ITE CA2 General 4 Flashcards
most common periop anaphylactic causes in kids and adults
In adults, neuromuscular blocking agents are the most likely agents to induce an anaphylactic reaction in the perioperative period. In children, latex is the most likely causative agent.
Anaphylaxis is mediated by
Anaphylaxis is an IgE-mediated type 1 hypersensitivity reaction.
signs and symptoms of anaphylaxis
Signs and symptoms include bronchospasm and upper airway edema, urticaria, changes in capillary permeability and inotropy, and vasodilation.
what is carboxyhemoglobin
Carbon monoxide forms a tight bond with hemoglobin producing carboxyhemoglobin
Methemoglobin left or right shift of oxygen dissociation curve
left
hypophosphatemia left or right shift of oxygen dissociation curve
left
anesthesia information management systems (AIMS)
AIMS are a form of the electronic health record which allows automatic collection, storage, and presentation of patient data during the perioperative period.
limitations or problems with anesthesia information management systems
There are several limitations for the use of AIMS. Implementation of AIMS can be expensive and time-consuming. The cost can range from $4000 to $9000 per operating room with an additional cost for the servers and maintenance. AIMS can help with billing and charge capture which may help offset some of the costs. Another major problem is vertical integration. Information may not transfer from one phase of care to the next, for instance from the preoperative, intraoperative, and postoperative periods. There also may be difficulty with communication between different systems, for instance the patient monitor may not communicate with the ventilator and the AIMS creating data capture problems. The initial time and effort to implement and train staff on the AIMS can be significant with many roadblocks.
prob with asynchronous pacing
An R-on-T phenomenon occurs when a cardiac depolarization (R-wave) is initiated during a period of myocyte repolarization (T-wave) and can precipitate polymorphic ventricular tachycardia. Causes of R-on-T Phenomena include asynchronous cardiac pacing, long QT syndrome, or frequent PVC’s.
Inverted T waves differential
Inverted T waves can result from bundle branch blocks, myocardial ischemia/infarction, left ventricular hypertrophy, pulmonary embolism, and elevated intracranial pressure. They can also be a normal finding in children.
Lung abscesses usually occur due to
Lung abscesses usually occur due to primary infections, namely aspiration pneumonia, and are commonly caused by anaerobic bacteria. Broad-spectrum antibiotics are first-line treatment and lung isolation should be utilized if surgical intervention is necessary.
Lung abscesses organisms
Lung abscesses are most commonly a result of primary lung infections, such as aspiration pneumonia, leading to further necrosis and abscess formation. Organisms that are commonly implicated include anaerobes (Bacteroides, Peptostreptococcus), as well as some aerobes (Staphylococcus, Klebsiella, and Pseudomonas).
Things that affect billing and payment
The total billable charge for an anesthetic is generally represented by: (BU + TU + Modifying Factors) x Anesthesia Conversion Factor. Modifying factors include QCU, physical status modifier, and specialized monitoring.
Many insurance providers allow for additional units (QCUs) to be billed for four unique clinical situations.
1) Extremes of age (patients < 1 year or >70 years)
2) Use of (deliberate) total body hypothermia
3) Use of controlled hypotension
4) Anesthesia complicated by emergency conditions
The intraoperative administration of drugs, IV fluids, blood products, etc. are considered an integral part of the global general anesthetic service and do not increase or decrease reimbursements for an anesthetic.
Transillumination
Transillumination involves placement of a lighted stylet into the trachea until a glow is visualized at the cricoid cartilage, with subsequent passage of an endotracheal tube. It is useful in cases of increased airway secretions and blood but should be avoided in morbidly obese patients and cases of airway anatomy distortion.
A patient experiencing acute respiratory alkalosis should demonstrate a pH increase of ___ and a HCO3- decrease of ___ mEq/L per acute 10 mm Hg decrease in PaCO2.
