1 rule
Do children require higher weight-adjusted doses of most medications compared to adults?
Yes
Children have higher rates of metabolism and elimination than adults which means they require a higher weight-adjusted dose of medication
Define pharmacodynamics;
The study of the molecular, biochemical and physiologic effects and actions on the body
Define pharmacokinetics;
The study of how the body interacts with administered substances for the entire duration of exposure
What are the fasting requirements for children for surgery?
6 hours – milk and food
4 hours – breastmilk
2 hours – clear fluids
List 5 different places a patient’s temperature can be measured from;
Nasal
Oral
Rectal
Catherter
Skin
Ear
Explain the advantages and disadvantages of the use of a Jackson Rees modification of a T-Piece;
Low resistance with minimal dead space and acts as a manual ventilator
Allows for spontaneous breathing and controlled ventilation
No pressure relief valve
No scavenging
Inaccurate capnograhy
No rebreathing and requires higher fresh gas flow
What is the formula for estimating body weight?
2 x [age x 4]
What is the formula for estimating ET tube depth to both lips and nostril?
Lips - [age/2] + 12cm
Nasal - [age/2] + 15cm
Discuss the immediate management of an airway fire;
Stop laser immediately
Turn O2 off
Call for help
Establish a hands-off team leader and delegate roles
Use saline swabs to put out fire
Get the fire extinguisher and fire blanket and attempt to extinguish the fire
Turn off medical gases and disconnect ventilator
Remove ETT and remove flammable material from airway
Pour saline into airway
After fire extinguished re-establish tube and reintubate and reestablish ventilation
Using AMBU bag with room air
Assess airway for injury
Emergency tracheostomy if intubation failed
Define the coroner’s clot
Occult hidden clot of blood remaining in the nasopharynx behind the soft palate following surgery or trauma which can cause a fatal airway obstruction following extubation
Define epistaxis;
nosebleed
Give three medical reasons why a women might be offered a LSCS;
Birth Defects
Abnormal positioning
Chronic health conditioning
What is a LSCS?
Lower segment caesarean section
Give 5 reasons why a women would require an emergency LSCS
Prolonged labour
Foetal distress
Cord prolapses
Exhaustion
Placenta problem
What is the reason for the 15’ left tilt for a LSCS?
Reduces aortocaval compression and inferior vena cava compression
Define reaming;
Technique used with rotational cutting tools known as reamers. Used to remove cartilage from the acetabulum
List equipment required for an intravenous regional block;
Double cuff tourniquet
Sterile preperation pack
IV access equipment
Standard monitoring
Local anaesthetic agent [lidocaine or prilocaine]
Fluids primed and ready
Emergency drugs available
Intralipid to treat local anaesthetic toxicity
Syringe and needles
Define diagnosis of compartment syndrome;
Increased pressure in a confined space that causes significant pain and can decrease blood flow
Discuss 3rd spacing in relation to fluid shifts during a major laparotomy;
3rd spacing describes the movement of bodily fluid from the blood into the spaces between the cells
This can lead to problems such as oedema, reduced cardiac output and hypotension
3rd space fluid shifts are calculated as 4-6ml/kg/hr which can be compensated with fluids
Define anastomosis;
Surgical connection between two structures usually between tubular structures
Define vasovagal;
Over activity of the vagus nerve resulting to a temporary fall in blood pressure, heart rate, fainting
List common post operative complications;
Wound infection
Deep vein thrombosis
Pulmonary embolism
Lung pulmonary complications
Anaesthesia reaction
Shock
Nerve damage
Pressure sores
Discuss first degree burn;
Effect the outer layer of skin – superficial
Discuss second degree burn;
Involves the epidermis and part of the lower layer of skin - dermis
Discuss third degree burn;
Destroys the epidermis and dermis
This may go into the subcutaneous tissue
Discuss fourth degree burn;
Go through both layers of skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone
Explain the rule of nines and how it is used to estimate the extent of a burn’s injury;
Dividing the bodies surface area into percentages to calculate the extent of the burns injury
Front + back of head and neck = 9%
Front + back of each arm = 9%
Chest = 9%
Stomach = 9%
Upper back = 9%
Lowerback = 9%
Front and back of each leg and foot 9% each side
Genital area = 1%
Explain common complications associated with burns surgery;
Blood loss – debrided tissue bleeds freely
Hypothermia
Infection
Breathing problems
Fluid loss
Difficult placement of monitoring and IV
Define GCS;
Glasgow coma scale
Define ACVPU;
Alert
Confusion [new onset or worsening] confusion
Voice
Pain
Unresponsive
What are the 3 consciousness ratings of the Glasgow coma scale?
