Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Miscellaneous Topics > Apex- Misc: Thermoregulation/Airway Fires/Lasers/Burns > Flashcards

Apex- Misc: Thermoregulation/Airway Fires/Lasers/Burns Flashcards

1
Q

What is the BEST method of minimizing intraoperative heat loss?

A. Forced air warmer
B. Circulating water mattress
C. Warm blankets
D. Fluid warmer

A

A. Forced Air warmer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Rank the four mechanisms of heat transfer in order of importance:

Convection, Evaporation, Radiation, Conduction

A
  1. Radiation
  2. Convection
  3. Evaporation
  4. Conduction

  1. You love to radiate in the sun- thats your primary preference of warming
  2. convection oven would be second warmest compared to the sun
  3. Evaporation - sweating
  4. Conduction ….. idk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hypothermia is defined as a core body temp less than what

who’s at greatest risk of developing perioperative hypothermia?

A

< 36 degrees celsius

extremes of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

1 source of heat loss

A

Radiation

-heat follows a temp gradient. If pt is warmer than the enviornment, the heat is lost to the envionrment in the form of infrared radiation
-most heat is lost thru the skin and covering hte patient reduces radiant heat loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

T/F: most of the heat is lost through the skin

A

True

radiation*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

T/F: covering the patient reduces radiant heat loss

A

true

most heat is lost through skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What kind of heat loss is the transfer of heat by the movement of matter

A

Convection - Air

second mort important source of heat loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What kind of heat loss describes when air movement over the body whisks awary the heat that has radiated from the body

A

Convection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Does laminar or turbulent flow increase the amount of heat lost to convection

A

laminar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what kind of heat loss is a function of the exposed surface area and the relative humidity of the envionrment

A

evaporation

water can be lost by evaporation from respiration, wounds, and exposure of internal organs during surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What kind of air loss describes when heat is lost when the patient comes into direct contact with a cooler object

examples?

A

conduction

cold OR table, IVF, irrigation fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which temp monitoring site offers the BEST combination of accuracy and safety over an extended period of time?

  1. Rectal
  2. Esophageal
  3. Tympanic membrane
  4. Esophageal
A

B. Esophageal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Shivering increases O2 consumption by how much?

what does this increase the risk of?

A

400-500%

myocardial ischemia and infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where should esophageal temp be monitored?

how many cm pas the incisiors?

A

distal 1/3 - 1/4 of esophagus

38-42 (~40)cm passt incisiors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T/F- skin temp does not correlate with core body temp

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Temp is (directly/inversely) related to solubility of anesthetic agents

A

inversely related

-decreased temp = increased solublity (longer wakeup)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

O2 comsumption is reduced by what % for every 1 degree C reduction in body temp?

A

7%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Skin temp is often how many degrees less than core temp?

A

2-4 degrees celsius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Anesthetic considerations for removal of vocal cord papilloma with a carbon dioxide laser include:

A. reducing the FiO2 by adding nitrous
B. applying reflecting tape to a red rubber ETT
C. using amber goggles
D. adding saline instead of air to the cuff of the ETT

A

D.

2 benifits:

  1. acts as a heat sink for the thermal energy produced by the laser
  2. if the laser breaks the balloon, then the surgeon will see the salline in the surgical field- adding dye to the saline makes it more obvious
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When should you add saline to your ett cuff instead of air and why?

A

airway surgery with a laser

  1. acts as a heat sink for the thermal energy prodduced by the laser
  2. if the laser breaks the balloon, then the surgeon will see the saline in the surgical field
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When a laser is in use, air should be blended with o2 to maintain an fio2 < what

can nitrous be used?

A

< 30%

no- nitrous supports combustion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What color glasses for CO2 laser?

A

clear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Fire triad and 2 examples of each

A
  1. ignition source- cuatery, laser
  2. oxidizer: oxygen, nitrous
  3. fuel: ETT, drapes, surgical supplies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What color goggles for each laser:

