Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles I Final > Crisis Scenarios > Flashcards

Crisis Scenarios Flashcards

1
Q

What process occurs to cause a bronchospasm?

A

Reflex Bronchiolar Constriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the two mechanisms in which bronchospasms occur?

A

Centrally mediated

Local reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What two things occur in a bronchospasm that would cause air trapping and hyperinflation?

A

Constriction

Mucus hyper secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What complication could occur from excessive air trapping after a bronchospasm has occurred?

A

May result in pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How would a bronchospasm eventually lead to cardiac collapse?

A

Alveolar distention increases intrathoracic pressure
Decreased venous return and cardiac output
Results in cardiac collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the causes of a bronchospasm?

A 
Airway Manipulation
Noxious Stimuli
Cold Air
Airway Irritants
Acute Exposure to Allergens
Stress of Surgery
Histamine Releasing Medications (morphine, vancomycin, atracurium)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What other pathologies should be ruled out from wheezing?

A

Pneumothorax, endotracheal tube obstruction, anaphylaxis, pulmonary edema, pulmonary aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the signs of a bronchospasm that an anesthetic provider may see?

A

Mucus Hyper secretion
High inspiratory pressures
Blunted expiratory CO2 waveform
Hypoxemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How might an awake patient present with a bronchospasm?

A

Tachypnea & Dyspnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can wheezing tell us about a bronchospasm?

A

Degree of wheezing is a poor indicator of the extent of obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the immediate treatment for a bronchospasm in the OR setting?

A

Check endotracheal tube position for carinal stimulation
Deepen the level of anesthetic, volatile agents are usually sufficient, if ventilation impaired, use IV sedative
Increase FiO2 to 100%
Administer a short-acting β2-agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some additional treatments for a bronchospasm if unable to relax the tissue?

A

Administer IV/IM epinephrine (10 mcg/kg)
Administer IV corticosteroids (Hyrdrocortisone 2-4 mg/kg)
Consider IV aminophylline if long term mechanical ventilation is planned

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When does negative pressure pulmonary edema occur?

A

Usually occurs during emergence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What two events usually cause negative pressure pulmonary edema?

A

Result of two events:
Airway obstruction
Patient initiated forceful breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of pulmonary edema is experienced by patients with negative pressure pulmonary edema?

A

Non-cardiogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What physiologic process occurs with negative pressure pulmonary edema?

A

Forceful inhalation attempt against a “closed glottis” creates extreme negative intrapleural pressure

Increased pulmonary transcapillary hydrostatic pressure

Rapid movement of fluid into lung interstitium, pulmonary lymphatic system overwhelmed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the primary cause of NPPE?

A

Laryngospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What other processes can also contribute to causing NPPE?

A

Airway Obstruction

Forceful inhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What other forms of pulmonary edema should be ruled out when considering NPPE?

A

Congestive heart failure & fluid overload
Acute respiratory distress syndrome
Aspirate gastric contents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does NPPE present once the laryngospasm has resolved?

A

Bilateral rales heard on auscultation
Rapid onset
May progress to hypoxemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a late sign of NPPE?

A

Frothy, pink sputum or frank bloody secretions indicate alveolar injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the most important components in treating NPPE?

A

Quick recognition is critical (vigilance) critical to treat before hypoxia and alveolar injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the typical treatment for NPPE?

A 
Identify and resolve airway obstruction
Supportive Therapies, oxygen & CPAP
May require (re)intubation for mechanical ventilator support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What medications may be used to treat symptoms related to NPPE?

A

Consider steroids to stabilize capillary membranes

Important! – Diuretics are not always indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the typical treatment for NPPE?

A 
Identify and resolve airway obstruction
Supportive Therapies, oxygen & CPAP
May require (re)intubation for mechanical ventilator support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is pulmonary aspiration?

A

Misdirection of oropharyngeal or gastric contents into the larynx and lower respiratory tract.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is another name for Aspiration Pneumonitis?

A

Mendelson’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How does an infection occur after aspiration if the fluid is acidic?

A

Acid aspiration pneumonitis reduces host defenses, increasing the risk of superinfection
Infection develops if aspirated material is colonized with bacteria, or when airway burns allow infection to develop from commensal pathogens.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What determines the severity of aspiration pneumonitis?

A

Varies directly with the volume of aspirate & indirectly with its pH.

30
Q

When is aspiration most likely to occur?

A

Largest number of aspirations occur during induction and emergence.

31
Q

How is aspiration diagnosed?

A

Visualization of gastric content in ET tube
ABG results
Infiltrates in perihilar and dependent regions with pulmonary edema

32
Q

What is the hallmark sign of intraoperative aspiration?

A

Arterial hypoxemia

33
Q

What actions should be taken if a patient vomits during induction?

A

Turn paFent’s head to the side, put bed in trendelenburg
Suction mouth and pharynx
Intubate using RSI as soon as possible
Perform tracheal suctioning and check pH of aspirate

34
Q

What actions should be taken if a patient vomits during induction?

A

Turn patient’s head to the side, put bed in trendelenburg
Suction mouth and pharynx
Intubate using RSI as soon as possible
Perform tracheal suctioning and check pH of aspirate

35
Q

What treatment should a patient receive if aspiration occurs?

A

Supportive Treatment
Oxygenation to minimal extent necessary
Aspiration of caustc material can increase likelihood of O2 toxicity
PEEP (after suctioning!) to treat/prevent atelectasis • Bronchodilators
• Empirical antibiotic/steroid treatment is discouraged

36
Q

What are the functions of the laryngeal muscles?

