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KLowe APA/Foundations 1 > Final Exam Review > Flashcards

Final Exam Review Flashcards

1
Q

Should you plug electrical devices into the back of the anesthesia machine?

A

No, never!

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2
Q

What are the 3 pressure systems in the anesthesia machine?

A
  • High pressure (think back of the machine)
  • Intermediate pressure (machine itself)
  • Low pressure (connections to patient)
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3
Q

Pressure ranges for high pressure system

A

750-2200 psi

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4
Q

Pressure ranges for intermediate pressure system

A

40-50 psi

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5
Q

Pressure ranges for low pressure system

A

16 psi

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6
Q

Cylinders/hanger yoke are part of the ___ pressure system

A

High

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7
Q

O2 flush valve is part of the ___ pressure system

A

Intermediate

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8
Q

Vaporizers are part of the ___ pressure system

A

Low

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9
Q

Cylinders should be left in the ___ position

A

Off—reserve for emergency use only

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10
Q

Oxygen cylinder color, PSI, and E-cylinder capacity

A

Green, 1900-2200 psi, 660 capacity

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11
Q

Nitrous oxide cylinder color, PSI, and E-cylinder capacity

A

Blue, 745 PSI, 1600 capacity

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12
Q

Air cylinder color, PSI, and E-cylinder capacity

A

Yellow, 1800 PSI, 600 capacity

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13
Q

Pin index safety system (PISS) is meant to prevent ___

A

Misconnections of cylinders

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14
Q

Oxygen pin index on the yoke =

A

2,5

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15
Q

Nitrous oxide pin index on the yoke =

A

3,5

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16
Q

___ orients the cylinders

A

Hanger yoke

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17
Q

What is the most fragile part of the anesthesia machine?

A

Cylinder valve

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18
Q

Oxygen in the pipeline is supplied at ___

A

50 psi

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19
Q

What happens if oxygen pressure is lost?

A

Oxygen low-pressure alarm sounds; fail-safe valves stop delivery of other gases

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20
Q

What should you do if the oxygen pipeline supply fails?

A

Use backup oxygen cylinder, disconnect pipeline supply, use low flow O2, turn off vent, bag patient manually…do NOT reconnect pipeline supply until it has been tested

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21
Q

What are three valves on the anesthesia gas machine?

A
  • Free-floating valve
  • Ball and spring valve
  • Diaphragm valve
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22
Q

Which type of valve moves in the direction or push of gas flow; prevents gas from leaking out of the system; and prevents the emptying of gases into an empty cylinder or from wall oxygen coming into a cylinder (“safety” valve)?

A

Free-floating valve

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23
Q

Failure to open the cylinder valve on the free-floating valve results in ___ to the anesthesia machine

A

No gas flow

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24
Q

Which type of valve prevents mixing of nitrous oxide and oxygen and contains the oxygen fail-safe device?

A

Ball and spring valve

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25
Q

The oxygen fail-safe device will turn off the flow of other gases (i.e.: nitrous oxide) if the oxygen pressure falls below ___

A

25 psi

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26
Q

What type of valve is the oxygen flush valve?

A

Ball and spring valve

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27
Q

How much oxygen (L/min) flushes through the oxygen flush valve?

A

35-75 L/min

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28
Q

What type of valve reduces pressure in the system?

A

Diaphragm valve

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29
Q

What are two types of diaphragm valves?

A
  • First stage regulator

- Second stage regulator

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30
Q

First stage regulator reduces pressure to ___ psi

A

40-50 psi (intermediate pressure)

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31
Q

Second stage regulator reduces pressure from ___ psi to ___ psi

A

40-50 psi to 16 psi (intermediate to low pressure)

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32
Q

Should you use a vaporizer if it tips over?

A

NO!!! More liquid vapor will get into the chamber and carry more agent to the patient (can be a lethal dose)…DO NOT USE

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33
Q

What type of breathing system do we use?

A

Semi-closed system—patient hooked up to anesthesia machine; anesthetic gas remains in system, no room air inspired, expired air exits through scavenging system

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34
Q

What color does soda lime turn when exhausted?

A

Purple

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35
Q

What inhalation agent generates compound A when degraded?

A

Sevo

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36
Q

What are HMEs?

A

Heat and moisture exchangers—retain heat and moisture in anesthesia circuit; effective bacterial/viral filters

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37
Q

HMEs increase ___ and ___

A

Dead space and work of breathing

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38
Q

What can occur if HME becomes blocked?

A

Obstruction

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39
Q

Two types of HMEs?

A

Hydrophobic and hygroscopic

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40
Q

What are two types of bellows in the AGM?

A
  • Ascending

- Descending

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41
Q

Ascending bellows ___ on expiration

A

Ascends

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42
Q

Descending bellows ___ on expiration

A

Descends

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43
Q

Which bellows is safer?

