Exam 3: endo pulm disorders/disease Flashcards
1
Q
body homeostasis is controlled by what two systems
A
nervous
endocrine
2
Q
what does the endocrine system work through
A
mediator hormones
3
Q
what is the master endocrine gland
A
pituitary gland
4
Q
what are 4 body functions the pituitary gland modifies
A
homeostatic
developmental
metabolic
reproductive
5
Q
what structure is the pituitary gland located in
A
sella turcica
6
Q
what region of the brain is the pitutiary gland connected to
A
hypothalamus
7
Q
how does the pituitary gland connect to the hypothalamus
A
hypophyseal stalk
8
Q
what controls the secretion of pituitary hormones
A
hypothalamus
9
Q
what are the lobes of the pituitary gland
A
anterior: adenohypophysis
posterior: neurohypophysis
10
Q
what does AAA mean in pituitary gland
A
Anterior Adenohypophysis- acromegaly
11
Q
which hormones come out of anterior lobe of pituitary gland- 6
A
growth hormone
adrenocorticotropic hormone
thyroid stimulating hormone
follicle stimulating hormone
luteinizing hormone
prolactin
12
Q
which lobe is 80% of the pituitary gland by weight
A
anterior lobe-adenohypophysis
13
Q
after removal of tumor causing hypopituitarism, you worry about your patient developing polyuria. What problem are you worried about and what medication should be available to fix it
A
diabetes insipidus
vasopressin
14
Q
what is the approach to the surgery for anterior pituitary tumor
A
transphenoidal- through the nose to reach gland
15
Q
what two meds may the patient with hypopituitarism require peri-op during removal of tumor of anterior pituitary gland
A
steroids
thyroid hormone replacement
16
Q
t or f- you can nasally intubate patient who will be have a transphenoidal surgical approach
A
false
17
Q
what position is patient in for transphenoidal surgical approach
A
sitting
18
Q
what two monitors are key during surgery and why for removal of tumor on anterior pituitary using transphenoidal surgical approach in sitting position
A
precordial doppler
etco2
-detect venous air embolism
19
Q
what are other important monitors during transphenoidal appraoch for removal of anterior pituitary tumor
A
BP
HR
20
Q
what monitor gives the earliest evidence of air embolism during sitting position
A
precordial doppler
-mill wheel bubble in heart
21
Q
what gas should not be used during anterior pituitary tumor removal via transphenoidal surgical approach- and why
A
nitrous oxide- expands spaces, draws in air into cranial spaces= increased ICP
22
Q
what do you do when surgeon asks for a valsalva maneuver
A
put vent on manual mode
increase apl pressure to 70
pulse o2 flush to fill bag
squeeze bag- pip will jump up
23
Q
why would neurosurgeon ask for a valsalva maneuver
A
surgeon is looking for increased pressure in ICP and leaks in dura. If there are no leaks, he can finish the surgery
24
Q
why should patient be paralyzed during valsalva maneuver when the high pressure is provided
A
avoid coughing
25
the neurosurgeon is about ready to finish his case and asks for a vasalva maneuver. should your patient be paralyzed at this point
paralyzed to avoid coughing
26
t or f- patient may cough during valsalva maneuver even when deeply sedated
true
27
what is a drip that could help prevent cough during valsalva maneuver
lidocaine
28
what is a precaution to take with patient that has head pins or instruments in a sensitive location who will be getting valsalva
paralyze to avoid damage from cough
29
what volatile gas is neurosafe
isoflurane
30
what is the preference for patient condition during valsalva maneuver during transphenoidal surgical approach for anterior pituitary tumor removal
1. paralyzed
2. deep sedation
31
how many twitches should be present before doing valsalva during transphenoidal surgical approach for anterior pituitary tumor removal
1 or less
32
during surgery for anterior pituitary tumor removal, what is a consideration with emergence
quick emergence to allow for neuro check
33
during surgery for anterior pituitary tumor removal, how should emergence be planned for neuro check
