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1Fall24 PoA II > PACU & Complications pt2 (Ex2) > Flashcards

PACU & Complications pt2 (Ex2) Flashcards

1
Q

What are some ways to assess for residual neuromuscular blockade? (4)

A
  • Grip strength
  • Tongue protrusion
  • Ability to lift legs
  • Able to hold head up for 5 seconds
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2
Q

What medication class are OSA patients sensitive to?

A

Opioids

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3
Q

What is the STOP-BANG assessment? What is it for?

A

Questionnaire for assessing Sleep Apnea

Snore
Tired
Observed apnea
Pressure (BP)
BMI > 35
Age > 50
Neck circumference > 16 in
Gender (male)

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4
Q

What score on the STOP-BANG assessment is indicative of a low risk for OSA?

A

0 - 2 Yes

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5
Q

What score on the STOP-BANG assessment is indicative of a intermediate risk for OSA?

A

3 - 4 Yes

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6
Q

What score on the STOP-BANG assessment is indicative of a high risk for OSA?

A

5 - 8 Yes

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7
Q

Review the STOP BANG Sleep Apnea Questionnaire:

A
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8
Q

What are common causes of arterial hypoxemia in a PACU patient?

A
  • Room air - Need O₂
  • Hypoventilation
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9
Q

What are common treatments for arterial hypoxemia in the PACU patient? (3)

A
  • Apply O₂
  • Opioid/Benzo reversal
  • Stimulate patient
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10
Q

What is Diffusion Hypoxia?

A

Rapid diffusion of N₂O into alveoli at end of anesthetic.

Dilutes alveolar gas and decreases PaO₂ and PaCO₂ → hypoxemia w/ ↓ respiratory drive.

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11
Q

How long can diffusion hypoxia persist after discontinuation of N₂O anesthetic?

A

5-10 min

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12
Q

What are the standard treatment thresholds for hypertension in the PACU?

A

SBP > 180
DBP > 110

may depend on the surgery and surgeon preference

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13
Q

What medications (and doses) are typically used for treatment of systemic HTN in the PACU?

A

Labetalol (5 - 25mg)
Hydralazine (5 - 10mg)
Metoprolol (1 - 5mg)

need to treat underlying cause

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14
Q

Hypotension that is due to decreased preload is __________.

A

Hypovolemic shock (lost volume)

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15
Q

Hypotension that is due to decreased afterload is __________.

A

Distributive shock (large tank)

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16
Q

Hypotension that is due to intrinsic pump failure is __________.

A

Cardiogenic shock (lost pump)

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17
Q

What are four common causes of decreased preload?

A
  • Third spacing
  • Inadequate fluid replacement
  • Neuraxial blockade → SNS tone loss
  • Bleeding
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18
Q

What are four common causes of decreased afterload?

A
  • Sepsis
  • Anaphylaxis/allergic rx
  • Critical illness
  • Iatrogenic sympathectomy

.

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19
Q

What are the two primary types of severe allergic reactions?

A

Anaphylactic & Anaphylactoid (not previous exposed)

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20
Q

What is the drug of choice for hypotension in an allergic reaction?

A

Epinephrine

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21
Q

What are the most common drug classes to cause anaphylactic reactions?

A

NMBD (especially Roc)

22
Q

What potent inflammatory mediators can cause bronchial constriction and increased vascular permeability?

A

Leukotrienes and Prostaglandins

23
Q

__________ drugs are engineered with quaternary ammonium ions.

A

Neuromuscular blocking

24
Q

What patient populations are at high risk for latex allergy?

A
  • Repeated exposures (HCW’s)
  • Spina Bifida patients
25
Q

What are the three latex-mediated reactions?

A
  • Irritant contact dermatitis
  • Type IV cell-mediated reactions
  • Type I IgE-mediated hypersensitivity reactions
26
Q

What antibiotic causes a direct histamine release?

A

Vancomycin (red-mans)

27
Q

What is the most common Abx allergy?

A

Penicillin

28
Q

What two surgical procedures mentioned in lecture can lead to sudden sepsis?

A

Procedures involving urinary tract & biliary tract manipulation

29
Q

What are the three most common causes of intrinsic pump failure?

A
  • Myocardial ischemia/infarction
  • Tamponade
  • Dysrhythmias
30
Q

What is the risk stratification guideline for non-cardiac surgery?

A
31
Q

What are factors that decrease myocardial O₂ supply?

A
32
Q

What are factors that increase myocardial O₂ demand?

A
33
Q

What are the most common causes of sinus tachycardia? (5)

A
  • SNS stimulation
  • ↓ volume
  • Anemia
  • Shivering
  • Agitation
34
Q

Risk for atrial dysrhythmias is greatest after what types of surgeries?

A

Cardiac and Thoracic

35
Q

What are risk factors for atrial dysthrythmias? (4)

A
  • Pre-existing cardiac conditions
  • Hypervolemia
  • Electrolyte abnormalities
  • O₂ desaturation
36
Q

Patients that are hemodynamically unstable due to atrial dysrhythmias require _________. What consideration should be made prior?

A
  • Cardioversion
  • Need to consider if new onset: may need TEE prior to conversion due to potential for clots if not new onset.
37
Q

What medications tend to work well for atrial fibrillation?

A
  • β blockers
  • CCBs

most common cardizem

38
Q

Greater than ____ ms QRS complex is considered wide complex.

A

120 ms (0.12s)

39
Q

What should be investigated with true ventricular tachycardia?

A

H’s & T’s

40
Q

What procedures are associated with bradydysrhythmias? (4)

A
  • Bowel Distention from GI stuff
  • ↑ ICP (Trendelenburg, etc.)
  • ↑ Intraocular pressure (eye sx’s)
  • Spinal Anesthesia
41
Q

High spinals reaching the _______ level can block the cardioaccelerator fibers.

A

T1 - T4

42
Q

What risk factors for Postoperative Cognitive Dysfunction (POCD) were discussed in lecture? (4)

A
  • > 70 years old
  • Pre-operative cognitive impairment
  • ↓ Functional status
  • EtOH abuse
43
Q

What intra-operative factors are associated with POCD? (4)

A
  • Surgical blood loss (HCT < 30%, PRBC infusions)
  • HoTN
  • N₂O administration
  • GETA
44
Q

What is the #1 cause of delayed awakening?

A

Residual sedation from anesthetic

45
Q

For delayed awakening secondary to opioids treat with ________ mcg of ______.

A

20 - 40 mcg of narcan

46
Q

For delayed awakening secondary to benzodiazepines treat with ________ mg of ______.

A

0.2mg of flumazenil

47
Q

For delayed awakening secondary to scopolamine (anticholinergics) treat with ________ mg of ___________.

A

0.5 - 2mg IV Physostigmine.

48
Q

What (besides residual sedation) are some common reasons for delayed awakening from anesthesia? (5)

A
  • Hypothermia < 33°C
  • ↑ ETCO₂
  • ↓BG
  • ↑ICP
  • Residual NMBD’s
49
Q

What are some basic recommendations for discharge from PACU?

A
50
Q

What is/are the criteria for Determination of Discharge from PACU Score?

A
51
Q

What are common causes of hypertension intra/postoperatively? (6)

A
  • emergence excitement
  • shivering
  • hypercapnia
  • pain/agitation
  • bowel distention
  • urinary retention
52
Q

What are some symptoms of histamine release? (5)

A
  • vasodilation/HoTN
  • erythema/pruritus
  • edema
  • tachycardia
  • GI constriction

1Fall24 PoA II (30 decks)

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