Must Know Flashcards
1
Q
Hypoxemia - What Do You Do?
A
- Increase 100% O2
- Check vitals (BP, EKG, EtCO2, PIP)
- Hand ventilate - check compliance, rule out circuit leak/machine factors
- Listen breath sounds
- Check ETT - correct position, suction to clear secretions/obstruction
- DDx
- Treat as indicated - recruitment breaths, bronchodilators, reposition ETT, adjust vent settings (PEEP), increase FRC (reverse T, desufflate abd), etc
- Additional tests: ABG, CXR
2
Q
Hypoxemia: DDx
A
- Hypoventilation
- Low FiO2
- V/Q Mismatch or Shunt
- Diffusion Problem
- Increased Metabolic O2 Demand
- Artifact
3
Q
Hypoventilation: Signs
A
Low TV or RR High or low EtCO2 Poor chest rise Decreased breath sounds Patient bucking ventilator
4
Q
Hypoventilation: Rule out or fix equipment and patient causes
A
Circuit leak ETT: obstruction or kink High PIP Residural NMB Asynchronous breathing with ventilator
5
Q
PostOp Respiratory Failure: DDx
A
Residual Rx: NMB, Opioids, Anesthetic Laryngospasm/Bronchospasm Pulmonary edema High spinal Pain
6
Q
V/Q Mismatch or Shunt: DDx
A
Mainstem intubation Atelectasis Aspiration Bronchospasm/Anaphylaxis Mucus plug Pleural effusion *PTX *Hypotension *Embolus - air, blood, fat, AFE
7
Q
Increased Metabolic Demand: DDx
A
MH Thyrotoxicosis Sepsis Hyperthermia NMS
8
Q
Bronchospasm - What Do You Do?
A
- Increase 100% O2
- Deepen anesthetic
- Inhaled agents: albuterol +/- ipratropium
- If persists = small dose of epinephrine (10 mcg)
- Ketamine, hydrocortisone, nebulized racemic epi
- Rule out anaphylaxis & problems with ETT
- Change I:E ratio - allow of adequate exhalation
- ABG
9
Q
Bronchospasm: DDx
A
Mainstem intubation Kinked ETT Mucus plug Anaphylaxis Asthma COPD
10
Q
Delayed Emergence
A
- Monitors - check vitals (BP, oxygenation, ventilation)
Hypoxemia, hypercarbia, hypothermia - Meds
Anesthetic agents OFF?
Residual NM paralysis? and reverse prn
Opioids (naloxone 40 mcg q2 min, max 400 mcg)
Benzos (flumazenil 0.2 mg q1 min, max 1 mg)
Scopolamine (physostigmine 1 mg)
Medication swap or dosing error? - Neuro exam for focal deficits
Pupils, asymmetrical movement, gag reflex
Stat head CT? - Labs
Glucose, ABG, electrolytes - Treatment as indicated
- Residual abnormalities - neuro ICU with serial exams. Repeat CT or MRI as indicated.
11
Q
PEA: What Do You Do?
A
- Verify and initiate CPR
- Secure airway, ventilate 10 BPM
- Ensure adequate IV access
- Epinephrine 1 mg q 3-5 mins
- Continue to monitor for shockable rhythm
- Find and treat causes - H&Ts
- Consider TTE/TEE or ECMO
12
Q
PEA: DDx
A
Hemorrhage Shock PE PTX Auto PEEP Anaphylaxis Anesthesia OD Medication error High spinal LAST Vagal stimulus
13
Q
H’s & T’s
A
Hypovolemia Hypoxemia Tension PTX Thrombosis - Coronary, Pulmonary Toxins Tamponade - Cardiac Hypo/Hyperthermia Hypo/Hyperkalemia Hypoglycemia H+ (acidosis) Hypocalcemia
14
Q
ROSC
A
Presence of pulse and BP
Abrupt sustained increase PetCO2 (>40)
Appearance spontaneous arterial pressure waves
15
Q
Therapeutic Hypothermia: Indications
A
Comatose post-cardiac arrest/ROSC
Inpatient: all cardiac arrest
Outpatient: V fib or PEA
