key words Flashcards

1
Q

succinylcholine in strabismus surgery

A

interferes with the “forced duction test” that the opthalmic surgeons use. interference can last up to 20 minutes

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2
Q

MMR

A

masseter muscle rigiditiy –> when severe i.e. jaws of steel, high risk of progression to malignant hyperthermia or rhabdo.

cancel case!

if mild and transient –> cancel if elective but continue with non-triggering anesthetic if emergent/urgent

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3
Q

bradycardia during strabismus surgery

A

this is most likely the
“oculocardiac reflex”

check if patient is HD stable
ask surgeon to stop manipulation of the eye
DEEPEN anesthetic

if it persists, give atropine 20 mcg/kg
local anesthetic

this reflex is subject to fatigue with repeated stimulation

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4
Q

limbs of the oculocardiac reflex?

A

afferent: trigeminal nerve

efferent: vagus nerve

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5
Q

concerns with tachycardia in the PACU

A

poorly controlled pain vs. low volume status

assess at bedside, look at vitals, and quick chart review

pain meds if poor pain control
fluids if low volume status

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6
Q

treatment for MH?

A

Call for help and MH cart.

STOP TRIGGER, change circuit and soda lime

Hyperventilate with 100% oxygen

dantrolene 2.5 mg/kg every 5-10 minutes PRN and sodium bicarb 1-2 mEq/kg

get a-line +/- CVP to SUPPORT CIRCULATION with vasopressors/antiarrhythmics

aggressive COOLING(lavage, cooling blanket, ice packs, cold IV fluids, cold dialysis) –> stop when temp drops to 38 degrees

fluids plus mannitol/lasix to maintain UOP

ABGs, electrolytes, CK-MB, coags – treat acidosis, treat hyperkalemia

Continue dantrolene 1 mg/kg q 6 hours x 24-48 hours to prevent relapse

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7
Q

low urine output in setting of rhabdo?

A

myoglobinuria – improve urine output and alkanize urine to prevent cast formation

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8
Q

pathophys of MH?

A

hypermetabolism and lactic acidosis from uncontrolled muscle contractions due to an abnormal ryanodine receptor that leads to a dysregulated release of calcium from sarcoplasmic reticulum

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9
Q

early signs of MH?

A

MMR
tachycardia
hypercarbia

hyperthermia is a late sign

general muscle rigidity is NOT always present

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10
Q

the different types of shock

A

distributive shock = low SVR state

cardiogenic shock = low CO state

hypovolemic shock = low intravascular state

common distributive shocks: sepsis, SIRS, neurogenic, anaphylaxis

common cardiogenic shocks: arrhythmias, cardiomyopathy from MI/valvular origin, RV failure (from PHTN or embolism), OR
extracardiac (aka obstructive shock) such as tamponade/PTX

common hypovolemic causes: hemorrhage, third spacing, insensible losses

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11
Q

Cushings Triad

A

Sign of increased ICP:
bradycardia
irregular respirations
widened pulse

Do things to decr ICP:
mannitol/lasix
raise head of bed 30 degrees
hyperventilate
insert drain
deepen anesthetic

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12
Q

Causes of hypoxia?

A

Causes are classified into 5 groups:
1. Low FiO2
2. Alveolar hypoventilation - RR, TV, tube malposition, tube obstruction
3. Impaired diffusion across blood-gas membrane - bronchospasm, pulmonary edema
4. Shunt
5. Ventilation-perfusion mismatch

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13
Q

increased peak AW pressure - what to do?

A

feel, look, listen

hand ventilate to assess compliance

look at machine, monitors, circuit, valves, tube, chest

listen to chest

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14
Q

How to block SLN for awake airway?

A

lidocaine soaked swabs in piriform sinuses

-OR- 1-2 mL lido injected just inferior to the greater cornu of the hyoid bone

supplies sensation from epiglottis to level of cords

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15
Q

how to block glossopharyngeal nerve for awake airway?

A

inject at the

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16
Q

adjuvant medications in setting of nerve injury?

A

gabapentin, TCAs, SSRIs, anticonvulsants
NSAIDs, tramadol
TENS units

17
Q

Rheumatoid Arthritis

A

airway: cervical instability, narrow glottis, limited TMJ; Evaluate ROM preop. Consider AFOI. Consider lateral films.

cardiac: pericarditis, tamponade, AI, condxn abnormalities

pulm: restrictive dz

renal: insuff 2/2 NSAIDs

GI: bleeding 2/2 NSAIDS

Immune: prone to infections 2/2 DMDs

18
Q

primary survey

A

A: airway
B: breathing
C: circulation
D: disability - FAST, other imaging
E: exposure: ABG, labs, other studies

19
Q

signs of cholinergic crisis? and treatment?

A

DDUMBBELLS

diarrhea
diaphoresis
urination
miosis
bronchospasm
bronchorrhea
emesis
lacrimation
lethargy
salivation

hypotension
tachycardia
confusion
shock

treat with atropine!! endpoint is adequate oxygenation!! (do not stop bc of tachycardia/mydriasis).

20
Q

What to do in myasthenic crisis?

A

Presents with weakness:
secure AW if critical hypoxia
tensilon test improves weakness in 2 min
give pyridostigmine or neostigmine
consult neurology (IVIG, steroids, immune modulators, plasmapheresis)

21
Q
A
22
Q

Ddx for fever, hypotension, tachycardia in setting of bowel surgery?

A

Anastomotic leak, bowel ischemia, sepsis, drug reaction