-narcotic controlled: not too much so they can wake up
-bp controlled: to make up for htn/tachycardia from pain
34
t or f-during surgery for anterior pituitary tumor removal, patient should be heavily narcotized at the end of surgery for pain
f-light or no narcotics so patient can perform neuro check on emergence
35
what is key preop education for patient undergoing surgery for anterior pituitary tumor removal
will wake up with nasal packing
breath through mouth when waking up from surgery/getting extubated
36
what equipment should be avoided while undergoing surgery for anterior pituitary tumor removal w/ transphenoidal approach
nasal airways- npa or ntt
nasal temp probes
ng tubes
37
what happens to etco2 during co2 air embolism
drops out
38
t or f- panhypopituitarism is more common than single decrease in 1 anterior pituitary hormone
true
39
why does anterior pituitary tumor more commonly cause- hypersecretion or hyposecretion
hypersecretion
40
anterior pituitary: growth hormone is regulated by ______________________ feedback, where hypothalamus or pituitary hormone synthesis/discharge is stopped
negative
41
what are the airway considerations for acromegaly
Difficult mask
Difficult DL
Smaller ETT
nothing in nose- large turbinates
42
why would a DL be more difficult for acromegaly patient
tissue overgrowth
macroglossia
43
why is a smaller ETT needed for acromegaly patient
vocal cord enlargement
subglottic narrowing
44
what intubation method should be used for acromegaly patient
rsi with glidescope
-LMA 5 ready as backup
45
how should acromegaly patient be extubated
awake
46
what lab should be test pre op for acromegaly patient
glucose
47
how should patient that is difficult to mask and has sleep apnea be extubated
awake
48
what hormones does the posterior pituitary secrete
adh/vasopressin
oxytocin
49
a decrease in plasma volume or blood pressure by what % stimulates adh release
5-10%
50
what are the two hallmark signs of diabetes inspidius
polyuria
polydipsia
51
with diabetes insipidus, what med should be given for long term treatment
desmopressin- ddavp
(short term= vasopressin)
52
is preop vasopressin needed for patient with partial diabetes insipidus and why
no- surgery increases adh release
53
what meds may be used intraoperatively to treat patient with complete di
desmopressin
vasopressin
54
when inducing patient with DI, what will likely happen when giving sedative meds and why
hypotension- they will be dry
55
which disease causes high adh levels causing increased water reabsorption in renal tubules even with hypoosmolarity
SIADH
56
which portion of pituitary is involved with siadh
posterior
57
is urine output low or high in siadh
low
58
_________ can result in water intoxication and hyponatremia leading to brain edema
SIADH
59
Is sodium high or low in siadh
low- diluted
60
when should fluid be restricted vs given for siadh
restrict: asymptomatic w/ hyponatremia
hypertonic saline: symptomatic w/ neuro s/s
61
your diabetic patient has a sudden onset of hypotension. what may be happening
silent MI
62
what is the goal hbg a1c for dm
<6.5
63
why is hgb a1c for dm so important
<6.5 prevents long term complications of microvascular diseases
64
what should be evaluated preoperatively for dm patient
cardiovascular resistance
volume status
ecg
65
t or f- make sure to positive pressure mask DM patient before rsi
f- no positive pressure masking during RSI
66
what med should be given preop to dm patients to prevent aspiration
h2 blockers, antacids, gastroprokinetic agents
67
which patient may have an impaired respiratory response to hypoxia
DM
68
how do you prevent aspiration in dm patient during preop, intubation, and intraop
preop meds: pepcid, bicitra po
intubate: rsi- roc, succ, intubate
intraop: reglan
69
what medication helps to speed up gut in dm patient
reglan- helps to speed the gut up and get out of gastraparesis
70
what is very important to document preoperatively for dm patient
-peripheral neuropathy: sensation, numbness, tingling, parasthesia
-retinopathy
