CLINICAL Flashcards by Ama xo

TRAUMA from surgery can be from what? 4 examples

stress response
fluid shifts
blood loss
cardiovascular, respiratory, renal or metabolic stress

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general Anaesthesia - is what in other terms?

drug induced reversible coma

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what considerations are taken into place when administering ANA?

patient - co-morbidities and known pathologies

nature of surgery

post-op care

ANA techniques

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ANA role pr-operatively? 5

assess 
identify high risk - high risk of getting those complications 
minimise risk 
consent 
inform and support patients decisions

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pre-operative assessment inckudes what?

history
examination
investigations

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history pre-operative assessment includes what info? 3

known co-morbidities
unknown co-morbidities
ability of withstand stress - exercise tolerance etc

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history pre-operative assessment includes what info? 3

known co-morbidities
unknown co-morbidities
ability of withstand stress - exercise tolerance etc

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potential ANA problems asssociated with what areas of body? 4

airway - issues with intubation
spine - any deformities
reflux - not fasted?
obesity - gaining access difficult

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what grading systems are used to see what tests needed for patient pre-operatively? 3

ASA GRADE

SURGERY GRADE

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ASA GRADING? FOR?

explain the levels

scale to see how fit healthy patient is pre-operatively

ASA1 = otherwise healthy patient 
ASA 2 = MILD to moderate systemic disturbance 
ASA3 = severe systemic disturbance 
ASA 4 = life threatning disease 
ASA 5 = moribund patient 
ASA 6 = ORGAN RETREIVAL

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cardiac risk index includes what? 6

high risk surgery 
ischaemic heart disease 
congestive heart failure 
CVD
diabetes 
renal failure

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excericise tolerance - METS? why? explain levels?

indicator how well patient goes through surgery

list of which actviities patient can do without getting breathless

2mets to 9mets (healthy person)

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why look at lifestyle of patient before surgery?

look at this pre-operatively too as increase risk of surgery complications

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what happens in pre-operative medication provided by ANA?

most continue as normal
esp - inhalers, anti-anginals etc

might stop others that might hinder surgeyr - anti-coags.

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IPS?

MDT trained for acute pain management

ANA
NURSES
etc

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stages of an ANA?

INDUCTION - making patient sleep

MAINTENANCE - keeping patient asleep

EMERGENCE - process of waking up

RECOVERY - after ANA & recovery from surgery

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end tidal co2 is?

measure of co2 in gas exhaled

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mointoring standard in ANA when giving GA? 5

ECG
NIBP - 3 leads 
SATURATIONS 
ETCO2 
airway pressure

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what is the effect of ANA on patient blood pressure?

vasodilation

so goes down

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what access is needed prior to ANA?

need to find cannula before ANA - usually hands is where IV access is found

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why does ANA reduce o2 saturation when given?

under ANA - muscles relax and lung volume decreases

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why give pre-oxygenation?

to prevent reduction of gas to happen quickly - as muscles relax and lung volume decrease under ANA

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affect of residual capacity under ANA?

reduced UNDER ANA

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induction in patient given how and why?

gaseous - slow and in kids

IV cannula - used in fast and in adults

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induction medications categories? 3

multi drugs usually used analgesic hynotic muscle relaxant

analgesic drugs e/g 1

fentanyl

hypnotic drugs example ? 2

propofol | ketamine

planes of ANA describe?

not on/off = definite stages/levels of consciousness

planes of ANA - describe the 4 planes ?

