Foundations Final Flashcards
1
Q
Risk of MI in the GP
A
0.3%
2
Q
Risk of MI in previous MI patients (<1, <3, 3-6, 6>)
A
> 1- greatest risk
<3- 30%
3-6- 15%
6- 6%
3
Q
How long to wait after MI for elective surgery?
A
4-6 weeks
4
Q
What SYMPTOM increases the risk of MI during surgery/ anesthesia?
A
Unstable angina
5
Q
What heart valve condition is the greatest risk for intraoperative MI?
A
Aortic stenosis (14x higher risk)
6
Q
Goal METS score
A
0- pain at rest
4- can you walk up 2 flights of stairs? (Goal)
10- can endure athletics
7
Q
Anesthetic considerations for OSA pateints
A
Awake extubation
Minimize opioids and versed
8
Q
What are asthmatics at risk for?
A
Bronchospasm
9
Q
Which pt are at high risk for aspiration?
A
SBO
GERD
DM
Hiatal hernia
Ascites
Previous gastric bypass
Obesity/ pregnancy
10
Q
What is mendelson syndrome?
A
Chemical pneumonitis
>25 ml
<2.5 PH
Particulate aspirate > clear aspirate
11
Q
DM rules
A
Hold oral DM meds the morning of surgery (metformin 2 days)
Take 1/4-1/2 insulin
Check BG upon arrival and intra-op
12
Q
Signs and symptoms of pheochromocytoma
A
HTN
Diaphoresis
Tachycardia
Headache
Tremulousness (tremors)
Weight loss
HCT >45
Orthostatic HOTN
13
Q
Cessation of smoking for how long will reduce the effects of nicotine
A
12-48 hours
14
Q
Cessation of smoking for how long will improve PPC to normal rates
A
8 weeks
15
Q
Drug of choice for cocaine induced HTN
A
CCBs
16
Q
ASA classes
A
1- healthy
2- BMI 30-40
3- BMI >40
4- Surgery is constant threat to life; CVA, TIA, MI <3 months,
5- NEED surgery to survive; AAA, trauma, MODS
6- brain dead, organ donor
17
Q
6 questions to ask in pre op
A
Name
DOB
Allergies
Surgery
Anesthesia history (and family)
Last meal
18
Q
Most common intraop allergic reaction cause
A
Roc
19
Q
Which meds decrease anesthesia needs?
A
Kava kava, valerian root
20
Q
Which meds increase bleeding?
A
Ginkgo, garlic, ginseng, fish oil
21
Q
How long to stop ASA before surgery?
A
7 days
22
Q
How long to stop NSAIDS before surgery?
A
1-2 days
23
Q
How long to stop plavix before surgery?
A
7 days
24
Q
NPO guidelines
A
2h- clear liquids
4- breast milk
6- cow milk, light meal
8- greasy, fatty meal
25
What is STOP BANG
Assessment for OSA
Snoring
Tiredness
Observed apnea
Pressure (high blood pressure)
-
BMI >35
Age >50
Neck >40
Gender of male
0-3- low risk
4+- high risk
26
Mallampati is used to assess ___
Oropharyngeal space
1- pillars
2- uvula
3- soft
4-hard
27
Inter incisor gap assesses ___
Mouth opening and ability to align the oral, pharyngeal, and laryngeal axis
4-6 cm
28
Why would the TMD be out of range?
<6- Mandibular hypoplasia
>9- Larynx is caudal, tongue is caudal
29
Mandibular protrusion test assesses ___
TMJ funciton
1- good overbite
2- even bite
3- underbite- high risk
30
Normal AO function
Flexion and extension- 90-165
Extension- 35, 23 is difficult
31
Conditions that impair AO mobility
DM
Downs
DJD
Ankylosing spondylitis
Klippel feil
RA
Surgical fixation
Trauma
32
BONES
Mask
Beard
Obesity
No teeth
Elderly >55
Sleep apnea
33
LEMON
Look at airway (shape of face, physiology)
Evaluate 332
Mallampati
Obstruction
Neck mobility
34
SHORT
Surgical airway
Surgical hx
Hematoma
Obesity
Radiation
Tumor
35
RODS
Restricted mouth opening
Obstruction of airway
Distorted airway
Stiff lungs
36
How to chronic HTN patients react to induction?
