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Intro To AA > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Equalization of pressure throughout the arterial system; increased R-handed filling and CO; decreased HR and peripheral vascular resistance

A

Horizontal Cardiac

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2
Q

Gravity increases perfusion of dependent (posterior) lung segments; abdominal viscera displace diaphragm cephalad. Spontaneous ventilation favors dependent lung segments, while controlled ventilation favors independent (anterior) segments. Functional residual capacity decreases and may fall below closing volume in older patients.

A

Horizontal Respiratory

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3
Q

Activation of baroreceptors, generally causing decreased CO, peripheral vascular resistance, HR, and BP.

A

Trendelenburg Cardiac

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4
Q

Marked decreases in lung capacities from shift of abdominal viscera; increased ventilation/perfusion mismatching and atelectasis; increased likelihood of regurgitation.

A

Trendelenburg Respiratory

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5
Q

Increase in ICP and decrease in cerebral blood flow because of cerebral venous congestion; increased intraocular pressure in patients with glaucoma.

A

Trendelenburg Other

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6
Q

Preload, CO, and arterial pressure decrease. Baroreflexes increase sympathetic tone, HR, and peripheral vascular resistance.

A

Reverse Trendelenburg Cardiac

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7
Q

Spontaneous respiration requires less work; functional residual capacity increases.

A

Reverse Trendelenburg Respiratory

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8
Q

Cerebral perfusion pressure and blood flow may decrease

A

Reverse Trendelenburg Other

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9
Q

Autotransfusion from leg vessels increases circulating blood volume and preload; lowering legs has opposite effect. Effect on BP and CO depends on volume status.

A

Lithotomy Cardiac

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10
Q

Decreases vital capacity; increases likelihood of aspiration

A

Lithotomy Respiratory

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11
Q

Pooling of blood in extremities and compression of Abdominal muscles may decrease preload, cardiac output, and blood pressure

A

Prone Cardiac

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12
Q

Compression of abdomen and thorax decreases total noncompliance and increases work of breathing

A

Prone Respiratory

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13
Q

Extreme head rotation may decrease cerebral venous drainage and cerebral blood flow

A

Prone Other

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14
Q

Cardiac output unchanged unless venous return obstructed (kidney rest). Arterial blood pressure my fall as a result of decreased vascular resistance (R side> L side)

A

Lateral Decubitus Cardiac

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15
Q

Decreased Volume of dependent lung; Increased perfusion of dependent lung. Increase ventilation of dependent long in awake patients (no mismatch); Decreased dilation of dependent long anesthetize patients (mismatch). Further decreases and dependent long ventilation with paralysis is in an open chest.

A

Lateral Decubitus Respiratory

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16
Q

Pulling blood in lower body decreases central blood volume. Cardiac output and arterial blood pressure falls bike rides and heart rate and systemic vascular resistance.

A

Sitting Cardiac

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17
Q

When the volume is in functional Residual capacity increase; work up breathing increases

A

Sitting Respiratory

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18
Q

Cerebral blood flow decreases

A

Sitting Other

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19
Q

Positions with complication of air embolism?

A

Sitting
Prone
Reverse Trendelenburg

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20
Q

Positions with complication of alopecia?

A

Supine
Lithotomy
Trendelenburg

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21
Q

Positions with complication of backache?

A

Any

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22
Q

Positions with complication of compartment syndrome?

A

Lithotomy

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23
Q

Positions with complication of corneal abrasion?

A

Prone

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24
Q

Positions with complication of digit amputation?

A

Any

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25
Q

Positions with complication of nerve palsies for brachial plexus?

A

Any

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26
Q

Positions with complication of nerve palsies for common peroneal?

A

Lithotomy

Lateral decubitus

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27
Q

Positions with complication of nerve palsies for radial?

A

Any

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28
Q

Positions with complication of nerve palsies for ulnar?

A

Any

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29
Q

Positions with complication of nerve palsies for retinal ischemia?

A

Prone

Sitting

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30
Q

Positions with complication of nerve palsies for skin necrosis?

A

Any

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31
Q

How to prevent brachial plexus?

A

Avoid stretching or direct compression at neck or axilla

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32
Q

How to prevent common peroneal?

A

Pad lateral aspect of upper fibula

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33
Q

How to prevent radial?

A

Avoid compression of lateral humerus

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34
Q

How to prevent ulnar?

A

Padding at elbow, forearm supination

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35
Q

How to prevent retinal ischemia

A

Avoid pressure on globe

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36
Q

How to prevent skin necrosis?

A

Padding over bony prominences

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37
Q

How to prevent air embolism?

A

Maintain venous pressure above 0 at the wound

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38
Q

How to prevent alopecia?

