Maintenance Flashcards
How to anticipate effects in care phase 2?
Look online or relay on experience or ask
Major vascular = sig blood loss and drop in bp
What direction is autonomic?
Increase
Usually treat hypertension not hypo
Individualize succinylcholine so you don’t need ephedrine later
Maintenance goals
Control autonomic
Fluids
Blood
…
Cap refill test
Touch forehead 2sec good
5s hypovolemic
Conjunctiva look can tell us
On darker patient. Pale? Then more blood!
Anesthesia depth parameters
Eye position- divergent with MR
RR
Reflex muscle
Always check before intubation
Suction
Ambu
Circuit
Call attend
Who is the best monitor?
You!
How much propofol does dan give and why
150mg so he has 50 left
What’s that nice necklace for?
After intubation for breaths bilateral
Quality
Stridor= bronchospasms
Heart failure use esophageal temperature probe
Think about narc since less of a resp effect
EtCO2 goes up means? Decrease?
Increase minute vent
Malignant hypothermia?
Check CO2 absorber (might be out)
Decreased
Sudden etCO2 = mechanical or CO dropped
Slow = hypervent
How does capnograph work? When cap changes and rule out mechanically what do you do?
INfrared light through the cap tube so absorbed light tells us a percentage (Beer lambert)
Blood pressure
At 45 etco2 at incision for a spontaneously breathing ???.?
Green for if depth is good
Give prop if patient stop breathing
Mac
Theoretical value with just gas!
Minimum alveolar concentration or MAC is the concentration of a vapour in the alveoli of the lungs that is needed to prevent movement (motor response) in 50% of subjects in response to surgical (pain) stimulus
List these!
End tidal agents and gases low and patient light
Increase flow rate ( note will decrease temp note heat and flow relation)
Increase vap only if low BUT keep hand on why????
Causes hypotension
Minimum total flow and why?
2L/min bc sevo toxic residues
Anatomical dead space
2cc per kg or about 1 per lb
For pulse ox what are the wavelengths of lights that shine into
650 950 deox and ox
Glycopyrrolate for adults or kids
Atropine for adults or kids
Glycopyrrolate adults
Atropine kids cuz they are SV driven
HR up and then Blood pressure down
HR up and BP high
- Hypovolemia you can give phenylephrine
- more prop
Common labelalol given just when BP looked at but HR needed
Check BP with HR
Toes to the nose?
When bp low and HR is fine POSITION
Minimum acceptable BP
80/40 especially if zem given and intubation will cure hypotension
Lowest MAP
60 mmhg
Which heart nerve fibers slow down so ventricles can fill.
P is SA
QRS is AV
Internodal pathway
Which ventricle vectors do we like besides RA LA RL LL
V2 for inferior left vent V4 or 5 for anterior left ventricle
When does core temp stabilize
3-4 hours need temp prob if greater than half hour temp or one hour
Ask nurse if you don’t know how long
Keep up with timing
BIS monitor
If paralyzed
Lower number deeper anesthetic
Found by measuring brain waves when people waking