Severe - 3-8
Moderate - 9 - 12
Mild - 13-15
What are the 3 assessments for the Glasgow coma scale?
Eye opening
Spontaneous – 4
To sound – 3
To pressure – 2
None - 1
Verbal response
Orientated – 5
Confused – 4
Words – 3
Sounds – 2
None - 1
Motor response
Obey commands -6
Localising - 5
Normal flexion - 4
Abnormal flexion - 3
Extension - 2
None - 1
State normal range of an ICP measurement;
5-12mmHg
State normal range of a CVP measurement;
8-12mmHg
Define CBF;
Cerebral blood flow
State the relationship between CSF, CBF and ICP;
CSF, CBF, ICP are constant so an increase in one should cause a reciprocal decrease in one both remaining two
Vice versa
Briefly explain the relationship between CPP, MAP and ICP
Cerebral perfusion pressure is the effective pressure that results in blood flow to the brain
CPP = Mean Arterial Pressure – Intracranial Pressure
Define CPP;
Cerebral perfusion pressure
Explain Cushing’s triad;
Refers to a set of signs that are indicative of increased intracranial pressure
Consists of bradycardia
Irregular respirations
Widened pulse pressure
Increase between systolic and diastolic pressure
What muscle relaxant produces a rise in ICP and is commonly avoided for neurosurgical patients?
Suxamethonium
Define RCD;
Residual control device
What is the normal range for CO2?
35-45 mmHg
List two reasons why the CO2 may be increasing?
Hypercapnia can be caused by;
Hypoventilation
Increased CO2 production such as a MH event
What are some components of a VIE?
Thermally insulated double walled steel tank with a layer of perlite in a vacuum
Pressure regulators allow gas to enter a pipeline and maintain pressure of 410 Kpa
Safety valve opens at a pressure of 1700kpa
Control valves
What size are the gas cylinders in a cylinder manifold?
Size J
What are some safety features of a bulk gas?
Colour coded pipelines
Non-interchangeable screw thread hose
Colour coded wall connectors
Gas pressure and contents visible on the front of the machine
Second stage regulators which controls pipeline pressure surges
Why might a pipeline fail?
High demand of oxygen
Fault in the Schrader valve connector
Fault in the manifold room
Broken/failure in the pipeline
What markings are engraved on a cylinder?
Test pressure
Date the test was performed
Chemical symbol and name
Tare weight when empty
What are the 4 tests performed on a gas cylinder?
Internal endoscopic exam
Impact, bend and flattening test
Pressure test at 22,000 kPa
Tensile test – strips cut and stretched
What are some labelling featured on a gas cylinder?
Name, chemical symbol
Substance identification number
Batch number
Hazards warning and safety instructions
Max contents in litres
Pressure
Cylinder size code
Storage and handling
Filling date, shelf life and expiration
direction
What are some safety features of a flowmeter?
Gas knobs are colour coded for each gas
Oxygen knob is always positioned on the left and is larger than the other knobs with a different tactile feel
Oxygen is the last gas to be added to the common gas manifold
Each knob is calibrated for that specific gas
Doesn’t allow N2O to be given without O2
O2 will rise with N2O – anti hypoxic device and ensures no less than 25% oxygen can be delivered when running N2O
What are some types of anti-hypoxic devices?
Mechanical chain link
Pneumatic pressure sensitive device
Paramagnetic oxygen analyser
What are some characteristics of an ideal vaporiser?
