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Nur 943 OB > FINAL 3 > Flashcards

FINAL 3 Flashcards

1
Q

Acute bacterial infection involving lingular surface of epiglottis, aryepiglottic folds, and aretynoids.

A

Epiglottitis

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2
Q

Another name for Epiglottitis is

A

Acute Supraglottis

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3
Q

Is Epiglottis life threatening?

A

Yup

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4
Q

4 Ds of Epiglottis

A

Dysphagia
Dysphonia
Dyspnea
Drooling

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5
Q

Epiglottitis starts as

A

sore throat and dysphagia with thick, muffled voice

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6
Q

Classic presentation of epiglottis

A

child sitting, dyspneic, mouth open, drooling, forward chin thrust, tripod position

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7
Q

Induce Epiglottitis with ____ and _____

A

Sevo and oxygen

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8
Q

Dose for atropine

A

0.02mg/kg

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9
Q

Fluid bolus epiglottis pts with

A

20-30ml/kg

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10
Q

Epiglottitis…ETT should be ________ than usual

A

1-2x smaller

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11
Q

______ confirms epiglottitis diagnosis

A

cherry red edpiglottis

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12
Q

Do you want to use muscle relaxants with epiglottitis?

A

nope- contraindicated, relaxation of pharyngeal muscle could block laryngeal airway

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13
Q

Epiglottitis- maintain _______pressure ( ____ cmH20) to minimize collapse of airways.

A

positive pressure (10-15cm H2O)

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14
Q

Epiglottitis. After stabilized, child may be sedated for _____hours to prevent extubation.

A

24hours

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15
Q

Epiglottitis. Have emergency _____ kit available during intubation and and ____ doc around.

A

trach

ENT

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16
Q

Abnormality of the POSTERIOR fossa causing cephalad displacement of the cerebellum through the formamen magnum

A

Chiara malformations

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17
Q

What type of chiari malformation?
Caudal herniation of vermis, brainstem, and 4th ventricle. Associated with myelomeningocele and other anomilies. “ARNOLD CHIARI MALFORMATION”

A

Type 2

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18
Q

What type of chiari?
Tonsillar herniation >5mm below the plane of the foramen magnum. No associated brainstem herniation or supratentorial anomalies. Low frequency of hydrocephalus.

A

Type 1

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19
Q

What type of chiari?
Most severe.
Occipital encaphalocele containing dysmorphic cerebellar and brainstem tissue

A

Type 3

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20
Q

What type of chiari?
Hypoplasia or aplasia of the cerebellum
“absent cerebellum”

A

Type 4

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21
Q

What is the most common pediatric neurosurgical condition?

A

Hydrocephalus

22
Q

What happens with hydrocephalus?

A

Mismatch of CSF production and absorption, leading to increased intracranial CSF volume.

23
Q

Most hydrocephalus is due to (2 things). With the exception of _____

A

Obstruction
Inability to absorb CSF
Exeption: Choroid Plexus Papillomas

24
Q

Hydrocephalus is caused by (5 things)

A 
Congenital Cause (like aqueductal stenosis)
Hemorrhage
Trauma
Infection
Tumors
25
Q

Classification of Hydrocephalus is based on______ ______________
2 classifications

A 
the ability of CSF to flow around spinal cord
1 Nonobstructive (communicating)
2 Obstructive (Noncommunicating)
26
Q

Treatment of hydrocephalus (2)

A
  1. Treat cause (etiology)

2. Surgical placement of ventricular drain or V-P shunt

27
Q

Most shunts carry CSF from ______ to _______

A

lateral ventricles to peritoneal cavity

28
Q

Anesthetic plan with Hydrocephalus
Control ____ and relieve _______
Increased ICP increases risk for ______and ______
Avoid _______ (induction drug)
Avoid _________(ventilation)
Risk of ____ during placement of distal end of VP shunt

A

Control ICP and relieve obstruction
Increased ICP increases risk for vomiting and aspiration
Avoid Ketamine
Avoid Hyperventilation
Risk of VAE during placement of distal end of VP shunt

29
Q

Mannitol is used to treat i_______

A

increased ICP

30
Q

PO dose of midazolam and onset time

A

0.5-1mg/kg 10-20mins

31
Q

IV dose of midazolam

A

0.05mg/kg

32
Q

Art line- transduce at level of the

A

head

33
Q

Contraindications to nasal intubations

A

choanal stenosis
possible basilar skull fracture
transsphenoidal procedures
sinusitis

34
Q

Ensure free _____ movement during prone positioning

A

abdominal

35
Q

VP shunts, temporal & parietal craniotomies will use what position

A

modified lateral

36
Q

Posterior fossa & spinal cord surgery will use what position?

A

Prone

37
Q

What position may be used in morbidly obese

A

Sitting

38
Q

2x MAC of isoflurane can cause

A

isoelectric EEG

39
Q

Volitile agents and vasodilators ___ CBF and ICP

A

increase

40
Q

Fentanyl dosage- loading and maintenance.

A

5-10 mcg/kg with 2-5mcg/kg/hr for maintenance

41
Q

Most blood loss begins at the ____ of neurosurgery

A

beginining

42
Q

VAE risk is greatest in the ____ position

A

sitting

43
Q

VAE Sx is sudden decrease in

A

ETCO2

44
Q

What is the most specific method to detect VAE

A

Echo

45
Q

VAE- use precordial dopper to monitor ___ sounds

A

RH

46
Q

VAE- The larger the press gradient between ______ site and ______ the greater the risk for air embolism

A

The larger the press gradient between operative site heart, the greater the risk for air embolism

47
Q 
Put these in order from most sensitive to least sensitive for detection of air embolisms.
ECG
Systemic Blood Pressure
ECHO
ETCO2
ET-Nitrogen
Respiratory Pattern
Esophageal Stethoscope
Right Atrial Pressure
Precordial Doppler
A 
Precordial Doppler
Echo
ET-Nitrogen
ETCO2
RAP
SBP
Esophageal Stethoscope
Respiratory Pattern
ECG
48
Q

ETCO2 will _____ after VAE

A

Decrease

49
Q

Treatment for VAE- To prevent entrainment of air

A 
Flood Field with Saline
Bone Wax to exposed bone edges
D/C N20
T-Burg
Occude IJV, but don't occude carotid
PEEP to Increase CVP
Aspiration of air from CVP line- rarely works
50
Q

Emergence from neurosurgical anesthesia- avoid ___ to avoid _____ ICP.
Also give Lidocaine ______mg/kg to help suppress____

A

vomiting
increased
1.0-1.5mg/kg
coughing

51
Q

Dose for Labetelol in adolescents

____ with the use of esmolol in infants d/t _____

A

0.1-0.4mg/kg IV q 5-10 mins

Caution- HR dependent from CO

52
Q

Do you want to deep extubate neurosurgery patients?

A

Nope- Adequate spontaneous ventilation, oxygenation and wakefulness required before extubation

Nur 943 OB (11 decks)

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