CLINICAL SCENARIOS Flashcards
A medianstinoscopy is most useful for _______.
right lung cancers
What is the first and second most common complication during a medianstinoscopy?
1) hemorrhage
2) pneumothorax (primarily on right side)
Where should a BP cuff be placed during a medianstinoscopy?
left arm
Where should an a-line be placed during a medianstinoscopy?
right radial to assess for compression of innominate and right brachiocephalic arteries
Where should the pulse oximeter be placed during a medianstinoscopy?
right hand–> to assess vascular compression
Where is the incision made for a medianstinoscopy?
transverse incision just above suprasternal notch or in the 2nd or 3rd rib interspace
What arteries may be compressed during a medianstinoscopy?
innominate and right brachiocephalic arteries
What tissues can a pheochromocytoma be found in?
found in the abdominal cavity 95% of the time and originates in the adrenal medulla about 90% of the time
What is the diagnostic triad for pheochromocytoma?
1) diaphoresis
2) tachycardia
3) headaches
If a pheochromocytoma is not diagnosed and treated in a timely manner, the patient may die from _______. (3 main things)
1) CHF
2) myocardial infarction
3) intracerebral hemorrhage
What is the treatment (pre-operative preparation) for pheochromocytoma?
- alpha before beta
- alpha block with phenoxybenzamine 20-30mg/day and increase to 60-250mg/day in order to control BP
- prazosin is also an alpha blocker
- beta block primarily for treatment of tachycardia
- also need to check fluid status and assess for hypovolemia prior to surgery
What are some anesthetic considerations for pheochromocytoma surgery?
- DO NOT stimulate SNS
- Must have anesthesia in place before any stimulation occurs
- control tachycardia with esmolol, labetalol, and propanolol
What is the goal of one-lung ventilation?
to optimize arterial oxygenation
Name 2 absolute indications for one-lung ventilation.
1) prevent contamination of healthy lung
2) control distribution of ventilation
Name 1 relative indication for one-lung ventilation.
1) surgical exposure
What is the most common DLT used?
Robertshaw–> available in left or right and does not have a carinal hook like the Carlens (left DLT) or White tube (right sided Carlens DLT)
What is a description of Class 1 ASA?
healthy patient, no organic, physiologic, biochemical, or psychiatric disturbance
What is a description of Class 2 ASA?
patient with mild systemic disease (disturbance) that may or may not be related to the reason for surgery
EX) essential HTN, heart disease that only slightly limits activity, diabetes, anemia, extremes of age, morbid obesity, and chronic bronchitis
What is a description of Class 3 ASA?
patient with severe systemic disease (disturbance) that limits activity but is not incapacitating and may or may not be related to the surgery
EX) heart disease that limits activity, poorly controlled essential HTN, diabetes with vascular complications, chronic pulmonary disease that limits activity, history of prior MI and angina pectoris
What is a description of Class 4 ASA?
patient with an incapacitating systemic disease that is a constant threat to life with or without surgery
EX) CHF, persistent angina pectoris, any advanced kidney, liver, or pulmonary disease
What is a description of Class 5 ASA?
moribund patient not expected to live 24 hours with or without surgery; submitted to surgery as resuscitative effort
EX) pulmonary embolus, cerebral trauma or ruptured AAA (uncontrolled)
What is a description of Class 6 ASA?
a brain dead patient whose organs are being harvested
EX) organ donation
What is a description of Class E ASA?
any patient requiring emergency surgery (not elective)
EX) appendicitis, D&C for bleeding, etc.
A painless degeneration and atrophy of skeletal muscles (associated with mental retardation) is called ______.
muscular dystrophy
*hereditary disease
What is the most common and most severe neuromuscular disease?
Duchenne’s muscular dystrophy
- X-linked recessive
- Early childhood
What are some ECG changes seen with Duchenne’s muscular dystrophy?
prolonged QRS and PR interval; ST segment abnormalities, bundle branch block, Q waves, tall R waves
Why should you avoid succinylcholine with patients having Duchenne’s muscular dystrophy?
increased incidence of malignant hyperthermia
Should you use neuromuscular monitor with a patient having Duchenne’s muscular dystrophy?
neuromuscular monitoring is mandatory
______ is characterized by random and multiple sites of demyelination of corticospinal tract neurons in the brain and spinal cord, exclusive of peripheral neurons.
multiple sclerosis
What are some s\s of multiple sclerosis?
- visual distrubances
- ataxia
- limb paresthesia and weakness
- spastic paresis of skeletal muscles
- exacerbations and remission
With multiple sclerosis you should avoid marked ______ changes.
temperature
