capsule peri op and anaesthesia Flashcards
what to give for local procedure in digits
local anesthetic agent-ring block. rapid and effective regional anaesthesia. never use anaesthetic containing adrenaline in digits as vasoconstroctor effects can cause ischaemia
when should lidocain not be used
intra arterially as regional anaesthetic
when does lidocain become peak plasma arterial concentration
25-20 min post injection. pt need to be monitored for at least this amount of time if larger doses of lidocaine has been used
when can you use IV lidocain as initial treatment
ventricular tachy arrthythmias
how does local anaesthetic work
inhibits influx of sodium into cells, and act on small unmyelinated c fibres before (which transmit pain and temperature sensation) large A fibres (which transmit touch and power)
when does lidocaine become peak plasma arterial concentration
25-20 min post injection. pt need to be monitored for at least this amount of time if larger doses of lidocaine has been used
when does lidocaine become peak plasma arterial concentration
25-20 min post injection. pt need to be monitored for at least this amount of time if larger doses of lidocaine has been used
how would you try to make anaesthetic more affective
enabling anaesthetic to warm up, adding adrenaline (so effect can last longer because delays anaesthetic being washed out into circulation)
but never use adrenaline in digits as it can cause ischaemia
what are side effects of local anaesthetic
cardiac arrythmias, neurotoxicity, central resp depression.
allergic reaction eg urticaria or anaphylaxis
insensible loss
evaporative water loss from skin and resp tract
50ml/h in hospitalised pt, or 0.5-1ml/kg/h
how to calculate maintenance fluid
4 2 1 rule (4mls/ kg for the first 10kg, 2mls/ kg for next 10kg and 1ml/kg for the remaining weight)
Daily sodium requirements are between 1-2 mmol/kg and potassium 0.5 – 1mmol/kg.
crystalloid
inorganic ions or small molecules- glucose
gelatin
colloidal solutions with molecular weight of 30,000. no longer in regular use
dextrose 5%
will distribute throughout total body water
hartmann’s solution
balances salt solution containing lactate-metabolised by liver to bicarbonate. balanced because it has less chloride than normal saline and closer to electrolyte contents of plasma
how to dec risk of regurgitation of stomach
A rapid sequence induction is the standard technique to rapidly secure the airway with an endotracheal tube. This technique is indicated in any patient at risk of regurgitation to reduce the likelihood of aspiration of stomach contents of which he is at a high risk of due to his hiatus hernia.
administer antacid before anaesthesia
which conditions are associated with higher risk of aspiration under anaesthesia
diabetic, diagnosed with hiatus hernia, symptoms of acid reflux, BMI 45
when do you transfuse blood post op
post op pt without cardiovascular disease do not need to be transfused unless Hb less than 80
how can peri-op transfusion of donated blood be dec?
using regional anaesthesia instead of local, correcting pre op anaemia before pt undergo surgery. adhering to guidelines for approrpiateness of post- op blood transfusion
using intra-operative cell salvage techniques
what should you transfer to anaemic pt
packed RBC, - have been seperated from whole blood by centrifuge. RBC are denser and settle to bottom and majority of liquid blood plasma remains on top
how to test if pt is hypovolaemic
elevate pt legs and measure BP with her lying supine- inc venous return to heart and stroke vol which will inc BP
MAP
Diastolic pressure+ 1/3 pulse pressure (systolic-diastolic)
ST elevation in lead II, III, AVF
inf MI and reciprocal changes in I and AVL
ST elevation in precordial leads and I an dAVL
LAD ant stemi
st elevation in II, III, AVF and depression in V1-3
post stemi, often occurs with inferior MI- in L Cx artery
what anti coagulation do you give in acute inf MI
clopidrogel and aspirin
new heart murmur and fever indicative off
infective endocarditis
peripheral oedemma, basal crackles, SOB
acute heart failure
SOB and pain on deep inspiration
PE
febrile, tachycardic, productive cough
pneumonia
central chest pain, non radiating worse at night and relieved by eating
oesophagitis, gastritis
SOB, heavy smoker, occasional wheeze, productive cough
COPD
lung bases dull to percuss, poor air entry bilaterally
pleural effussion
syncope: sudden collapse (transient loss of consciousness), immediately waking on reaching floor
aortic stenosis
how does warfarin work?
vit K antagonist so prevents formation of clotting factors. takes a few days to work
waht does intrinsic pathway involve
begins in blood stream, involves factors XII, XI, IX
what does extrinsic pathway involve
begins in blood vessle and involves factor III and VII. prothrombin time so can be ued to monitor warfarin
what is common pathway
X and II
what is INR
international normalised ratio compares time taken for blood sample to clot compared to normal control sample.
how does warfarin affect INR
prolongs the time for clotting so inc INR
what can cause change in INR
warfarin metabolism de activates cytochrome PD50 so interacts with many medication
Vit K
lifer function
other drugs that can affect vit K synthesis-cephalosporin
what reaction is ABO incompatavilty
raised temp, HR, abrnormal bleeding ( haemoglobinuria) and low BP. wrong blood given to wrong person so cause acute intravascular haemolysis
transfusion related lung injury PC
tachypnoea, hypoxia, low BP, pulmonary oedema due to donor HLA antivodies that attack host leucocyte antigen which activate lung neutrophils that damage lung tissue so cause oedema
what criteria used to ascertain what anticoagulatn needed
CHA2DS2-VASc- ascertain LT risk of stroke in pt with Af
CHA2?
C: congesitv heart failure-1
H: HTN-1
A: age over 75:2
DS2
DM
S: stroke, TIA, thrombo-embolism: 2
VASc?
V: vascular disease-1
A: age 65-74: 1
S: sex femal=1