A

Ascending—will not fill if disconnect occurs; descending bellows will continue upward/downward motion despite disconnect (must have CO2/apnea alarm)

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44
Q

4 ventilator modes:

A
  • Volume control
  • Pressure control
  • Synchronized intermittent mandatory ventilation
  • Pressure support
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45
Q

Volume control—constant ___ delivered per breath

A

Tidal volume

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46
Q

Pressure control—constant ___ with each breath

A

Inspiratory pressure

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47
Q

Synchronized intermittent mandatory ventilation—preset ___

A

Respiratory rate

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48
Q

Pressure support—adds preset ___ during inspiration, can also provide a preset ___

A

Pressure, PEEP

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49
Q

What are 3 single cartilages in the airway?

A
  • Epiglottis
  • Thyroid
  • Cricothyroid
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50
Q

What are 3 paired cartilages in the airway?

A
  • Arytenoid
  • Corniculate
  • Cuneiform
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51
Q

What is the only full ring of the trachea?

A

Cricoid ring

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52
Q

What is the thryomental distance?

A

Measure from upper edge of thyroid cartilage to chin with the head fully extended

Should be 2 fingers

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53
Q

A short thyromental distance =

A

An anterior larynx, not an easy intubation

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54
Q

Thyromental distance > 7 cm =

A

Easy intubation

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55
Q

Thryomental distance < 6 cm =

A

Difficult airway

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56
Q

Mallampati-Class 1

A

Tonsillar pillars/fauces, uvula, soft palate

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57
Q

Mallampati-Class 2

A

Tonsillar fauces ONLY, uvula, soft palate

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58
Q

Mallampati-Class 3

A

Soft palate

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59
Q

Mallampati-Class 4

A

Hard palate only

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60
Q

What is the normal A-O (Atlanto-occipital) angle?

A

35 degrees

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61
Q

How does having no teeth affect mask ventilation vs. intubation?

A

Difficult mask ventilation, easy intubation

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62
Q

Cormack/Lehane View-Grade 1

A

Full view of epiglottis, glottic opening, and vocal cords

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63
Q

Cormack/Lehane View-Class 2

A

Partial view of epiglottis and vocal cords

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64
Q

Cormack/Lehane View-Grade 3

A

Epiglottis only

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65
Q

Cormack/Lehane View-Grade 4

A

Soft palate only

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66
Q

Amount of air to inject in LMAs

A

10 x the size of the LMA minus 10

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67
Q

LMA size 3

A

20 ccs, for children 30-50 kg

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68
Q

LMA size 4

A

30 ccs, adults 50-70 kg

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69
Q

LMA size 5

A

40 ccs, adults 70-100 kg

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70
Q

LMA size 6

A

50 ccs, adults over 100 kg

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71
Q

Obtain ___ when doing a spinal or epidural and patient has a history of taking anticoagulants

A

Coagulation screen

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72
Q

How do seizure disorders affect MAC?

A

Increase MAC value—patient may require higher doses of meds d/t seizure meds being CYP inducers

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73
Q

What should you do if a patient has pre-existing nerve injuries?

A

Document them!

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74
Q

What are METs?

A

How we can assess a patient’s CV function—exercise tolerance in metabolic equivalents

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75
Q

We want at least ___ METs

A

4 = good functional capacity

Examples:

  • Light/heavy housework
  • Climbing a flight of stairs without stopping
  • Walking or running a short distance
  • Moderate recreational activities
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76
Q

Want to maintain patient within ___ of their baseline BP

A

20%

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77
Q

Should wait at least ___ days after an MI for elective surgery

A

60 days

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78
Q

What puts a patient at greatest risk for non-cardiac surgery MI?

A

Aortic stenosis

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79
Q

Always want patient to continue taking their scheduled ___

A

Beta-blocker—if they didn’t take it, have to give beta-blocker pre- or intraoperatively to reduce the risk of perioperative ischemia

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80
Q

Risk of ___ increases as surgical site approaches the diaphragm

A

Pulmonary complications

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81
Q

Length of surgery > ___ increases risk for pulmonary complications

A

2-3 hours

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82
Q

Patients with OSA have difficult with ___

A

Mask ventilation

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83
Q

Risk for ___ in patients with asthma—be prepared

A

Bronchospasm

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84
Q

STOP-BANG questionnaire assesses what?

A

OSA risk

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85
Q

STOP-BANG stands for…

A 
S-Snore loudly?
T-Tired during daytime?
O-Observed not breathing when asleep?
P-blood Pressure high?
B-BMI > 35
A-Age greater than 50
N-Neck circumference greater than 40
G-Gender = male?
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86
Q

Chest x-ray pre-op only if active ___, ___ surgery, age > ___

A

Active chest disease, intrathoracic surgery, age > 60

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87
Q

High risk for ___ in SBO

A

Aspiration—RSI intubation, Sellick’s maneuver (cricoid pressure)

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88
Q

Previous gastric bypass = NO ___

A

NGT

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89
Q

Active or uncontrolled GERD = NO ___

A

LMA

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90
Q

Aspiration pneumonia is AKA ___

A

Mendelson syndrome

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91
Q

Fasting guidelines before surgery—no ___ or ___ after midnight

A

Chewing gum or candy

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92
Q

Fasting guidelines—clear liquids up to ___ hours before surgery

A

2 hours

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93
Q

Fasting guidelines—breast milk up to ___ hours before surgery

A

4 hours

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94
Q

Fasting guidelines—no infant formula, nonhuman milk, or light meal for at least ___ hours before surgery

A

6 hours

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95
Q

Fasting guidelines—prescribed medications can be administered with ___ ml water for adults (up to ___ ml for children) up to ___ hour before anesthesia

A

150 ml; 75 ml; 1 hour before

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96
Q

For total joint procedures, always check ___ during procedure, regardless if patient is diabetic or not

A

Blood glucose

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97
Q

If patient is taking metformin, when should they stop taking it before surgery and why?

