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Foundations > Complications > Flashcards

Complications Flashcards

1
Q

Perioperative Mortality: Death occurs how long after surgery?

A

Within 48 hrs.

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2
Q

How many anesthesia related deaths per year?

A

1 : 100,000.

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3
Q

A higher ASA means what perioperative?

A

> Risk

I .04 : 10,000
II. 0.5 : 10,000
III. 2.7 : 10,000
IV. 5.5 : 10,000

> ASA = > Risk

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4
Q

ASA Lawsuits and Claims (*)

A

(*) Slide 3. (prob wont be on test but maybe boards.)

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5
Q

Unpreventable things:

A
  • Sudden Death Syndrome.
  • Fatal idiosyncratic drug reactions.
  • Poor outcomes despite proper management.
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6
Q

Preventable things:

A

Human Error

Equipment Malfunction

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7
Q

Top 3 Closed Claims in the 90’s

A

Death 22% (not really most common complication, most common claim).
Nerve injury 18%
Brain damage 9%

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8
Q

3 Emerging Claims:

A

Regional anesthesia 16%
Chronic Pain Management 18%
Acute Pain 9%

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9
Q

Preventable Human Errors:

A
  • Unrecognized breathing circuit disconnect.
  • MEDICATION ERRORS Blue top Vs Orange top.
  • Airway mismanagement
  • Machine misuse
  • Fluid mismanagement
  • IV disconnection
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10
Q

4 Factors associated w/ Human Error

A
  • Inadequate preparation
  • Inadequate experience
  • Environmental limitations
  • Physical & Emotional Factors
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11
Q

7 Airway Injuries:

A
  • Sore Throat
  • Dysphasia
  • Dental injury
  • TMJ
  • Vocal cord Paralysis & Granuloma
  • Arytenoid dislocation
  • Esophageal perforation
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12
Q

Peripheral Nerve Injury

A

Positioning

Hypotension (poor perfusion)

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13
Q

Complication : Position Slide (*)

A

(*) Look at slide 16

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14
Q

Awareness occurs how often?

A

0.2-0.4%

Major trauma the lost (43%)
OB (1.5%)
Cardiac Surgery (0.4%)

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15
Q

Preventative Intraoperative Recall

A
  • Consent process
  • Define MAC
    == MAC 0.6 - Opioids & N2O
    == MAC 0.8 - 1.0 when used alone
  • Yes, use BIS monitor if available
  • ET Concentration Documentation
  • Amnesia Drug Documentation
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16
Q

3 most common Eye Injuries:

A
  • Corneal Abrasion (most common eye injury)
  • Blindness (general, MAC, movement)
  • Ischemic Optic Neuropathy (ION)
    == most common post operative LOV.
    == prone, CPBypass, neck & abdominal
    > Risk: HTN, DB, CAD, Smoking
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17
Q

(^) What 3 things compromise venous outflow during surgery?

A
  • Prone
  • Head Down
  • Compressed Abdomen
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18
Q

Surgical and Anesthesia Factors:

A

Deliberate Intraoperative Hypotension
Anemia
> Surgical Time (^)

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19
Q

How often can onset occur post-operatively?

A

12 days

== < Visual acuity-compete blindness

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20
Q

ION Prevention:

A 
> venous BF
< Abdominal constriction
Monitor BP
< duration of hypotension
Avoid anemia
Staging of surgeries for pts at risk for ION
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21
Q

Cardiopulmonary Arrest during Spinal Anesthesia. Where? How Long? Assoc w/?

A
  • High Level of block (T4) prior to arrest.
  • Occurs within 36-18 mins.
  • Assoc. w/ resp. depression from >CO2 from sedation. “Just laying there”
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22
Q

Spinals/Epidurals are placed where?

A

Lower Back

23
Q

What are the cardiac accelerators?

A

T1-T4

24
Q

Spinals/Epidurals affect what first, Respiratory or Cardiac?

