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DPD 2019 > Fundamentals of anaesthetics > Flashcards

Fundamentals of anaesthetics Flashcards

1
Q

What do the pre-operative investigations that are done depend on

A

Patient co-morbidities & medication
Type of surgery : minor/intermediate/ complex (including haemorrhage risk)
Setting: elective OR emergency

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2
Q

Which score is used to as a common peri-operative risk system

A

ASA and POSSUM

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3
Q

Outline ASA

A

ASA 1: Healthy patient
ASA 2: Mild systemic disease. No functional limitation
ASA 3: Moderate systemic disease. Have functional limitation
ASA 4: Severe systemic disease that is a constant threat to life
ASA 5: Moribund patient. Unlikely to survive 24 hours, with or without treatment

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4
Q

What is POSSUM

A

Can be used to explain to patient if risk is high or not

-Mortality & morbidity risk

Pre-operative: risk discussion

Peri-operative: Need for Invasive monitoring?

Postoperative: Over 5% mortality risk should -> HDU/ITU post operative

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5
Q

How do you optimise and what is the perioperative control for: Diabetes

A

Optimise: Glycosylated Hb

Perio-operative control: When to use Insulin Sliding scales?

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6
Q

How do you optimise and what is the perioperative control for: HTN

A

Optimise: When to treat? (BP>160/80)

Perio-operative control: Maintain 20% of normal BP

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7
Q

How do you optimise and what is the perioperative control for: IDH

A

Optimise: Symptomatic (or major procedure) /ECG anomaly

Perio-operative control: BP & HR control. Consider post operative HDU

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8
Q

How do you optimise and what is the perioperative control for: asthma/COPD

A

Optimise: Symptomatic? Signs?

Perio-operative control: Medication according to BTS

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9
Q

How do you optimise and what is the perioperative control for: anticoagulants

A

Optimise: Why? Stop or not?

Peri-op: INR/APTR <1.5
Anti-platelets/LMWH resumption?

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10
Q

How do you optimise and what is the perioperative control for: sickle cell

A

Optimise: Haem review

Peri-op: Good care- warm, hydrated, analgesia, infection free

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11
Q

Who and what surgery is suitable for day surgery

A

Social: Patient consent, carer, home setup

Medical: Fitness, stable chronic, obesity not preclude

Surgical: Complication risks, controllable post op symptoms, mobile

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12
Q

When should you consider investigations for surgery: blood test anomalies

A

: anaemia, renal dysfunction

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13
Q

When should you consider investigations for surgery: lung function tests

A

Baseline ABG’s, FEV1<40% (predictor for postoperative ventilation)

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14
Q

When should you consider investigations for surgery: cardiac

A

ECG – ischaemia, arrhythmias, baseline

Echo – LV function & valves

Stress echo – low/int/high risk of ischaemia

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15
Q

Mallampati score, neck movement

A

……..

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16
Q

Why are patients starved before surgery

A

Reduce aspiration risk

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17
Q

What is the usual starve guidance

A

Food : 6 hours

Water: 2 hours

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18
Q

Which patients are at increased risk of aspiration during surgery

A

Bowel obstruction, reflux disease, trauma (causing slow gastric transit, opioids

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19
Q

What do you need to include to prescribe opioids

A 
The dose
The form
The strength (where appropriate)
The total quantity or dosage units of the preparation in both words and figures
For instalment prescriptions, specify the instalment amount AND instalment interval

You must write how often to take in numbers and words

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20
Q

USE THE ANAESTHETIC SLIDE FOR PRESCRIPTION

A

……..

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21
Q

How is the oropharyngeal tube sized up

A

Compare the oropharyngeal tube from the corener of the mouth to the angle of the mandible

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22
Q

When is oropharyngeal tube used

A

To help to bag a patient

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23
Q

When do you use the bag-mask-valve

What oxygen can it deliver

A

When somebody is apnoiec only (not when a patient is trying to breathe because of the valve)

Can deliver up to 100% o2

24
Q

What is a definitve airway

A

a tube placed in the trachea with cuff inflated below the vocal cords

25
Q

Is an endotracheal tube a definitive airway

A

Yes it is

26
Q

Is a supraglottic device a definiive airway

A

No

27
Q

5 steps to safer surgery

A

……..

28
Q

What does one need to consider for VTE

A

Mobility
Risk factors
Bleeding risk

29
Q

How is dalteparin usually given

A

Sub cut

30
Q

What is the MOA, SE and dose/route of the following antiemetics; Ondansetron

A

5HT3R-antagonist

Bradycardia
Long QT syndrome

4-8mg TDS
PO/IV

31
Q

…..

A

…..

32
Q

…..

A

…..

33
Q

…..

A

…..

34
Q

…..

A

…..