A

Stop taking 48 hours prior to surgery d/t risk for renal impairments

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98
Q

If patient is on insulin, take ___ or ___ of dose morning of surgery

A

1/4 or 1/2 dose

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99
Q

What is goal for patients who are hyperthyroid before surgery?

A

Get them euthyroid!

Anti thyroid meds for 6-8 weeks pre-op, followed by iodine for 1-2 weeks pre-op

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100
Q

May need to use what medication intraoperatively for patients who are hyperthyroid?

A

Beta-blockers—usually propanolol

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101
Q

What about patients who are hypothyroid and having surgery?

A

No recommendations

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102
Q

If patient is on long-term steroids, they may need ___ for the procedure

A

Stress dose steroids

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103
Q

Acute alcohol intoxication ___ anesthetic requirements

A

LOWERS

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104
Q

Alcohol withdrawal ___ anesthetic requirements

A

INCREASES

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105
Q

Avoid ___ in cocaine users

A

Beta blockers! Will have unopposed alpha stimulation—accelerated HTN

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106
Q

What type of medication should you use in cocaine users instead of beta blockers?

A

Calcium channel blockers to manage tachycardia/HTN

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107
Q

What medication is the most common cause of intraoperative allergic reaction?

A

Rocuronium

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108
Q

ASA Class I

A

Healthy patient

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109
Q

ASA Class V

A

Surgery is a last effort in this patient—i.e.: PE, uncontrolled hemorrhage from AAA, head injury with increased ICP

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110
Q

ASA Class VI

A

Declared brain dead patient donating organ

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111
Q

What ASA Class is this? — mild to moderate systemic disease—i.e.: essential HTN, diabetes, chronic bronchitis, anemia, morbid obesity, age extremes

A

ASA Class II

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112
Q

What ASA Class is this? — severe systemic disease that limits activity—i.e.: poorly controlled HTN, DM with vascular complications, angina pectoris, history of previous MI

A

ASA Class III

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113
Q

What ASA Class is this? — severe systemic disease that is constantly life threatening (i.e.: CHF, persistent angina, advanced pulmonary, renal, or hepatic dysfunction)

A

ASA Class IV

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114
Q

Failure to obtain consent = breach of ___

A

Duty

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115
Q

Performing a procedure without proper consent = ___

A

Battery

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116
Q

Anesthesia can proceed without consent in emergencies—doctrine of ___

A

Doctrine of implied consent

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117
Q

SOAPM for all anesthetics

A 
S-suction
O-oxygen
A-airway supplies
P-positive pressure/pharmacy
M-monitors/medications
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118
Q

Standard I =

A

Perform pre-operative assessment

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119
Q

Standard II =

A

Obtain informed consent

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120
Q

Standard III =

A

Form patient-specific anesthesia care plan

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121
Q

What are 2 contraindications for esophageal stethoscope?

A
  • Esophageal varices/strictures

- History of bariatric surgery

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122
Q

Red light = ___ nm, ___

A

660 nm, deoxyhemoglobin

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123
Q

Infrared light = ___ nm, ___

A

940 nm, oxyhemoglobin

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124
Q

What Law is the basis for pulse oximetry?

A

Beer Lambert’s Law

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125
Q

ETCO2 is ___ mm Hg (higher/lower) than PaCO2 on ABG

A

2-5 mm Hg LOWER

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126
Q

D point on ETCO2 waveform =

A

End tidal measurement

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127
Q

Normal PR interval =

A

0.12-0.2 sec

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128
Q

Normal QRS

A

0.06-0.10 sec

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129
Q

Normal QT interval

A

< 500

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130
Q

How do anesthetics affect thermoregulation?

A

Inhibit central thermoregulation by interfering with hypothalamic function

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131
Q

How can you tell if patient is spontaneously breathing based on ETCO2 waveform?

A

Curare cleft

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132
Q

Low pressure alarm =

A

Disconnect, leak

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133
Q

High pressure alarm =

A

Kink, mucus plug

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134
Q

High pressure alarm is usually set at ___

A

40

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135
Q

Is EKG a measure of heart function?

A

NO

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136
Q

Stimulation of ulnar nerve = contraction of ___

A

Adductor pollicis muscle

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137
Q

Stimulation of facial nerve = contraction of ___

A

Orbicularis oculi

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138
Q

Which muscle recovers faster from neuromuscular blockage—adductor pollicis or orbicularis oculi?