1 analgyesia/ amnesia - relaxed/floaty 2 delirium to unconsciousness 3 surgical ANA --------- AIM (not move to surgical stimuli) 4 apnoea to death -------- AVOID

affect of ANA on airways? 2

loss of airway reflexes relaxation of tissues

breathing monitored by what 3 ?

saturation probe end tidal co2 airway pressure monitoring

3 types of breathing in ANA patient?

spontaneous venitlation - BREATHING on own controlled ventilation - help on breathing supported ventilation - can bretah but we help too

circulation affect under ANA?

haemodynamic instability common under ANA changes in BP and heart rate

how circulation monitored under ANA? 2

control of haemodynamics - BP checked reguaraly vasoactive drugs given - tighten bv to increase BP

SIGNS OF AWARENESS in ANA? 2

increase bp | sweaty

how to avoid awareness in ANA?

increase depth of AN monitoring | measure ANA in and out - tells how asleep patient is

body temp affect in ANA?

drop in temp - vasodilation

low temp consequences in ANA patient? 4

increase risk of surgical infection increase risk of bleeding increase pain after op increase risk of needing transfusion

what type of injury common in ana patient?

pressure injury - from cables/equipment

VTE in ANA patients?

thromboembolism | keep them active in long surgeries - stockings/pumpers to pump blood in legs

what needs to be carefully done when placing patient in ANA?

positioning of patient

constant adjustment means in ANA?

of level of ANA given to patient throughout to keep asleep

chronic pain is classed as ?

longer than 3 months

nociceptive pain describe?

obvious tissue injury inflammatory pain protective function

neuropathic pain?

nervous system damage tissue injury not as obvious burning, shooting, numbness

painkillers classification? 2 and examples 2 each

analgesics - paracetamol, NSAIDS | opioids - morphine, codeine

tramadol ?

mixed opiate

tramadol ?

mixed opiate - pankiller - analgyesic

amitriptyline?

TCA painkiller increases descedning inhibitory signals - to reduce pain

examples of anti-convulsant drugs? 2

carbamazepine | sodium valproate

pain ladder used in where?

in acute pain NOT NEUROPATHIC PAIN can use for nociceptive pain

PAIN LADDER EXPLAIN EACH STAGE

MILD/MODERATE PAIN = non-opioids - aspirins, NSAIDS, paracetemol MODERATE/SEVER PAIN = mild opioids, codeine, eith/without non-opioids(nsaids) SEVERE PAIN = strong opioids - morphine, with/without non-opioids(nsaids)

2 types of resp failure?

type 1 = oxygenation failure type 2 = oxygenation & ventilation failure

CVS failure due to shock??

shock leads to inability to get o2 into bloodstream - leading to cellular hypoxia

fluid either cooloids or crystalloids mean?

colloids - fluid that has large active particles in it crystalloids - fluid with small molecules in them

septic means?

unresposiveness to fluid intake

regional ANA?

prodcues insensbility in are/region of body ANA produced distal site served by that nerve

general ana means?

insensibilty in whole body

local ana means?

produces insensibility in only the relevant part of body ANA prodcued at site of injection

triad of ana?

analgesia hypnosis relaxation

opiates give what of triad of ANA?

analgesia | and hypnosis

local anaesthetics give what of triad of ANA?

analgesia relaxation no hypnosis

general ANA agents do what in the body?

supress neuron activity and interfere with neuronal ion channels by opening channels with alter neuron - hyperpolarise them

general ANA spare what function in the body?

reflexes - spinal/ autonomic

IV ANA - onset and recovery explained? e/g

onset - rapid rapid recivery thiopentone/ propofol

IV ANA drugs are what type?

highly fat soluble drugs - high % in fat

inhaled ANA are what type of drugs ? and their benefit?

halogenated hydrocarbons via lungs minimum alveolar conc - produce affect with any agent and low number also gives high potency - still gives same effect

maintenence of ANA in inhaled?

prologned duration - extends the time

GA common sequence?

general ANA is IV induction then inhaled maintenance

ana affect on sympathetic nerve actviity?

reduce it

muscle relaxants must be gIven with what? AND WHY

MUST BE GIVEN WITH HYPNOSIS DRUG as not nice being awake and cant communicate as muscles relaxed

indication to use muscle relaxant? 2

ventilation/intubation when need patient to be still

e/g of local ANA?

lignocaine bupivacaine ropivacaine

infusion technology for?

to find out right dose needed TCI - target controlled infusion system to achieve specific conc. of agents using pharmokinetics algorithms