71
what is a rare occurrence in dm where heart rate does not respond to demand- may not tolerate exercise
autonomic neuropathy
72
what are s/s of dm patient with gastraparesis
nausea
vomiting
get full quickly-early satiety
bloating
epigastric pain
73
your patient with dm has stiff joint sydnrome, how do you intubate
videoscope w/rsi
74
what lab tests should you always check pre op for dm patient- 3
glucose- 80-180 mg/dL= ideal
kidney function- ua, bun, creatinine
electrolytes
75
a patient with chronic hyperglycemia will likely undergo ________________ _________________ leaving them _______
osmotic diuresis
dry
76
when should you give insulin pre op for patient with dm- and what kind of insulin
>180 mg/DL
regular insulin
77
how do you assess stiff joint syndrome in dm patient
prayers sign
78
which dm med should be stopped 24-48 hours before surgery
metformin
79
what are the three times you should test blood glucose for dm patient
preop
intraop
post op
80
how should dm patient be intubated
videoscope with rsi-
likely have stiff neck
81
why would ns be used over LR for dm patient
lactate converts to glucose= hyperglycemia
82
what is the formula for calculating goal blood sugar
starting blood sugar- (0.1 unit/kg x 30)
83
what would your bolus dose of insulin be for a patient that weighs 187 pounds and has a starting blood glucose of 380 mg/dL and your goal blood sugar is 125 mg/dL
85kg x 0.1= 8.5 units of insulin IV
84
your patient weighs 176 pounds. Their goal blood sugar is 170 mg/dL and their current bs is 410 mg/DL. How much insulin should be given for a bolus to reach the goal blood sugar
176/2.2= 80kg
80kg x 0.1 units of insulin=
8 UNITS OF REGULAR INSULIN given IV
85
after giving 8 units of regular insulin as a bolus, how much would you expect blood glucose to decrease
8 units x 30mg/dL= 240 mg/dL
86
how much will blood glucose decrease if given 1 unit of insulin
30 mg/dL
87
how do you calculate the regular insulin bolus
weight (kg) x 0.1 unit of regular insulin
88
for the insulin calculations we do for dm, what is the route of regular insulin
IV
89
what is the risk for giving metformin on the day of surgery
hypotension
renal hypoperfusion
90
what lab tests may be elevated in patient taking metformin and therefore should be check preop
kidney function
91
when should surgery be scheduled for dm patient
morning, as early as possible
92
how often should blood glucose be checked during intraop
q1 hour
93
what is the goal of blood glucose control during anesthesia
mildly hyperglycemic
94
when are post op infection rates higher in patient with dm
prolonged hyperglycemia
95
what is normal and high normal blood glucose for surgery
normal < 100
high normal 101-125
96
when should type 2 diabetics stop their oral hypoglycemics
night before surgery- except METFORMIN- STOP 1-2 DAYS BEFORE
97
what is the biggest risk/cause of hypoglycemia for diabetic patient having surgery
insulin during npo time
98
how can you treat hypoglycemia for conscious and unconscious patient
1/2 amp of d50= conscious
unconscious= full amp
d50
-check bg q20 mins thereafter
-continuous d5 infusion
99
at what blood glucose does seizures and loss of conciousness appear
<50 mg/dL
100
what are some s/s of hypoglycemia
confusion, dizzy, ha, weak, tachycardia, diaphoresis, pupillary dilation, vasoconstriction
101
t or f- general anesthesia does not prevent the neurologic signs of hypoglycemia
f-it does, that is why you have to check blood glucose frequently
102
what may happen if hypoglycemia goes untreated
irreversible brain damage
103
ketoacidosis is more common in which diabetes
type 1
104
hyperglycemic hyperosmolarity is more common in which diabetes
type 2
105
which has higher glucose and osmolarity- hhms or dka
HHS
106
what is the anesthetic plan for conn's syndrome aka hyperaldosteronism
correct fluid/electrolytes preop
htn= spironolactone
muscle relaxer may be affected by hypokalemia
ekg monitor for hypokalemia
hyperventilation= worsens hypokalemia
107
in patient with cushing's, how should you dose muscle relaxants