A

Normotension, padding, and occasional head turning

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39
Q

How to prevent backache?

A

Lumbar support, padding, and slight hip flexion

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40
Q

How to prevent compartment syndrome?

A

Maintain perfusion pressure and avoid external compression

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41
Q

How to prevent corneal abrasion?

A

Taping and/or lubricating eye

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42
Q

How to prevent digit amputation?

A

Check for protruding digits before changing table configuration

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43
Q

Common adverse events related to anesthesia (5):

A 
Vomiting 
Nausea 
Sore throat 
Incisional site pain 
Emergence delirium (peds)
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44
Q

Physical examination of airway (5):

A 
Mouth opening 
Loose or problematic dentition 
Limitations in neck range of motion 
Neck anatomy 
Mallampati presentations
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45
Q

Full visibility of tonsils, uvula, and soft palate

A

class 1 of mallampati

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46
Q

Visibility of hard and soft palate, upper portion of tonsils and uvula

A

Class 3 mallampati

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47
Q

Soft and hard palate and base of uvula are visible

A

Class 3 mallampati

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48
Q

Only hard palate visible

A

Class 4 mallampati

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49
Q

Clear liquids NPO

A

2 hours

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50
Q

Breast milk NPO

A

4 hours

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51
Q

Infant formula NPO

A

6 hours

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52
Q

Non-human milk NPO

A

6 hours

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53
Q

Light meal NPO

A

6 hours

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54
Q

Full meal NPO

A

8 hours

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55
Q

Medications to stop taking for surgery (6):

A 
Anticoagulants
Oral hypoglycemias 
Monoamine oxidase inhibitors 
Certain anti-hypertensive agents 
Beta blocker therapy 
Non-prescribed, herbal, vitamins
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56
Q

DAMMIS

A 
Drugs 
Airway
Machine
Monitor
IV
Suction
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57
Q

Delays in inducing anesthesia (5):

A 
Slow arm-brain circulation (elders)
CVD
Patient anxiety 
Recreational drug use 
Extravasation (leak in fluids)
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58
Q

Does Propofol, a non-barbiturate IV anesthetic have less postoperative nausea and vomiting and more rapid, clear-headed recovery?

A

Yes

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59
Q

Why include time of draw up on label?

A

Because can be a medium for rapid bacterial growth if not handled using meticulous aseptic precautions

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60
Q

What should be done if person, for anatomical reasons, are likely to be difficult to intubate?

A

Use a flexible or rigid video scope or another advanced airway tool

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61
Q

Indications for ETT (5):

A

Potential air contamination (full stomach, GERD, GI or pharyngeal bleeding)
Predictable difficulty with ETT or airway access (later or prone)
Surgery of mouth or face
Prolonged procedure
Need muscle relaxant

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62
Q

Succinylcholine is not degraded by AChE so it remains in NM junction to cause continuous end plate depolarization and subsequent muscle relaxation

A

Phase I block

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63
Q

How is Succinylcholine metabolized?

A

By plasma cholinesterase (pseudocholinesterase)

64
Q

Why is there muscle flaccidity rather than tetany following fasciculations from Succinylcholine in phase I block?

A

Ca+ is removed from muscle cells cytoplasm independent of repolarization and as Ca+ is taken up by the sarcoplasmic reticulum, the muscle relaxes

65
Q

What factors affect plasma cholinesterase? (7)

A 
Pregnancy
Liver disease 
Kidney failure 
Heart failure 
Thyrotoxicosis (excessive thyroid hormone)
Cancer 
Number of other drugs
66
Q

Sux’s can cause uncontrolled increase in skeletal muscle oxidative metabolism that overwhelms the body’s capacity to supply oxygen, remove CO2, and regulate body temp (leading to circulatory collapse and dead

A

Malignant Hyperthermia (MH)

67
Q

How is MH treated?

A

Dantrolene sodium

68
Q

What can important agents, including sevo cause?

A

Neurotoxic to the developing brain

-cause neurobehavioral abnormalities long term

69
Q

Are FGF less than 2 L/mm recommended?

