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Endocrine - Summer 2019 > Endocrine - Temperature managment > Flashcards

Endocrine - Temperature managment Flashcards

1
Q

Homeothermic means we actively maintain our body termperature in a tight range usually between

A

36.5 to 37.3

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2
Q

Skin may be __ to __ degrees celsius lower than core body temperature

A

3 to 4

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3
Q

The axilla is usually __ degrees celsius lower than core body temperature

A

1 degree

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4
Q

Nasopharynx reflects _____ temp

A

brain

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5
Q

External Auditory Meatus reflects _____ temp but there is risk of TM rupture

A

Brain

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6
Q

Hypothermia

A

core body temperature is less than 36 Celsius

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7
Q

Hyperthermia

A

rise in core body temperature >38 degrees celsius

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8
Q

Normothermia

A

core body temperature 37 degrees +/- 1 degree

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9
Q

Ambient temperature

A

temperature of the surroundings

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10
Q

**What regulates the body temperature

A

the anterior hypothalmus / preoptic nuclei mediates temperature regulation

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11
Q

Set point temperature

A

Body attempts to maintain a ceratin temperature

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12
Q

**Hypothermia consequenees are extensive and _______ with degree of hypothermia

A

worsen

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13
Q

**Vascular consequences of hypothermia

A

vasoconstriction, hypoperfusion of tissues, pulse oximetry difficult

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14
Q

**Cardiac consequences of hypothermia

A

shivering increases oxygen consumption up to 300%, increased myocardial ischemia, increased cardiac morbidity, increased arrhythmias, Osborne of J wave (ST elevation), VF occurs @ 22-23 degrees Celsius, defib not successful below 30 degrees celsius, should resuscitate until rewarmed

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15
Q

**Pulmonary consequences of hypothermia

A

PVR increases, ventilatory drive is depressed, C02 levels in blood decrease

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16
Q

**Renal consequence of hypothermia

A

Cold diuresis, decreased plasma volume

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17
Q

**Hepatic consequnce of hypothermia

A

Hepatic blood flow is decreased

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18
Q

Will hypothermic patient be a slow wake-up?

A

SLOW

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19
Q

Hypothermia results in ______ drug metabolism and elimination

A

reduced

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20
Q

**For every degree celsius drop in temperature, MAC decreases ___ to ____%, meaning more gas has to come off before the patient will wake up

A

5 to 7%

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21
Q

Hypothermia results directly in a diminished state of ________ and NMBs will be _______ in cold patients

A

consciousness / prolonged

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22
Q

Hypothermic patients = _________ infections

A

increased

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23
Q

Hypothermic patients have decreased peripheral perfusion, decreased cutaneous perfusion which results in _____ penetration of antibiotics to these areas. In addition there is decreased phagocytic activity and impairment in neutrophil function

A

less

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24
Q

Prospective study of colorectal patients kept normothermic highlights

A

sutures removed 1 day earlier, 1/3 less infections, discharged from hospital 2.6 days earlier than nontreated group

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25
Q

The peripheral compartment consists of

A

limbs, skin, subQ tissue AND has 1/3 of the body’s heat content

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26
Q

The core compartment consists of what?

A

major thoracic and abdominal organs and brain AND holds 2/3 of the body’s heat content

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27
Q

Cord body temperature is maintained within a narrow temperature range of?

A

36.6 - 37.4

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28
Q

Peripheral body temperature varies widely from __ to ____ degrees celsius

A

0 to 40

29
Q

The difference between core and peripheral body temperatures is maintained by __________

A

vasoconstriction

30
Q

______ _______ from the body core to the skin provides heat transfer

A

blood flow

31
Q

The degree of heat conduction to the skin is controlled by the degree of _______ in the skin

A

vasoconstriction

32
Q

Vasoconstriction is controlled by the _____

A

SNS

33
Q

_______ production is the principal byproduct of metabolism

A

heat

34
Q

Heat production is increased by

A

exercise, shivering, non-shivering thermogenesis, hypermetabolic states (sepsis, thyroid storm), medications or hypothalmic lesioins

35
Q

Normal basal heat production would incerase a patients temp by ____ per hour if they werer completely insulated from heat loss

A

1.2 degree ceslsius

36
Q

**Shivering can increase heat production by ____%

A

300%

37
Q

Under normal conditions body heat is preserved by tonic _______ _____

A

peripheral vasoconstriction

38
Q

**Radiation heat loss

A

Loss of heat to cool surroundings via electromagnetic energy, major method of heat loss to environment, accounts for 60% of heat loss, determined by temp difference between patient and environment, also affected by exposed body surface area

