Exam 1 Flashcards
How is BMI in Metric calculated?
BMI= kg / m2 [Weight (Kg) / Height (m2)]
How is BMI calculated in the inferior Imperial way?
703 x lbs / in2 [703 x weight / height (in2)]
A normal BMI range is?
18.5 to 24.9
An obese BMI is?
30.0 & above
BMI can be used to determine?
- Fluid volume requirement,
- acceptable blood loss,
- drug dosage,
- adequate u/o
What Pre-op intervention can be done for someone with sickle cell?
Admit day before to hydrate & possibly pre medicate as it is very hard to control their pain.
What is G6PD deficiency?
Disregard
What should be avoided in Pts with neuromuscular disorders?
NMJB
How does anesthesia affect seizure meds?
It will reduce half-life of the seizure meds
What should be watched in someone with Raynaud’s?
Their BP, may do poorly in OR if BP is low
Blood glucose swings is a sign of what?
Poor nutrition
Examples of High risk procedures are?
- Aortic,
- major vascular Sx
- peripheral vascular
Examples of Intermediate risk procedures are?
- Intra-Abd
- Intra-thoracic Sx,
- Carotid Sx,
- Head & neck Sx
What all results in 1 point given in the Revised cardiac Index scale?
- High-risk Sx (intraperitoneal, intrathoracic, or suprainguinal vascular Sx)
- ischemic heart disease
- CHF
- cerebrovascular disease
- DM requiring insulin
- Creatinine >2.0mg/dL
A score of 3 on the Revised Cardiac Risk Index Score correlates to?
A 5.4% risk of major cardiac events.
What does the MET scale evaluate & what is the cutoff?
- Cadiopulmonary fitness & if further testing is necessary.
- Cutoff >4 METs (Want >4)
- <3 means to cancel Sx to run more tests
What is an urgent surgery?
Life or limb at risk if no surgery is done within 6-24hrs
How to asses cardiopulmonary function in a bedridden Pt?
With a chemical stress test.
What is ASA I?
A normal healthy Pt, no or minimal EtOH
What defines ASA II?
- Mild systemic disease without functional limitations.
- Social drinker
- pregnancy
- BMI 30-40
- controlled DM
- mild lung disease
What defines ASA III?
- Severe systemic disease. w/ functional limitations,
- Poorly controlled DM, HTN or COPD,
- Morbid obesity
- Active hepatitis
- EtOH abuse
- PPM
- CHF
- ESRD
- Hx of MI, CVA, TIA
- CAD/stents (>3mos)
- Premature infant postconceptual age.
What defines ASA IV?
- Severe systemic disease that is constant threat to life.
- Recent MI, CVA, TIA, CAD/stents
- Severe valve dysfunction
- Severe CHF
- Sepsis
- DIC
- ESRD not on HD
- ARDS
Define ASA V?
- A Pt that would die without Sx.
- Ruptured aneurysm
- Massive trauma
- Intracranial bleed
- Ischemic bowel in face of significant cardiac pathology or MODS
Define ASA VI?
Declared brain-dead. Organ donation
When to get CBC pre-op?
- Hx of bleeding
- Hematology disorder
- Anti-coag therapy
- Poor nutrition
- ASA III
- All major Sx
When to get pre-op renal panel?
- DM
- HTN
- Cardiac disease
- N/V/D
- Renal disease
- Fluid overload
- ASA III & IV undergoing intermediate Sx
- ASA II, III, IV undergoing major Sx
What is considered minimal sedation?
Drowsy, able to talk
What is the difference between regional & local anesthesia?
- Regional numbs large area (epidural, nerve block)
- Local numbs small area (biopsy)
What are the most common allergies?
- Rocuronium
- Latex (spina bifida)
- CHG/Iodine
- Abx
- Adhesives
- Opioids
What can be done in someone with an Abx allergy?
Give a test dose (1/10th)
In what kind of allergy are PCN/cephalosporin Abx avoided?
True IgE-mediated allergy
How can Amides & Esters be identified?
- Amides have 2 I’s in their name
- Esters have 1 I in their name.
Which antihypertensive medications should be d/c’ed before Sx & why?
- ACEi & ARB’s
- May cause severe hypotension under anesthesia.
What medication should be d/c’ed 4 weeks prior to Sx & why?
- Oral contraceptives
- High risk for post-op venous thrombosis
What interaction is there between NMJB’s & anticonvulsants?
Anticonvulsants decrease the lifespan of NMJB’s
What 2 medications should be avoided in Sx in someone that takes MAOI’s?
Meperidine & ephedrine
When should topical medications be discontinued prior to Sx?
24hrs
What diuretic should be d/c’ed & when prior to Sx?
Thiazides & 24hrs
When is it not okay to d/c P2Y12 inhibitors?
