Orientation Test 2 Flashcards
S/S of 15% fluid defecit
Mucous Membranes---Parched Sensorium---Obtunded Orthostatic changes---HR >15 bpm, BP >10mmHg Urinary Flow---Marked decrease Pulse rate--->120bpm BP---decreased
Fluid maintenance requirement
4ml/kg/hr for first 10kg
2ml/kg/hr for next 10kg
1ml/kg/hr over 20kg
How to calculate preexisting fluid deficit
Multiply normal fluid maintenance by the length of fast (NPO,etc)
Factors associated with increased evaporative loss
Losses are proportionate to
- –the surface area exposed
- –duration of surgical procedure
Sources of information used when estimating blood loss
- -Suction cannisters (subtract irrigation used)
- -Lap pads
- -Sponges
- -Blood on floor
- -Surgeon
Calculate how much crystalloid and colloid should be used to replace a given amount of blood loss
3-4ml crystalloid per ml blood loss
1ml colloid/blood per ml blood loss
Crystalloid most commonly used in OR for fluids replacement
LR
Crystalloid most commonly used for RF pts and blood administration
NS–lowest pH of all commonly used crystalloids
Comorbidities which indicate an early use of colloid instead of crystalloid
- large blood loss
- large protein loss (burns)
- severe hypoalbuminemia
Other uses-bacteremia,RI,trauma
Advantages of using hespan instead of albumin
- inexpensive
- stays in circulation 24hours
Can use up to 1000ml
disadvantages of hespan instead of albumin
- -muscle aches/flu-like s/s
- -high doses assoc with dilutional thrombocytopenia, Renal Insufficiency
Negatives to colloid/albumin
- Can cause allergic reaction
- can contract Creutzfeldt-Kakob dz
- max dose 10-20ml/kg
Compare HCT of cell saver blood to blood bank
cells are washed (PCV 50-60%)
Clinical situations that preclude the use of cell saver
- -malignant tumor
- -sepsis of operative site
HCT that indicates possible transfusion
21-24%
Methods of measuring HCT
- -serum Hgb (coulter counter)
- -Hemocue
- -iStat
- -IL-Gem
- -Masimo continuous Hgb
What is the anticoagulant used in blood bank and a consideration with transfusion?
CPDA-1(citrate phosphate dextrose adenine)
binds Ca-watch levels
What is the appropriate storage temp of blood bank and how long does it last?
1-6 degrees Celsius
35 days
PLT count during surgery which indicates transfusion
<50,000 –assoc with increased blood loss during surgery
What medications are used to pretreat PLT infusion?
H1 gastric (reglan) H2 antagonist (antihistamine)
Steroids
Indications for FFP administration
-isolated factor deficiencies
-reversal of coumadin therapy
-coronary artery bypass
-correction of coagulopathy associated with
liver disease
Potential complications of massive transfusion
- dilutional thrombocytopenia
- dilution of other coagulation factors
- citrate toxicity and hypocalcemia
- hypothermia
- alkalosis from citrate, lactate
- hyperkalemia
Lab test which may indicate hypovolemia
- -Serial Hct’s—increase (shows concentrated)
- -Arterial pH—increased metabolic acidosis
- -Lactate—increased
- -Urine Specific Gravity/Osmolality—>1.010
- -Urine Na/Cl concetration (450)
- -Serum Na-increased
- -Serum BUN:Cr ratio—>10:1
SCOM(ladig)
Suction, Stethoscope
Circuit
Oxygen
Monitor
(scom)LADIG
Laryngoscopes (and blades) Airways (nasal,oral, LMA, ETT) Drugs IV pole (and clamps) Gloves and Goggles
How do you know suction is strong enough?
It will stay suctioned to your thumb
Where does the ETCO2 connect in circuit?
port closest to pt
What is the amount an adult reservoir bag holds and how much does a child bag hold?
adult: 3L
child: 1L
What airway rescue device must be on every cart?
ambu bag
What is the numeric value we should look for with the BIS monitor for general anethesia?
