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F1 anesthetics > ILS pt.3 > Flashcards

ILS pt.3 Flashcards

1
Q

Causes of airway obstruction

A
  • Blockage in airway: Blood, secretions, vomiting, foreign body (dislodged tooth, food)
  • Infection and oedema: Direct trauma to face or throat, epiglottitis, pharyngeal swelling
  • Narrowing of airway: Laryngospasm, bronchospasm
  • CNS depression: This may cause loss of airway patency and protective reflexes
  • Blocked tracheostomy
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2
Q

CNS depression causes that can lead to airway obstruction

A
  • Head injury
  • Intracerebral disease
  • Hypercapnia
  • Depressing effect of metabolic disorders (e.g. hypoglycemia), and drugs (e.g. alcohol, opioids and general anesthesia)
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3
Q

Signs of airway obstruction

A
  • A conscious patient will complain of difficulty breathing
  • Choking
  • Noisy breathing is seen in partial airway obstruction
  • Complete airway obstruction is silent and there is no air movement or breath sounds in patient’s mouth or nose.
  • Any respiratory movements are usually strenuous
  • Accessory muscles of respiration will be involved causing paradoxical chest and abdominal movement (see-saw or rocking horse pattern): the chest is drawn in and the abdomen expands on inspiration, and the opposite occurs on expiration
  • Central cyanosis (blue lips and tongue) is a late sign of airway obstruction
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4
Q

What can airway obstruction be divided into?

A

Complete or partial

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5
Q

What can complete airway obstruction lead to?

A

It rapidly cause cardiac arrest

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6
Q

What can partial airway obstruction lead to?

A

Can lead cerebral or pulmonary edema, exhaustion, secondary apnea, and hypoxic brain injury, and eventually cardiac arrest

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7
Q

Treatment of airway obstruction

A
  • Priority is to ensure that the airway remain patent
  • In most cases, simple methods of airway clearance are all that are required
  • Treat any problem that places the airway at risk; for example, use suction to remove any blood and gastric contents from the airway and, unless contraindicated turn the patient on their side
  • Simple airway opening manoeuvers (head tilt/chin lift or jaw thrust), insertion of an oropharyngeal or nasal airway can improve airway patency
  • Give 100% oxygen (15L oxygen)
  • Tracheal intubation by an airway expert may be required if the above fail
  • Consider nasogastric tube to empty the stomach
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8
Q

Pathologies that may lead to impaired respiratory effort

A
  • Spinal cord lesions affecting areas controlling diaphragm or intercostal muscles
  • Diseases that cause inadequate respiratory effort due to muscle weakness or nerve damage such as Myasthenia gravis, Guillain-Barre syndrome, and Multiple sclerosis
  • Restrictive chest wall abnormalities like kyphoscoliosis
  • Pain from fractured ribs or sternum which will prevent deep breaths and coughing
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9
Q

What are the main respiratory muscles?

A

Diaphragm and intercostal muscles

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10
Q

What does tension pneumothorax lead to?

A

Impaired gas exchange and reduced venous return to the heart

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11
Q

Normal resp rate in adults

A

12-20 in adults

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12
Q

Normal heart rate in adults

A

60-100 bpm

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13
Q

Signs that a patient has breathing problems

A
  • Complains of shortness of breath and distress
  • Hypoxemia
  • Hypercapnea
  • Use of accessory muscles
  • Cyanosis
  • Sweating
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14
Q

What can hypercapnia cause?

A

Irritability, confusion, lethargy and depressed consciousness

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15
Q

Adequacy of pulse oximetry to assess ventilation, alternatives?

A

Not a reliable indicator of ventilation and an arterial blood gas sample is necessary to obtain values for arterial carbon dioxide tension (PaCO2) and pH

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16
Q

What is sudden cardiac arrest most commonly caused by?

A

Arrythmia secondary to an acute coronary syndrome

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17
Q

Most common initial cardiac arrest rhythm

A

Ventricular fibrillation

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18
Q

In acutely ill patients, what is the most common cause of circulation problems?

A

Hypovolemia

19
Q

When is it not a good idea to give GTN spray in an MI or angina patient?

A

If they are hypotensive

20
Q

What is the most common cause of sudden cardiac death?

A

MI

21
Q

Signs and symptoms of cardiac disease

A

Chest pain, SOB, syncope, tachycardia, bradycardia, tachypnea, hypotension, poor peripheral perfusion (prolong CR and cool peripheries), altered mental status (oliguria)

22
Q

What are silent cardiac diseases?

