Midblock Assessment 3 Flashcards
1
Q
Regarding oxygen cylinders:
- What is the Colour (1)
- Pressure in a full cylinder (2). [value&unit]
- Minimum acceptable pressure (2) [value&unit]
A
- Black with white shoulder
- Full = 137 x 100 kPa (137 bar)
- > 5000 kPa (50x100kPa)
2
Q
What are the standard pipeline colour codings for the following? (4)
- Oxygen
- Air
- Nitrous oxide
- Vacuum
A
- Oxygen - White
- Air - Black & white
- Nitrous oxide - Blue
- Vacuum - Yellow
3
Q
What device should be available in each OT to ventilate a patient in case of anaesthetic machine failure? (1)
A
Ambubag
4
Q
List 3 devices available to assist with a difficult intubation. State for each when it would be appropriate to use them. (6)
A
- Video laryngoscopy – difficulty visualising cords
- Bougie – difficulty passing ETT through cords
- LMA – failure of intubation x3
5
Q
Name 2 commonly used breathing systems and the main characteristic of each. (4)
A
- Circle:
- 1 Contained system
- 2 CO2 removed with soda lime
- 3 Efficient flow of gasses
- 4 Can use low flow
- Jackson Rees:
- 1 Decreased resistance due to not having valves
- 2 Useful in paeds cases
6
Q
When doing a pre-operative airway assessment, which 3 aspects regarding airway management have to be assessed? (3)
A
- Assessing difficulty with mask ventilation
- Assessing difficulty with laryngoscopy
- Assessing difficulty with rescue airway
7
Q
Describe the optimal positioning of a patient for direct laryngoscopy. (2)
A
- Neck flexed
- Head extended
- In “sniffing position”
8
Q
Which size laryngoscope blades should be available for an adult? (2)
A
- Size 3
2. Size 4
9
Q
What is the formula to calculate the size of uncuffed ETT + length to use in paediatrics? (1)
A
- Size: (Age/4) + 4
2. Length: ETT size x 3
10
Q
Which size ETT would you use for:
- An adult male (1)
- An adult female (1)
A
- Male: 7.5 - 8.0
2. Female: 7.0 - 7.5
11
Q
List 3 bloodresults you should review before anaesthetising a patient with pre-eclampsia for CS? Give a reason for each. (6)
A
- Hb – haemolysis – possible HELLP syndrome
- Platelets - thrombocytopenia – bleeding risk - possible HELLP syndrome
- U&E – proteinuria and renal disfunction
12
Q
Name 3 investigations that should be done for a 60yr old diabetic and hypertensive patient prior to a BKA? (3)
A
- CXR
- ECG
- U&E
13
Q
What investigation would you request for an 18yr old well patient coming for a minor orthopaedic procedure? (1)
A
- Ward Hb
14
Q
What are the standard fasting guidelines for:
- Clear fluids
- Breastmilk
- Formula milk
- Solids
A
- Clear fluids - 2 hours
- Breastmilk - 4 hours
- Formula milk - 6 hours
- Solids - 6 hours
15
Q
Regarding a rapid sequence induction:
- What is the aim of a RSI? (1)
- List the sequence of actions during a RSI. (5)
A
- Secure the airway quickly and safely
- 2 Reducing the risk of aspiration.
- RSI:
- Assessment
- Preparation: Pre-calculate doses of induction agent + MR
- Position head/neck
- Pre-O2 w/ 100% O2
- Cricoid pressure
- Give induction agent + MR
- Timer
- Intubate
- Confirm placement
- Change to vent
- Secure tube
16
Q
Induction agents:
- What is the induction dose of propofol? (1)
- What is the induction dose of etomidate?(1)
- What would be your induction agent of choice for an unstable trauma patient. Motivate. (1)
A
- 1 - 2 mg/kg
- 0.2 - 0.3 mg/kg
- Etomidate:
- 1 Minimal CVS depression
- 2 Good for use in CVS compromise
17
Q
For adrenalin. What is the:
- Dose in cardiac arrest (1)
- Ampoule size (1)
- Concentration in ampoule (1)
A
- 1 mg IVI repeated every 4 min
- 1 ml amp
- 1 mg/ml
18
Q
Isoflurane:
- Colour coding
- MAC
A
- Purple
2. 1.15%
19
Q
Sevoflurane:
- Colour coding
- MAC
A
- Yellow
2. 2%
20
Q
In addition to blood, name 3 blood products that may be required in a patient with massive blood loss. (3)
A
- Freeze dried plasma (FPD)
- Platelets 1 pooled megaunit
- Cryoprecipitate
21
Q
Which ABO blood group is regarded as the universal donor? (1)
A
Type O negative blood.