Performance is not affected by change in FGF
Low resistance to flow
Light weight and economical
What are some characteristics of an ideal breathing system?
Simple and safe to use
Delivers intended inspired gas mix
Permits spontaneous manual and controlled ventilation
Use low fresh gas flow
Protects patient from barotrauma
Sturdy and light weight
Permits easy removal of gas
What are some safety features of a breathing system?
High pressure relief valve
Soda lime changes colour when exhausted
Airways pressure gauge present
Breathing circuit 22mm and 15mm
What does NIM stand for?
Neural integrity monitor
What does the acronym HEAMP represent regarding bariatric airway set up?
H-hand hygiene
A – anaesthetic type
E - Environment positioning devices e.g. supports
M – level 2 or 3 machine check
P – sniffing the morning air position
What does MALES BIT MOA represent?
M- mask, Magill’s
A – airway oropharyngeal, nasopharyngeal, Ambu bag, agent
L – laryngoscope, LMA
E – ET tube, emergency drugs
S – Suction under the pillow, syringe, stylet, stethoscope
B – Bag of fluid, bougie
I – IV cannulation
T – tapes, ties
M – Monitoring
O – oxygen cylinder
A – Accessory equipment – air warmers, infusion pumps, fluid warmer
What is Einthoven’s triangle?
Used to determine the electrical axis of the heart in the frontal plane
What are some considerations for an elective case for a type 1 diabetic patient?
First on the list to minimise starvation time
Stop short and immediate acting insulin on morning of surgery
Test blood sugars on arrival to hospital
What is a LIM?
Line isolation monitor
Detects leakage of current within equipment however, instead of cutting off the power supplied
Define AHTR
Acute haemolytic transfusion reaction
Define asepsis;
It is a process in which microbial agents on a living surface are either killed or their growth is arrested
Define antiseptic;
These are the substances applied on the living tissues to reduce the possibility of infection and growth of microorganisms
Define aseptic processing;
It is defined as the processing and packaging of sterile product into sterilised containers followed by proper sealing with sterilised closure in a manner to control microbiological recontamination
Define microorganism;
Microscopic organisms which may exist in its single celled form or in a colony of cells
Define pathogen;
A pathogen is a tiny living organism such as a bacterium or virus that can produce disease in an individual
Define disinfection;
Antimicrobial process to remove, destroy or deactivate microorganisms on surfaces or in liquids
Define decontamination;
The process by which a person or a surface is made free from all the agents that contaminate the surface and lead to the surface and lead to the spread of infection
Define cleaning;
It is the process of removing all forms of foreign material by employing the mechanical action of washing or scrubbing
Defibrillator Proof
Double insulation
Protection Earthing
Equipotential Earthing
Body Protected
Cardiac Protected
Hazard
Radioactive/ X-Ray
Biohazard
Oxidising
Explosive
Corrosive substance
Dangerous for the environment
Flammable
Toxic
AED
Sterilised by Ethylene Oxide
Lot Number
Manufacturer Date
Expiry Date
MRI Safe
MRI unsafe
Laser
Reference Number
Sterilized by Radiation
Single use only
Conforms to European standards
Keep Dry
Contains Latex
Consult Instructions
Non-Sterile
Autoclavable
Storage Temperature Range
Storage Humidity range
Protect from sunlight
Mapleson A
Mapleson B – rebreathing circuit
Mapleson C – rebreathing circuit
Mapleson D
Mapleson E – valveless breathing system
Mapleson F – valveless breathing system
What Position is this? Risks and Considerations.
Supine
Risks: Pressure points including heels, scapula, or vertebrae. Neural injuries caused by flexion and extension
Considerations: Padding to the heels, elbows, and spine. Ensure occiput alignment of the hips and legs are parallel and are not crossed over. Ensure that the arm boards are at a less than 90-degree angle and are the height of the bed.
What Position is this? Risks and Considerations.
Prone
Risk: Compression on the eyes and forehead. Kink age or disconnection of tube. Decrease chest movement, genital torsion and pressure injuries to the knees and feet.
