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ANPR 520 (Sharkey) Principles of Anesthesia 1 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Best indicator of fluid status in NPO patient is what?

A

Urine output

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2
Q

General anesthetics increase the release of ADH, water is retained, and what else may occur?

A

Hyponatremia

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3
Q

IV fluid therapy - Crystalloids

A
  1. Low molecular weight
  2. Rapidly equilibrate with and distribute throughout the entire extracellular fluid space.
  3. D5W
  4. NS
  5. LR
  6. 7.5% NaHCO3
  7. Plasmalyte

Require 3 to 4 times the VOLUME than colloids for fluid resuscitation.

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4
Q

IV fluid therapy - Colloids

A
  1. Contain high molecular weight substances like proteins and large glucoses.
  2. Maintain plamsa colloid ONCOTIC pressure.
  3. Remain largely intravascular
  4. Hetastarch
  5. Dextran
  6. Albumin
  7. Plasma Protein Fraction

Good for restoring intravascular volume.

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5
Q

You receive a trauma patient with massive blood loss who is unconscious…. What to do?

A

Avoid fluid resuscitation with dextrose, as it can exacerbate brain damage.
NS or LR for hemorrhagic shock.
Blood products when available
Expect metabolic acidosis d/t increased lactic acid production in hypovolemic shock.

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6
Q

Emergency Blood transfusion

A

Exsanguinating patient, Need blood now, and patient blood type unknown… what do you give?

Type O Rh negative (O-) - is the “universal donor”.

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7
Q

Complications of blood transfusions (hemolytic reactions)

A
  • The recipients antibodies destroy the transfused RBC.
  • The Hemolysis of recipients RBC occurs as result of the RBC transformation (less common).
  • Acute or delayed reactions.
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8
Q

Hemolytic Reactions (Acute) - intravascular

A
  • ABO blood incompatibility
  • Misidentification of patient specimen/unit of blood
  • Severe
  • S/S (awake): chills, fever, nausea, flank and/or chest pain.
  • S/S (asleep): fever, tachycardia, hypotension, hemoglobinuria, diffuse oozing in field, rapidly develop shock, DIC, renal shutdown.
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9
Q

Hemolytic Reactions (Delayed) - extravascular

A

d/t antibodies formed by the patient against the antigens in the blood

  • Usually not a problem with the first unit of blood.
  • Subsequent exposure to same antigen triggers response.
  • 2-21 days after transfusion given
  • S/S generally mild: malaise, fever, jaundice, Hct fails to rise despite transfusion.
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10
Q

Anaphylactic reactions. How do we treat?

A

Are rare
Occurs with only a small amount of blood given.

Treatment: Epi, fluids, steroids, H1 H2 blockers

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11
Q

Massive blood transfusions

A

Defined as the need to transfuse 1-2 time the patients blood volume in a 24 hour period (10-20 units)
Ideally give 2 PRBCs, 1 FFP, and volume expander.
Anticipate platelet count decrease by 1/2 with each blood volume replaced, start the replacement platelets early.
Stored blood is acidic d/t citric acid anticoagulatn and accumulation of red cell metabolites (Co2 and Lactic acid).
Therefore significant metabolic acidosis can occur.
(Test Q omitted here, on another slide)
Once normal perfusion is restored, metabolic acidosis resolves, and slowly alkalosis occurs as citrate and lactate from transfusions and IVF are converted to bicarb by the liver.

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12
Q

Hypothermia r/t blood transfusion

A

Absolutely warm ALL IVF and blood products.

30 deg C = ventricular arrhythmias - fibrillation

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13
Q

Never use cell saver if what??

A
  • Malignant tumor, sickle cell disease, septic wound contamination, amniotic fluid, fat in wound, bone chips, bone cement, clotting agent (surgicel, gelfoam) in retrieved blood.
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14
Q

After a massive blood transfusion, the most consistent acid-base abnormality what?

A

post-op metabolic ALKALOSIS

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15
Q

Cell Saver

A

Shed blood retrieved from field, mixed with heparin into a reservoir (to prevent clotting).

  • RBC washed/concentrated/debris removed/anticoagulant removed/reinfused to patient.
  • Usually cell saver units have Hct of 50-60%, no clotting factors, no platelets.
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16
Q

The most sensitive indicator of Malignant Hyperthermia (MH) is what?

A

An UNANTICIPATED increase in ETCO2 levels, 2-3 times normal.

Fever is a LATE sign - core temp may rise as much as 1 deg C every 5 minutes.

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17
Q

Known triggers of Malignant Hyperthermia are what?

A

-Inhaled General Anesthetics
-Desflurane, Enflurane, Ether, Halothane, Isoflurane
Sevoflurane.
Succinylcholine

All other drugs are safe. (relatively)

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18
Q

MH treatment?

A
  1. Hyperventilate with 100% oxygen from NEW SOURCE! Everything in contact with contributing agent should be disconnected.
  2. Give Dantrolene 2.5 mg/kg IV immediately
  3. May repeat Dantrolene to total of 10mg/kg (or more if s/s persist)
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19
Q

The upper esophageal sphincter lies where?

A

At the lower edge of the hypopharynx

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20
Q

The lowermost portion of the pharynx leads to where?

A

The esophagus and larynx and on down to the trachea.

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21
Q

What does the epiglottis do?

A

Prevents aspiration by covering the glottis (entrance of the larynx) during swallowing.

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22
Q

Cricothyroid membrane

A
  • connects thyroid and cricoid cartilages
  • superficial and thin
  • non major vessels in its midline
  • Palpable transverse indentation between thyroid and cricoid cartilages.

Is the site for EMERGENT surgical airway access.

