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Sp: Intro to Anes > General, CV, Thoracic, Trauma, Ortho > Flashcards

General, CV, Thoracic, Trauma, Ortho Flashcards

1
Q

9 primary components of general surgeons

A

alimentary tract
abdomen
breast/skin/soft tissue
head/neck
vascular system
endocrine system
surgical oncology
trauma
critical care (ER/ICU/trauma/burn unit)

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2
Q

appendicitis

A

inflammation of appendix

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3
Q

appendicitis treatments

A
  1. abx (30% chance of recurrence)
  2. Lap appendectomy
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4
Q

lap appy setup

A

single incision (umbillicus)
or
3 port technique

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5
Q

mesoappendix

A

blood supply to appendix

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6
Q

stapler during a lap appy indicates

A

close to end
prep zofran and toradol

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7
Q

lap appy induction drugs

A

lido
propfol
sux/roc
fentanyl

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8
Q

lap appy fluids

A

balance crystalloid solution

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9
Q

lap appy lines

A

18ga IV

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10
Q

lap appy positioning

A

supine
trendelenburg w/right side up

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11
Q

lap appy can cause

A

pneumoperitoneum
decr venous return
decr CO
incr SVR (reflex brady)

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12
Q

lap appy pts are considered

A

full stomach
RSI induction

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13
Q

if pt has a perforated appendix w/active infection you should

A

withhold decadron

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14
Q

if pt has perforated appendix and its bloody you should

A

withold toradol

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15
Q

a perforated appendix is often painful you should consider

A

long-acting narcotic (dilaudid)

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16
Q

lap chole

A

removal of gal bladder

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17
Q

causes of cholecystitis

A

gb inflammation
unknown inflammation

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18
Q

what signals a lap chole is almost done

A

cautery

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19
Q

what are the drs looking for in lap chole

A

systic duct

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20
Q

what signlas a lap chole is 1/2 done

A

clips

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21
Q

how many trochars are used in lap chole

A

3-4

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22
Q

positioning for lap chole

A

supine
reverse tburg

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23
Q

what does pneumoperitoneum cause

A

decr venous return
decr CO
incr SVR
reflex brady

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24
Q

lap chole positioning may cause _____

A

decr BP

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25
Q

hernia

A

sac formed by tissue protruding through weak spot in peritoneum

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26
Q

types of hernia repairs

A

total extraperitoneal (TEP)
transabdominal preperitoneal (TAPP)
open hernia repair

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27
Q

which surgeries require pneumoperitoneum?

A

lap appy
lap chole
hernia repair
Ex lap

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28
Q

which surgeries require RSI?

A

lap appy
hernia
Ex lap

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29
Q

hernia positioning

A

supine
steep tburg

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30
Q

hernia positioning may cause

A

incr BP

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31
Q

Ex Lap indications

A

bowel obstruction
bowel trauma
perforated bowel
abdominal mass

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32
Q

Ex lap lines

A

2x 18ga IV
art line
central line (maybe)

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33
Q

Ex lap positioning

A

supine

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34
Q

Ex lap pts are more likely to be

A

hemodynamically unstable

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35
Q

2 types of interventional cardiology procedures

A

coronary revascularization
electrophysiology

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36
Q

cardiac catheterization indication

A

eval of cardiac lesions
symptomatic ischemic heart disease from atherosclerosis

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37
Q

Cath lab procedures are done under ______ anesthesia

A

MAC

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38
Q

cath lab positioning

A

supine

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39
Q

electrophysiology indications

A

pts who have electrical activity that disrupts natural propogation
- wolf parkinson white
- afib

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40
Q

what condition has accessory electrical pathway that leads to SVT

A

wolf parkinson white

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41
Q

electrophysiology ablation methods

A

radiofrequency: heat
cryoablation: cold

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42
Q

what does ablation cause

A

scar tissue

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43
Q

electrophysiology lines

A

18ga IV
art line

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44
Q

what cant you use during mx in electrophys cases?

