Epidural Flashcards
Patient had lobectomy, epidural at level of t3\t4, post op hypotension , Bradycardia & oxygen sat 92%.
Patient had lobectomy, epidural at level of t3\t4, post op hypotension ,
Bradycardia & oxygen sat 92%.
Q1: what is the deferential diagnosis ?
High epidural block / Distributive shock / Hypovolemic Shock
Q2: Why Bradycardia ?
High block will cause block of cardiac accelerating fibers from T1-T5 unopposed by parasympathetic activity from vagus N.
Q3: Factors affecting epidural?
Age / Height / Wt / Postion of Pt
type of anathesia and dose, vasoconstrictors Lvl of injection
Q4: what are the medications used in epidural ?
Analgecis – > fentanyl
Anathesia – > Bubivicane , lignocaine
Q5: how to test the level and why?
Temperature by Ethyl chloride spray
Q5: why temperature and not pin prick ?
Temp; because arrangemt of fibers, motor will be last to be affected
Pin; to avoid pain , inf. , bleeding
Q6: Why epidural in this case ?
Enhance early mobilization
Good prognosis post-op
decrease hospital stay
suitable for long surgeries
Q7 : Management ?
CCRISP protocol
Inform Consultant / anathesia
Maintain position / High flow O2 / IV fluid resus / stop any inj. In epidural
Inotropics (Epi / Phenylephrin) and Chronotropics (Atropin )
Rule our Hypovolemic shock
Q8. How to DD high epidural & hypovolemia ?
Epidural; worm peripheries / brady
Hypo; cold clammy peripheries / tachy
Q9. in what manner epidural can affect respiration ?
By paralysis of IC ms and Diaphragm ms
By paralysis of IC ms and Diaphragm ms
Q. Late complications of neurogenic shock on heart?
Autonomic dysreflexia, Orthostatic hypotension, CV
Loss of Muscle mass in left ventricle elevating troponin without ecg changes
Q. Cause of Hypotension?
Autonomic dysregulation btw symp and para leading to decrease periph. vascular resistance
