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UKMLA Prep > Perioperative medicine and anaesthesia > Flashcards

Perioperative medicine and anaesthesia Flashcards

Conditions and Presentations

1
Q

ASA grade

A

normal healthy patients, who are non-smokers and with no/minimal alcohol intake.

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2
Q

ASA grade I

A
  • mild systemic disease
  • well controlled diabetes or hypertension, current smoker, obesity (BMI 30-40), and mild lung disease.
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3
Q

ASA grade III

A

Severe systemic disease
e.g. poorly controlled diabetes or hypertension, COPD, morbid obesity (BMI >40), history of ACS/stroke/TIA >3 months ago.

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4
Q

ASA grade IV

A

*severe systemic disease
* constant threat to life
* MI/stroke/TIA within 3 months

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5
Q

ASA grade V is

A

moribund patients not expected to survive

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6
Q

ASA grade VI

A
  • brain dead
  • used for transplant
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7
Q

Simple airway manouvers

A
  • suction
  • head tilt/ chin lift
  • Jaw thrust
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8
Q

Aiway adjuncts

A
  • Oropharyngeal airway (OPA)
  • Nasopharynx airways
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9
Q

Nasopharyngeal airway

A

Useful in patients with a sensitive gag reflex when using OPA
Contraindicated in base of skull fracture

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10
Q

Supraglottic airway

A
  • Sits over the top of the larynx
  • Can be used with ventilation machine
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11
Q

Surigcal airway managment

A
  • Tracheostomy
  • Cricothyroidotomy
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12
Q

Signs and symptoms of c-spine injurt

A
  • Neck pain
  • Decreased range of motion in the neck
  • Focal neurological deficits, such as weakness or numbness in the arms or legs
  • Signs of spinal shock, including flaccid paralysis and loss of bowel or bladder control
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13
Q

Nexus criteria- what is it

A
  • criteria which suggest c-spine injury is **not likely **
  • All criteria has to be met in Nexus criteria
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14
Q

Nexus criteria

A
  • Normal level of alertness
  • No evidence of intoxication
  • No painful distracting injuries
  • No focal neurological deficit
  • Absence of midline cervical tenderness
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15
Q

What to do if C-spine isnt cleared

A

CT C-spine

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16
Q

Managment of C-spine fracture

A
  • airway managment
  • appropriately sized semi-rigid collar
  • block and tape use
  • full body stabilisation
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17
Q

Signs of post-operative bleed

A
  • mild pyrexia
  • hypotension
  • tachycardia
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18
Q

Managment of hypovolemic shock

A

fluid bolus of a crystalloid

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19
Q

Mild to moderate pain managment

A
  • Paracetamol.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen.
  • Aspirin (a salicylate NSAID).
  • Weak opioids, such as codeine, dihydrocodeine, and tramadol.
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20
Q

cluster headaches

A
  • Primarily unilateral and typically more severe around the eye region.
  • occur in clusters,
  • numerous attacks within small time frame (e.g weeks)
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21
Q

epidemiology of cluster headaches

A

more prevalent among middle-aged men

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22
Q

What precipitates cluster headaches

A
  • alcohol consumption
  • smoking
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23
Q

cause of cluster headaches

A

activation of the trigeminal nerve

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24
Q

Signs and symptoms of cluster headaches

A
  • Unilateral, severe headache, often around the eye
  • A bloodshot or teary eye on the affected side
  • Vomiting
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25
Q

Treatment of cluster headaches

A

100% oxygen and sumatriptan

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26
Q

Prophylaxis of cluster headaches

A

verapamil and steroids

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27
Q

compartmental syndrome

A

increase in pressure within the muscle compartments of a limb, typically following trauma.

28
Q

Signs and symptoms of compartmental syndrome

A
  • Severe pain, particularly evident during passive flexion of the toes
  • Pallor of affected limb
  • Paralysis or weakness of the limb
  • pulselessness
  • Paraesthesia
29
Q

Managment of compartmental syndrome

A
  • Keep the limb at a neutral level with the patient
  • Oxygen
  • Fluid administration
  • Remove all dressings/splints/casts down to the skin
  • Analgesia for pain management (usually opioids)
  • Fasciotomy
30
Q

Malignant Hyperthermia

A
  • life-threatening condition
  • occurs due to suxamethonium
31
Q

Aetiology of malignant hyperthermia

A
  • autosomal dominant mutation in the ryanodine receptor 1 gene
  • Causes hyperkalemia
  • results in increased metabolic rate
32
Q

Signs and symptoms of malignant hyperthermia

A
  • Rapid increase in body temperature
  • Muscle rigidity
  • Metabolic acidosis
  • Tachycardia
  • Increased exhaled carbon dioxide
33
Q

Investigation of malignant hyperthermia

A
  • Blood tests: metabolic acidosis and** increased creatine kinase levels.**
  • Core temperature monitoring to detect hyperthermia.
34
Q

Managment of malignany hyperthermia

A
  • stop drugs
  • supportive measurments
  • agressive cooling treatment
35
Q

Managment of head trauma

A
  • major trauma- given IV morphine (no IV access, intranasal diamorphine or ketamine)
  • TBI- sit patiet 30*
36
Q