conservative
108
what is the anesthetic plan for cushings (high glucocorticoid)
correct fluid/electrolytes preop
thin skin= prone to injury
increased risk of infection
thromboemboli are more common
109
pheochromocytoma orginates in what gland
adrenal gland
110
what does pheochromocytoma secrete
norepi alone or w/epi
111
what symptoms mentioned in preop would alert you to pheochromocytoma- 4
ha
diaphoresis
htn (paroxysmal)
palpitations
112
what are the non selective alpha antagonists
Phenoxybenzamine
Phentolamine
113
what are the selective alpha antagonists
prazosin
114
which should be given first for pheochromocytoma- labetalol or prazosin
prazosin
115
what lines/monitors are needed for pheochromocytoma
a line
2 large bore iv's
urinary cath
cvc/pac
116
when is htn most likely to occur in anesthesia for pheochromocytoma patient- 4
induction
intubation
surgical incision
manipulation
-pre treat!!! w/ prazosin
117
when is hotn most likely to occur in anesthesia for pheochromocytoma patient
removal of the tumor
118
what drugs should avoid with pheochromocytoma
droperidol/metoclopramide
histamine releasing drugs
antimuscarinics
desflurane
naloxone
glucagon
phenergan/compazine
119
what are some histamine releasing drugs to avoid with pheochromocytoma
atracurium
mivacurium
succ
meperidine
MORPHINE
codeine
120
what are some anti-muscarinics to avoid with pheochromocytoma
atropine, glyco, pancuronium
121
what nmb can be used for pheochromocytoma that she mentioned
vec
122
what do you need to be prepared for when pheochromocytoma tumor is removed
hypotension
hypoglycemia
123
once pheochromocytoma tumor is removed, what bp meds can be used
phenylephrine
epi
124
what should you ask patient with goiter before surgery
can you lie flat
how do you sleep at night
do you have trouble breathing while supine
125
what are tsh, t3, t4 in hyperthyroidism
tsh: low
t3/t4: high
126
what are tsh, t3, t4 in hypothyroidism
tsh: high
t3/t4: low
127
for patient with hyperthyroidism, what meds should be avoided for sns stimulation- 6
epi
ephedrine
atropine
ketamine
norepi
dopamine
128
for patient with hyperthyroidism, what med should be given for hypotension
phenylephrine
129
what nerves are the thyroid gland close to-2
-recurrent laryngeal nerve
-external motor branch of the superior laryngeal nerve
130
what is the external motor branch of the superior laryngeal nerve responsible for
cricothyroid muscle tension
adducts vocal cords
131
what happens if the external motor branch of the superior laryngeal nerve is damaged
voice change
132
what happens if recurrent laryngeal nerve is damaged unilaterally vs bilaterally
unilateral: partial airway obstruction, abduction paralysis- one cord stays closed- HOARSENESS
bilateral: stridor, closed cords, resp distress
133
t or f- patient needs to be paralyzed for thyroid surgery
f- paralyze for intubation, but not thereafter, use short acting paralytic
134
what kind of ett is used for thyroid surgery
nims tube
-electrodes in it for assessment of nerves throughout the surgery
135
how should patient be intubated for thyroid surgery
nims tube- videoscope
136
which side of vocal cord should red side of nims ett be on
right- make sure it is at certain level of vocal cord, careful placement- wait to tape until after monitor tech has verified electrodes
137
what are good meds for thyroid surgery removal after paralytic has worn off, to blunt airway response
LTA
iv lidocaine
narcotics
deep volatiles
-can't redose paralytic
138
during thyroid surgery, what should you make sure of before extubating
no cord damage
139
after extubating, what should you assess for patient w/thyroid surgery
-immediately put on mask and look for humidity
-look at tidal volumes
-spontaneous breathing rate
140
if you think there is damage to vocal cords post thyroid surgery, what is your intervention
immediately intubate
141
what is important to assess preop for thyroid surgery
airway assessment
-tracheal deviation
-enlarged thyroid
-hoarse voice: new onset?
-hard to breath when flat?