A drop in BP more than normal
Maintain 20% baseline
37
What is Sellick maneuver
Cricoid pressure
38
Hyperthyroid rules
Need to be normal for 6-8 weeks, then iodine for 2 weeks
Use Beta blockers intraop to reduce T4 to T3
39
Considerations for hypothyroid
None!
40
What to do if patient is high off of marijuana in pre op?
Delay
MJ will cause tolerance to sevo
41
What to do if patient didnt take their pre op beta blocker?
Give BB intraoperatively
42
Why would you give reglan in pre op?
Reduces gastric volume
43
Why would you give robinol in pre op?
Reduce secretions
44
Half life of cefazolin?
2 hours
45
How long does it take for vitamin K to improve PT?
6-8 hours
46
How would you treat central anticholinergic syndrome after a dose of scopalamine?
Physostigmine 1-2mg IV
47
How long to wait after a CVA for surgery?
9 months
48
Which ASA; sever sytemic disease of at least 1 organ system that causes functional limitation
3
49
How do illegal drugs affect the pupils?
PCP- nystagmus
Cocaine- midriasis (dilation)
Fent- Miosis (constriciton)
50
How long to delay surgery after a viral respiratory infection?
6 weeks
51
Risk of PONV
Female
History of PONV
Non smoker
<50
GA (instead of RA)
52
Which sites bring the greatest risk of PPC?
Thoracic
Aortic
Upper abdomen
53
When do anesthesia related deaths from airway occur?
During emergence, not induction
54
Intraoperative awarness risk factors
Female
Young
Obesity
Previous awareness
Trauma/ OB/ Open heart
NDNMB
55
What is the biggest factor in anesthesia related deaths?
1- Human error
2- Communications
56
What percent of soda lime is water content?
15%
57
Sevo + baralyme =
Fire
58
Which tank pressure reads the same unless its empty?
N2O
CO2
59
The HIGH pressure leak test requires a pressure of ___
30 cm H2O
60
Circuit compliance equation
VT on ventilator - (Compliance of circuit x peak pressure)
61
Which bellows is safer?
Ascending
62
Which modes of ventilation are best for the LMA?
SIMV, PSV
63
A jet ventilator functions based on the ____ effect
Venturi
64
Critical temp of N2O
36.5
65
The unidirectional valves must e placed between the ___ and ___
patient
Reservoir bag
66
How much pressure for low pressure test?
-65cmh2o for 10 seconds
67
Failsafe tasks
30cmh2o- alarm
20cmh2o- stops n2o output
68
What two steps if you suspect a pipeline crossover
1- open oxygen tank
2- close wall supply
69
Other names for flowmeters
Thorpe tubes
Rotameter
70
Where to read flowmeter indicators
Ball-middle
All others- top
71
Vapor pressure of iso, sevo, des
Iso- 238
Sevo- 157
Des- 660
72
Most common cause of a vaporizer leak?
Loose filler cap which is caught by a low pressure leak test
73
Estimates liquid anesthetic usage formula
% of anesthetic x FGF x 3
74
What causes the pumping effect?
PPV
O2 flush
75
What is the boiling point of Des?
23 C
76
Tec 6
Des
39 c, 2atm
Electronic
injects
non elevation compensated
Turn up at elevation
77
Why is the ascending bellow safer?
It will not rise if there is a leak/ crack, so it will be easily detected
78
How much peep does the gas driven bellow vs the piston ventilator ass?
Gas driven- 3
Piston- non
79
What is the primary base of soda lima?
Sodium hydroxide NAOH
Neutralizes CO2
80
What PH will change the soda lime to purple?
10.3
81
Sevo + dessicated soda lime =
Compound A
82
Order of carbon monoxide production from volatile agents and dessicated soda lime
Des
Iso
Sevo
83
open vs closed relief valves
open- active only, no need for any pressure relief valve
closed active- (needs positive and negative negative pressure relief)
closed passive- (needs positive pressure relief only)
84
High and low system parts
H- cyclinder x 3, yoke x 2
L- vaporizer, CGO, check valve, flowmeter tubes
85
What does the hig pressure leak test assess?