A

Hypertensive heart disease, aortic valve disease, cardiomyopathy, myocarditis, and coronary artery disease

23
Q

What can one deduce from listening to a patient breathing when close up to them?

A
  • Rattling airway noises indicate the presence of airway secretions, usually because the patient cannot cough or take a deep breath
  • Audible stridor (an upper airway noise on inspiration) or wheeze (on expiration) suggests partial but significant, airway obstruction
24
Q

Hyperresonance vs dull percussion on chest percussion

A

Hyperresonance suggests a pneumothorax
Dull percussion usually indicates pleural fluid or lung consolidation

25
Q

What does reduced or absent lung sounds indicate on auscultation?

A

Pneumothorax, pleural effusion, or consolidation (e.g. pneumonia)

26
Q

Where to check for position of the trachea to check if it is deviated?

A

Suprasternal notch

27
Q

What does deviation of the trachea to one side indicate?

A

Mediastinal shift, either caused by pneumothorax, lung fibrosis, pleural effusion

28
Q

Why shouldn’t COPD retainer get high amounts of oxygen?

A

Leads to hypercapnia which causes acidosis and decreased respiratory drive

29
Q

What should you consider as the most likely cause of shock in medical and surgical emergencies?

A

Consider hypovolemia as the likeliest cause of chock, unless proven otherwise

30
Q

What should you do in a patient with cool peripheries and a fast heart rate?

A

Give IV fluids unless there are obvious signs of a cardiac cause (e.g. chest pain, heart failure)

31
Q

What to do when assessing airway?

A

Look for signs of obstruction

32
Q

What to do when assessing breathing?

A
  • Look, listen and feel for the general signs of respiratory destress
  • Count the resp rate
  • Assess the depth of each breath
  • Note any chest deformities
  • Record the inspired oxygen concentration and the SpO2 reading of the pulse oximetry
  • Percuss the chest
  • Auscultate the chest
  • Check the position of the trachea
  • Feel the chest wall to detect surgical emphysema or creptus
33
Q

What is surgical emphysema?

A

Another name for subcutaneous emphysema, occurs when gas or air accumulates and seeps under the skin, where normally no gas should be present.

34
Q

What to do when assessing circulation?

A
  • Look at the colour of the hands and fingers
  • Hold the patient’s hand (is it cool or warm)
  • Measure CRT (Central and peripheral)
  • Count the patient’s pulse rate
  • Feel the peripheral and central (carotid) pulse
  • Measure the patient’s blood pressure
  • Auscultate the heart with a stethoscope
  • Look for other signs of poor cardiac output (e.g. decreased urine output)
35
Q

Signs and symptoms of heart failure

A

Dyspnea, increased heart rate, raised JVP, third heart sounds, pulmonary crackles

36
Q

What are common causes of unconsciousness?

A

Profound hypoxia, hypercapnia, cerebral hypoperfusion due to a low blood pressure, or sedatives or analgesic drugs

37
Q

What to do in disability section of A-E assessment?

A
  • Review and treat the ABCs (exclude or treat reversible causes of LOC)
  • Check the patient’s drug chart for reversible drug-induces causes of depressed consciousness
  • Examine the pupils
  • Make a rapid initial assessment of the patient’s conscious level using the ACVPU method
  • Measure blood glucose
  • Nurse unconscious patients in the lateral position if their airaway is not protected
38
Q

What to check for when examining pupils?

A

Size, equality, reactivity to light

39
Q

ACVPU method

A

Alert, new confusion, responds to vocal stimuli, response to painful stimulus, or unresponsive to all stimulus

40
Q

What to do in exposure section of A-E assessment?

A
  • Examine for rashes, bruising, bleeding, and other noted abnormality
41
Q

Causes of VF

A
  • Acute coronary syndromes
  • Hypertensive heart disease
  • Valve disease
  • Drugs (e.g. antiarrhythmic drugs, tricyclic antidepressants,
    digoxin)
  • Inherited cardiac diseases (e.g. long QT syndromes)
  • Acidosis
  • Abnormal electrolyte concentration (e.g. potassium,
    magnesium, calcium)
  • Hypothermia
  • Electrocution
42
Q

Agonal breathing description

A

(occasional, irregular gasps)

43
Q

What is a quick to assess airway obstruction

A

Ask the patient to cough, if obstruction is severe they will have an ineffective cough, if mild then the cough will be effective

44
Q

Which mask allows high flow of oxygen?

A

Non-rebreather mask

F1 anesthetics (39 decks)

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