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APA/Foundations 1 > complications > Flashcards

complications Flashcards

1
Q

Top 3 ASA closed claims

A

Death
Nerve Injury
Brain damage

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2
Q

3 biggest human errors leading to preventable anesthetic accidents

A

Medication errors**
IV line disconnection (or infiltration)
Anesthesia machine misuse

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3
Q

which 3 settings are associated with awareness*

A

major trauma**
obstetrics
cardiac surgery

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4
Q

awareness rate

A

0.1-0.4%

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5
Q

scopolamine has what kind of effect

A

retrograde amnesia

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6
Q

most common eye injury*

A

corneal abrasion

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7
Q

most common cause of post op loss of vision

A

ischemic optic neuropathy

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8
Q

Ischemic Optic Neuropathy

A

optic nerve infarction due to decreased oxygen delivery via one or more arterioles supplying the optic nerve
(ischemic optic nerve from hypotension, etc.)

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9
Q

ION is commonly reported after which surgeries

A

cardiopulmonary bypass
radical neck dissection
abd and hip procedures
spinal surgeries in prone

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10
Q

contributing patient factors to ION

A

HTN, DM, CAD, Smoking

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11
Q

3 positions that compromise venous outflow

A

prone
head down
compressed abd

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12
Q

onset of ION

A

immediately and through 12 post op day

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13
Q

prevention of ischemic optic neuropathy: enhance venous outflow by positioning the patient

A

head up

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14
Q

Most common CV event after non cardiac surgery

A

MI*

5% patients > 45 yo

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15
Q

Spinal anesthesia severe complication?

A

cardiac arrest

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16
Q

Spinal anesthesia cardiac arrest c/o associated with

A

high level of block (T4)

fast injection time

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17
Q

Signs and sx prior to cardiac arrest with spinal anesthesia

A
  • gradual ↓ in HR and BP (<20% of baseline)
  • ↓ HR
  • ↓ BP
  • cyanosis

check if can wiggle fingers

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18
Q

4 types of hypersensitivity reactions

A

type 1 immediate, type 2 cytotoxic, type 3 immune complex, type 4 delayed, cell-mediated

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19
Q

anaphylaxis

A

exaggerated response to an allergen that is mediated by a type 1 hypersensitivity reaction

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20
Q

anaphylaxis appears within

A

minutes of exposure

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21
Q

prevention of ION - minimize ___ constriction

A

abd

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22
Q

prevention of ION: limit degree and duration of ___

A

deliberate hypotension

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23
Q

prevention of ION: avoid ___ (think blood)

A

anemia

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24
Q

cardiac accelerators are

A

T1-T4

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25
Q

3 drugs for CPB arrest after spinal

A

ephedrine, atropine, epi

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26
Q

what causes hearing loss after spinal

A

CSF leak

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27
Q

what do you treat hearing loss due to csf leak with

A

blood patch

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28
Q

what is an allergic reaction

A

eggaterated immunologic response to antigenic stimulation a previously sensitized individual

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29
Q

antigen or allergen is typically

A

a protein, a polypeptide, or smaller molecule that is covalently bound to a carrier protein

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30
Q

first exposure in anaphylactic reaction what happens

A

antigen - b cell- IgE binds to surface of mast cell

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31
Q

second exposure of antigen

A

causes the cell to release histamine and histamine increases the permeability and distention of the blood capillaries

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32
Q

allergic reaction: pt can lose up to 50% of ___ volume into the ____ space

A

intravascular , extravascular

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33
Q

type 1 immediate allergic reaction

A

atopy, urticaria, angioedema, anaphylaxis

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34
Q

type 2 cytotoxic allergic reaction

A

hemolytic transfusion reactions, autoimmune hemolytic anemia, heparin induced thrombocytopenia,

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35
Q

type 4 delayed, cell-mediated

A

contact dermatitis

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36
Q

latex is type

A

4

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37
Q

graft rejection is type

A

4

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38
Q

RA is type

A

3

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39
Q

blood type incompatibilities is type

A

2

40
Q

anaphylaxis presents as

A

acute resp distress and/or circulatory shock

41
Q

incidence of anaphylactic reactions during anesthesia

A

1:500 to 1:25000

42
Q

mediators of anaphylaxis

A

histamine, leukotrienes, BK-A, platelet-activating factor

43
Q

CV anaphylaxis

A

hypotension, tachycardia, arrhythmias

44
Q

anaphylaxis pulmonary

A

bronchospasm, cough, dyspnea, pulm edema, laryngeal edema, hypoxia

45
Q

dermatologic manifestation of anaphylaxis

A

uticaria, facial edema, pruritis

46
Q

anaphylactoid reactions

A

resemble anaphylaxis but doe not depend on IgE antibody interaction with antigen (pt doesnt have to be exposed to the antigen prior)