A

No muscle relaxant

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45
Q

what will you use during mx in electrophys?

A

> 1.2MAC volatile agent
phenylephrine drip

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46
Q

electrophys positioning

A

supine

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47
Q

CABG indications

A

pt with significant symptomatic coronary artery diseaseC

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48
Q

CABG procedure

A

grafts vessels from aorta to region distal to the blocking

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49
Q

what should you do when they use a saw during the CABG

A

bring the lungs down

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50
Q

what vessels are they most likely using during a CABG

A

saphenous vein
left internal mamary artery

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51
Q

when do you need an aortic valve replacement?

A

aortic stenosis
aortic insufficiency
thransaortic valve replacement (TAVR)
mitral stenosis
mitral regurge

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52
Q

what is a catheter into the groin used for

A

TAVR

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53
Q

what lines do you need for a CABG

A

18 ga IV
art line
central line
PAC

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54
Q

when should you place the art line for a CABG

A

before induction

55
Q

what additional monitors are you using in a CABG?

A

art line
cvp
pap
tee

56
Q

what additional drugs should you consider using during mx of a CABG

A

norepi drip
epi drip
inotrope
heparin

57
Q

when would you use heparin in a CABG

A

if you are going on pump

58
Q

what inotrope is commonly used during a CABG

A

milrinone

59
Q

what drug do you give at the end of pump CABG case?

A

protamine

60
Q

bronchoscopy

A

pulmonologist uses a flexible bronchoscope to eval pulmonary pathology

61
Q

what pathology types are investigated w/bronchoscopy

A

bronchomalacia
infectious pathology
CG

62
Q

bronchioalveolar lavage indications

A

lung pathology that needs to be cleared
- excess mucus
- infectious agents

63
Q

bronchoscopy positioning

A

supine

64
Q

what additional drug could you give during a bronchoscopy?

A

lidocaine to spray on cords/carina to suppress cough reflex

65
Q

Video Assisted Thoracoscopy (VATS)

A

procedure to visualize the contents of the thoracic cavity

66
Q

blebectomy

A

removal of air-filled spaces in visceral pleura

67
Q

lobectomy

A

removal of entire lung lobe

68
Q

VATS tube

A

DLT
or bronchial blocker

69
Q

VATS lines

A

16 or 18ga IV
art line

70
Q

VATS positioning

A

lateral w/surgical side up[

71
Q

how long does it take for closure in ortho cases?

A

45 mins

72
Q

polymethylmethacrylate

A

bone cement

73
Q

polymethylmethacrylate results in

A

intramedullary hypertension >500mmHg

74
Q

bone cement implantation syndrome effects

A

vasodilation
decr SVR
platelet aggregation-embolism
decr CO
incr PVR
hypoxia

75
Q

how to treat bone cement implantation syndome

A

incr FiO2 to 100%
give vasoactive agent (incr BP)

76
Q

pneumatic tourniquet

A

used to provide a bloodless field

77
Q

torniquet is inflated to

A

100mmHg above systolic pressure

78
Q

torniquet on

A

incr central volume
hypertension
tachycardia

79
Q

tourniquet off

A

decr central volume
decr venous return
decr central BP
incr etCO2
incr HR
decr temp

80
Q

tourniquet max inflation time

A

2 hrs

81
Q

risk after tourniquet deflation

A

thromboembolisms

82
Q

when does tourniquet pain occur

A

after 1 hour

83
Q

best method to relieve tourniquet pain

A

let tourniquet down

84
Q

when does fat embolism syndrome occur

A

within 72 hrs of long bone or pelvic fracture

85
Q

fat embolism syndrome

A

fat cells liberated by bone fracture enter the medullary vessels

86
Q

fat embolism syndrome symptoms

A

ARDs (dyspnea/hypoxia)
agitation and confusion
coagulation abnormalities (petechiae)