142
what is the safest intubation approach for thyroid gland surgery with fear of airway compromise during induction
awake fiberoptic intubation with topical anesthesia- nebulized lidocaine, transtrahceal block
-put them to sleep after securing airway w/propofol
143
t or f- hyperthyroid patients should only have emergent surgeries completed
true
144
what sedative should be avoided with thyrotoxicosis/grave's disease
ketamine
145
what should be given to thyrotoxicosis/grave's disease preop
versed- anxiolysis
146
when intubating thyrotoxicosis/grave's disease patient, what level of anesthesia is needed
deep level
147
what med should be given for intraop hypotension for thyrotoxicosis/grave's disease patient
phenylephrine
148
which nurse is most important for preventing/treating thyroid storm
pacu
thyroid storm is most often seen in PACU
149
when is thyroid storm most often seen- pre, intra, or post op
post op 6-18 hours
150
how should hypothyroid patient be intubated
rsi with videoscope
151
what bp meds should be used for hypothyroid patient
indirect acting vasopressors
-ephedrine
-epi
-dopamine
**avoid phenylephrine
152
should direct or indirect acting bp meds be used for hypothyroidism
indirect
153
should direct or indirect acting bp meds be used for hyperthyroidism
direct
154
what two things is a post op parathyroidectomy at risk for
hypocalcemia
laryngospasm
155
what is immediate action with bilateral recurrent laryngeal nerve injury after parathyroid surgery
intubation
156
what line is important to have during hyperparathyroid surgery
art line- to draw labs
157
t or f- nims tube is used for hyperparathyroid surgery
false
158
t or f- use short acting nmb during parathyroid removal for hyperthyroidism
t- watch nerves innervating larynx/airway
159
what lab test is best measure of renal function
GFR
160
what lab test should be looked at before toradol admin
creatinine
avoid if >1
161
what is the most common cause of aki
ischemia reperfusion injury
162
how can aki be prevented
avoid low volume/low bp/low co to perfused kidneys
163
why can ckd patient have low blood levels and not get blood
chronic compensated anemia
164
what electrolyte should be checked with renal disease/esrd
potassium
165
what should be expected after intubation with renal disease
they are dry- so hypotension on intubation
166
what are anesthesia considerations for ckd/renal disease patient
fluids- micro ns
art line
labs-potassium
last day of dialysis
167
if patient had dialysis the day of surgery, how can you prevent hypotension during induction
neo drip
albumin
trickle in fluids
168
what meds should be avoided w/carcinoid syndrome to avoid carcinoid crisis
succ, mivacurium, atracurium
epi, isoproterenol
thiopental
demerol
169
what is the main treatment for carcinoid tumor/syndrome
octreotide
24-48 hrs before surgery
and before manipulation of tumor
170
what things are necessary to manage carcinoid patient
-art line
-octreotide pre op and before manipulation of tumor
-general anesthesia= delayed awakening from increased serotonin
-epidural is safe
-zofran
171
how can GETA be affected by carcinoid syndrome
carcinoid syndrome= increased serotonin= delayed awakening
172
what are the four volume loops she mentioned
obstructive
normal
restrictive
fixed
173
what kind of flow volume loop is tracheal stenosis
fixed obstruction
174
what is a flow volume loop shifted to the right
restrictive
175
what is a flow volume loop shifted to the left
obstructive
176
what are some causes of obstructive flow volume loop- 4
copd
asthma
emphysema
bronchitis
177
how do you help patient with obstructive flow volume loop
change i:e ratio from 1:1 to 1:1.5 or 1:2
178
what are some causes of restrictive flow volume loop- 4
interstitial lung disease
chest wall deformity
scoliosis
marked obesity
179
which flow volume loop is able to deflate but has difficulty inflating characterized by shallow breaths
restrictive
180
which flow volume loop has a difficult time exhaling
obstructive
181
how do intubate patient with tracheal stenosis
-awake intubation
-videoscope