22
Q
In addition to the ABO blood group, which other blood group has to be checked before administering blood to a female?
Why and how would you check this? (3)
A
- Rh
- How to check:
- 1 Rhesus card:
- 2 Drip blood
- 3 Then add reagents
- 4 If clumps +:
- Why to check:
- 1 Need to check as can sensitise an Rh- mother should she fall pregnant and her child be Rh+
- 2 Causes intrapartum complications - eg hydrops fetalis
23
Q
List 3 of the details you would check before administering a unit of packed cells to a patient.(3)
A
- Correct patient name & IP number
- Correct pack number
- Correct expiry date
(Correct blood group of patient + blood)
24
Q
A 23 yr old well patient is booked for emergency CS.
Which local anaesthetic and adjunct (name&dose) would you use for the spinal? (2)
A
1.8 mls of 0.5% Heavy macaine + 0.2 mls of fentanyl (50 ug/ml)
25
A 23 yr old well patient is booked for emergency CS.
The patient’s BP 5min after the spinal is 80/48 with a pulse rate of 70, what must you do? (5)
1. ABC
2. Ensure wedge is in place
3. Fluid bolus
4. Vasopressor – preferably phenylephrine
5. Speak to the patient and make sure they are responsive:
5. 1 Check the level of your spinal
5. 2 Check for sudden haemorrhage, difficulty breathing or signs of tamponade/tension pneumothorax
5. 3 Check BP cuff position & function
26
A 23 yr old well patient is booked for emergency CS.
1. What would you administer immediately after delivery of the baby?
2. How would you give this drug?
3. Name 1 major side effect of this drug. (3)
1. Give oxytocin immediately after delivery of the baby
2. 1 Give 2.5 IU oxytocin IVI over 1 min
2. 2 Give 7.5 IU as slow infusion
2. 3 After completion of the C/S 20 IU in one litre to run at 125ml/hr
3. 1 Vasodilator
3. 2 Myometrial contraction
3. 3 Arrhythmias
27
Paracetamol:
1. Adult dose
2. Paediatric dose
3. Dosing interval
1. PO: 20 mg/kg 6hrly - rounded to 1 g 6 hourly
IV: 15 mg/kg 6hrly - rounded to 1 g 6 hourly
2. IV + PO: 15 mg/kg 6hrly
3. Dose 6hrly
28
Diclofenac:
1. Adult dose
2. Paediatric dose
3. Dosing interval
4. Main side effect
1. 1 mg/kg IVI in 200 mls N/S over 20 mins 8hrly x 3 doses
Then 12hrly
2. 1 mg/kg PO/IVI 8hrly
3. Dose 8hrly
4. GIT ulcer/bleed; platelet dysfunction
29
Fentanyl:
1. Adult dose
2. Paediatric dose
3. Onset of action
4. Duration of action
5. Main side effect
1. 1 ug/kg
2. 1 ug/kg
3. 5 min
4. 20 - 30 min
5. Respiratory depression
30
Morphine:
1. Adult dose
2. Paediatric dose
3. Onset of action
4. Duration of action
5. Dosing interval
6. Main side effect
1. 0.1 mg/kg
2. 0.1 mg/kg
3. 20-30 min
4. 3-4 hours
5. 6hrly
6. Respiratory depression
31
Name 5 devices used to monitor a patient intra-op? [5]
1. Pulse oximetry
2. 3 lead ECG
3. NIBP
4. Capnography
5. Temperature
(PAW/spirometry)
32
Name any 5 things you would assess when you carry out a machine check? [5]
1. Power supply & battery
2. Wall connections & pipeline pressures
3. Emergency oxygen cylinder
4. O2 hypoxic device & O2 failure alarm
5. Vaporisers
6. Soda lime
7. Circuit leaks
8. Ventilator
33
Name 5 emergency drugs you would prepare before starting a case? [5]
1. Suxamethonium - 100 mg in 2ml (50 mg/ml)
2. Atropine – 1 mg in 10 ml (0.1 mg/ml)
3. Ephedrine – 50 mg in 10 ml (5 mg/ml)
4. Phenylephrine – 10 mg in 200 ml NaCl (50 ug/ml)
5. Adrenaline – 1 mg to 200 ml NaCl (5 ug/ml)
34
Name 6 items that should be found on the standard airway trolley? [6]
1. Introducer/ stylet/ bougie
2. Magill's forceps, face masks
3. OPA, LMA
4. Laryngoscopes + blades
5. ETT of various sizes
5. Syringe, strapping, available suction
35
Name 4 items that you may find on a difficult airway trolley? [4]
1. Different blades
2. Short handle laryngoscope
3. Video laryngoscope
4. Fastrac intubating LMA
5. Light wands
6. Cricothyroidotomy set
36
Name 4 drugs you could use for induction of a GA with their doses? [8]
1. Propofol – 1 - 2 mg/kg
2. Etomidate – 0.2 - 0.3 mg/kg
3. Thiopentone - 3 - 5 mg/kg
4. Ketamine – 2 mg/kg
5. Midazolam - 0.2 mg/kg
37
Name 2 drugs (and their doses) you would used to treat spinal hypotension in an obstetric case? [4]
1. Phenylephrine – 100 ug boluses 2-3min
| 2. Ephedrine – 5 mg boluses 2-3min
38
List 4 concerns when anaesthetising children? [4]
1. Large head
2. Short neck
3. Prominent occiput
4. Large tongue
5. Long epiglottis
6. Larynx cephalad and anteriorly
7. Narrowest at cricoid – high risk of trauma
8. Short trachea – easily intubate bronchi
39
List 4 factors that increase risk of post op nausea and vomiting? [4]
1. Female
2. Non-smoker
3. Hx of PONV or motion sickness
4. Post-op opioids
40
List 3 drugs (and their doses) that are used to treat PONV? [6]
1. Dexamethasone 4-8 mg
2. Ondansetron 4-8 mg
3. Droperidole 0.625 mg
41
What are the 3 H's used when approaching an unconscious pt?