A

Orbicularis oculi

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139
Q

You don’t lose twitches until ___% of muscles are blocked

A

70%

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140
Q

4/4 twitches =

A

70% paralyzed

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141
Q

3/4 twitches =

A

75-80% paralyzed

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142
Q

2/4 twitches =

A

80-85% paralyzed

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143
Q

1/4 twitches =

A

90-95% paralyzed

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144
Q

0/4 twitches =

A

100% paralyzed

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145
Q

Only thing that will NOT affect pulse ox reading is ___

A

Fetal hemoglobin

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146
Q

Succinylcholine =

A

Depolarizing agent, does NOT cause fade, causes fasiculations

147
Q

Non-depolarizing agents cause ___

A

Fade (i.e.: rocuronium, vecuronium, pancuronium)

148
Q

TOF =

A

2 Hz for 2 seconds, every 0.5 seconds

149
Q

Double burst =

A

50 Hz, 2 short bursts, every 0.75 seconds

150
Q

Tetany =

A

50 or 100 Hz for 5 seconds

151
Q

Which twitch monitoring method is used to see if patient is on their way to waking up?

A

Tetany

152
Q

Will see ___ with tetany if non-depolarizing blocking agents are used

A

Fade

153
Q

___ provides early evidence of ischemia intraoperatively

A

EEG

154
Q

Goal is to titrate concentrations of anesthesia to maintain BIS near ___

A

60

155
Q

Light moderate sedation = BIS ___

A

80

156
Q

BIS < 60 =

A

Unresponsive

157
Q

What monitor should you use during carotid surgery to monitor oxygen levels?

A

Cerebral oximetry monitor

158
Q

What alters evoked potentials?

A

General anesthesia

159
Q

What are 4 types of evoked potentials?

A
  • Visual
  • Auditory
  • Somatosensory
  • Motor
160
Q

Perioperative mortality = death that occurs within ___ days after surgery

A

2-30 days

161
Q

Top 3 ASA closed claims:

A
  • Death
  • Nerve injury
  • Brain damage
162
Q

3 emerging claim areas:

A
  • Regional
  • Chronic pain management
  • Acute pain
163
Q

What is the most common airway injury from anesthesia?

A

Dental injury

164
Q

What can contribute to peripheral nerve injury?

A

Positioning

165
Q

How can you prevent corneal abrasion?

A

Tape/lubricate eye

166
Q

How can you prevent retinal ischemia when prone?

A

Avoid pressure on globe

167
Q

Brachial plexus, radial, and ulnar palsies can occur in ___ position(s)

A

Any

168
Q

Common peroneal palsy can occur in ___ positions

A

Lithotomy/decubitus positions

169
Q

How can you avoid nerve palsy injuries?

A

Use padding over bony prominences and avoid stretching/compression of these areas

170
Q

What are 3 high-risk cases for intraoperative awareness?

A
  • Major trauma*
  • Obstetrics
  • Cardiac surgery

Up to 10x risk

171
Q

3 risk factors for Intraoperative awareness

A
  • Female
  • Younger
  • Obese
172
Q

What is the most common transient eye injury?

A

Corneal abrasion

173
Q

What is the most common cause of post-operative loss of vision?

A

Ischemic optic neuropathy (ION)

Caused by optic nerve infarction d/t decreased oxygen delivery to the optic nerve

174
Q

ION is commonly reported after what 4 surgeries?

A
  • Cardiopulmonary bypass
  • Radical neck dissection
  • Abdominal and hip procedures
  • Spinal surgeries in prone position*
175
Q

What positions contribute to ION?

A
  • Prone
  • Head down
  • Compressed abdomen

All compromise venous return to the heart*

176
Q

ION onset

A

Immediately post-op through 12th post-op day

177
Q

What are 4 types of allergic rxns?

A

Type I-IV

178
Q

Type I allergic reaction

A

Immediate—anaphylaxis*

179
Q

Type II allergic reaction

A

Cytotoxic (antibody-mediated, blood type incompatibilities) i.e.: hemolytic transfusion reactions, autoimmune hemolytic anemia, heparin-induced thrombocytopenia

180
Q

Type III allergic reaction

A

Immune complex (i.e.: RA, SLE)

181
Q

Type IV allergic reaction

A

Delayed, cell-mediated, cytotoxic (i.e.: contact dermatitis)

182
Q

Anaphylactoid reaction does NOT depend on ___

A

IgE antibody interaction with antigen (anaphylaxis does)

183
Q

Anaphylactic/anaphylactoid reactions can be clinically ___ and equally ___

A

Clinically indistinguishable; equally life threatening

184
Q

What is the most common cause of anaphylaxis during anesthesia?

A

Muscle relaxants

185
Q

What are two hypnotic agents that can cause allergic reactions?

A
  • Propofol

- Pentothal

186
Q

What is the second most common cause of anaphylaxis during anesthesia?

A

Latex!

187
Q

What 6 foods cross-react with latex?