40-60
What is the BIS monitor based on and what does it tell us?
EEG waveform-helps us to know pt is adequately unaware
What are two things to check on the laryngoscope before use?
light works
bulb is tightly screwed in
How to size nasopharyngeal airways
Avg female/short male–6
Avg Male/tall female-7
Tall male-8
When do you not use an LMA?
pts with risk of aspiration
-does not protect the trachea from aspiration
What are indications for an LMA
- -rescue intubation for difficult mask and failed intubation
- -alternative to ett in appropriate pt
- -conduit to ETT (some LMA’s help with intubation
What are the most common sizes of LMA’s?
3,4,5
What 5 things should be written on a label?
name of drug concentration date drawn up time of day drawn up ---(all ok for 24hrs except prop=6hrs initials
When is it ok to not label a drug?
if drawing up for immediate use
(i.e. atropine for bradycardia)
How many IV poles do you need and why?
2 IV poles with clamps
- one for IV pump - one to hold up surgical drape
Which 7 drugs are good to have prepared before a case?
Versed Fentanyl Lidocaine Anectine Diprivan Ephedrine Neosynephrine
How do you reconstitute Neosynephrine to 100mcg/ml?
1st dilution
10,000 mcg/ml
- –take 10ml NS vial and remove 1 ml
- -add the 1ml of 10,000mcg/ml to vial
(10,000/10=1,000)
How do you reconstitute Neosynephrine to 100mcg/ml?
2nd dilution
Using a 10ml syringe
- take a new bottle of NS and remove 9ml
- take the diluted vial of Neo and remove 1ml and place in the 9ml syringe of NS
(1,000/10=100mcg/ml)
List the four type of airways needed when setting up a room and there most common sizes
Oral (8,9,10mm)
Nasal (6,7,8mm)
LMA (3,4)
ETT (7.0, 8.0)
List the functions of IV access
- -Admin of anxiolytics, induction/maintenance/ emergent agents
- -Admin of antibiotics, electrolytes, blood
- -Fluid Resuscitation
- -Blood sampling for venous labs
What is the smallest gauge IV recommended for blood administration?
18 gauge
What 3 things should ALWAYS be done regarding IV in preop?
–assess pt for IV access issues before taking to OR room
–visually inspect IV started by another provider
–make sure IV flows freely before taking into
OR room
List complications of IV insertion
Infiltration Hematoma Air embolus Phlebitis/ thrombophlebitis Extravascular/ intraarterial injection Medication error
List contraindications of IV access
- -Massive edema, burns, injury in extremity
- -Severe abdominal trauma (place in upper ext)
- -Infection/ cellulitis
- -Indwelling fistula
- -Lytics
- -??Mastectomy
List things to consider for IV consideration
Ease of access
Use of non-dominant extremity
Avoid joint locations
Avoid lower extremeties
What is the location of the intern vein?
portion of the cephalic vein in the region of the radial styloid
What things should you consider when selecting a lower extremity vein?
- -Lower ext veins tend to collapse and are difficult
- -Not ideal for placement
- -Can be more painful than upper extremity
Any vein in the foot large enough to accept catheter is ok to use
What are the landmarks for locating the EJ?
Originates near the angle of the mandible and courses over the sternocleidomastoid muscle
Proximal to the clavicle
What are the predictors of difficult IV access?
- -Dehydration/intravascular depletion
- -Chronic illness w/ venous scarring
- -IV drug use
- -Obesity
- -Significant edema, burns
- -Tortuous fragile veins
- -Thin vessel walls
What are techniques for promoting vasodilation?
- -Tourniquets/BP cuff
- -Warming
- -Topical anesthetics
- EMLA cream
- SQ Lido 27-30g
How do you thread a difficult IV?
lower and advance catheter
posterior wall penetration
List sources of flow interruption in a functional IV
Tubing Kinks
Remove T-connector
Suspect old IV’s
List steps or maneuvers associated with missing an IV
Go slow
Lower angle