87
Q

petechiae

A

non-blanching pinpoint rash

88
Q

knee athroscopy indication

A

meniscus damage
joint pathology
ACL damage

89
Q

autograft

A

use pts own tissue

90
Q

allograph

A

use donor tissue

91
Q

knee arthroscopy anesthetic choices

A
  1. GA w/LMA/ETT and adductor block
  2. MAC w/spinal/epidural
92
Q

what is the benefit of an adductor canal block

A

early ambulation

93
Q

total knee indication

A

osteoarthritis

94
Q

total knee anesthesia

A

GA (LMA) and regional (adductor block)

95
Q

total hip indications

A

osteoarthritis
avascular necrosis
rheumatoid arthritis

96
Q

which sx has the highest risk of BCIS

A

total hip
(4x more than knee)

97
Q

total hip anesthesia

A

GA
or
GA w/neuraxial block

98
Q

are tourniquets used for hips

A

no

99
Q

long bone fracture indications

A

trauma
bone cyst

100
Q

2 methods of long bone fixation

A

intramedullary rod/nail
plate fixation

101
Q

long bone fixation will use a tourniquet for

A

distal femur
tibia

102
Q

special consideration for long bone fracture

A

move pt to bed prior to wakeup

103
Q

trauma primary assessment

A

Airway
Breathing
Circulation
Disability
Exam/Exposure

104
Q

trauma secondary assessment

A

Signs/symptoms
Allergies
Meds
Past medical hx
Pictures (CXR/CT/US)
Last oral intake
Lab values
Events

105
Q

trauma pts are always considered

A

full stomach

106
Q

FAST scan

A

ultrasound for internal bleeding

107
Q

common locations to FAST scan

A

pericardium
RUQ
LUQ
Suprapubic area
Right anterior thoracic
Left anterior thoracic

108
Q

TBI eval

A

glascow coma scale
AVPU scale

109
Q

AVPU scale

A

Awake
Verbal (responds to verbal)
Pain (responds to pain)
Unresponsive (to stimulus)

110
Q

cushings reflex

A

hypertension
bradycardia
incr ICP

111
Q

common TBI symptoms

A

cushings reflex
seizures
amnesia
vomiting

112
Q

Glascow coma scale: eye reponse

A

No opening: 1
open spontaneously: 4

113
Q

GCS: motor response

A

no motor response: 1
obeys commands: 6

114
Q

GCS: verbal reponse

A

no verbal response: 1
oriented: 5

115
Q

postures common in brain injury

A

decorticate
decerebrate

116
Q

decorticate

A

fists tucked to chest supine

117
Q

decerebrate

A

fists by side rotated outward

118
Q

what can be used to rule out cervical injury

A

neuro
radiology

119
Q

what is possible with spine injury

A

neurogenic shock

120
Q

what should you note when placing tourniquet

A

time

121
Q

what should you do with ortho long bone fracture

A

splint immediately

122
Q

how much EBL for each long bone fracture

A

1-3 units of EBL

123
Q

how much EBL for pelvic fracture

A

several liters

124
Q

retroperitoneal bleeding can be caused by

A

pelvic fracture

125
Q

flail chest

A

caused by multiple larger rib fractures

126
Q

what should you do with a flail chest pt

A

place ETT for PPV

127
Q

what conditions can be associated with rib fractures

A

hemothorax
pneumothorax

128
Q

hemo/pneumothorax diagnosis

A

CT
CXR
ausculation
tracheal deviation
distended jugular veins

129
Q

hemo/pneumothorax treatment

A

chest tube
14ga needle decompression

130
Q

cause of diaphragmatic rupture

A

intense acute abdominal pressure
- bowel content can push through diapragm

131
Q

effects of diaphragmatic rupture

A

decr FRC
extrinsic cardiac compression
hypoxiqa

132
Q

abdominal compartment syndrom

A

incr abdominal pressure
decr venous return
decr perfusion

133
Q
A

Sp: Intro to Anes (12 decks)

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