Considerations: ensure that the head support is padded, and the eyes are free and that there is easy access to the tube. Place chest roll supports to free up the chest area to allow chest movement and decrease abdominal pressure. Keep genitals free and place pillows underneath the knees and feet.
What Position is this? Risks and Considerations.
Lithotomy
Risk: Hip and knee damage due to over extension and flexion. Pressure injuries on the lumbar and sacrum region, restricted diaphragm movement, crushing of digits due to equipment and poor venous flow to the legs.
Consideration: Place the stirrups at even height and elevate the legs slowly and simultaneously. Padding on the spin and protection of the hands to prevent crushing. Place hands on the side or on arm boards and not on chest as this will increase the restrictive chest movement.
What Position is this? Risks and Considerations.
Lateral
Risk: bony prominences on knees and ankles and pressure on the dependant axilla, risk of neural injuries if neck and spine are not in alignment.
Considerations: Place a pillow in between the knees and the ankles. Place an axillary roll on the dependant axilla and maintain spinal alignment during surgery and ensure that the ear is free
Is this arterial waveform normal, under or over damped?
Normal
Is this arterial waveform normal, under or over damped? And what can cause it?
Overdamped
Loose connections
Air bubbles
Kinks
Clots
Spasms
No volume or low pressure in pressure bag and tubing
Is this arterial waveform normal, under or over damped?
Underdamped
Increased vascular resistance
Hypothermia
tachycardia
Excessive movement of the catheter within the artery leading to false high systolic or a false low diastrolic pressure
What is this capnography trace?
Oesophagus intubation
Low level ETCO2 that quickly tapers off
What is this capnography trace?
ETT in the right main bronchus
Irregular plateau the initial right lung ventilation followed by CO2 escaping from the left lung
Sometimes it can appear as normal capnography
What is this capnography trace?
Bronchospasm
Due to delayed exhalation often seen in airway obstruction
COPD
Asthma exacerbation
What is this capnography trace?
Normal waveform
Sudden loss of waveform
What is this capnography trace?
CPR
What is this capnography trace?
ROSC
Return of spontaneous circulation
What is this capnography trace?
Hypoventilation
Low respiratory rate
High EtCO2 value
What is this capnography trace?
Airway obstruction or apnoea
Interrupted breaths
What is this capnography trace?
Hyperventilating
High respiratory rate and relatively low EtCO2
What is this capnography trace?
Apnoea
What is this capnography trace?
Mechanical airway obstruction
What is this capnography trace?
Reversal of alveolar slope in emphysema
[emphysema is one of the diseases that comprises COPD]
What is this capnography trace?
Cardiac oscillations
What is this capnography trace?
The curare cleft
Patient making an attempt to breathe
What is this capnography trace?
Recirculated CO2 due to saturated CO2 absorber
What is this capnography trace?
Tube displacement
Airway obstruction
Loss of circulatory function
What is this capnography trace?
Hypoventilation
Increasing ETCO2
Caused by;
decreasing respiratory rat
Decreased in tidal volume
Increase in metabolic rate
Rapid rise in body temperature
What is this capnography trace?
Hyperventilation
Decreasing ETCO2
Caused by;
Increase in respiratory rate
Increase in tidal volume
Decrease in metabolic rate
Fall in body temperature
What is this ECG trace?
Sinus Arrhythmia
What is this ECG trace?
Normal sinus Rhythm
What is this ECG trace?
Sinus tachycardia
What is this ECG trace?
Sinus bradycardia
What is this ECG trace?
Paroxysmal supraventricular tachycardia PSVT
Rate changes abruptly and unexpectedly
What is this ECG trace?
Ventricular tachycardia
What is this ECG trace?
Ventricular Fibrillation
What is this ECG trace?
asystole
Contains phthalates
Mapleson circuits
What is an ectopic heartbeat?