47
Q

4 risk factors associated w hypersensitivity to anesthetics

A

female, atopic history, preexisting allergy, previous anesthetic exposure

48
Q

treatment of anaphlaxis - epi dose

A

0.01-0.5mg IV or IM

49
Q

treatment of anaphlaxis - drugs

A

diphenhydramine (H1 blocker),Ranitidine (H2 blocker), hydrocortisone or methylpred

50
Q

what are the most common cause of anaphylaxis during anesthesia

A

muscle relaxants

51
Q

what is the mechanism for allergic reaction to muscle relaxants

A

anaphylaxis - IgE antibody directed against tertiary or quaternary ion epitope

52
Q

hypotic agent that cause allergic reaction

A

pentothal propofol

53
Q

ester local anesthetic allergic reaction

A

IgE mediated, share common antigenicity with PABA

54
Q

amide local anesthetic allergic reaction

A

paraben or methylparabel

55
Q

second most common cause of anaphylaxis d/t anesthesia

A

latex

56
Q

foods that cross react with latex

A

mango, kiwi, chestnut, avocado, passion fruit and banana

57
Q

how do you pre-treat someone for latex allergy

A

h1 and h2 histamine

58
Q

occurane of MH in bed

A

1:15,000

59
Q

occurrence of MH in adult

A

1: 40,000

60
Q

MH causes what acid bace imbalance

A

metabolic acidosis

61
Q

signs of Mh -jaw

A

masseter spasm

62
Q

electrolyte imbalance in MH

A

hyper K, NA, Phos, CK, myoglobinemia, myogloinuria

63
Q

late sign of MH -

A

core temp rise 1 degree C every 5 min

64
Q

MH hyperkalemia caused by

A

efflux of K from muscle cells and systemic acidosis

65
Q

drug that trigger MH

A

halogenated agent and depolarizing muscle relaxant (succs)

66
Q

dantrolene doe

A

2.5mg/kg

67
Q

max dose of dantrolene

A

10mg

68
Q

how to treat hyperkalemia

A

dextrose 25-50g IV, regular insulin 10-20units IV

69
Q

what does insulin do to K

A

forces it into the cell

70
Q

albuterol in treatment of hyperk

A

beta 2 agonist, pushes K into the cell

71
Q

bicarb

A

pushes K back into cell

72
Q

how does dantrolene work

A

interfere with muscle contraction by binding ryr1, inhibit CA ion release from sarcoplasmic reticulum

73
Q

side effects of dantrolene

A

muscle weakness, resp insufficiency, risk of aspiration, phlebitis

74
Q

larynogospasm

A

complete spasmodic closure of the larynx as a consequence of an outside stimulus. closer of the glottis as a result of reflex obstruction of the laryngeal muscles

75
Q

complete larynogospasm

A

silent paradoxical movement of the chest, tracheal tug, and no ventilation

76
Q

partial larynogospasm

A

crowing noise

77
Q

laryngospasm treat with

A

deepen patient, CPAP

78
Q

signs of bronchospasm

A

prolonged expiration, high inflation pressures, exp wheezes, decreased O2 sat

79
Q

increasing circuit pressure is a sign of

A

bronchospasm

80
Q

wheezing is a sign of

A

bronchospasm

81
Q

bronchospasm best tx with

A

anesthetic gas

82
Q

bronchospasm tx med

A

epi, albuterol

83
Q

3 things on the fire triangle

A

heat, fuel, oxygen

84
Q

maximum acceptable trace concentration of N20

A

<25ppm

85
Q

maximum acceptable trace concentration of N20 and halogenated agent

A

<25 ppm and 0.5HA

86
Q

maximum acceptable trace concentration of halogenated agent only

A

~2 ppm

87
Q

inverse square law

A

amt of radiation changes inversely with the square of the distance.

88
Q

exposure at 4m will be ___ of that at 1m

A

1/16

89
Q

maximum occupational whole body exposure annually is

A

5rem/year

90
Q

maximum occupational whole body exposure annually is

A

5rem/year

91
Q

sensory innervation (afferent) apex

A

SNL internal

92
Q

motor innervation (efferent)

A

SLN external + RLN

93
Q

bronchospasm will give you prolonged

A

expiration

94
Q

bronchospasm will give you high ___ presures

A

inflatoin

95
Q

STPC

A

standard color, tall man lettering. technology (scanning), pharmacy (pre-mixed/pre-filled), culture (nonpunative)

APA/Foundations 1 (9 decks)

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