A
  • Mango
  • Kiwi
  • Passion fruit
  • Banana
  • Avocado
  • Chestnut
188
Q

Airway mortality is NOT due to difficulty ___, it is due to failure to ___

A

Intubating; failure to ventilate

189
Q

What is a late sign of MH?

A

Core temperature rise as much as 1 degree Celsius every 5 minutes

190
Q

What causes MH?

A

Uncontrolled release of Ca from the sarcoplasmic reticulum, leading to constant muscle contraction

191
Q

What triggers MH?

A

-All halogenated agents (so not nitrous oxide) + succs (depolarizing muscle relaxant)

192
Q

What is the treatment for MH?

A

Dantrolene 2.5 mg/kg q 5 mins; max dose 10 mg/kg

193
Q

How does dantrolene work?

A

Binds to ryanodine receptor and inhibits calcium release from the SR

194
Q

What should you do if laryngospasm occurs?

A
  • 100% O2
  • Deepen anesthesia
  • Positive pressure
195
Q

What are two main signs of bronchospasm?

A
  • High peak inspiratory pressures

- Wheezing

196
Q

What should you do if bronchospasm occurs?

A
  • 100% O2
  • Deepen anesthesia
  • Albuterol
  • Treat the underlying cause
197
Q

What are 3 causative agents of fire in the OR?

A

Oxygen + heat + fuel = fire

Oxygen = anesthesia
Heat = surgeon’s cautery
Fuel = surgical nurse’s alcohol prep
198
Q

What should you do if there is a fire in the OR?

A
  • Disconnect the circuit
  • Pour sterile water/saline down ETT
  • Replace patient’s ETT quickly
199
Q

Keep FiO2 below ___ for tonsillectomy/ENT surgery

A

30%

200
Q

Total body water = ___% total body weight

A

60%

201
Q

Intracellular volume = ___%

A

40%

202
Q

Extracellular volume = ___%

A

20%

203
Q

ECF is comprised of what two compartments?

A
  • Interstitial fluid (75% ECF)

- Plasma (25% ECF)

204
Q

Interstitial fluid

A

75% ECF; fluid in tissue spaces

205
Q

Plasma

A

25% ECF; intravascular fluid; high concentration of plasma proteins (albumin) that remain in vascular space

206
Q

TBW is ___% male’s weight

A

55%

207
Q

TBW is ___% female’s weight

A

45%

208
Q

TBW is ___% infant’s weight

A

80%

209
Q

ICF has high concentration of ___

A

Potassium

Also contains phosphate and magnesium

210
Q

ECF has high concentration of ___

A

Sodium

Also contains chloride

211
Q

___ is the main determinant of osmotic pressures

A

Albumin

212
Q

What are 3 sources of intraoperative fluid loss?

A
  • Insensible loss
  • Third space loss
  • Blood loss
213
Q

What are insensible losses?

A
  • Urine
  • Feces
  • Sweat
  • Respiratory tract
214
Q

Replace insensible fluid losses with ___ cc/kg/hr

A

Crystalloid 2 cc/kg/hr

215
Q

Third space loss is fluid lost from ___ space to ___ space

A

Intravascular space (plasma) to interstitial space

216
Q

Minimal trauma fluid replacement

A

3-4 cc/kg

217
Q

Moderate trauma fluid replacement

A

5-6 cc/kg

218
Q

Severe trauma fluid replacement

A

7-8 cc/kg

219
Q

Third space losses become mobilized ___ day post-op

A

3rd day—may see increase in intravascular volume; caution in patient’s with limited cardiac reserve/renal dysfunction

220
Q

Blood loss fluid replacement

A

Replace 3x blood loss with crystalloid

We do 3x because you have to replace intravascular loss + fluid loss from the extravascular (interstitial) space to replenish the intravascular loss during acute hemorrhage

221
Q

How much colloid should be used to replace blood loss?

A

1:1 blood loss replacement

222
Q

5% albumin is used for ___

A

Expansion of intravascular volume

223
Q

25% albumin is used for ___

A

Treatment of hypoalbuminemia

224
Q

Young healthy patients may lose ___% of circulating blood volume without demonstrating clinical signs

A

20%

225
Q

Acute blood loss causes vasoconstriction of ___ vessels; blood volume loss of ___% can be masked by this compensatory response

A

Vasoconstriction of splanchnic/venous capacitance vessels; blood volume loss of 10% can be masked by this compensatory response

226
Q

Indication for blood transfusion = increase ___ of the blood

A

Oxygen carrying capacity

227
Q

Hgb < ___ g/dL = transfuse

A

< 6 g/dL

228
Q

In acute hemorrhage, ___ preferred over PRBCs

A

Whole blood

229
Q

PRBCs are used for treatment of ___ not associated with acute hemorrhage or shock; augments ___ of the blood

A

Acute anemia; augments oxygen-carrying capacity

230
Q

Decreased risk for ___ with PRBC transfusion over whole blood transfusion

A

Citrate toxicity//allergic reaction

231
Q

Platelet transfusion for platelet count < ___

A

50,000

232
Q

Risks of platelet transfusion (3)

A
  • Transmission of viral diseases
  • Bacterial infection
  • Sepsis
233
Q

FFP = ___ portion of blood; contains all plasma proteins except ___

A

Plasma; contains all plasma proteins except platelets

234
Q

When would you administer FFP (3)?

