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