- Unstable pt - refusal - long procedure - not appropriately starved (NBM 2/6)

Deck 5 Flashcards by K D

Lethal triad of trauma

Coagulopathy
Acidosis
Hypothermia

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Flail chest def

Fractures of 2 ribs in 2 or more places creates free section of thoracic wall

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Causes of T2 resp failure

Untreated T1 resp failure eg pneumothorax/contusion

Central cause: head injury

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Where does furosemide work

Ascending loop of Henle

Blocks Na/K channel

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How does hyponatraemia cause confusion

Low Na leads to cerebral oedema

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SIRS criteria

RR>20
HR>90
WCC 4> or >12
Temp 36> or >38

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SIRS criteria

RR>20
HR>90
WCC 4> or >12
Temp 36> or >38

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Causes of post temp

Water Wind Walk Wound Weird drugs

UTI
Atelectasis or pneumonia
DVT or PE
Wound or deeper infection (leak)
Drugs: haloperidol and

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Voltgage criteria for left ventricular hypertrophy on ECG

R > = 7 small squares (35mm) in V5/6

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Where do thiazides work

Proximal part of distal convoluted tubule

Blocks Na/Cl symporter

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Where does spironolactone work

Distal part of distal convoluted tubule
Blocks Na/K exchange pump

Leads to Hyperkalaemia

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What is sedation

Altered conciousness +/- analgesia +/- decreased anxiety

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Difference between Light, deep sedation and GA

Light:

maintains airway
responds to stimuli
anxyiolytic

Deep:

airway not necessarily patent
responds on repeated painful stimuli

GA:

not rousable
airway not protected

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What sedation used for joint reduction

Light sedation

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Indications for sedation

Reduction of fractures
nervous patient undergoing imaging
endoscopy

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Indications for sedation

Reduction of fractures
nervous patient undergoing imaging
endoscopy

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CIs to sedation

Unstable pt
refusal
long procedure
not appropriately starved (NBM 2/6)

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Complications of sedation

Early:

respiratory depression
anaphylaxis to meds
hypotension

Later:
- aspiration pneumonia

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Complications of sedation

Early:

respiratory depression
anaphylaxis to meds
hypotension

Later:
- aspiration pneumonia

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Drugs used in sedation

Benzo: midazolam
Opiate: morphine
Gas: NO

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Reversal of benzos

Flumezanil

Often not given as precipitates seizures (instead supportive measure waiting for it to wear off)

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When safe to discharge home post sedation

obs back to baseline
motor and mental function back to baseline
E+D ok
Collected by responsible adult

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Septic shock anaesthetic definition with numbers

Sepsis and BOTH

persistant hypotension requiring vassopressor to maintain MAP>65mmHg
Lactate >2 despite volume resus

Difference in presentation of septic shock and hypovolaemic shock

Septic:
- warm red peripheries (vasodilation_

Hypovolaemic
- cool clammy peripheries

Shock definition

Inadequate tissue perfusion to meet metabolic requirements

Potential blood loss in tibia, humerus, femur, pelvis

Tibia/humerus: 750ml Femur: 1.5 Pelvis: all circulating volume

Stages of haemorrhagic shock (obs)

Transfusion protocol in haemorrhagic trauma case

1. Pack A (volume replacement) and Pack B (RBC, FFP, Platelets) 2. Other trusts: RBC:FFP:Platelets 1:1:1 ratio

Transfusion protocol in haemorrhagic trauma case

1. Pack A (volume replacement) and Pack B (RBC, FFP, Platelets) 2. Other trusts: RBC:FFP:Platelets 1:1:1 ratio

Different types of shock

1. Hypovolaemic 2. Obstructive 3. Cardiogenic 4. Distributive

Examples of obstructive shock

PE Tamponade Tension pneumothorax

Examples of cardiogenic shock

MI | Arrhythmia

Examples of distributive shock

Neurogenic Anaphylaxis Septic

Examples of distributive shock

Neurogenic Anaphylaxis Septic

Triggers for release of aldosterone

Angiotensin II Low sodium High K

Sx of Addisonian crisis

Abdo pain N+V Shock Hyper/hypothermia

Primary causes of addisonian crisis

Addisons disease (low cortisol supply cannot meet body requirements) can lead to acute crisis

Secondary cause of addisonian crisis

Sudden stopping of steroids tablets Not doubling the dose in stress (trauma, operation, infection) Both caused by body not being able to suddenly increase its production of cortisol

Mx addisonian crisis

IV steroids IV fluids Replacement of electrolytes

Prevention of addisonian crisis in pt undergoing operation

Bolus IV hydrocortisone 100mg on induction Infusion of IV hydrocortisone 200mg/24hr until patient can eat and take tablets Double the routine dose of oral Tapper down to normal dose at later date

Day case criteria

Social: - live within reasonable distance - responsible adult Medical: - good pre-op performance status - no unstable medical conditions Surgical: - short op - no serious complication requiring immediate attention - post op mobilisation

Day case criteria

LEMON assessment of difficult intubation

Look: short neck, facial trauma Evaluate 3-3-2 rule Mallampati score Obstruction: epiglotitis, tonsillar oabscess, trauma Neck mobility: c-spine injury, rheumatoid

3-3-2 rule for intubation

Incisors: 3 fingers fit between Hyoid and chin: 3 fingers Thyroid notch and floor of mouth: 2 fingers

Referral to coroner criteria

1. death within 24hrs of admission 2. suspicious accidental death 3. after an operation or procedure 4. unknown cause

Content of emergency tracheostomy box

- Tracheostomy tube of same size and one size smaller - spare inner tubes - resus bag and mask - suction - 0.9% saline + syringe - scissors, tape

System to manage desaturating pt with Tracheostomy

1. call anaesthetist 2. remove vocal cap/valve 3. remove inner tube 4. apply intratracheal suction 5. deflate cuff 6. remove tracheostomy and oxygenate

What does FFP include

Albumin All clotting factors Fibrinogen vWF

What does cryoprecipitate include

Factor 8 and 13 | vWF

What does cryoprecipitate include

Factor 8 and 13 | vWF

Causes of gastric outlet obstruction

Benign: pyloric stenosis due to stricture, ulcer, foreign body Malignant: - gastric ca - pancreatic, duodenal Ca

Electrolyte abnormalities seen due to vomiting

Metabolic alkalosis (loss of H+ and Cl) Low K (increased aldosterone to restore volume leads to low K)

Sx of low K

myalgia Weakness Cramps

ECG changes in low K

Prolonged PR U wave Flattened T wave

ECG changes in low K

Prolonged PR U wave Flattened T wave