A
  • When PT/aPTT > 1-1.5 x normal
  • Reversal of warfarin therapy
  • Correction of known factor deficiencies
235
Q

Risks of FFP transfusion (2)

A
  • Transmission of viral diseases

- Allergic reaction

236
Q

Cryoprecipitate contains high concentration of ___

A

Clotting factors—i.e.: fibrinogen*

237
Q

Cryo is given for ___

A

Clotting factor deficiencies (i.e.: fibrinogen deficiency)

238
Q

Transfuse Hgb < ___ g/dL in patients with CV/pulmonary disease over the age of 65 years

A

7 g/dL

239
Q

Transfuse Hgb < ___ g/dL in patients undergoing cardiopulmonary bypass

A

6 g/dL

240
Q

Transfuse if > ___% blood volume loss

A

> 30% (1500 cc cumulative loss)

241
Q

Transfuse platelets if platelet count < ___

A

< 50,000

242
Q

Give FFP if INR > ___; PT ___ x normal; aPTT > ___x normal

A

INR > 2; PT 1.5 x normal; aPTT > 2x normal

243
Q

Give cryo if fibrinogen < ___

A

< 80-100

244
Q

Local anesthetics are weak ___

A

Weak bases

245
Q

What is pKA?

A

The pH at which you have 50% ionized (charged) and 50% nonionized (uncharged)

246
Q

Lower PKA = ___ onset of action

A

Faster (because you have more in the uncharged form)

247
Q

Uncharged form = most ___

A

Lipid soluble—this is what accesses the axon

248
Q

Local anesthetics block the influx of ___ into the cells to prevent conduction of action potentials

A

Sodium

THRESHOLD POTENTIAL IS NOT REACHED

249
Q

Lipid solubility increases ___

A

Potency

250
Q

High degree of protein binding = ___ duration of action

A

Longer

251
Q

PKA determines ___

A

Onset of action

Lower PKA = faster onset because you have more nonionized form

252
Q

___ fibers are more easily blocked than ___ fibers

A

Thin fibers, thick fibers

253
Q

Which is more easily blocked—myelinated or unmyelinated axons?

A

Myelinated

254
Q

Where is the block produced specifically—node of ___

A

Ranvier

255
Q

Which type of locals are metabolized more quickly?

A

Esters are metabolized more quickly than amides (d/t cholinesterases in the circulation)

256
Q

Half-life of esters

A

~1 min

257
Q

Byproduct of ester metabolism = ___

A

PABA (p-aminobenzoic acid)

258
Q

Where are amides broken down?

A

Liver—patients with severe hepatic disease may be more susceptible to adverse reactions

259
Q

Half-life of amides

A

2-3 hours

260
Q

What is baricity?

A

Density of local anesthetics compared to density of CSF

261
Q

How does sodium bicarb affect local anesthetics?

A

Increases concentration of nonionized (free) base, thus increasing the rate of diffusion of the local/speeding onset of action

262
Q

Ester anesthetics may trigger allergic reactions in persons sensitive to ___ or ___

A

Sulfonamides or thiazide diuretics

263
Q

IV injection of ___ or ___ may result in CV collapse that is refractory to therapy because of high degree of tissue binding of these agents

A

Bupivicaine or etidocaine

264
Q

Spinal anesthesia = injecting into the CSF within the ___ space

A

Subarachnoid/intrathecal space

265
Q

What is the most common causative organism in epidural abscess? Which is a growing concern?

A

Most common = Staph aureus; MRSA is a growing concern

266
Q

What are 6 absolute contraindications for a spinal?

A
  • Patient refusal/lack of cooperation
  • Increased ICP
  • Coagulopathy
  • Skin infection at the site
  • Uncorrected hypovolemia
  • Spinal cord disease
267
Q

Aspirin and spinal

A

No contraindication

268
Q

Plavix and spinal

A

Discontinue 7 days preoperatively

269
Q

Heparin and spinal

A

Place catheter 1 hour before scheduled dose; remove catheter 1 hour before next dose

270
Q

What are signs of spinal/epidural hematoma?

A
  • New onset weakness to lower limbs and sensory deficit
  • New onset back pain
  • New onset bowel or bladder dysfunction
271
Q

Must diagnose and surgically decompress hematoma within ___ hours for best outcome

A

Within 8 hours

272
Q

Spinal needles are placed below ___, as the mobility of the spinal nerves reduces the danger of needle trauma

A

L2

273
Q

CSF specific gravity =

A

1.004-1.009

274
Q

What are 3 types of local anesthetic solutions?

A
  • Hyperbaric
  • Hypobaric
  • Isobaric
275
Q

Which type of local solution is most commonly used?

A

Hyperbaric

276
Q

What is hyperbaric mixed with?