35
Q

What temperature do you want to keep people at

A

Keep temp>360 C

36
Q

How do you maintain temperature dor someone with a procedule longer than 30 minutes?

What about longer procedure?

A

Procedure>30mins –> Bair hugger

Longer procedures –> consider fluid warming

37
Q

How do you manage an acute asthmatic (severe bronchospasm outside of theatre)

A

A,B,C
O2 -Start high flow oxygen and gain IV access
Salbutamol nebulised 2.5-5mg
Hydrocortisone 100 mg IV 6 hourly or prednisolone orally 40–50 mg/day.
Ipatropium nebulised 0.5 mg (4–6 hrly) • IV salbutamol if not responding (250 mcg slow bolus then 5–20 mcg/min).
Theophylline/Aminophylline
Magnesium 2g IV over 20 minutes

38
Q

When might adrenaline be used in severe bronchospasm

A

NB- In extremis (decreasing conscious level or exhaustion) adrenaline may be used: nebuliser 5 ml of 1 in 1,000;
Senior clinician only: IV 10 mcg (0.1 ml 1 : 10,000) increasing to 100 mcg (1 ml 1 : 10,000) depending on response.

39
Q

Learn the table of drugs slide 38

A

……

40
Q

How do you treat a severe tension pneumothorax

A

You can put a large bore cannula in the 2nd ICS

Chest drain might take too long in this situation

41
Q

Triggers for anaphylaxis

A

Stinhgs, nuts, food, Abx, anaesthetic drugs, contrast media

42
Q

How might you recognise anaphylaxis

A

Airway problems:
Airway swelling, e.g., throat and tongue swelling (pharyngeal/laryngeal oedema). The patient has difficulty in breathing and swallowing and feels that the throat is closing up.
Hoarse voice.
Stridor – this is a high-pitched inspiratory noise caused by upper airway obstruction.

Breathing problems:
• Shortness of breath – increased respiratory rate.
• Wheeze
• Patient becoming tired.
• Confusion caused by hypoxia.
• Cyanosis (appears blue) – this is usually a late sign.
• Respiratory arrest.

43
Q

Anaphyaxis treatment

A

Legs up, adrenaline, IV fluids, chlorphenamine and hydrocortisone???

44
Q

When to transfuse generally

A

if fit and well, then when Hb <70

If they have acute conroanary syndrome, sepsis, neuro injusty, is when Hb is <90

45
Q

What is the early warning scores

A

, based on simple scoring system in which a score is allocated to physiological measurements already undertaken when patients present to, or are being monitored in hospital

46
Q

What are the paramteres used for NEWS score

A 
1 respiratory rate	
2 oxygen saturations	
3 temperature
4 systolic blood pressure
5 pulse rate
6 level of consciousness.
47
Q

What score is low medium and high

A

0 or 1-4 is low

5-8 (or individual parameter scoring 3)= medium

Aggregate 7 or more= high

48
Q

What is sepsis

A

Infection + systemic inflammatory response syndrome

49
Q

What is SIRS

A

Systemic inflammatory response syndrome

Two or more of Temp >38 or <36

heart rate>90bmp

Resp rate >20/min

White cell count

50
Q

What to do if recognise sepsis within 3 hrs

A

1) Measure lactate level
2) Obtain blood cultures prior to administration of antibiotics
3) Administer broad spectrum antibiotics
4) Administer 30 ml/kg crystalloid for hypotension or lactate ≥4mmol/L “Time of presentation” is defined as the time of triage in the emergency department

51
Q

What to do if recognise sepsis within 6hrs

A

5) Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation) ; maintain a mean arterial pressure (MAP) ≥65 mm Hg
6) In the event of persistent hypotension after initial fluid administration (MAP < 65 mm Hg) or if initial lactate was ≥4 mmol/L, re-assess volume status and tissue perfusion.
7. Re-measure lactate if initial lactate elevated.

52
Q

Indications for ABG

A

To obtain & interpret oxygenation levels

To assess for potential respiratory derangements

To assess for potential metabolic derangements

To monitor acid-base status

To assess carboxyhaemoglobin in CO poisoning

To assess lactate

To gain preliminary results for electrolytes and Haemoglobin

Can be conducted as a one off sample or repeated sampling to determine response to interventions

53
Q

Contraindications for ABG

A

Local infection
Distorted anatomy
Presence of arterio-venous fistulas
Peripheral vascular disease of the limb to be sampled
Severe coagulopathy or recent thrombolysis

54
Q

Sampling error for ABG

A

Presence of air in the sample
collection of venous rather than arterial blood
an improper quantity of heparin in the syringe, or improper mixing after blood is drawn
delay in specimen transportation

55
Q

Complications related to ABG

A 
Haematoma 
Nerve damage 
Arteriospasm or involuntary contraction of the artery 
Aneurysm of artery 
Fainting or a vasovagal response

DPD 2019 (30 decks)

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