Low pressure system and breathing circuit
86
When will the failsafe not alarm?
Pipeline crossover
Flowmeter leak
87
When will hypoxia prevention device not alarm?
Pipeline crossover
Flowmeter leak
3rd gas administration
Defective mechanic / pneumatic components
88
Types of oxygen analyzers
Galvanic- Needs daily calibration
Pragmatic- faster, self calibrating
89
What are the risks of a leak in the bellow?
Barotrauma
Alteration in concentration
90
How to prevent rebreathing in the Bain system
FGF needs to be 2.5x minute ventilations
91
Best breathing system for spontaneous vs mechanical ventilations
ADB- spont
DBA- mech vent
92
Intrinsic muslces of the larynx and their function
Chubby tired leprochauns piss terrible venom
Cricothyroid- cords tense/ elongate
Thyroaryetnoids- shorten/ relax
Lateral cricoaryetnoids-adduction
Posterior cricoaryetnoids- abduction
Traverse aryetnoids
Vocalis- shorten/ relax
93
Risk factors for either RLN to be damaged
Overinflation of ETT
Tumor
Excessive neck stretching
Neck surgery- thyroidectomy
94
Risk factors for injury to the L RLN
LA enlargement
PDA ligation
AAA
Thoracic tumor
95
Pharmacologic tx for laryngospasm
Adult/kids - succ 1mg/kg IV or 4mg/kg IM
Neonates- 2mg/kg iv or 5mg/kg IM
0.02mg/kg atropine in kids under 5
96
Valsalva vs muller
opposites
97
How much pressure for sellick maneuver
20N before induction
40N after induction
98
Anesthetic considerations for ludwigs angina?
Bacterial infection in mouth
Awake nasal intubation or trach
99
HELP aligns what two axis?
external auditory
Sternum
100
Contraindications for NPA
Cribiform plate injury (lefort 2 or 3)
Coagulopathy
Nasal fracture
Previous caldwell luc
Previous transphenoidal hypophysectomy
101
Max cuff pressure in LMA
60cm h2o
102
Max PPV pressure in LMA
20cm h2o
103
Which meds to give for extubation of a difficult airway
BB, CCB, vasodilators
Lidocaine
Opioids
104
Strongest contraindication to an LMA
Tracheomalacia
105
What angle is the glidescope
60
106
Which local anesthetic has the fastest onset for the oral mucosa?
Benzocaine
107
What position for intubation with the LMA Fastrach?
Neutral with a pillow
108
Steps in airway fire
Remove ETT
Turn off gas
Pour saline
Reestablish airway
109
Most important factor from BONES
Beard
110
When is cricoid pressure contraindicated?
Active vomiting
C spine fracture
111
The order of laryngospasm treatment
Fio2 1.0
Remove offending stimulus
Deepend anesthetic
CPAP
SUCC 1mg/kg iv or 4mg/kg im
112
What is the largest ETT an LMA Fastrach can intubate?
8.5
113
What do the roots of the brachial plexus pass thru?
Between the anterior and middle scalene muscles
114
What do the brachial plexus trunks pass thru?
Lateral border of scalenes
115
What do the brachial plexus divisions pass thru?
Between the clavicle and first rib
116
Where do the cords of the brachial plexus pass thru?
Under the pec minor
117
Where do the branches of the brachial plexus diverge?
Axilla
118
Suprascapular branches of the brachial plexus
Long thoracic c5 c6 c7
Suprascapular c5 c6
Dorsal scapular c5
119
Infraclavicular branches of the brachial plexus
Lateral pectoral
Medial pectoral
120
Supraclavicular indications
Clavicular
Carotid endarectomy
121
Intercostobrachial indications
Arm pain from bier block
122
Dermatome of upper arm
c4- superior delt
c6- lateral delt, thumb
c7- 2 and 3 finger
c8- 4 and 5 finger
t1- medial arm
t2- axilla
123
Brachial plexus combined sensory and motor peripheral nerves
MARMU
124
Brachial plexus sensory peripheral nerves
Medial brachial cutaneous
Medial antebrachial cutaneous
125
Clinical assessment of brachial plexus blockade
Push er- radial- elbow extension
Pull em- musculocutaneous- bicep contraction
Pinch u- ulnar- pinch pinky
Pinch me- median- pinch 2nd digit
126
Interscalene indications, side effects, and volume
Shoulder, upper arm, clavicle (although it may need a superficial cervical plexus block as well)
phrenic nerve paralysis, horners, hypo-brady episode (prevent with BB), total spinal, RLN injury from large volume
7-15 ml
127
When is a pneumo from a block a higher risk?
