AP Exam 4 part II Flashcards
preventing PE
- antiembolic stockings 2. compression devices 3. anticoagulants (heparin therapy)
the goal of heparin therapy for PE prophylaxis is to have an aptt that is __________x the control
1.5-2
aspiration of ________________ is the most severe form of aspiration, and is called _________________
gastric contents; chemical pneumonitis
what is the goal with aspiration? (prevention or tx?)
prevention
prevention of aspiration
- identify who is at risk (obesity, full belly, trauma, prego) 2. prophylactic pharmacology 3. appropriate airway technique (RSI)
tx of gastric aspiration
- correct hypoxemia/respiratory support 2. hemodynamic stability 3. antibiotics (only if have s/sx of infection)
T/F: corticosteroids are very beneficial in the tx of gastric aspiration
FALSE
perioperative pharmacology to decrease aspiration risk
- non-particulate antacids (Bictra/sodium citrate) 2. H2 receptor antagonists & PPIs 3. gastric prokinetics (reglan) 4. antiemetics to moderate nausea and vomiting
non-particulate antacids MOA for aspiration prevention?
they increase gastric pH
H2 receptor antagonists & PPIs MOA for aspiration prevention
reduce gastric volume and acidity
T/F: use of anticholinergics like atropine and glycopyrolate are recommended for aspiration prevention
FALSE
H2 receptor antagonists must be given ______________ prior to surgery for aspiration prevention
few hours
PPIs for aspiration prevention work best when they are given how?
as 2 successive doses
what is teh best induction technique for prevention of aspiration
RSI
what type of airway securement device is recommended in those at high risk for aspiration
cuffed ETT
_______________ results from increase in bronchial smM tone, with resultant small airway closure
bronchospasm
what can cause a bronchospasm
- aspiration 2. secretions 3. ET intubation 4. pharyngeal or tracheal suction 5. histamine release 2/2 medicatinos or allergic response
there is an increased incidence of bronchospasm in PACU in pts with ______________ & _____________
asthma; COPD
s/sx of bronchospasm
- wheezing 2. dyspnea 3. use of accessory muscles 4. tachypnea 5. increased PIP with MV
tx of bronchospasm
- B2 agonist 2. anticholinergics 3. corticosteroids 4. IV lidocaine 5. inhalation anesthetics
hypoventilation is manifested clinically with a decreased ______________ and ____________ –> increased _________________
RR; alveolar ventilation; paCO2
hypoventilation may occur because of?
- decrease in central respiratory drive (2/2 IV and inhaled anesthetics) 2. poor respiratory muscle function 3. combination of both
most common reasons for poor respiratory muscle function –> hypoventilation in the PACU?
- inadequate reversal of NMB 2. surgery involving upper abdomen 3. positioning 4. obesity and OSA 5. DZ of neuromuscular system
PACU management of hypoventilation
- verbal and tactile stimuli 2. turn, cough, deep breathe 3. reposition 4. CPAP
for hypoventilation ______________ monitoring reflect oxygenation, but not adequacy of ventilation; however __________________ is of use in patients at risk of hypoventilation
spO2; etCO2
for a patient with dz of NM system, to mitigate risk of hypoventilation in PACU, what could you do?
keep the pt intubated until fx returns and residual anesthetic effects are absent
hypotension is defined as a fall in arterial BP > __________% below baseline, or an absolute value of <_______mmHg systolic or MAP < ______ mmHg
20; 90; 60
clinical signs of hypoperfusion
- altered MS 2. hypotension 3. tachycardia 4. tachypnea 5. cool & clammy skin 6. decreased capillary refill 7. peripheral cyanosis and mottling 8. oliguria
in the PACU what is the most common cause of hypotension
hypovolemia
in the PACU your patient has hypotension, and you fluid resuscitate the patient, but there is no response, what should be considered the cause of hypotension?
myocardial dysfunction
what should be the initial tx of hypotension in the PACU
- assess for active bleeding 2. give 300 - 500 mL fluid bolus of NS or LR
respiratory cause of hypotension in PACU
tension pneumothorax
differential dx for hypotension in the PACU
- hypovolemia 2. MI, tamponade, PE 3. dysrhythmia 4. CHF exacerbation 5. tension pneumothorax 6. anaphylaxis/histamine release 7. anesthetic agents 8. vasodilators 9. sepsis
____________ is the leading cause of HTN and tachycardia in the PACU
pain
what is defined as hypertension
BP > 20% of baseline
htn and tachycardia 2/2 pain is known as the __________________ reflex
somatosympathetic
where should planning for postop pain control begin?
in the holding room
multimodal approach to pain control
- tylenol and NSAIDs 2. ketamine 3. alpha agonists 4. gabapentin 5. regional/local anesthetics 6. corticosteroids 7. opioids 8. repositioning and reassurance
differential dx for htn in the PACU
- pain 2. hypoxemia and hypercarbia 3. distension of the bladder 4. hypothermia + shivering 5. preexisting HTN 6. medications
medications that cause htn in the PACU
- vasopressors used intraoperatively 2. withdrawal from opioids 3. narcan administration 4. ketamine 5. rebound effects of clonidine and/or BB
incomplete reversal of neuromuscular blockade can lead to what postoperative pulmonary complications?
- compromised cough 2. obstruction 3. loss of airway patency 4. hypoventilation
who would you expect to be the most at risk for having residual NMB effects (after reversal) in the PACU
elderly
what objective measurement tools should be used in early postop to assess for depth of residual block
TOF and double burst
why is marginal NMB reversal more dangerous than near total paralysis?
bc an agitated pt exhibiting uncoordinated movements and airway obstruction is more easily identified with near total than marginal
what medications potentiate NMB
- aminoglycosides 2. lasix 3. inderal 4. dilantin
what NM dz’s will have a prolonged response to NMBA?
MG, eaton lambert, muscular dystrophies
______________ is defined as a condition characterized by extreme distrubances of arousal, attention, orientation, perception, intellectual fucntion, and affect
delirium
delirium is MOST commonly accompanied by __________ & _____________
fear; agitation
what are the four categories of postoperative delirium
- withdrawal psychosis 2. toxic psychosis 3. circulatory and respiratory origin 4. funtional psychosis
what is withdrawal psychosis
withdrawal of various substances such as alcohol and illcit drugs