An ectopic heartbeat is a type of arrhythmia that occurs when your heart contracts too soon
Fells as though your heart has skipped a beat or is racing all of a sudden
Most of the time they are harmless
Atrial ectopic
Ventricular ectopic
type b applied part
type bf applied part
Defibrillation proof type B applied part
Defibrillation proof type BF
Pyrogenic
List two drugs used for gastric emptying;
Ranitdine
Metoclopromide
sodium Citrate
why is oxytocin given in an obstetric case and what is the infusion dose?
Oxytocin prevents excessive postpartum bleeding by helping the uterus contract.
The medication works immediately when given IV
40IU Oxytocin in a 500 ml saline bag running at 125 ml/hr for 4 hours
What medication is commonly given for preeclampsia?
Magnesium sulfate
what is preeclampsia?
pregnancy complication characterised by high blood pressure
why should GTN spray be available in an obstetric theatre?
GTN is a smooth muscle relaxant and vasodilator
what is the correct position for a lower segment caesarean section?
supine
15’ left lateral tilt until baby is gone
gels under feet
side support
armboards out on a 90’
to reduce aortocaval compression
to reduce inferior vena cava compression
List this type of surgical anatomy location;
Nephro
Kidney
List this type of surgical anatomy location;
Derma
Skin
List this type of surgical anatomy location;
Laryngo
Layrnx
List this type of surgical anatomy location;
Oophro
Ovary
List this type of surgical anatomy location;
Oculo
Eye
List this type of surgical anatomy location;
Salpingo
Fallopian tubes
List this type of surgical anatomy location;
Gastro
Stomach
List this type of surgical anatomy location;
Orchid
Testicles
List this type of surgical anatomy location;
Thoracic
Chest
List this type of surgical anatomy location;
Pneumo
Lungs
List this type of surgical anatomy location;
Cysto
Bladder
List this type of surgical anatomy location;
Hyster
Uterus
List this type of surgical anatomy location;
Colpo
Vagina
List this type of surgical anatomy location;
Myo
Muscle tissue
List this type of surgical anatomy location;
Angio
blood vessel
Arthr
Joint
Colono
large intestine / colon
Encephal
Brain
Lamino
Laminar
Rhino
Nose
Do not enter
What are the side effects of suxamethonium?
Bradycardia
Hypotension
Increased intracranial / Intraocular pressure
MH
What are three side effects of suxamethonium?
Neurosurgery due to increase in intracranial pressure is not ideal
Muscular disorders
MH history
PS03 - What is the purpose for the guidelines for the ANZCA PS03 management of major regional analgesia?
to facilitate management of major regional blocks including major regional blocks including;
epidural, subarachnoid, plexus and nerve blocks
to reduce the likelihood of adverse outcomes and complications which may be associated with such nerve blocks including;
cardiovascular collapse, seizures, hypotension, allergic reactions, ventilatory impairment, impaired consciousness, infection and nerve damage
PS03 - what are some principles of the PS03 management of major regional analgesia?
Requires a medical practioner
systems and protocols to eliminate complications
informed consent
appropriate assistance
environment consistent with PS55
infection control
coagulation status
IV access prior to regional anaesthesia
monitoring BP, RR, consciousness ECG available, if sedating use O2 source EtCO2 and SpO2
Block time out; name, site and reconfirm this prior to needle insertion
procedure list to remain available
can delegate to another practioner
record and document technique, drug, dose
protocols and procedure to continue post op
PS03 - what are some equipment required for the PS03 management of a major regional analgesia?
Ultrasound
nerve simulator
Liquid emulsion; Intralipid
PS08 - what is the purpose of the ANZCA document PS08 statement of assistant for anaesthetist?
to recognize the importance of and to promote the development of quality assistants to the anaesthetist and to guide training of assistants
Scope - applies whenever there is a GA, regional or local / sedation is administered by an anaesthetist
PS08 - what are some principals of the PS08 statement of assistant for anaesthetist
present of a trained assistant to the anaesthetist during the preparation, induction, maintenance and conclusion of anaesthesia
service which ensures equipment is available, clean, maintained and serviced
staff properly trained assistance must be wholly and exclusively responsible to that anaesthetist
informed consent
informed on risks of sedation of decreased airway patency and decreased RR
patient assessment
staffing
facilities and equipment; ambu bag, ability to call for help, adequate lighting, ability to tild head down, sharps bin, stethoscope, suction, tourniquet/IV equipment, monitoring, emergency airway equipment, emergency drugs
what are the guidelines on sedation on analgesia?