A patient experiencing acute respiratory alkalosis should demonstrate a pH increase of 0.10 and a HCO3- decrease of 2 mEq/L per acute 10 mm Hg decrease in PaCO2.
A patient experiencing acute respiratory acidosis should demonstrate a pH decrease of ____ and an HCO3- increase of ____ mEq/L per acute 10 mm Hg increase in PaCO2.
A patient experiencing acute respiratory acidosis should demonstrate a pH decrease of 0.05 and an HCO3- increase of 1.0 mEq/L per acute 10 mm Hg increase in PaCO2.
If the respiratory acidosis becomes chronic, pH nearly normalizes, and HCO3- concentrations increase __ mEq/L per 10 mm Hg sustained increase in PaCO2.
If the respiratory acidosis becomes chronic, pH nearly normalizes, and HCO3- concentrations increase 4-5 mEq/L per 10 mm Hg sustained increase in PaCO2.
If a respiratory alkalosis becomes chronic, pH nearly normalizes and HCO3- decreases ___ per 10 mm Hg sustained decrease in PaCO2.
If a respiratory alkalosis becomes chronic, pH nearly normalizes and HCO3- decreases 5-6 mEq/L per 10 mm Hg sustained decrease in PaCO2.
Plasma albumin has a half-life of
Plasma albumin has a half-life of nearly 3 weeks.
5′-nucleotidase is a marker of cholestasis
5′-nucleotidase is a marker of cholestasis, along with γ-Glutamyl transpeptidase and alkaline phosphatase. However, alkaline phosphatase lacks specificity for hepatobiliary disease and may be derived from bone or other sources.
Brachial artery catheterization potential complications
Brachial artery catheterization is low risk and can be used for long-term monitoring. Potential complications include thrombosis, infection, and median nerve injury.
Nerve injury is a concern when puncturing the upper extremity arteries. The brachial artery is in close proximity to the median nerve (just medial to the artery), and can potentially injure the nerve during catheterization. The axillary artery runs through the axillary sheath, which contains the median, ulnar, and radial nerves. Bleeding during the puncture of the axillary artery can cause a hematoma to form within the sheath. This can result in nerve compression leading to serious neurological deficits.
The axillary sheath contains
TrueLearn Insight : The axillary sheath contains the median, ulnar, and radial nerves. The musculocutaneous nerve is located outside of the axillary sheath.
absolute contraindication to shock wave lithotripsy.
pregnancy, bleeding disorders, and anticoagulation therapy
relative contraindications to shock wave lithotripsy
Relative contraindications include large aortic or renal aneurysms, untreated urinary tract infection (UTI), ureteral obstruction distal to the calculus, implanted pacemaker/defibrillator, and morbid obesity.
crystal vs colloid for resuscitation
Both crystalloids and colloids have been used for resuscitation. There have been many different studies evaluating the efficacy of each therapy. The SAFE and ALBIOS studies suggest no difference in mortality between the two when used for resuscitation.
Induced hypothermia following cardiac arrest
reasoning
guidelines
Induced hypothermia following cardiac arrest can reduce ischemic injury and improve neurologic outcomes. It is accomplished by various cooling methods for a duration of 12-24 hours post-resuscitation with a goal temperature of 32 °C to 36 °C. Rewarming should occur slowly to avoid major complications.
Most deaths associated with the use of induced hypothermia occur ___
Most deaths associated with the use of induced hypothermia occur during the rewarming phase due to too rapid rewarming.
pupillary light reflex under GA
intact
PO2 of room air
room air PO2 of about 159 mmHg
delay in ABG causes what
Delays in analysis and exposure of a sample to room air are the two most common sources of error in blood gas analysis. A delay will result in decreased PaO2, pH, and base excess values and an increase in PaCO2. Entrainment of room air will tend to cause the PaO2 value of the sample to approach the PO2 of room air (159 mmHg at sea level) and result in a decreased measured PaCO2.