A

Glucose

277
Q

Hyperbaric flows ___

A

Down to most dependent part d/t gravity

278
Q

Hypobaric solution is mixed with ___

A

Sterile water

279
Q

Hypobaric solutions flow ___

A

Up to highest part

280
Q

Hypobaric solutions are used for ___ procedures

A

Perineal procedures in prone

281
Q

Isobaric solutions

A

Predictable spread through CSF independent of patient position

282
Q

Increasing dose of isobaric anesthetic will affect ___, rather than spread to a higher dermatome

A

Duration of action

283
Q

Lateral position—hypobaric/hyperbaric solutions

A
  • Affected side UP if using hypobaric solution

- Affected side DOWN if using hyperbaric solution

284
Q

Sitting position is often used with ___ anesthetics

A

Hyperbaric

285
Q

Prone position is often used with ___ anesthetics

A

Hypobaric

286
Q

Prone position is useful for procedures on ___, ___, and ___

A

Rectum, perineum, and anus

287
Q

Increased resistance is felt with spinal needle as it passes through ___

A

Ligamentum flavum

288
Q

As spinal needle is passed beyond the ligamentum flavum, a sudden ___ is felt

A

“Pop” or loss of resistance

289
Q

Correct placement of spinal needle is indicated by ___

A

Free flow of CSF into the hub of the needle

290
Q

Paresthesia occurring with placement of spinal needle requires ___

A

Immediate withdrawal of needle and repositioning

291
Q

For onset of blockade, monitor BP, HR, and respiration’s every ___ until patient is deemed stable

A

Minute

292
Q

Fixation of local anesthetic takes approximately ___ minutes

A

20

293
Q

Neural blockade order of action

A

Autonomic > sensory > motor (difference of 2 segments, with autonomic fibers being highest level of blockade)

294
Q

Epidural anesthesia = injection of local anesthetic into the ___

A

Epidural space

295
Q

Onset of epidural anesthesia is ___ and ___

A

Slower and less intense than spinal

296
Q

Provider has greater control of sensory/motor blockade with ___ vs. ___

A

With epidural vs. spinal

297
Q

Epidural anesthesia is ___ dependent

A

Diffusion dependent

298
Q

___ volumes used with epidural anesthesia

A

Larger—spinal dose is usually 2 ccs; epidural dose is usually 20 ccs

299
Q

Epidural anesthesia takes ___ to achieve than spinal anesthesia

A

Longer

300
Q

Epidural needle should always enter the epidural space ___ because the space is widest

A

MIDLINE—decreased risk for puncturing epidural veins, spinal arteries, or spinal nerve roots

301
Q

Epidural test dose—if placed in epidural space, will have ___ effect

A

Little effect

302
Q

Epidural test dose—if placed in the CSF, will rapidly behave like ___

A

Spinal

303
Q

Epidural test dose—if injected into an epidural vein, a ___ in HR will be seen

A

20-30% increase in HR

304
Q

DOA lidocaine

A

30 mins to 2 hours

305
Q

DOA bupivacaine

A

2-4 hours

306
Q

DOA ropivacaine

A

2-6 hours

307
Q

Always have patient on standard hemodynamic monitors/supplemental oxygen when setting up peripheral block—T/F?

A

TRUE

308
Q

What technique is this?—LA injection targets terminal cutaneous nerves; used to minimize incisional pain; don’t use this technique if local tissue is acidotic/infected; used in dental procedures.

A

Field block technique

309
Q

What technique is this?—look for sensory nerve with needle, patient feels paresthesia, inject local

A

Paresthesia technique

310
Q

What technique is this?—look for motor nerve with needle, muscle contracts, inject local

A

Nerve stimulator technique

311
Q

What is the most favored method for peripheral anesthesia today?

A

Ultrasound

312
Q

Hypoechoic

A

Dark, muscles

313
Q

Hyperechoic

A

White, bone

314
Q

Anechoic

A

No reflection, fluid and blood

315
Q

Which probe is preferred and good for superficial nerves?

A

Linear probe

316
Q

Which probe is good for deeper structures but provides a poorer image?

A

Curvilinear probe

317
Q

What does the nerve look like on ultrasound?

A

Honeycomb structure; seen on short-axis

318
Q

What alignment is this?—longitudinal/long-axis; can visualize needle better but need good hand-eye coordination; can lose image easily with any slight movement

A

In-plane needle alignment

319
Q

What alignment is this?—transverse/short-axis; preferred for peripheral nerve blocks and central venous cannulation

A

Out-of-plane needle alignment

320
Q

What does the needle tip look like in out-of-plane needle alignment?

A

Looks like a bright white dot on ultrasound

321
Q

What nerves comprise the brachial plexus?

A

C5-T1

322
Q

What are 4 types of brachial plexus blocks?

A
  • Interscalene block
  • Supraclavicular block
  • Infraclavicular block
  • Axillary block
323
Q

Interscalene block is used for ___ surgeries; NOT for surgery ___

A

Used for shoulder/upper arm surgeries; NOT for surgery at or below elbow

324
Q

Interscalene block targets ___

A

C5-C7 roots

325
Q

How can you achieve complete anesthesia of shoulder with interscalene block?