A

Cardiac (Accelerators) T1-T4

Resp C3,C4,C5 “Keep the man alive”

25
Q

Bellybutton

A

T10

26
Q

Zyfoid

A

T6-T7

27
Q

Nipple

A

T4

28
Q

Pinky

A

C8-T1

29
Q

S & S of Cardiopulmonary Arrest

A

< HR & BP
Bradycardia
Cyanosis

30
Q

TX for Cardiopulmonary Arrest

A 
Vent Support
Ephedrine (>HR &amp; BP)
Atropine (>HR)
Epinephrine 
CPR
ACLS (DOSES)
31
Q

Hearing Loss

A

After Spinal ~50% (CSF leak)

After General Barotrauma, Vascular injury…

32
Q

Allergic Reaction

A

(1st exposure) B-cell, IgE, binds to mast cell.

(2nd exposure) reacts with IgE causes release of histamine and other swelling agents.

33
Q

4 Types of Allergic Reactions:

A

I. - Immediate (Urticaria, Anaphylaxis)
II - Cytotoxic (HIT)
III- Immune Complex (allergies)
IV- Delayed (latex)

Slide 39

34
Q

Rate of Anaphylaxis

A

1 : 5,000 - 1:25 : 000

Type I hypersensitivity reaction

35
Q

What 2 things result from Anaphylaxis

A
  • Asphyxiation

- Irreversible circulatory shock.

36
Q

4 Mediators of Anaphylaxis:

A

Histamine
Leukotrienes
BK-A
Platelet-activating factor

37
Q

Cardiovascular Reaction of anaphylaxis:

A

Hypotension
Tachycardia
Arrythmias

38
Q

Pulmonary Reactions of Anaphylaxis:

A

Bronchospasm
Cough
Hypoxia
Laryngeal and pulmonary edema

39
Q

Dermatological Reaction of Anaphylaxis:

A

Urticaria
Facial edema
Pruritus

40
Q

Anaphylactoid Reactions:

A
  • Not dependent on IgE antibody

- Same cardiovascular and respiratory symptoms

41
Q

4 Risk Factors with Hypersensitivity to Anesthetics:

A

Female
Atopic Hx
Preexisting allergies
Previous anesthetic exposure

42
Q

Tx of anaphylactic and anaphylactoid reactions:

A 
DC Drug
100% O2
Epinephrine (.01-.5 mg)
Intubation
IV Fluid (1-2 L LR)
Benadryl (50-75mg)
Ranitidine (150mg
Hydrocortisone (200mg)
43
Q

Anaphylaxis Algorithm Slide #50

A

Slide 50

44
Q

Most common anesthetic drug that causes allergic reactions:

Others:

A

Muscle Relaxants (1 : 6500)
70% of all reactions.
IgE,
Rocc, Succ

Others:
Pentathol
Propofol
Opioids
Local anesthetics (rare) (Ester / Amide)
Antibiotics 
==Vancomycin (Red Man’s Syndrome)
45
Q

Latex Allergy

A

2nd most common
Type IV sensitive reaction
IgE
Foods: Tropical fruits & chestnuts

46
Q

Malignant Hyperthermia Most Specific

A

ET CO2

47
Q

MH Most Sensitive:

A

Tachycardia

48
Q

Pathophysiology of MH

See Slide # 65-68

A

Slide 65-68

> intracellular Ca, Muscle contractions.

> K

Abnormal Ryanodine Ryr1 receptors.

Sudden death in 15 mins

49
Q

MH Drugs

A

Iso, Des, Sevo
Succ (depolarizing)

Not:
Rocc, N20, Propofol, benzo/barb

50
Q

MH Tx

A
  • DC Meds
  • Call for Help
  • Hyperventilate 100% O2
  • Dantrolene 2.5 mg/kg ASAP q 5 mins. Max 10 mg/kg
  • Sodium Bicarb 1-2mEq/Kg
  • Ice
  • Change AGM and Soda Lime
  • Promote Urinary Output
  • Tx > K
51
Q

Laryngospasm

A

Complete vs Partial
Inspiratory Stridor
Paradoxical Chest/and movement

52
Q

Bronchospasm

A
  • Narrowing of airway passages
  • > Airway resistance
  • Expiratory wheezes
  • < O2 Sat
  • Prolonged expiration
53
Q

4 things needed for Fire:

A

Oxygen
Heat
Fuel

Foundations (5 decks)

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