Know Cold Flashcards
Cushings triad
bradycardia, irregular respirations, and widened pulse pressure as a result of an acute increase in ICP.
Do things to decr ICP:
mannitol/lasix
raise head of bed 30 degrees
hyperventilate
insert drain
deepen anesthetic
Contraindications to nitrous?
PHTN
known air bubble
untreated pneumothorax
Pathophysiology of TURP syndrome?
absorption of dilute fluids into the circulation
if hyponatremia with no neuro symptoms: give saline and lasix
if hyponatremia WITH neuro symptoms: give hypertonic fluids slowly to avoid cerebral pontine myelinosis
Implication of HTN?
shifts cerebral autoregulation curve to the right
how to manage venous air embolism?
100% oxygen, positive pressure ventilation, and flood field with saline, then support circulation
change in potassium?
first think are there ANY EKG CHANGES? otherwise unlikely that it needs to be corrected preop
Mechanism and treatment of ocular mediated bradycardia?
vagus nerve is the EFFerent pathway
treatment:
surgeon should release retraction
atropine, epinephrine
infiltration of the muscle with lidocaine
What to do if there is recall?
Check the anesthetic record
listen with sympathy
discuss things that can be improved
offer counseling
Increased incidence in trauma, OB, female gender, and cardiac cases
hypothermia and shivering: what to do?
meperidine or other options include clonidine, dexamethasone, tramadol, propofol, alfentanil, sufentanil
forced air warming
increase ambient room temp
warm IV fluids
blankets
what to do if inspired CO2 is high?
inspiratory valve is stuck open
CO2 absorber is exhausted
change out absorber, replace valve or temporize by increasing fresh gas flow
problem with EMLA?
methemoglobinemia
treat with methylene blue
treat with ascorbic acid if G6PD deficiency
abdominal pain in sickle cell anemia?
splenic sequestration – this is an impending transfusion emergency – get IV access and type and cross
What is heard on the doppler if there is a VAE?
mill wheel murmur
Anytime you correct hyponatremia, worry about ______?
central pontine myelinolysis
correct hyponatremia with hypertonic saline no faster than 1-2 mL/kg/hr and stop once Na =125
therapeutic Mg level?
4-8 mg/dL
TIVA or inhalational anesthesia for one lung ventilation?
Either but TIVA with propofol may have a slight advantage because volatiles inhibit hypoxic pulmonary vasoconstriction.
signs/symptoms of cocaine toxicity
Tremors, dilated pupils, conjunctivitis, EKG changes
cancer pain treatment with limited expected lifespan?
Combination of….
non-opioids
adjuvants
+/- opioids dependent on level of pain control
(PO preferred but can be IV or SC)
if still inadequate pain control or intolerable side effects from PO meds:
intrathecal pumps
spinal column stimulators
neurolytic blocks
Adjuvant meds include:
TENS units, lidocaine patches, gabapentin, anticonvulsants, TCAs, bisphosphonates (for bony mets)
treatment for torsades?
Mg therapy, isoproterenol, replete K
EKG changes with hyPeRK, hyPeRCa, hyperMg?
prolonged PR, prolonged QRS, short QT
(opposite with hypoK, Ca, Mg so short PR, short QRS, widened QT)
Management of hyperkalemia intraop?
Calcium to stabilize cardiac membranes
insulin/glucose
hyperventilation
bronchodilator
lasix
indicators of difficult mask ventilation?
MOANS
- Mask fit difficult (beard, blood, trauma, syndromic facies)
- Obesity (BMI >26)/ Obstruction
- Age >55
- No teeth
- Stiff lungs/chest wall/
- Etc (tonsils, polyps, trauma)
- Prior anesthetic record
> 50% decrement in SSEP
or >65% decrement in MEP…
WWYT?
- surgical instrumentation
- change in anesthetic levels
- HoTN, decrease in arterial pressure below the levels of cerebral autoregulation
- Hypoxia
- hypercarbia
- Hct <15% (anemia)
- Hypothermia
hypotension with transfusion…WWYT?
CASH-TO
- Citrate Intoxication/hypoCalcemic
- Anaphylactic/oid
- Sepsis- “dirty blood”
- Hemolysis -Acute Txf Rxn/ ABO Incompatibility
- TACO/TRALI
- Ongoing Bleeding
STOP BANG
> 4 = high risk OSA
Snores
Tired daytime
Observed (gasping/choking)
Pressure (HTN)
BMI > 35
Age > 50
Neck circumference > 43 centimeters male or
41 centimeters female
Gender male
LAST dosing (bolus vs. infusion vs max vs epi)
Lipid bolus: 1.5 mL/kg
infusion: 0.25 mL/kg/min
Repeat bolus if pt remains unstable
Max dose: 12 mL/kg
Epi dose for ACLS: start <1 mcg/kg
Continue infusion for 15 min after stable BP
Monitor for 2 hours after seizure
Monitor for 4-6 hours after cardiac instability
Monitor as appropriate for cardiac arrest
problems related to hypothermia?
poor wound healing, coagulopathy, cardiac dysrhythmias, and imparied renal function
**inconclusive evidence for brain protection 2/2 decreased CMRO2
DDx for bilat pulmonary infiltrates?
ARDS
Aspiration pneumonitis
cardiogenic pulmonary edema
neurogenic pulmonary edema
TACO/TRALI
Cvp in setting of mechanical ventilation
Less reliable in assessing volume status 2/2 decr preload
CRF induced hyperK in setting of cadaveric kidney transplant
Correct to normal to prevent hyperkalemic arrest during reperfusion.
AW bleeding
Could lead to laryngospasm, bronchospasm, neg pressure pulm, and even loss of airway. Call for difficult AW cart and cric kit!
uterine relaxants vs uterine tocolytics
uterine relaxation (retained placenta, uterine inversion or exit procedure):
beta 2 agonists: terbutaline, ritodrine
magnesium
volatile agents
nitroglycerine
tocolysis:
mag
indomethacin
nifedipine
beta 2 agonists: terbutaline, ritodrine
ACLS in pregnancy
chest compressions higher on the sternum
LUD
discontinue Mg
Give calcium to stabilize myocardium
Baby out if no return of ROSC after 4 minutes