A

Supplement C3-C4

326
Q

Caution using interscalene block in patients with ___ d/t possibility of phrenic nerve paralysis

A

Severe pulmonary disease (can result in dyspnea, hypercapnia, and hypoxemia

327
Q

___ artery injection is a risk with interscalene block; what is a sign?

A

Vertebral artery injection; suspect if immediate seizure activity is observed

328
Q

Interscalene block can cause what syndrome?

A

Horner’s syndrome—myosis, ptosis, anhydrosis (excessive constriction of pupil, lazy eye, and inability to sweat)

329
Q

What lung complication is possible with interscalene block?

A

Pneumothorax

330
Q

What nerve palsy can occur from interscalene block?

A

RLN palsy—hoarseness

331
Q

Supraclavicular block is for surgeries at ___, NOT ___ surgeries

A

For surgeries at or distal to elbow; NOT shoulder surgeries

332
Q

Supraclavicular block targets ___

A

C5-T1 divisions

333
Q

Supraclavicular block has risk of ___ palsy in ~50% of patients

A

Ipsilateral (same side) phrenic nerve palsy

334
Q

What syndrome can supraclavicular block cause?

A

Horner’s syndrome

335
Q

___ artery puncture is a risk with supraclavicular block

A

Subclavian artery puncture

336
Q

Supraclavicular block can also cause ___ and ___ (just like infraclavicular block)

A

Pneumo and RLN palsy

337
Q

Infraclavicular block is for surgeries ___, NOT ___ surgeries

A

Surgeries at or distal to elbow, NOT shoulder surgeries

338
Q

Infraclavicular block targets level of ___

A

Cords C5-T1

339
Q

Axillary block targets ___ of brachial plexus

A

Large terminal branches of brachial plexus

340
Q

Axillary block blocks ___

A

Entire arm distal to the elbow

341
Q

What type of block is IV regional anesthesia?

A

Bier block

342
Q

Bier block is good for ___ procedures

A

Short—45-60 mins; i.e.: carpal tunnel release

343
Q

Bier block—tourniquet must be inflated for ___ minutes to avoid systemic toxicity

A

15-20 mins

344
Q

Bier block—___ deflation of tourniquet

A

Slow incremental deflation

345
Q

What are 4 contraindications for ALL brachial plexus blocks?

A
  • Local infection
  • Severe coagulopathy
  • Local anesthetic allergy
  • Patient refusal
346
Q

___ and ___ are favored sites for blocks of terminal nerves

A

Elbow and wrists

347
Q

Increased risk for ___ with regional blocks (like brachial plexus blocks) because the drugs are rapidly absorbed into the systemic circulation

A

Toxicity

348
Q

Tibial nerve stimulation results in ___ of foot and toes; ___ of foot

A

Plantarflexion of foot and toes; inversion of foot (pushing foot down and inward)

349
Q

Superficial peroneal nerve stimulation = ___ and ___ of foot

A

Abduction and eversion of foot (pushing foot outward)

350
Q

Deep peroneal nerve stimulation = ___ of foot

A

Dorsiflexion of foot (flexing foot up)

351
Q

What are 5 types of lower extremity nerve blocks?

A
  • Femoral nerve block
  • Sciatic nerve block
  • Popliteal block
  • Saphenous block
  • Ankle block
352
Q

What are 3 indications for a femoral nerve block?

A
  • Anterior aspect of thigh procedure
  • Superficial surgery on medial aspect of leg or below knee
  • Knee arthroscopy*
353
Q

What are 2 unique contraindications for a femoral nerve block?

A
  • Previous ilioinguinal surgery (i.e.: femoral vascular graft, kidney transplant)
  • Large inguinal lymph nodes or tumor
354
Q

What are 4 contraindications for ALL lower extremity nerve blocks?

A
  • Patient refusal
  • Local infection
  • Coagulopathy
  • Neuropathy
355
Q

Is neuropathy an absolute contraindication for a lower extremity nerve block?

A

No, but it definitely needs to be considered

356
Q

What type of surgery would a sciatic nerve block be indicated?

A

Lower limb surgery

357
Q

Sciatic nerve block is often combined with ___

A

Other blocks, i.e.: femoral

358
Q

If doing a sciatic nerve block for the lower leg, it is preferable to go ___

A

Lower

359
Q

What type of surgery would a popliteal block be used?

A

Lower leg surgery—especially foot and ankle

360
Q

A popliteal block may require ___ coverage

A

Saphenous

361
Q

Tendons of biceps femoris/semi-tendinosus muscle are ~ ___ cm from the popliteal fossa crease

A

~7cm

362
Q

When would a saphenous block be used?

A
  • Saphenous vein stripping/harvesting (for CABG)

- Analgesia for knee surgery in combo with other techniques

363
Q

A saphenous block is typically used in combination with ___ nerve block to supplement medial foot/ankle surgery

A

Sciatic nerve block

*Popliteal block (used for surgery on foot/ankle) may also require saphenous coverage

364
Q

When would an ankle block be used?

A

Foot surgery

KLowe APA/Foundations 1 (3 decks)

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