-armored small tube (protects from bovi)
-2nd provider present*
-fiber optic available
-difficult airway cart available
-have ent in OR when inducing
182
when is systolic pressure considered high in pulmonary artery
> 30 mmhg
183
when is mean pulmonary artery pressure considered high
> 25 mmhg
184
pulmonary htn causes which kind of heart failure
right sided
185
what are some causes of pulm htn
smoking
drugs-cocaine
alcohol
copd
lupus
left sided heart failure
186
what are s/s of right sided heart failure
edema, JVD, enlarged liver, abd ascites
187
what are some s/s of pulm htn
exercise intolerance
sob
coughing
weakness/fatigue
abdominal distention
syncope
angina
parasternal lift
murmurs
jvd/peripheral edema/hepatomegaly/ascites
188
pulmonary htn can lead to _________________ regurgitation
tricuspid
189
t or f- pulmonary htn can lead to scarring in vessels
true
190
what murmurs are associated with pulm htn
pulmonic insufficiency
tricuspid regurg
191
what type of irregular heart sound can be heard during pulm htn
s2 s3 gallop
192
what are some s/s of pulm htn that has developed into right heart failure
jvd
peripheral edema
hepatomegaly
ascites
193
how can you assess functional status of pulm htn patient
6 min walk test
194
how do you assess parasternal lift
heel of hand to the left of sternum, fingers lifted slightly off of chest
normal: none or inward
pulm htn: heal of hand is lifted off chest w/systole
195
how will pulm htn affect ecg- 5
right axis deviation
right ventricular strain
right ventricular hypertrophy
complete/incomplete rbbb
P pulmonale
196
what lead should be looked at for p wave abnormalities
2
197
how will p waves be affected during pulmonary htn
peaked, larger
198
what leads should be looked at for rbbb
v1- upright, odd complex
199
what leads should be looked at for Lbbb
v1- wide complex, not upright
200
what happens if you see a new bundle branch block when getting back to the OR
if non-emergent, cancel case and get cardiac eval
201
which is worse- right or left bbb
left
202
where is nitric oxide distributed in lung
alveoli causing vasodilation
-improves v/q matching and oxygenation
203
what case would nitric oxide be used in OR
cabg with severe pulmonary htn
204
t or f- nitric oxide has many systemic effects, which limits its use
f- inactive in pulmonary circulation so systemic effects are minimized
205
what induction meds should be avoided w/ pulmonary htn patient
ketamine
etomidate
-suppress pulmonary vasorelaxation mechanisms
206
can an epidural be used for pulm htn patient
yes- but watch intravascular volume and SVR
207
you are using nitric oxide for your pulmonary htn patient, what are they at risk for
inhibit platelet function
at risk for bleeding
208
what should you have available for pulmonary htn patient receiving nitric oxide
platelets
209
what are three drugs that increase pvr
nitrous oxide
ketamine
desflurane
210
what are three things that increase intrathoracic pressure, and thus pvr
peep
atelectasis
mechanical ventilation
211
what are 6 causes of increased pvr
hypoxemia
hypercarbia
acidosis
sns stimulation
pain
hypothermia
212
what are 3 causes of decreased pvr
increased pao2
hypocarbia
alkalosis
213
what are 4 causes of decreased intrathoracic pressure, thus causing decreased pvr
preventing coughing/straining
normal lung volumes
spont ventilation
high frequency jet vent
214
what are 6 drugs that decrease pvr
inhaled nitric oxide
nitroglycerin
pde5- sildenafil
prostaglandins- PGE1, PGI2
ccb
ace inhibitors
215
what is the scooped out portion on the obstructive flow volume loop
premature airway closure during exhalation
216
t or f- flow can be increased on exhalation in obstructive resp diseases by increasing exhalation effort
false
217
which flow volume loop is a mini normal flow volume loop
restrictive
218
which flow volume loop has decreased residual volume
restrictive
219
what is normal residual volume on flow volume loop
2
220
which flow volume loop has increased residual volume 4L
obstructive
221
where is total lung capacity on flow volume loop
very end of inspiration/beginning of exhalation where flow is 0L
