Palliative Extras Flashcards
Patient is breathless + pain eg due to end stage COPD. What do you give
Morphine PO - reduces resp rate + helps with pain
start small dose then titrate up
how does ASA rankings work for surgery
ASA score of 1 would be awarded to a healthy patient who does not smoke and has no or low alcohol intake
2 –with mild systemic disease
score of 3 is for patients with severe systemic disease and functional limitations
score of 4 is for patients with systemic disease severe enough to constantly threaten life
score of 5 are unlikely to survive if surgery does not go ahead
if using more than 2 doses of breakthrough pain medication eg if He takes modified-release morphine sulphate tablets (MST) 20 mg twice daily. He also takes 4–6 doses daily of oramorph 10 mg/5 ml for breakthrough pain, what should you do
increase dose of longer acting analgesia
what must be given the day before colonoscopy
laxatives
diabetes control in major surgery/poorly controlled diabetes into surgery
variable rate insulin
what is used for the neuromuscular relaxation part of rapid sequence induction
suxamethonium
how do you calculate breakthrough dose of morphine
1/6th of daily morphine dose
what type of airway intervention can you not use in basal skull fractures
nasopharyngeal airways
what are the opioid of choice for pain management in severe renal impairment
buprenorphine or fentanyl
what are features of malignant hyperthermia
happens after anaesthetics
hyperpyrexia and muscle rigidity
susceptibility is inherited in autosomal dominant fashion
what drugs cause malignant hyperthermia
halothane
suxamethonium
what investigations do you do in malignant hyperthermia
CK raised
what is the management of malignant hyperthermia
dantrolene
what are indications and contraindications for cyclizine use
indication -
movement related nausea/vomiting
bowel obstruction
what are indications and contraindications for dexamethasone use
indications -
intracranial disease eg metastases
bowel obstruction
what are indications and contraindications for domperidone use
useful in gastric stasis
can be used in parkinsons/not cross BBB
Contraindication - bowel obstruction
what are indications and contraindications for metaclopramide use
useful in gastric stasis
contraindication - not in parkinsons
not in bowel obstruction
treatment for anxiety related nausea/vomiting
lorazepam
treatment for chemotherapy related nausea/vomiting
ondansetron
when should you start LMWH after surgery
6-12 hours after
when can you have clear fluids until before surgery
until 2 hours before
when can you have non clear liquids/food until before surgery
6 hours before
decreased oxygen saturation 10 minutes after intubation
intubation was done in oesophagus
what are the things that are checked before induction of anaesthesia
Patient has confirmed: Site, identity, procedure, consent
Site is marked
Anaesthesia safety check completed
Pulse oximeter is on patient and functioning
Does the patient have a known allergy?
Is there a difficult airway/aspiration risk?
Is there a risk of > 500ml blood loss (7ml/kg in children)?
what analgesia is given in mild-moderate renal impairment
oxycodone
how should wounds be cleaned post surgery up to 48 hours
sterile saline
when can a patient shower after surgery
after 48 hours
what BMI is ASA 2 and 3
BMI 30-40 = 2
BMI 40+ = 3
how do you manage secretions at end of life
eg patient makes gargling noises, dullness to percussion
Hyoscine hydrobromide or hyoscine butylbromide
subcut
what treatment is given for reducing discomfort in a painful mouth eg due to ulcers
Benzydamine hydrochloride mouthwash or spray
how can multiple intubations lead to increased infections
formation of a Tracheo-oesophageal fistula
how do you convert morphine to diamorphine
/3
what would you give for bowel colic eg abdominal pain in bowel cancer
hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide
how would you treat local anaesthetic toxicity eg due to lidocaine
IV 20% lipid emulsion
what changes to prednisolone are made prior to surgery
supplement with hydrocortisone
isolated fever in a patient 24 hours after surgery
physiological reaction to operation
What is given for the actual induction agent in rapid sequence induction
sodium thiopentone
What drugs slow down wound healing
Non steroidal anti inflammatory drugs
Steroids
Immunosupressive agents
Anti neoplastic drugs
if patients temp is <36 degrees before operation, can you do operation
No unless urgent -> must warm up
Causes of post operative fever pneumonic
Day 1-2: ‘Wind’ - Pneumonia, aspiration, pulmonary embolism
Day 3-5: ‘Water’ - Urinary tract infection (especially if the patient was catheterised)
Day 5-7: ‘Wound’ - Infection at the surgical site or abscess formation
Day 5+: ‘Walking’ - Deep vein thrombosis or pulmonary embolism
Any time: Drugs, transfusion reactions, sepsis, line contamination.
for hip replacement, what VTE prophylaxis is used and when
TED stockings once admitted and LMWH 6 hours after surgery
treatment for hiccups in palliative care
chlorpromazine or haloperidol
When would you use total parenteral nutrition
when the intestines dont work
what vessel is TPN given through
subclavian line
codeine to morphine conversion
/10
what anaesthetic agent would you use if the patient is haemodynamically unstable
ketamine
What drug can be given to reverse neuromuscular blockade
neostigmine
oral morphine to subcut morphine conversion
/2
what is the risk of giving hypotonic (0.45%) fluid in paediatric patients
risk of hyponatraemic encephalopathy
what is central pontine myelinolysis
rapid correction of hyponatraemia
what is a contraindication for suxamethonium
penetrating eye injuries or acute narrow angle glaucoma, as suxamethonium increases intra-ocular pressure