39
Q

**Convection heat loss

A

wind chill, layer of air next to skin moves and carries heat away from body, can account for 25% of heat loss in OR’s with forced airflow, degree depends on body surface area exposed and airflow

40
Q

Evaporation heat loss

A

loss of heat with skin prep solutions and in major surgeries with open abdominal cavities, normal respiration of inspired gases can account for evaporative losses, inspired gases are usually dry and moderately cool increasing heat loss

41
Q

Conduction heat loss

A

transfer of heat between adjacent surfaces (OR table), contributes <5% of heat loss, affected by temperature

42
Q

Anesthesia (both general and regional) _______ peripheral vasconstriction

A

inhibit

43
Q

In the first hour after induction of anesthesia there is a __ to ___ decreased in the core temp because of peripheral _______

A

1-1.5 degrees celsius / vasodilation

44
Q

Basic Metabolic Rate decreases ___ to _____% with general anesthesia decreasing heat production in the next 2-3 hrs

A

20-40%

45
Q

Initial heat losses slow as most significant and slow with ________ time

A

anesthetic

46
Q

Regional anesthesia (spinal or epidural) produce similar patterns of heat loss because of ________

A

vasodilation

47
Q

One unit of refrigerated blood or one liter of room temp crystalloid decrease core body temp by ____ degree celsius

A

0.25 degree celsius

48
Q

Cutaneous heat loss is proportional is proportional to exposed body surface area and accounts for ___% of heat loss

A

90%

49
Q

General anesthesia promotes vasodilation, decreases metabolic rate/heat production, and decrease hypothalmic responsiveness to ________

A

hypothermia

50
Q

Do NMBs prevent shivering?

A

Yes

51
Q

Heat loss becomes more pronounced with ___ and ______ patients

A

elderly and neonates

52
Q

Basic metabolic rate decreases approximately __% per year beyond age 30

A

1

53
Q

**Elderly and neonatal patients have diminished _____ _____ functioning which results in less vasoconstrictive heat conserving mechanisms

A

autonomic neural

54
Q

**Neonates have ____ surface area to mass resulting in more rapid ___ ____ to the environment

A

increased / heat loss

55
Q

Preoperative prevention of hypothermia

A

warm environment, insulate patient with blanket, actively warm so that peripheral body temp is warm, avoid sweating

56
Q

Intraoperative prevention and treatment of hypothermia

A

warm the OR, inuslate patient, forced warming, circulating water mattress, HME, cover exposed areas, used warm IVF, field irrigation with warm fluids, use low flow circuits, heating lamps for neonates, CPB warming

57
Q

Postoperative prevention and management of hypothermia

A

forced air warming, treatment of postop shivering

58
Q

**Post op shivering occurs in up to ___% of unwarmed patients after general anesthesia

A

40%

59
Q

**Causes dramatic increases in oxygen consumption and catecholamine release

A

shivering

60
Q

post-op shivering is associated with __ times increase in myocardial events

A

3 times

61
Q

Post op shivering is induced by cooling of preooptic region of _______ which causes the involuntary, oscillatory muscular activity to increase heat production

A

hypothalmus

62
Q

Treatment of postoperative shivering

A

prevention is preferable, demerol is the most commonly used agent for post operative shivering

63
Q

Demerol is the most commonly used agent for post operative shivering because….

A

effective, partially mediated by kappa opiod receptors, decreases shivering threshold twice as much as vasoconstriction

64
Q

Hyperthermia is relatively _______ in OR

A

uncommon

65
Q

Causes of Hyperthermia that should be ruled out

A

MH, sepsis/infection, thyrotoxicosis, pheocromocytoma, hypothalmic lesion, trauma, anoxia, neuroleptic malignant syndrome, transfusion reactions, medications

66
Q

With infection/sepsis - during bacteremia, pyogens cause release of _______ ______, increasing set point for temperature in the hypothalmus. This leads to heat conservation (vasconstriction) and increased heat production (shivering)

A

interleukin one

67
Q

**Malignant hyperthermia initially manifests as a _______ state with tachycardia, hypercapnia, muscle rigidity, tachyarrhythmias, metabolic acidosis. Treatment includes discontinuing triggering agents, administering dantrolene, active cooling, adequate hydration, and supportive care

A

hypercatabolic

68
Q

Hyperthermia treatment

A

Preop: Acetaminophen Intraop: cooling the OR, forced air cooling, cooled IVF, field irrigation with cold fluids, NG or Bladder irrigation with cooled fluids Postop: forced air cooling

Endocrine - Summer 2019 (7 decks)

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