222
on flow volume loop, what is the space from residual volume to total lung capacity called- aka the width of the flow volume loop
vital capacity
223
how is flow measured in flow volume loop
L/sec
224
what is the max volume the lungs can hold
total lung capacity
225
t or f- asthma patients can have air trapping
true
226
what is the major clinical sign of bronchospasm and asthma
wheezing
227
t or f- asthma airways have a hypersensitive response and is considered a reactive airway
true
228
how can you manage reactive airway (asthma) during intubation
-LTA
-RSI- get tube in quicker
-succ
-deep anesthesia
229
how should extubation take place for asthma vs sleep apnea
asthma: deep
osa: awake
230
what should you make sure to assess pre op for asthma/reactive airway patient
airway- listen for wheezing
231
what meds should be given preop for asthma/reactive airway
albuterol/zopinex- wheezing
versed-anxiety
robinul-secretions
232
when did she mention to give albuterol for asthmatic patients- 2 different times
pre op
intraop: right before intubation
233
t or f- LTA's work well with videoscopes
f- difficult placement
234
what should NOT be happening before induction of asthma patient if possible
wheezing
235
what patient would you want to send to pre anesthesia eval 1 week before surgery
asthmatic patient with hx of emergent events, unstabilized asthma
236
which beta blockers should be given for asthmatic patient-3
-selective beta 1 blocker
atenolol
metoprolol
esmolol
237
what are the non selective beta blockers
carvedilol
labetalol
propranolol
timolol
238
what is a good beta blocker to control hemodynamic changes during induction
esmolol
239
what are some good induction meds for asthma patient
propofol
ketamine
volatiles except desflurane
robinul
benzos
etomidate
fentanyl
nimbex/roc
240
which meds are not good for asthma patient
desflurane
nitrous oxide
methohexital
demerol/morphine?
succ-histamine release
morphine-histamine release
nsaids-toradol, ibuprofen
asa
241
what is the most effective bronchodilator of the volatiles
sevoflurane
242
what should you do if you have des running and patient bronchospasms
turn off des
turn on sevo
get patient deep
243
t or f- give succ for smooth muscle relaxation during bronchospasm
f- terbutaline
244
what is the dose of terbutaline for bronchospasm
subq 0.25mg= 0.25 ml q 15-30 min x 2
245
what is the most common med to cause allergic reactions intraop
nmb- abx
246
what meds can you give in preop to prevent anaphylaxis/allergic reaction
pepcid
benadryl
decadron
247
what method of securing airway is best if it is possible to use-for-asthma-pt.
LMA
248
how do you manage vent for asthma patient
no peep
higher i:e ratio
no suctioning
249
how should you remove LMA in asthma patient
deep
250
what can happen if you don't keep asthmatic patient deeply sedated enough
bronchospasm
laryngospasm
251
how do you decrease/treat auto peep
d/c from circuit
increase flows
increase e on i:e ratio
decrease tidal volume
no peep
252
what happens to pip with auto peep
increased
253
how does flow volume loop look when auto peep is present
exhalation side is flat
254
t or f- auto peep effects venous return
t- can cause hypotension by poor venous return
255
t or f- increase peep with hypotensive patient to help with venous return
f- turn off peep
256
what are the signs of bronchospasm while under anesthesia
-wheezing
-up sloping etco2 -narrow/peaked
-decreased tidal volume
-decreased/absent etco2
-increased pip
-hypoxemia
257
in a patient with pulmonary disease, should you give suggamadex vs neostigmine/robinul
neostigmine/robinul
-less risk of bronchospasm
258
t or f- if bronchospasm is going on, reverse nmb to wake up patient
f- do not reverse at this time
259
what is best way to extubate asthmatic patient-deep or awake
deep
avoid coughing, irritant, spasms
-do not extubate deep if they are at risk for aspiration
260
who has the highest risk of bronchospasm
uncontrolled asthma
261
what are the best indicators of severity of asthma before surgery
pef
fev1
>80% projected personal best=normal
262