CO2
Nd: YAG
Ruby
Argon

A

CO2 = Clear
Nd: YAG = Green
Ruby = Red
Argon = Amber

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
5 key points regarding laser safety
1. keep FiO2 < 30% 2. No nitrous 3. Laser resistant ETT 4. Fill cuff with saline 5. Protect pt's eyes by taping eylind closed, covering them with saline-soaked gauze, and using protective glasses specific to the laswer used
26
T/F: you should squeeze the reservior bag when extubating the patient for an airway fire
false ## Footnote can create a blow-torch effect at the distal end of hte ETT and push debris in to the lower airway
27
5 steps for airway fire ## Footnote 3 steps to take after fire is controlled
1. stop ventilation and remove ETT --> AKA: Disconnect and pull 2. turn off all flows 3. remove other flammable materia lfrom the airway -> throw down drapes 4. pour water or saline into airway 5. if still not extinguished - use a CO2 fire extinguisher ## Footnote 1. re-establish ventilation by masking on RA 2. check ETT for damage - fragments may still be in airway 3. bronch to inspect for airway injury or retained fragments
28
T/F: short wavelength lasers penetrate DEEPER into tissue
true- bc they absorb LESS water ## Footnote opposite of what you would think -long wavelength laswers absorb more water and do NOT penetrate deep into tissue
29
4 C's of CO2 lasers
CO2 Clear goggles Cords (vocal cord surgery) Cornea at risk for damage
30
Most lasers pose risk to which eye structure | what's the exception
Retina | CO2 = CORNEA
31
Match Laswer with type of surgery: Nd:Yag, Ruby, Argon, CO2 retinal, tumor debulking/tracheal, oropharyngeal/vocal cords, vascular lesion
**C**O2 = **c**ords Nd: YAG = tumor debulking/tracheal **R**uby = **R**etinal Argon = Vascular lesion
32
which of these ETTs are flammable, those madefrom: -polycinyl chloride, red rubber, or silicone
all of them!
33
T/f: laser reflective tape is no longer advised
true ## Footnote better to use a laswer resistant ETT (its not laser proof though)
34
what is the most vulnerable part of the ETT to laswer
the cuff
35
T/f: laser resistant tubes have laser resistant cuffs
FALSE- the cuffs are not laswer resistant
36
ETT for a co2 laser vs Nd:Yag laswer
CO2 = LaserFlex Nd:Yag = Lasertubus
37
laser resisant tube - 2 cuffs, distal and proximal - which one do you fill with saline and why
saline goes in proximal cuff - it helps absorb theral energy produced by the laser, making it less likely to ignite distal cuff = air hopefully if the proximal cuff perf's , the distal cuff will remain intact and permit continued PPV
38
Why is gas embolus a risk with laser surgery?
Bc gas may be used to cool the tip of the laswer probe | highest risk in laparoscopic uterine surgery
39
T/F: laser resistant ETT also reduce the risk of fire when electrosugical cautery is used
False
40
How should the patien'ts eyes be protected when laswer are in use (3) | what type of lubricants should be avoided
1. type eyelids closed 2. cover eyelids with saline-soaked gauze 3. appropriate glasses | no petroleum-based lube
41
37% | I dont understand how this computes but okay —->full arm =9 + front = 18 + head = 10 ## Footnote Rule of nines: Head = 10 Trunk = 36% Arm = 9% Leg = 18% Perneum= 1%
42
4 Classes of burn injury: name and what parts
1- Superficial- Epidermis only 2- Partial-thickness- Extends to dermis 3- Full thickness - Complete destruction of both epidermis and dermis (subq) 4th - Full-thickness- Extends to muscle and bone
43
At which classification does a burn not hurt because the nerve endings are obliterated?
3rd and 4th
44
45
What is the BEST IVF to administer in the intial 24hrs after a major burn: A. D5W B. 3% NaCl C. 5% Albumin D. LR | what about 24 hours AFTER a major burn
D. LR for first 24hrs | D5W for 2nd 24 ## Footnote *Albumin should be avoided during the first 24 hours bc it's lost to the intersistal space
46
How long should albumin be avoided after a major burn and why
first 24 hrs bc it'll be lost to the intersistial space
47
Why are burn pts at risk for hypovolemic shock
bc immediately after a burn, microvascular permeability increases --> capillarly leak --> edema, hypovolemia, and shock
48
T/F- fluid requirements are higher in the 2nd 24 hours following a burn
False - ## Footnote *fluid shifts and edema are greatest in the first 12 hrs and begin to stabllize by 24 hours
49
2 most common fluid resusitation formulas for the acutely burned patient | These formulas are used for adults and kids > what