A

No

70
Q

Minimal rest of the patient independent of the anesthesia
Little to no blood loss
Done an office setting

A

Category one

71
Q

Minimal to moderately invasive procedure
Blood loss Less than 500 cc
Mild risk to patient

A

Category two

72
Q

Moderately to significantly invasive procedure
Blood loss 500 to 1500Cc
Moderate risk to patient

A

Category three

73
Q

Highly invasive procedure
Blood loss greater than 1500Cc
Major risk to patient

A

Category four

74
Q

Highly invasive procedure
Blood loss greater than 1500Cc
Critical risk to patient
Postop ICU

A

Category five

75
Q

A normal healthy patient

A

ASA 1

76
Q

Patient with mild systemic disease with no functional limitations (Hypertension, tobacco, age, DM)

A

ASA 2

77
Q

A patient with severe systemic disease that results in functional limitations (uncontrolled HTN or DM with vascular complications, MI)

A

ASA 3

78
Q

Patient with severe systemic disease that is a constant threat of life (CHF, angina, pulmonary dysfunction, ESRD (end stage renal disease))

A

ASA 4

79
Q

Patient who is not expected to survive without the operation (ruptured AAA, PE, head injury with ICP)

A

ASA 5

80
Q

Organ procurement on a brain dead patient

A

ASA 6

81
Q

Patient on whom an emergency procedure is required

A

E

82
Q

When should stop Street/illegal drugs?

A

72 hours

83
Q

When should stop alcohol?

A

48 hours

84
Q

When should stop tobacco?

A

24 hours

85
Q

Symptoms for malignant hyperthermia? (10)

A 
Hypercarbia
Tachycardia 
Tachypnea
Hyperthermia 
HTN
Cardiac dysrhythmias 
Hypoexmia 
Hyperkalemia 
Skeletal muscle rigidity 
Myoglobinuria
86
Q

Diagnosis test for MH

A

Halothane-caffeine contracture test

Future - genetic testing of ryanodine receptor

87
Q

What does pseudocholinesterase do?

A

Breaks down ACh

88
Q

Ischemic Heart Disease (4)

A

Age (male 45 female 55)
Family history of premature CHD (male 55 female 65)
Current smoker
HTN

89
Q

Your blood pressure and pulse rate drops in normal levels how long after last cigarette?

A

20 min

90
Q

Circulation improves and lung function increases by after 30% and breathing becomes noticeably easier after how long of last cigarette?

A

2-12 weeks

91
Q

Risk of heart disease drops half that of a current smoker after how long of last cigarette?

A

Within a year

92
Q

Death rate from lung cancer for the average former pack a day smoker decrease by almost 50% how long after last cigarette?

A

5 years

93
Q

Death rate from lung cancer is similar to that of a non-smoker after how long of a cigarette?

A

10 years

94
Q

Risk of heart disease is the same as that of a non-smoker after how long of last cigarette?

A

15 years

95
Q

No dyspnea while walking at a normal pace

A

Grade 0

96
Q

Able to walk as far as I like provided I take my time

A

Grade 1

97
Q

Specific Street block limitations

A

Grade 2

98
Q

Dysnpea on mild exertion

A

Grade 3

99
Q

Dyspnea at rest

A

Grade 4

100
Q

4 D’s of airways evaluations

A

Dentition
Distortion
Disproportion
Dysmobility

101
Q

Patient fully extend neck and measure distance from mandible to thyroid notch (3fingers)

A

Thyromental distance

102
Q

3 axis of airway?

A

Axis of cavity of mouth (oral)
Axis of cavity of pharynx (pharyngeal)
Axis of larynx and trachea (laryngeal)

103
Q

What joint is being measured when patient flex and then extension neck? (>35degrees)

A

Atlanto-axial joint mobility

104
Q

Difficulties of mouth opening (6):

A 
Less than 2 fingers between teeth
Loose teeth
Protruding upper teeth 
High arched palate 
Long narrow mouth 
TMJ problems
105
Q

Difficult mask ventilation (OBESE+)

A 
Obese 
Bearded 
Elderly (55)
Snorers 
Edentulous 
Thick neck
Sleep apnea 
BMI >30
106
Q

<18.5 BMI

A

Underweight

107
Q

18.5-24.9 BMI

A

Normal

108
Q

25-29.9 BMI

A

Overweight

109
Q

30-34.9 BMI

A

Obesity

110
Q

35-39.9 BMI

A

Morbid obesity

111
Q

> 40 BMI

A

Extreme obesity

112
Q

Systolic sound heard over the carotid artery area that may occur as result of carotid artery stenosis

A

Carotid bruit

113
Q

Testing neurological extremities:

A

Hand grip
Head lift
Numbness
Tingling

114
Q

Normal Na level:

A

135-145

115
Q

Normal K levels

A

3.6-5.2

116
Q

Normal Cl levels

A

96-106

117
Q

Normal Co2 level

A

23-29

118
Q

Normal BUN levels

A

7-20

119
Q

Normal Cr levels

A

.84-1.21

120
Q

Normal Glu levels

A

100 after 8 hours of fasting

140 after 2 hours of fasting

121
Q

Normal WBC level

A

4500-11000

122
Q

Normal Hgb level

A

Men: 13.5-17.5
Women: 12-15.5

123
Q

Normal Hct level

A

Men: 38.3-48.6
Women: 35.5-49.9

124
Q

Normal PLT level

A

150,000-450,000

125
Q

measures the integrity of the extrinsic system as well as factors common to both systems