Managment of ICP

A
  • DO NOT do LP
  • short-term hyperventilation
37
Q

Confirm positioning of NG tube

A
  • pH (1.5-3.5) aspiration
  • Erect CXR tip should ideally be seen at least 10cm beyond the gastro-oesophageal junction
38
Q

CPAP

A
  • Type I respiratory failure, providing positive pressure
  • keep the alveoli open for a longer period of time to facilitate gas exchange.
39
Q

BiPAP

A
  • type II respiratory failure
  • two different levels of positive pressure on inspiration and expiration
40
Q

Criteria of NIV

A
  • Patient awake and able to protect airway
  • Co-operative patient
  • Consideration of quality of life of patient
41
Q

Contradictions of NIV

A
  • Facial burns
  • Vomiting
  • Untreated pneumothorax
  • Severe co-morbidities
  • Haemodynamically unstable
  • Patient refusal
42
Q

Steps of rapid induction sequences

A
  • Airway
  • Drug preparation
  • Monitoring of vital signs
  • Drug administration
  • Cricoid pressure
43
Q

Pre-operative anaemia managment

A
  • Oral iron if >6 weeks until planned surgery
  • IV iron if <6 weeks until planned surgery
  • B12/folate replacement
  • Erythropoiesis‐stimulating agent (ESA) therapy
  • Transfusion if profound anaemia and surgery cannot be delayed
44
Q

Post-operative anaemia managment

A
  • Transfusion
  • IV iron
  • Oral iron
45
Q

Causes of type 1 resp failure

A
  • Decreased atmospheric pressure
  • Ventilation-perfusion mismatch
  • Shunt
  • Pneumonia
  • ARDS
  • Pulmonary embolism
46
Q

Managment of trigeminal neuralgia

A
  • Decreased atmospheric pressure
  • Ventilation-perfusion mismatch
  • Shunt
  • Pneumonia
  • ARDS
  • Pulmonary embolism
47
Q

Diabetic drugs and surgery

A
48
Q

Post-operative poor urinary output

A

output of less than 0.5 mL/kg/hour in adults is considered low.

49
Q

Post-renal causes of less urine output

A
  • Benign prostatic hypertrophy
  • Effects of drugs such as anticholinergic or alpha adrenoreceptor antagonists, often used in anaesthetics
  • Pain following surgery, particularly hernia operations
  • Psychological inhibition
  • Opiate analgesia
50
Q

Pre-renal causes of poor urine output

A
  • Hypovolaemia
  • Hypotension
  • Dehydration
51
Q

Renal causes of poor urine output

A

Acute tubular necrosis

52
Q

Signs and symptoms of poor urine output

A
  • Decreased urine frequency/volume
  • Hypotension and tachycardia (pre-renal causes)
  • Abdominal pain or discomfort
  • Symptoms of drug side effects such as dry mouth, blurred vision, and constipation (post-renal causes due to anticholinergic drugs)
53
Q

poor urine output after surgery investigations

A
  • Urine output measuremen
  • Urinalysis
  • U+E
  • Ultrasound of kidneys and bladder: To identify any potential obstructions in the urinary tract.
54
Q

Managment of poor urine output after surgery

A
  • Correction of any fluid or electrolyte imbalances
  • manage underlying cause
  • urinary catheterisation
55
Q

Suxamethonium apnoea

A
  • defect in the plasma cholinesterase enzyme
  • Patients will have prolonged period of paralysis
56
Q

Signs and symptoms of suxamethonium apnoea

A
  • prolonged paralysis
  • make little effort to cough or breathe spontaneously.
57
Q

Investigations of Suxamethanoium apnoea

A

checking plasma cholinesterase levels to identify any potential defects.

58
Q

Managment of Suxamethanoium apnoea

A
  • intubated and ventilated until they are able to breathe spontaneously.
  • do not use in future again
59
Q

Major trauma, first line analgesia

A

IV Morphine
If IV cant be accessed, intranasal diamorphine or ketamine.

60
Q

Suspected TBI managment

A
  • patient at 30 degrees
  • If ICP is raising, increase rate of ventilation
61
Q

Systemic inflammatory response syndrome (SIRS)

SIRS

A

Must have one of the following to diagnose
* Temperature >38 or <36 degrees Centigrade
* Heart rate >90
* Respiratory rate >20
* White cell count >12 or <4 x10^9/L

62
Q

<1 paeds signs

A
  • RR 30-40
  • HR 110-160
  • SBP 70-90
63
Q

1-2 vital signs

A
  • RR 25-35
  • HR 100-150
  • SBP 80-95
64
Q

2-5 vital signs

A
  • RR 25-30
  • HR 95-140
  • SBP 80-100
65
Q

5-12 vital signs

A
  • RR 20-25
  • HR 80-120
  • SBP 90-110
66
Q

> 12 vital signs

A
  • RR15-20
  • HR 60-100
  • SBP 100-120
67
Q

Peri op guidance on hypertension

A

Only cancel if BP persistently elevated
•Stage 1 = proceed as normal •Stage 2 = Proceed as normal
•Stage 3 = if no evidence of end-organ damage – consider proceeding with fastidious BP monitoring + A-line. If evidence of end-organ damage or patient is unwell – consider postponing surgery for 4weeks.
•Consider peri-op Beta-blockade – reduces risk of myocardial ischaemia / CVS complications

UKMLA Prep (38 decks)

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