Parkland and Modified Brooke | adults and kids > 20kg ## Footnote both use LR in the 1st 24hrs and D5W thereafter
50
What does a rising hemoglobin in the first few days after a major burn suggest?
inadequate fluid volume resuscitation
51
Burn pts: consider transfusion if Hct < what in the thealhy patient or < what in the pt with cardiovascular disease
Healthy- HCt < 20 CVD- Hct < 30
52
Parkland and Modified brooke formula main difference ## Footnote other aspects that are the same
Parkland = 4ml LR x %TBSA burned x kg Modified Brooke = 2ml LR x %TBSA burned x kg | in the first 24 hours ## Footnote both say no to colloids for first 24 hours 2nd 24 hours: both say D5W maintenance rate & Colloids at 0.5ml x %TBSA burned x kg
53
# Burn Resusitation: Urine output: Adult- Child (<30kg) High voltage electrial burn:
Adult > 0.5ml/kg/hr Child (<30kg) > 1ml/kg/hr High voltage electrical injury > 1-1.5ml/kg/hr
54
# Burn Resusitation: Goal BP: Adult: Infant: Child:
Adult- MAP > 60 Infant- SBP > 60 Child- SBP - 70-- 90 + (2 x age in years) | gimme a break
55
Burn Resusitation: HR goal
80-140 | age depedent
56
Burn Resusitation: Base deficit goal
<2
57
Burn Resusitation: O2 delivery index
600ml 02/min/m2 | never gonna use that
58
Burn Resusitation: mixed venous oxygen tension (PvO2)
35-40mmHg
59
T/f: electrical burns often leave little visible damage on the skin
True- but can cause great damage to the viscera
60
Why would an electrical burn necessitate a greater fluid volume resusitation
myoglobinemia ## Footnote from extensive muscle damage - it's nephrotoxic and needs to be washed out
61
What might Abdominal Compartment Syndrome happen in the burn patient? | criteria ## Footnote treatment (4)
Aggressive fluid resuscitation | IAP > 20mmHg AND evidence of organ dysfunction ## Footnote Neuomuscular blockade Sedation Diuresis Abdominal decompression via lapartomy
62
CO binds to hemoglobin with an affinity of _ x that of oxygen
200x
63
T/F- why is the pulseox inaccurate in the pt with CO poisioning
bc it cant differentiate between oxyhemboglobin and carboxyhemoglobin resulting in a falsely levated result
64
tx for carboxyhemoglobin
100% FiO2 or hyperbaric o2
65
What is the **first** priority in all burn patients
administering a high FiiO2
66
What is the gold standard for diagnosing hte extent of airway injury
Fiberoptic bronchosocpy
67
T/F: tracheal intubation should occur early in burn patietns
true ## Footnote *the fiberoptic approach is prob the safeest method But at the same time it says a surgical airway increases the risk of pulmonary sespsi and later pulmonary complications and should only be used as a last resort
68
Discuss the use of Sux and NDMR's after a burn
After 24 hours, upregulation of receptors: No sux - massive hyperkalemia NDMR- increase 2-3 fold (to cover the increased receptors)
69
Difference in order of importance of heat loss mechanisms in burn pts compared to non-burn patients
Burns : Radiation > **Evaporation** > Convection > Conduction ## Footnote Non- Burn: Radiation > Convection > Evaporation > conduction
70
Abdominal compatement syndrome is defined as an IAP greater than what
20mmHg ## Footnote + signs of end organ damage (hd instability, oliguria, ect)
71
What causes Neuromalignant syndrome?
**dopamine depletion** in the* basal ganglia *and *hypothalamus* ## Footnote Tx: bromocriptine, dantrolene
72
What is Bromocriptine used for?
To treat neuroletpi malginant syndrome | *dopamine depletion in basal ganglia and hypothalmus
73
T/F: Dantrolene can be used to treat neuroleptic malignant syndrome
True | dantrolene, bromocriptine, and ECT
74
T/F: Sux is contrainndicated in NMS
false -it's safe
75
Which has muscle rigidity: Serotonin syndrome, Anticholineregic Syndrome, or NMS?
SS & NMS; | not anticholinergic syndrome
76
What is chlorpromazine ? | what can it cause ## Footnote what can it treat?
Thorazine- dopamine antagonist (antiemetic/antipsychotic) | NMS ## Footnote supportive care for serotonin syndrome (main tx- cypohepatadine)
77
4 main serotonergic drug classes that can cause serotonin syndrome ## Footnote 6 other drugs that can cause it
1. SSRI's 2. SNRI's 3. MAOI's 4. TCA's ## Footnote 1. methylene blue 2. mmeperidine 3. fentanyl 4. tramadol 5. sibutramine - appetite suppress (NE + SSRI)
78
Is serotonin syndrome more likely to cause right or left sided heart failure? ## Footnote why
right sided ## Footnote it's metabolized in the lungs and spares the left heart

Miscellaneous Topics (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions