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Intro To AA > Exam 3- Dan's Jazz > Flashcards

Exam 3- Dan's Jazz Flashcards

1
Q

Who has higher incidence of awareness under GA?

A

Children

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2
Q

What are the 9 risk factors for having awareness under GA?

A
  1. Routine use of paralytics
  2. TIVA
  3. Production pressure
  4. Hemodynamic instability
  5. Obstetric/Cardiac/Trauma
  6. Patient age
  7. Difficult airway
  8. Limited cardiac reserve
  9. Substance abuse
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3
Q

What type of substance abuse is a risk factor (3)

A

Chronic ETOH
Anxiolytics
Cocaine

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4
Q

Experiences with awareness during GA and percentages (4)

A

Audio (48%)
Not being able to breath (48%)
Pain (30%)
PTSD (30%)

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5
Q

4 classes of etiologies for patient awareness:

A

Class 1: pt specific altered increase in anesthetic receptors
Class 2: pt can’t tolerate anesthetic
Class 3: pt hemodynamics mask awareness
Class 4: anesthetic delivery failure

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6
Q

Hemodynamic; 5 typical indicators of physiologic and motor response:

A
  1. High BP
  2. HR
  3. Movement
  4. Lacrimation
  5. Dilated pupils
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7
Q

Major criteria for high risk awareness under GA (7):

A
  1. Longer term use of narcotics/ETOH/cocaine
  2. EF <40%
  3. H/O anesthesia awareness
  4. H/O difficult airway
  5. ASA 4/5
  6. Aortic stenosis/ open heart surgery
  7. End stage lung disease
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8
Q

Minor criteria to be high risk of awareness under GA (4)

A
  1. Periop use of Beta Blockers
  2. COPD
  3. BMI >30
  4. Tobacco 2 packs/day
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9
Q

Prevention for awareness under GA (5)

A
  1. Premed with versed
  2. Frequent machine checks
  3. Insure pt is asleep prior to intubation
  4. Concerned when giving BB or antiHTN
  5. Avoid paralysis unless needed
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10
Q

Is assist-control ventilation (ACV) desirable for patients who breathe rapidly, why?

A

NO because may induce both hyperinflation and respiratory alkalosis

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11
Q

Each breath is either an assist or control breath, bu they are all of the same volume

A

Assist control ventilation (ACV)

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12
Q

Guarantees a certain number of breaths, but pt breaths are partially their own, reducing the risk of hyperinflation or alkalosis

A

Synchronized intermittent-mandatory ventilation (SIMV)

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13
Q

Disadvantage of SIMV:

A

Increased work of breathing and tendency to reduce CO (which prolong ventilator dependency)

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14
Q

Which ventilator should be used for pt who has LV dysfunction:

A

ACV

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15
Q

When is pressure-control ventilator preferred:

A

Pt with neuromuscular disease

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16
Q

Variation of CPAP that releases pressure temporarily on exhalation that results in high average airway pressures

A

Airway pressure release ventilation

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17
Q

Does APRV require more or less sedation?

A

More

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18
Q

Volume target backup is added to a pressure assist-control mode

A

Pressure regulated volume control (PRVC)

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19
Q
  • Clinician sets the percentage of work of breathing
  • Positive feedback loop
  • Compliance and resistance calculated using intermittent end-inspiratory and end-expiratory Pasteur maneuvers
A

Proportional assist ventilation

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20
Q

Low levels of PEEP are most dangerous in with pts:

A

Hypovolemia and cardiac dysfunction

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21
Q

PEEP is indicated clinically for (3):

A
  1. Low volume ventilation cycles
  2. FiO2 requirements >.60 (stiff, diffuse lay injured lungs; ARDS)
  3. Obstructive lung disease
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22
Q

Who do you NOT use PEEP on?

A

Pneumonia; affect healthy tissue and worsen oxygenation

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23
Q

How to see effect on PEEP?

A

Peak inspiratory pressure (PIP)

-if PIP increases less than added PEEP=PEEP improved compliance of lungs

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24
Q

Ways PEEP can be monitored (2)

A

PIP

PaO2/FiO2 ratio (increase)

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25
Q

Prone ventilation may improve what?

A

Oxygenation by redistributing pulmonary blood flow

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26
Q

When is prone not good?

A

Neurosurgery

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27
Q

2 absolute contraindications of prone positioning:

A
  1. Unmonitored or increased ICP

2. Unstable vertebral fractures

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28
Q

Respiratory rate greater than 4x the normal value (>150breaths/min) and very small tidal volumes

A

High frequency oscillatory ventilation

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29
Q

What is high frequency oscillatory ventilation referred to as and why?

A

Lung protective ventilation

-reduce vent associated lung injury (ARDS and acute lung injury)

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30
Q

Combines conventional cycles with high frequency percussion

-conventional ventilation and HFPV with a high frequency of 400-800 cycles/min

A

High frequency percussive ventilation

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31
Q

When is high frequency percussive ventilation used?

A

Burn ICU

32
Q

Step wise reduction from ventilator in superior to intermittent mandatory ventilation (3)

A
  1. Mechanical support
  2. Pressure support mode
  3. Multi daily T-piece trails
33
Q

What is good for trails of unassisted breathing with weaning off vent:

A

Low levels of pressure support

34
Q

Successful first trial, followed by discontinuation of mechanical ventilation

A

Simple transition

35
Q

3 spontaneous-breathing trials but fewer than 7days between the first unsuccessful trial and successful discontinuation of mechanical ventilation

A

Difficult transition

36
Q

At least 3 unsuccessful spontaneous-breathing trial or 7days or more of mechanical ventilation after the initial unsuccessful trial

A

Prolonged transition

37
Q

3 reasons why trials of spontaneous breathing do not succeed:

A
  1. Respiratory mechanics worsen during spontaneous breathing trial
  2. Deterioration of respiratory mechanics can result from
    - increased respiratory resistance (asthma and obstructive pulmonary)
    - decreased lung compliance (pulmonary fibrosis, edema, acute lung injury, ARDS)
    - air trapping (COPD)
  3. Challenge the circulation
38
Q

3 things with respiratory load:

A
  1. Lung disease
  2. Cardiovascular dysfunction
  3. Chest-wall disease
39
Q

3 things with respiratory capacity:

A
  1. Muscle weakness
  2. Diminished respiratory drive
  3. Impaired neuromuscular function
40
Q

2 big things during weaning from ventilator:

A
  1. SBT for 30min

2. Assess airway, cough, airway secretions and mentation

41
Q

When can respiratory distress develop after extubation?

A

Up to 48 hrs

42
Q

What reduce the need for reintubation after discontinuation of mechanical ventilation:

A

Noninvasive positive pressure ventilation

43
Q

Risk factors for unsuccessful discontinuation of mechanical ventilation: age

A

> 65 yr

44
Q

Risk factors for unsuccessful discontinuation of mechanical ventilation: APACHE II score

A

> 12 on day of extubation

45
Q

Risk factors for unsuccessful discontinuation of mechanical ventilation: partial pressure of arterial CO2 after extubation

A

> 45 mmHg

46
Q

Hypotension due to peripheral vasodilatation but also by a poor response to a therapy with vasopressors drugs

A

Vasodilators shock

47
Q

What is vasodilator shock due to hemorrhage also known as:

A

‘Irreverisible’ or late phase hemorrhagic shock

48
Q

4 other things that are characterized by cardiovascular collapse and that are likely to be associated with vasodilatation:

A
  1. Lactic acidosis due to metformin intoxication
  2. Certain mitochondrial diseases
  3. Cyanide poisoning
  4. Cardiac arrest with pulse less electrical activity
49
Q

What is nitric oxide in both septic shock and decompensated hemorrhagic shock:

A

Increased

50
Q

Inhibits NO preventing SM relaxation by nitrogen-based vasodilators:

A

Methylene blue

51
Q

As shock worsens, the initial very high concentration of vasopressin in plasma does what?

A

Decreases

52
Q

Vasodilator shock has no effect with what (4)

A

Vasopressor
Norepinephrine
Angiotensin II
Endothelin

53
Q

Vasopressin max dose for post cardiotomy shock

A

.1untis/min

54
Q

Vasopressin max does for septic shock:

A

.07units/min

55
Q

How long should Sux not be given after burns, trauma, and denervation:

A

24-72hrs

56
Q

What should be used to test for TOF

A

Double burst

57
Q

What test to use to test for TOF >.7:

A

Tetanus for 5 seconds of 50Hz

58
Q

4 twitches:

A

0-75%

59
Q

3 twitches?

A

75%

60
Q

2 twitches?

A

80%

61
Q

1 twitch?

A

90%

62
Q

0 twitches?

A

> 90%

63
Q

How long does neostigmine take to peak?

A

10min

64
Q

Initial dose of neostigmine?

A

1mg

65
Q

Shallow medium block vs deep block dosage of sugammadex?

A

2mg/kg

4mg/kg

66
Q

Immediate reversal dose of sugammadex 3 min after giving max 1.2 mg/kg of Roc?

A

16mg/kg

67
Q

Is there a dose adjustment needed for sugammadex?

A

Not when pt is >65yr, obese, or gender

68
Q

Trigger CO2 <35

A

Pt needs narcotics

69
Q

Trigger CO2 >50:

A

Pt do NOT need narcotics

70
Q

CO2 between 35-50:

A

Wait and titrate to effect later

71
Q

When are colloids (volume expanders) used (2):

A
  1. Hyperproteinemia

2. Malnourished pts who can’t tolerate large infusions of crystalloids

72
Q

3 times to use colloid:

A
  1. Renal failure
  2. Large trauma
  3. Microsurgical
73
Q

When should crystalloid fluids be used:

A

Pts with dehydration (loss of ISF and IVF)

74
Q

When should crystalloid fluids be limited:

A

Replaced of deficits and ongoing clear-fluid losses

75
Q

Where are colloid fluids designed to stay?

A

In IV space

Intro To AA (8 decks)

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