In someone that is within the first 6 months of taking drug eluting stents.
When should Post-menstrual HRT be d/c’ed prior to Sx?
4 weeks
What should a type 1 diabetic do with their insulin regimen prior to Sx?
- Take 1/3 of their usual dose the morning of Sx
- Continue basal rate if infusion pump present
What should a type 2 diabetic do with their insulin regimen prior to Sx?
Take none or up to half of a long-acting the day of Sx.
What & how much stress dose medication is given?
100mg hydrocortisone q8hr for up to 24-48hrs.
What are the NPO times for full meal, light meal, breast milk, & clear liquids?
8hrs, 6hrs, 4hrs, & 2hrs
When can tube feeds be continued?
With a Dobhoff unless it is a abdominal case.
What is Mendelson syndrome & what are the factors?
- Increased risk of aspiration.
- > 25cc gastric residual & pH <2.5
What are some aspiration prophylactic measures?
- Decrease gastric volume
- Increase gastric pH (sodium citrate),
- H-2 receptor antagonist
- PPI’s
- Dopamine-2 antagonist.
H-2 receptor antagonists like Pepcid & PPI’s do what?
Increase gastric pH & decrease gastric acid secretion
Who is at risk for pulmonary aspiration?
- Pregnancy
- DM
- Significant opioid users
- BMI >40
- Emergent Sx
- Any esophagus or abdominal issue Pt
According to the Apfel score, who is at risk for PONV?
- Female
- HX of PONV/motion sickness
- Nonsmoking
- Post-op opioids
For someone with an Apfel score of 3-4 should receive what considerations?
- Avoid general anesthesia
- Propofol
- Minimize opioids
- Prevent 3 drugs from different classes.
For a Pre-op Pt currently on Vanc or fluoroquinolone should receive their Abx when?
2hrs before incision
What anesthesia considerations are made in someone taking Echinacea?
It reduces effectiveness of immunosuppressants.
What anesthesia considerations are made in someone taking Ephedra?
- Risk of MI
- Arrhythmia
- Hemodynamic instability
- D/C 24hrs pre-op
What anesthesia considerations are made in someone taking garlic (ajo)?
Inhibits plt aggregation. D/c 7 days prior to Sx
What anesthesia considerations are made in someone taking ginger?
Increased risk of bleeding
What anesthesia considerations are made in someone taking Ginko?
Increased risk of bleeding. D/C 36hrs before Sx.
What anesthesia considerations are made in someone taking Ginseng?
- Hypoglycemia
- Increased bleeding
- Decrease effect of Warfarin. D/c 7days prior to Sx.
What anesthesia considerations are made in someone taking Green tea?
Increased risk of bleeding
What anesthesia considerations are made in someone taking Kava?
Increase sedative effects of anesthetics
What anesthesia considerations are made in someone taking Saw palmetto?
Increased risk of bleeding.
What anesthesia considerations are made in someone taking St John’s?
- Induction of CYP450
- Affects benzos, CCB’s
- Delayed emergence.
What anesthesia considerations are made in someone taking valerian?
- Increased sedation effects
- Acute benzo withdrawal
- Increased anesthetic use with long-term use.
Scopolamine patch should not be used in what kind of Pt?
Narrow-angle glaucoma, confused Pts
What N/V medication is given after induction & what can it cause?
Dexamethasone. Can cause increased blood glucose
When are Abx re-dosed in the OR?
When the Sx lasts >4hrs
What is the audible frequency range for humans?
20Hz – 20,000Hz
What range do ultrasounds operate in?
2 – 18 megahertz
What generates & receives the ultrasound waves?
Piezoelectric crystal
What frequency do linear, curved, & phased ultrasounds use?
High frequency, medium to low, & medium to low frequency.
What are Linear US used for?
Superficial imaging such as vessels, muscle, tendon, breast, thyroid.
What are curved US used for?
Anatomy needing wider & deeper field of view such as abdominal
What are phased US used for?
Smaller footprint allows for scanning small spaces such as between ribs, cardiac.
What frequency is used for scanning superficial structures such as tendons?
High frequencies (10MHz or higher)
What frequency is used for scanning abdominal aorta?
Low frequency (4MHz or less)
Vibration travels faster through water than air?
True, vibration travels fastest thru bone.
The higher the density, the___ the speed, & the higher the stiffness, the___ the speed?
Lower & higher
What is the aperture size?
The number of activated piezoelectric elements
What can improve the lateral resolution with curved transducers?
Adjusting the focal zone
Phased US transducers produce what kind of field of view?
A cone shaped view
What is the US Focal Zone?
Point at which the US beam is narrowest & beam intensity the greatest. The Focal zone is the area around the focal point. Lateral resolution is best within this zone.