Tall patients
128
SS of pneumo
Dyspnea
Chest pain
Coughing
129
Infraclavicular indications, side effects, and volume
Upper arm, elbow, wrist, hand- good alt for supra (respiratory) and axilla (mobility)
LAST, pneumo, PAIN bc all pec muscles
20-30 ml
130
Axillary block indications, side effects, and volume
Forearm and hand, full stomach,
Musculocutaneous injury,
LAST
15-20 ml
131
Distal blocks indication, SE, volume
Used in forearm or hand surgery if nerves were missed in brachial plexus block
Radial- 5ml/ 10ml low
Ulnar- 5ml high or low
Median- 5ml high or low (NOT IN CARPAL TUNNEL PT, no epi)
132
Volume for digital nerve block
3 ml no epi
133
Volume for bier block, what drug not to use
50ml NO BUPIVICAINE NO EPI
134
Max inflation of bier block tourniquet
2hr
135
Biggest risk of IVRA
LAST- wait 20 minutes at least
136
IVRA pressure
250 upper
350 lower
137
Contraindications to IVRA
Crush injury/ compound
No peripheral access
Cellulitis
Sickle cell
PVD
138
Which artery will be at risk for LAST during a supraclavicular block?
Subclavian
139
Landmarks for a low median nerve block
Flexor palmaris longus tendon
Flexor carpi radialis tendon
140
What angle of insertion for different parts of the spine durine neuraxial anesthesia
Lumbar- 90 degrees
Thoracic- 45 degrees
141
Spine landmarks
C7- cervical prominens
T3/ T7- top/ bottom of scapula
L1- 10th rib
L4- superior iliac crest
S2- superior iliac spine
142
What is the hardest and thickest layer in the spine?
Dura- collagen and elastic fibers
143
Epidural space borders
Cranial- Foramen magnum
Caudal- Sacrococcygeal ligament
Anterior- Ligamentum flavium
Posterior- posterior ligament
Lateral- pedicles
144
Batsons plexus
Epidural veins
Can become engorged in pregnancies and obese, will increase risk of needle injury
145
3 meninge layers
DAP
146
Epidural needles
Crawford- 0
Hustead- 15
Tuohy- 30
147
Spinal needles
Cutting- Quincke, pitkin
Pencil- Sprotte Whitaker Pencan
Rounded- Greene
148
How far to inject for epidural
4-6cm
149
Onset and duration of spinals
Rapid
<2 hours
150
Sequence of blocks and reversal
Sympathetic
slow pain, temperature, touch
fast pain, temperature, touch
Touch/ pressure
motor/ proprioception
151
What determines the spread of a spinal
Baricity, dose, site, position
152
What determines the spread of an epidural?
Volume, dose, level
153
What determines the duration of a spinal?
LA used, dose
154
What determines the duration of an epidural?
LA used
155
Benefits of hyperbaric vs isobaric
Hyper- denser, consistent block
Iso- longer blocks for non pregnants
156
How does age affect spinals?
Older age causes a slower onset and longer duration
157
What patient variables dont effect spinal spread?
Height
Weight
BMI
Spine length
158
How does gender affect spinal?
Females and pregnant- increased motor block with bupivicaine
159
How does pregnancy affect a spinal?
Pregnant patients develop a higher level of sensory block
160
161
Supraclavicular indications, side effects, and volume
Upper arm, elbow, wrist, hand (no shoulder)
Pneumo (highesy risk), subclavian artery puncture, LAT,
20-25 ml
162
Biggest ETT that can fit inside an LMA
3.5
4
4.5
5
6
6
7
163
Thyromental distance assesses ___
Submandibular space
6-9cm