1. Hazards
2. Help
3. Hello
42
What is the ratio of chest compressions to rescue breathes in adult resus? [2]
30:2
43
What rate should you aim for when doing adult chest compressions? [1]
100 - 120 bpm
44
Name 2 shockable and 2 non-shockable cardiac rhythms? [4]
1. Shockable - Vfib, Vtach
| 2. Non-shockable - pulseless electrical activity (PEA) and asystole
45
Name classes off local anaesthetics and give an example of each?
1. Esters - cocaine
| 2. Amides - lignocaine
46
Toxic doses of lignocaine & bupivacaine:
1. Lignocaine:
3 mg/kg without adrenaline
7 mg/kg with adrenaline
2. Bupivacaine:
2 mg/kg with or without adrenaline
47
4 S/E of local anaesthetics:
1. Local:
1. 1 Cardiotoxicity
1. 2 Neurotoxicity
1. 3 Transient neurological Sx
2. Systemic:
2.1 CNS toxicity - Perioral paresthesia (initial), Dizziness
Slurred speech, Seizures
2.2 CVS toxicity - Decreased CO, Sinus bradycardia/arrhythmias, Asystole
48
List 10 reversible causes to be excluded in event of a cardiac arrest.
1. Hypoxia
2. Hypovolaemia
3. Hypothermia
4. Hypo/hyperK
5. H+ ion (acidosis)
6. Tension pneumothorax
7. Thrombosis - coronary (AMI)
8. Thrombosis - PE
9. Tamponade - cardiac
10. Toxins/trauma
49
Useful dermatomes for spinal anaesthesia
1. T10 dermatome - umbilicus
2. T6 dermatome - xiphoid.
3. T4 dermatome - nipples.
50
When performing a spinal anaesthetic using the midline approach, the layers of anatomy that are traversed (from posterior to anterior) are:
1. Skin
2. Subcutaneous fat
3. Supraspinous ligament
4. Interspinous ligament
5. Ligamentum flavum
6. Dura mater
7. Subdural space
8. Arachnoid mater
9. Subarachnoid space
51
Absolute CIs to spinal:
1. Pt. refusal
2. Raised ICP/ active neurological disease
3. Haemodynamically unstable pt.
4. Fixed CO states - severe AS/MS
5. Coagulopathies: Plt < 80; INR > 1.5; PTT > 1.5
6. Septic pt.
7. Infection over site of injection
8. Allergy to LA
9. Dr unable to provide GA
52
What is a high spinal?
1. The spread of intrathecal local anaesthetic
| 2. Above T4
53
What is total spinal?
1. Intrathecal local anaesthetic-induced depression
| 2. Of the cervical spinal cord and/or brainstem
54
What factors determine the intrathecal spread of local anaesthetic?
1. Local anaesthetic: dosage, volume and baricity
2. Patient position
3. Patient characteristics - height
4. Injection technique - speed of injection, barbotage
55
What are the clinical features of high spinal blockade?
1. Cardiovascular:
1. 1 Hypotension (vasodilation)
1. 2 Bradycardia (inhibition of cardio-accelerator fibres T1-T4)
2. Resp:
2. 1 IC mm paralysis
2. 2 Resp arrest (C3 blocked)
2. 3 Apnoea (total spinal involving brainstem)
3. Neuro:
3. 1 LOC (total spinal)
4. Sensory:
4. 1 Paraesthesia in upper limbs
5. Motor:
5. 1 Motor loss in upper limbs