A

Prothrombin Time (PT)

126
Q

measures the integrity of the intrinsic system and the common components

A

Partial Thromboplastin Time (PTT)

127
Q

calculation based on results of a PT and is used to monitor individuals who are being treated with the blood-thinning medication (anticoagulant) warfarin

A

international normalized ratio (INR)

128
Q

makes it harder for your clots to break up

A

Factor 5 Leiden

129
Q

fibrinogen functions in helping to form a blood clot. Measures the amount of fibrinogen in the blood

A

Fibrinogen level

130
Q

What is anesthesia (6):

A 
Analgesia
Amnesia 
Immobility 
Unconsciousness 
Skeletal muscle relaxation 
Block autonomic responses (BP HR)
131
Q

What are the 5 monitors:

A 
BP
Pulse ox 
EKG 
Temp 
ETCO2
132
Q

3-3-2 rule

A

Mouth opening of 3 fingers
Mental and hyoid bone of 3 fingers
Thyroid cartilage to hyoid bone of 2 fingers

133
Q 
Between initial administer of induction meds and loss of consciousness: 
Conscious 
Voluntary movements
Sense of unreality 
Increased sense of hearing
A

Stage 1 analgesia (induction phase)

134
Q 
Loss of consciousness and marked by excited and delirious activity: 
Uncontrolled movements 
Pupillary dilation 
Irregular respirations, HR 
Breath holding 
Vomiting 
Delirium 
Stimulation 
Respond violently (peds)
A

Stage 2 Excitement (delirium stage)

135
Q

Return of regular respiration’s:
Plane 1-return of regular respiration’s to the cessation of REM
Plane 2-cessation of REM to onset of paresis of intercostal muscles
Plane 3-onset to complete paralysis of intercostal muscles
Plane 4-from paralysis of intercostal, the patient will be apneic

A

Stage 3 surgical (operative phase)

136
Q 
Toxic or danger stage: 
Impending death 
Dilated and non reactive pupils 
Hypotension 
Bradycardia 
Complete circulatory arrest
A

Stage 4 overdose (Bulbar paralysis)

137
Q

Who do you RSI? (7)

A 
No NPO
Trauma victims 
Unknown NPO
Long-standing DM 
Pregnant 9-12weeks (morning sickness)
GERD
Morbidly obese
138
Q

How much pressure for cricoid pressure (selleck’s maneuver) is applied?

A

20-44N (2-3kg)

139
Q

Less time to perform
Rapid onset
Better quality motor and sensory block
Less pain during surgery

A

Advantages to spinal:

140
Q

Lower risk of PDPH
Slower onset of hypotension
Controlled, prolonged analgesia with indwelling catheters
Postoperative analgesia

A

Advantages to epidural:

141
Q

Failure of block
Decrease in systemic BP
Patient awake +/-

A

Disadvantages to spinal/epidural

142
Q 
Hypovolemia 
Increased ICP 
Coagulopathy (thrombocytopenia)
Sepsis 
Infection at cutaneous puncture site
Preexisting neurological disease 
Patient refusal
A

Spinal/epidural contraindications

143
Q

3 pillars of documentation:

A

Legibility
Consistency
Accuracy

144
Q

Initial preop anesthesia assessment was done to the time the patient arrives for surgery there must be no longer than…

A

48 hours time limit

145
Q

Repeated regularly and frequent lay in steady rapid succession

A

Continually

146
Q

Prolonged without any interruption at any time

A

Continuous

147
Q

Charting drugs/doses must have order:

A

Drug
Dose
Route (IV,IM,SubQ)
Time

148
Q

2 lights to analyze hemoglobin (1 red of 650 and 1 infrared of 950)

A

Pulse ox

149
Q

SeXy DARLing…

A

At SiX hundred, wavelength Deoxy hb Absorbs Red Light

150
Q

BP reading too high and error can be as much as 50mmHg

A

Undersized BP cuff

151
Q

Low BP reading because…

A

Too large BP cuff

152
Q

MAC awake:

A

Volatile: .3MAC
N2O: .6MAC

153
Q

MAC-BAR (blunt the autonomic response)

A

1.6MAC

154
Q

MAC-EI (prevent laryngeal response to ETT)

A

1.3MAC

155
Q

What is the fluids 4-2-1 rule?

A 
100kg= 40 (bc 4x10)+20 (bc 2x10)+80 (bc 1x80)= 140cc/hr
20kg= 40 (1x10) + 20 (2x10) + 0= 60cc/hr
156
Q

Pathologic state of DM affect the airway management:

A

May decrease mobility of atlanto-occipital joint

Intro To AA (8 decks)

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