what is samter's triad
-Asthma
-asa/nsaid sensitivity
-sinusitis w/nasal polyps
263
what factors should be looked at before giving toradol
bleeding
kidney function
asthma
264
how long should patients quit smoking before surgery to decrease post op complications the most
> 8 weeks
265
what is the single principle factor that predisposes a patient to copd
cigarette smoking
266
what is the single best action the patient can take to treat copd
stop smoking
267
how should ventilator be managed for copd patient
low tidal volume
increase e time
slow inspiratory flow rate to optimize v/q matching
low or no peep
268
you have a patient with sarcoidosis. which flow volume loop will they show
restrictive
269
your patient aspirates and develops aspiration pneumonitis. what flow volume loop will they show
restrictive
270
how do you treat aspiration pneumonitis
o2 and peep
271
which pulmonary edema is caused by laryngospasm, obesity, or osa in spontaneously breathing patients
negative pressure pulmonary edema
272
what are s/s of negative pressure pulmonary edema
tachypnea
cough
failure to maintain o2 above 95%
htn
273
how do you maintain airway in negative pressure pulmonary edema
self limited
clear obstruction
274
what is an example of chronic intrinsic restrictive lung disease
sarcoidosis
275
what is an example of acute restrictive lung disease
pulmonary edema
276
what is the most common sign of pe
acute dyspnea, sudden onset
277
what are the manifestations of PE during anesthesia
unexplained hypoxemia
hypotension
tachycardia
bronchospasm
ekg= pulm htn/rv dysfunction
decreased etco2=increase in dead space ventilation
positive d dimer***
elevated troponin
278
what is the gold standard for diagnosing PE
pulmonary arteriography
279
how would ecg appear with PE
increased p wave in lead 2
rbbb in V1
decreased etco2
280
how can pe be treated- 2
anticoags: heparin, lovenox, coumadin- 6 months
ivc filter
281
what is the greatest risk factor for osa
obesity
282
osa can lead to __________________ heart failure
chronic
283
what are some symptoms of osa
frequent arousal while asleep
always tired
irritable
cannot think clearly
impaired sensory/motor skills
284
what assessment should be completed preop for potential osa patient
stopbang assessment
285
what are some questions in the stopbang assessment
s- snoring
t-tired
o-obersvation
p-blood pressure
b-bmi >35
a- age >50
n- neck >40cm, or 17/16 inch
g- gender= male
286
the stop bang questionnair has an overall sensitivity of ____% in predicting moderate to severe OSA
93%
287
how many questions does patient need to answer yes on stopbang to be at high risk for osa
3
288
how should patient with osa be extubated
fully awake
semi upright position
full nmb reversal
289
where is the safest location for osa patient to have surgery
hospital
290
what can 100% o2 cause if given for prolonged periods of time via ventilator
absorption atelectasis
291
what are the normal tidal volume, rr, and peep for male vs female
f: 500 tv, rr: 12, peep 5
m: 600 tv, rr: 12, peep 5
292
what is normal range for sevo to hit 1 mac
1.7-2%
293
what is normal range for iso to hit 1 mac
0.6-1%
294
what should fgf be for sevo
1L o2
1L medical air
= 2 Liters
295
what should fgf be for iso
0.5 L o2
0.5L medical air
= 1 Liter
296
what is A
Liters
297
what is B
L/Sec
298
what is C
expiration
299
what is D
inspiration
300
what is E
obstructive
301
what is F
normal
302
what is G
restrictive
303
what is H
fixed
304
what is A (x axis)
volume
305
what is B
vital capacity
306
what is C (y axis)
flow
307
what is D
peak expiratory flow rate
308
what is E
normal
309
what is G
obstruction
310
what is A
Vt
311
what is B
expiration
312
what is C
L/sec
313
what is D
total lung capacity
314
what is E
residual volume
315
what is F
functional residual capacity
316
what is G
vital capacity
317
What disease is shown and how would you intubate
acromegaly
-rsi with glidescope
318
what disease is shown here and what med should be given preop to treat it
carcinoid syndrome
-octreotide 24-48 hours before surgery, plus before manipulation of tumor intraop
