List style questions Flashcards
Hypoxemic vs hypercapnic RF symptoms:
Early manifestations:
- Mental status changes
- Increased HR
- Increased RR
- Mild HTN
Hypoxemic RF:
- Paradoxical breathing
- Retractions
- Nasal flaring
- Tachypnea/dyspnea
- Cyanosis
Hypercapnic RF:
- Pursed-lip breathing
- Morning headache
- Retractions
- Rapid shallow breahting
- Tripod position
Type 1 vs Type 2 RF symptoms:
Type 1:
- Dyspnea, irritability, confusion, fits, somnolence, cyanosis, pulmonary HTN
Type 2:
- High CBF, headache, blurred vision (papilledema), excitation, coma, warm extremities, asterix, collapsing pulse due to hypercapnic peripheral vasodilation, acidosis
Part of a tracheostomy tube:
Neck plate, obturator, inner cannula
Main types of tracheostomy tube:
Cuffed, fenestrated, cuffless
Oral intubation advantages and disadvantages:
- Advantages - Performed easily and quickly, Larger tube used (facilitates suctioning and procedure, lesskinking of the tube)
- Disadvantages - Not reccommended with cervical injury, uncomfortable, risk of dental trauma, more difficult to perform mouth care
Nasal intubation advantages and disadvantages:
- Advantages - Greater patient comfort and tolerance, better cmouth care, lower risk of accidental intubation
- Disadvantages - More difficult to perform, may cause nasal hemorrhage, sinusitis, nasal septal necrosis, suctioning more difficult
Complications of intubation:
Trauma to airway stuructures
Hypoxia
Dysrhythmias
Aspiration
Intubation of esophagus or right mainstem bronchus
Laryngospasm, bronchospasm
Advantages of tracheostomy over endotracheal intubation:
- Faster weaning, enhanced patient comfort and communication, possibility of oral feeding, more effective clearing of secretion
Disadvantages of tracheostomy:
- Hemorrhage, pneumothorax, tracheal stenosis, accidental decannulation, need for an operative procedure
Regional anesthesia advantages and disadvantages:
- Advantages - Cheap, high patient satisfaction, maintin patent airway, decreased blood loss, selective muscle relaxation, decreased incidence of DVT, PE
- Disadvantages - Hypotension, toxicity risk, many patients prefer to sleep instead, skills required, patient can talk, patient anxiety, not reliable
Spinal anesthesia:
Only in lumbar region, brief duration, high quality of block
Drug contraindicated with vasoconstrictors:
CHLORPROCAINE is CONntraindicated with vasoCONstrictors
Absolute contraindications of spinal anesthesia:
Increased intracranial presure
Sepsis
Coagulation therapy / disorders
Hypovolemia
Infection at site
Patient refusal
Severe hypovolemia
Relative contraindications of spinal anesthesia:
Peripheral neuropathy
Mini-dose heparin
Psychosis
Aspirin and antiplatelet drugs
Demyelinated CNS disease
Cardiac lesions **
Emotional instability
Prolong surgery
Surgical team resistance
Complications of spinal anesthesia:
Failed block
Back pain
Hypotension
Local anesthesia toxicity
High blockade
Urinary retention
Local infection
Meningism
Epidural hematoma
Spinal headache
Epidural test:
3mL lidocaine 1.5% w/ epinephrine
Positive:
Tachycardia (increase>30bpm)
High BP
Lightheadedness
Metallic taste in mouth
Ringing in ears
Facial numbness
Complications of epidural anesthesia:
Penetration of blood vessels
Hypotension
Nausea and vomiting
Headache
Back pain
Intravascular cathetization
Dural puncture
Infection
Factors increzasing MAC:
Hyperthermia
Hypernatremia
Drugs that increase catecholamine levels (tricyclic antidepressants, acute cocaine ingestions)
Chronic ethanol abuse
Factors decreasing MAC:
Hypothermia
Hyponatremia
Pregnancy
Li, lidocaine, a2 agonsists
PaO2<38mmHg
BP <40mmHg
Increased age
Preoperative medication
Drugs that decrease CNS catecholamine levels (a-methyldopa, clonidine)
Acute ethanol ingestion
Factors not affecting MAC:
Duration of anesthesia
Potassium disturbances
Magnitude of anesthetic metabolism
Gender
PaCO2 15-95
PaCO2 >38mmHg
BP<>40mmHg