to optimise patient care in the management of procedural sedation
to identify the competencies that sedationists should possess
Minimal sedation; a drug induced state during which patients respond purposefully to verbal commands or light tactile stimulation
moderate sedation; a druge induced state of depressed consciousness during which patients retain the abilityt to respond purposefully to verbal commands and tactile stimulation
deep sedation; a druge induced sate of depression consciousness during which patients are not easily roused and may respond only to noxious stimulation
PS18 - What is the purpose of PS18 monitoring during anaesthesia?
The purpose of this guideline is to guide practioners on monitoring standards that should be applied to clinical management in order
monitoring defined as observing and checking progress and quality over a period of time
what are the 5 must haves of monitoring?
SpO2
EtCO2
oxygen analyser
agent analyser
ventilator alarms
monitoring available; ECG, NIBP, NMT, EEG, temp, invasive monitoring,
Circulation where arterial pulse is checked every 10 minutes
Ventilation is continuously monitored
Oxygenation observe the colour of the patient with adequate lighting
PS54 - what are 10 minimum safety requirements for an anaesthetic machine?
Pin index
Reserve oxygen supply
Non-interchangeable gas hose connectors both inlet and outlet
Gas supply line and cylinder pressures displayed on front of machine
Oxygen failure alarm - generates automatically, cuts off gas supply except air or oxygen cant be cancelled until supply restored above preset pressure
Oxygen must enter gas manifold last and be the first knob from the left on the rotameter
One gas flow knob per gas
Mechanical knob is tactically different from other gas knobs
No less than 25% oxygen can be delivered in the presence of N2O
a vaporiser interlock system must prevent more than one from being used at a time
Vapour can only be increased by turning dial anti-clockwise
Fresh gas outlet must have an outer diameter of 22mm and inner 15mm
High pressure relief valve must be present
Gas scavenging connection must be a different diameter than other breathing systems - 30mm
Monitor alarm functions must activate automatically
High priority high airway pressure alarm
High priority low airway pressure alarm - less than 10cmH20 for more than 1 second
Emergency oxygen flush cannot be unintentionally activated
On/Off switch should not be unintentionally activated or deactivated
Backup power supply should be present and permit at least 30 minutes of operation
PS55 minimum facilities for anaesthesia in OT or other location
The minimum requirements to be provided by healthcare facilites when designing upgrading and equipping and staffing clinical areas where anesthesia is delivered
Anaesthesia delivery system capable of delivering measure oxygen flow
Calibrated vaporisers for inhalation agents
Infusion devices capable of giving an intravenous anaesthetic
Range of suitable breathing system
Separate means of inflating the lungs
Oxygen source independent of the anaesthetic machine
Exclusive suction
PS55 what are 10 things that must be present in every location for anaesthesia?
Appropriate PPE
Stethoscope
Monitoring
Range of face mask
OPA and NPA
LMA / SAD device
ET tube and connection
Two laryngoscope blades
Range of tube introducers
Syringe
Magills
Tapes
Scissors
Tourniquet
IV cannualation equipment
IV infusion equipment
Sharps bin
Equipment for savanging
PS55 what must be available in every location for anaesthesia?
Managing difficult intubation
Automatic ventilation
Rapid infuser
Arterial line and central line
Cool the patient
Regional block
Safe positioning
Additionally;
Appropriate lighting
Ability to communicate
Refrigeration facilities
Mean maintaining room temperature
Patient trolley and slide equipment with a minimum of 3 people
Health and disability patient rights - What are the 10 patient rights?
Right to be treated with respect
Right to fair treatment and freedom from discrimination
Right to dignity and independence
Right to service of an appropriate standard
Right to be listened to and understood
Right to receive information benefit and risks of treatment
Right to make informed choice
Right to support
Right to teaching and research
Right to complain
