Final Exam - Anesthesia/Analgesia Considerations For Polytrauma Patients Flashcards

1
Q

what are the goals of anesthesia & analgesia in the polytrauma patient?

A
  1. produce an adequate level of unconsciousness needed for diagnostic examination & surgical treatment
  2. to provide comfort & minimize the deleterious effects of pain
  3. to cause minimal complications that could further impair organ function
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2
Q

what is the risk associated with sick dogs & cats that need emergency sedation/anesthesia?

A

dogs - 5X risk

cats - 10X risk

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3
Q

what are some underlying reasons we see an increase in mortality in trauma dogs?

A

cardiovascular injury

SIRS/MODS

prolonged anesthetic times

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4
Q

what diseases/conditions decrease pre-load in a patient needing emergency sedation/anesthesia?

A

bleeding/hypovolemia - can be internal or external, reduces venous return to the heart & contribute to decrease in CO & MAP

mechanical ventilation

caudal vena cava compression - uroabdomen & hemoabdomen

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5
Q

what diseases/conditions cause vasodilation in a patient needing emergency sedation/anesthesia?

A

drugs

severe hypothermia

severe hypercalcemia

SIRS

neurogenic shock

disease

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6
Q

what are some causes of vasodilation in the polytrauma patient? why is this a concern?

A

neurogenic shock, SIRS, septic shock, severe hypothermia, severe hypercapnia, drugs

vasodilation decreases the SVR which can lead to hypotension

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7
Q

what are some causes of myocardial depression in the polytrauma patient? why is this a concern?

A

metabolic acidosis

severe hypothermia

severe hypercapnia

ischemic myocardial dysfunction

cardiogenic shock

decrease the stroke volume which will decrease CO & cause hypotension

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8
Q

how should anesthesia be induced in a patient with polytrauma?

A

pre-oxygenate them

lidocaine can be splashed on the larynx prior to intubation

use iv induction agents slowly to effect

monitor HR or pulse while inducing

be ready to intubate, ventilate, & provide oxygen to your patient

(midazolam + fentanyl for very sick patients)

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9
Q

what are the disadvantages of using inhalant anesthetics such as isoflurane, sevoflurane, or desflurane, for patients with polytrauma?

A

they have cardiovascular & respiratory depressant effects

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10
Q

what are the benefits of using a CRI alongside inhalant anesthetics in polytrauma patients?

A

MAC-sparing technique

rapid recovery

lessen cardiovascular & respiratory depressant effects

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11
Q

what components make up respiratory support provided to polytrauma patients under anesthesia?

A

protect the airways - intubation

ventilation - ETCO2 35-45mmHg (30-35mmHg)

oxygenation - pre-oxygenation, oxygen supplementation, & minimal effective FiO2

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12
Q

what drugs are used to improve SVR in a patient with polytrauma undergoing anesthesia?

A

vasopressors - dopamine, norepinephrine, etc

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13
Q

what products do you use to improve SV through affecting preload, myocardial contractility, & afterload?

A

iv fluids, blood products, adjust mechanical ventilationinotropic drugs - dobutamine, dopamine, & ephedrine

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14
Q

when would you reach for colloids for fluids in a patient with polytrauma undergoing anesthesia?

A

need to provide fluid resuscitation

increase COP

need to provide coagulation factors & platelets

need to provide efficient & prolonged plasma expansion

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15
Q

when would you reach for hypertonic saline for fluids in a patient with polytrauma undergoing anesthesia? why?

A

ECV depletion!!!! hemorrhage!!

provides efficient plasma expansion of high magnitude - can use for fluid resuscitation & plasma expansion

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16
Q

how do you avoid further increasing intracranial pressure in a traumatic brain injury patient with polytrauma undergoing anesthesia?

A

avoid letting them retch/cough/vomit

avoid compressing their jugular veins

maintain the head at a higher level than the heart

maintain ETCO2 at 30-35mmHg

maintain map at slightly higher levels - >75mmHg

17
Q

how can you check level of consciousness in a sedated patient with polytrauma?

A

palpebral reflex

eye position

jaw & tongue tone

18
Q

how can you check cardiovascular function & perfusion in a sedated patient with polytrauma?

A

ECG, HR, arterial blood pressure, mucus membrane color, & CRT

19
Q

how can you check ventilation & oxygenation in a sedated patient with polytrauma?

A

RR & effort, ETCO2, SpO2, blood lactate, & arterial blood gas analysis

20
Q

when do we see highest mortality rates in patients with polytrauma requiring sedation?

A

47-61% mortality occurs within the first 3 hours post-op!!!!

21
Q

how should you support the polytrauma patient during anesthetic recovery?

A

close monitoring

oxygen, ventilation, & anesthesia ready to go if needed

cardiovascular support

re-warm the patient

consider the need for drug reversals

22
Q

what is the trauma triad of death?

A

hypothermia, coagulopathy, & acidosis

23
Q

what criteria are used to define SIRS in dogs?

A

must meet 2 criteria to be considered SIRS!

temp: <100 or >103

HR: > 140

RR: > 20

WBC: <6 or > 16

band cells: >3%

24
Q

what criteria are used to define SIRS in cats?

A

must meet 3 criteria to be considered SIRS!!

temp: <100 or >103.5

HR: <140 or > 225

RR: > 40

WBC: <5 or > 19.5

band cells: > 5%

25
what are some signs of cardiovascular instability in a polytrauma patient? how do you correct it?
decreased systemic vascular resistance due to vasodilation (from drugs, hypercapnia, hypothermia, SIRS, disease) - vasopressors decreased heart rate (increased vagal tone, drugs, hyperkalemia, hyperthermia, hypercapnia, or disease) - anticholinergics decreased stroke volume (bleeding, hypovolemia, mechanical ventilation, vena cava compression, drugs, myocardial ischemic injury, SIRS) - iv fluids, blood products, change ventilation/body position, & inotropic drugs
26
what all is going wrong in SIRS?
increased inflammatory cytokines vasodilation, increased vascular permeability, & coagulopathy mitochondrial dysfunction
27
what is MODS?
multiple organ dysfunction syndrome - abnormalities in multiple organs that weren't originally affected by the insult mortality rates increase with more organ dysfunction
28
what is the difference in effect seen from benzodiazepines given to sick animals vs healthy animals?
in healthy animals - can cause excitement in sick animals - can cause sedation
29
why do you have to be careful when using opioids for polytrauma patients? what can you do to counter this?
opioids can cause vomiting, panting, & histamine - need to use low doses! anti-emetics - maropitant & ondansetron
30
why do you have to be careful when using ketamine for polytrauma patients?
causes sedation in sick animals!!! use lower doses!!
31
why should you give minimal inhaled oxygen to a polytrauma patient under sedation needing respiratory support?
you need to give the minimally effective FiO2 to reduce damage from free oxygen radicals