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23
Q

Layrngeal muscles..

A

The intrinsic posterior cricoarytenoid (abduction) opens/dilates vocal cords, and opens glottis.

The intrinsic lateral cricoarytenoid (adducts) closes vocal cords, narrows glottis.

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24
Q

What is the MAJOR motor nerve of the larynx

A

The recurrent layrngeal nerve. - innervates ALL muscles of larynx except cricothyroid muscle.

25
Q

Epiglotitis

A

Caused by haemophilus influenza B bacteria
- don’t try to look or visual unless in OR
- sitting position
- inhalation induction, 100% 02 and sevo, with ETT 1/2 to 1 size smaller than usual.
- extubate 24-96 hours, an airleak usually appears.
-extubate in OR only after DL has confirmed resolution of swelling.
- usually in children 1 to 7 years of age
S/S: upper airway obstruction - stridor, chest retractioins, tachypnea, cyanosis, drooling, difficulty swallowing, child insists on sitting up, is frightened.
-Is contagious

26
Q

Cricoid cartilage….

A

At C5-C6, only complete cartilagenous ring in respiratory tree.

27
Q

Vagus nerve…

A

Cranial nerve 10,
Airway below epiglottis, covers superior laryngeal branch, external motor, internal sensory.

Recurrent laryngeal branch is larynx below vocal cords and trachea.

28
Q

Bilateral palsy

A

Acute - stridor and resp. distress. (intubation required)
Chronic - less frequent airway problems. (compensated)
pt’s usually have aphonia (can’t speak)

29
Q

Laryngospasm….

A

sensory stimulation of EXTERNAL BRANCH of superior laryngeal nerve (motor).
Cricothyroid muslces tense and adduct (close) the true vocal cords in laryngospasm.

30
Q

Laryngospasm stimuli?

A

Stimuli: blood secretions vomitus attempted intubation with insufficient anesthesia, visceral pain reflex, chemical irritation.

31
Q

Laryngospasm treatment?

A

Initial: head tilt, jaw thrust, positive airway pressure with 100% oxygen.
- IV lidocaine (1-1.5mg/kg) IV
- Persists and hypoxia occurs: Succinylcholine (0.25-1 mg/kg) to paralyze and control ventilation (short acting)
-Intubate
What is crowing? Sound for partial laryngospasm, total laryngospasm has no sound (no air movement)
- common complication of extubation.

32
Q

The Remiglottitis is what?

A

The aperture of between true vocal cords.

33
Q

What is narrowest point in adult airway?

A

Glottis

34
Q

Carina does what when stimulated?

A

Produces a strong cause reflex.

35
Q

Putting tube in….. you want the cuff at what?

A

Minimal occlusive pressure… (not to exceed 30 mmHg) -20 is usual.

36
Q

Tracheal stenosis

A

causes: post tracheotomy, congenital, cancer of the airway, result from long term intubation with inflammation.

37
Q

Mallampati scores.

A

1 - soft palate, fauces, uvula, tonsilary pillars.
2 - soft palate, fauces, uvula
3 - soft palate, base of uvula
4 - hard palate only.

38
Q

Repositioning patient

A

MUST CHECK ETT placement…. and document
Neck extension - ett AWAY from corina
neck flexion - ett TOWARD corina.

39
Q

LMA

A

Preferred device to help manage difficult airway. NEVER USE ON A FULL STOMACH. (does not provide adequate protection)

40
Q

Most common malpractice lawsuits?

A

Dental related

41
Q

Most important muscle of inspiration?

A

Diaphram
accounts for 75% of air that enters during SV.
Innervated by phrenic nerve (C3-C5)

42
Q

Reglan does not do what?

A

Does not decrease gastric volume, and does not affect pH.

43
Q

First aspiration sign?

A

Hypoxemia if the most early response.

44
Q

Aspiration pneumonitis..

A

Risk increases:
intragastric volume greater than 25 ml
pH less than 2.5 (gastric)
ARDS is MOST SERIOUS COMPLICATION!

45
Q

OSA

A

read about it in slide 91.

46
Q

OSA… if BMI is greater than 30.

A

Higher level of incidence.

47
Q

How many divisions are there in the airway? (tracheal bronchial tree)

A

23

48
Q

How many alveoli do we have?

A

300 million

Each alveolar SAC has 17 alveoli.

Alveolar size is a function of gravity and lung volume.

49
Q

Two types of cells in pulmonary epithelium?

A
  1. Pneumocytes
  2. Flat and formed tight junctions prevent passage of large oncotically active molecules in the alveolus (ALBUMIN) - produces surfactant.
50
Q

Changes in intrapulmonary pressures….

A

See slide 111.

51
Q

Pulmonary perfusion…

A

regardless or body position, lower portions of the lung receive greater bloodflow than upper.

52
Q

What drives ventilation?

A

Normally co2, - central chemoreceptors respond primarily to PaCO2.

53
Q

General Anesthetics cause what kind of shift on oxy-hgb dissociation curve?

A

Right

54
Q

Effects of Anesthesia on Respiratory Pattern

A

Inhalation agents - Rapid shallow respirations
Nitrous - narcotic techniques - slow, deep respirations.
Light anesthesia - irregular respiratory pattern, breath holding

55
Q

What is FRC?

A

Functional residual capacity - Is a RESERVOIR for oxygen

56
Q

Anatomic + Alveolar = what?

A

Physiologic Deadspace

57
Q

Most common post-op complication?

A

Pulmonary dysfunction

58
Q

Most common form of pulmonary disorder encountered in anesthesia?

A

COPD

ANPR 520 (Sharkey) Principles of Anesthesia 1 (3 decks)

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