A

Swallowing
Breathing
Coughing
Speech

37
Q

What is the purpose of the laryngeal adductor reflex?

A

Essential reflex
• Allows swallowing without aspiration
• Protects lower airway
• Medullar mediation

38
Q

What is a laryngospasm?

A

A prolonged and intense exaggeration of the glottic closure reflex
Mediated through vagal stimulation of the superior laryngeal nerve

39
Q

What are patient specific risk factors for a laryngospasm?

A 
Patient factors:
•  Hypocalcemia
•  Hypoparathyroidism
•  Reactive airway disease 
•  Airway trauma
40
Q

What procedures can predispose a patient to a laryngospasm?

A

Parathyroid surgery

Septoplasty or rhinoplasty surgery

41
Q

What population is at a higher risk for laryngospasm?

A

Pediatrics

42
Q

What risk factors are associated with laryngospasm?

A

Recent or current URI
Exposure to secondhand tobacco smoke
GERD
Oropharyngeal secretions

43
Q

What two conditions must be present for a laryngospasm to occur?

A

Noxious stimuli

Inadequate anesthetic depth (stage II)

44
Q

What drugs can be administered to prevent a laryngospasm for occurring?

A

IV lidocaine
Topical lidocaine
IV magnesium
Deep extubation

45
Q

What is Larson’s maneuver?

A

Forceful jaw thrust with bilateral digital pressure on body of mandible, anterior to mastoid process

46
Q

What dose of succinylcholine should be given initially to a patient with a laryngospasm?

A

0.1 -0.5mg/kg, usually 10-20mg

47
Q

If a small dose of succinylcholine does not break the spasm can an additional dose be given?

A

Use intubating dose (1-1.5mg/kg) followed with tracheal intubation

48
Q

If the anesthetic provider is unable to intubate the patient what should be done?

A

Perform percutaneous airway

49
Q

When does a type I allergic reaction occur?

A

Occurs in those previously exposed and sensitized
The antigen joins IgE antibodies to mast cells or basal cells
Histamine is released acting on H1 or H2 receptors

50
Q

What causes a type II allergic reaction to occur?

A

IgG and IgM antibodies!

51
Q

What is a type III allergic reaction?

A

Immune complex disease, antigen- antibody complex causes tissue damage

52
Q

What is a type IV allergic reactions?

A

Delayed-type hypersensitivity

53
Q

What is an anaphylactoid reaction?

A

Caused by mediator release from basophils and mast cells in response to a non-IgE-mediated triggering event!

54
Q

What receptors does histamine agonize and what are their functions?

A

H1: vasodilation, bronchoconstriction, increased vascular permeability
H2: cardiac stimulation, stimulation of gastric secretion

55
Q

What are the top six causes of anaphylaxis in the medical field?

A 
NMB: 69.2%
Latex: 12%
ABX: 8%
Colloids: 2.3%
Opioids: 2.2%
Hypnotics: 1.1%
56
Q

What two NMBA are most likely to cause an anaphylactic reaction?

A

Succinylcholine and rocuronium are responsible for the highest frequency of allergic reactions

57
Q

What type of allergic reactions can be seen with latex use?

A

Type I or Type IV hypersensitivity reaction

58
Q

What populations are at risk for latex allergies?

A

Healthcare workers
Multiple surgeries
Congenital NTDs
Fruit allergies to avocado, banana, and kiwi!

59
Q

What drug is known to cause majority of the fatal drug reactions that can occur?

A

Penicillin allergy accounts for 75% of the most fatal anaphylactic drug reactions

60
Q

What are the three types of transfusion reactions?

A

Febrile: caused by the interaction between recipient’s antibodies and antigens present on leukocytes or platelets of the donor
Allergic: reaction to properly typed and cross- matched blood
Hemolytic: reaction to wrong blood type causing intravascular hemolysis

61
Q

What immediate steps should be taken if intraoperative anaphylaxis is suspected?

A

Stop the infusion/remove the allergen
Administer Epinephrine!
Manage ABC: Maintain airway and administer 100% oxygen

62
Q

What fluids can be given to help with the hypotensive effects of anaphylaxis?

A

NS: 10-25 ml/kg for 20 minutes; total of 2-4 L
Colloid: 10 ml/kg

63
Q

How does epinephrine help an anaphylactic reaction?

A

Stabilizes mast cells, Alpha 1 effects support BP, Beta 2 effects produce array smooth muscle relaxation

64
Q

How do antihistamines help an anaphylactic reaction?

A

May reverse hypotension refractory to EPI and fluids; particularly useful for uticaria and
angioedema

65
Q

How should an anaphylactic reaction be immediately investigated?

A

Circulatory serum tryptase (predominant mast cell protease), plasma histamine, specific IgE assays: high circulating levels strongly suggest an immunological reaction

66
Q

What follow up precautions should a patient with an anaphylactic reaction take?

A

Skin tests should be carried out 4-6 weeks after the reaction
Should be performed with all drugs used during anesthesia, excluding inhalation agents

67
Q

What signs are typically the first to be recognized in an anaphylactic reaction?

A

Bronchospasm and circulatory collapse are the first recognized signs of anaphylaxis

68
Q

What gender is more likely to experience anaphylaxis?

A

Females

69
Q

What individuals are at an increased risk for allergy to propofol and latex?

A

Atopic individuals with increased IgE

70
Q

What precautions should be taken in the OR if a patient has a latex allergy?

A

For patients with a latex allergy in non-latex free environments, the patient should be scheduled first in the OR since latex allergens remain airborne.

Principles I Final (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions