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S5 - Principles III - Test 4 > Post-op Complications > Flashcards

Post-op Complications Flashcards

1
Q

common causes of laryngospasm in children

A

Secretions and/or stimulation during Stage 2

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2
Q

steps/tips for intubation to reduce the likelihood of laryngospasm

A
  • Do not rush, especially with no muscle relaxant
  • Before repeated laryngoscopy with no MR,re-dose propofol or mask ventilate with high-percent sevo
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3
Q

steps/tips for extubation to reduce the likelihood of laryngospasm (5)

A
  • Suction oropharynx before extubation
  • Extubate end-inspiration or with positive pressure
  • if Extubating awake, make sure they are AWAKE
  • if Extubating deep, Keep them DEEP
  • Immediately upon extubation, apply PEEP until air movement is confirmed.
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4
Q

Laryngospasm treatment

A
  • 100% O2 with positive pressure
  • lidocaine 0.5-1mg/kg
  • Sux 0.5-1mg/kg with atropine 0.1mg
  • intubate
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5
Q

complication of laryngospasm seen more in muscular adolescent males

A

post-obstructive negative pressure pulmonary edema

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6
Q

why is it not smart to wait for the laryngeal nerve to become hypoxic to break the laryngospasm

A

bc the babes will become bradycardic and die

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7
Q

what patients have an increased risk of bronchospasm

A

hx of reactive airway disease

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8
Q

when does bronchospasm most often occur

A

emergence, before extubation

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9
Q

bronchospasm treatment

A

B2 agonist (albuterol)

if severe epinephrine 10mcg/kg and reintubate

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10
Q

for every 10kg give how many mL of 1:10,000 epi for bronchospasm

A

1mL

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11
Q

list some things that can cause airway obstruction

A
  • Sedation due to opioids, midazolam, general anesthesia
  • Residual neuromuscular blockade
  • Positioning
  • Sleep apnea
  • Laryngospasm
  • Laryngeal edema
  • Secretions
  • Wound hematoma
  • Vocal cord paralysis
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12
Q

Symptoms of airway obstruction (4)

A
  • stridor
  • desat
  • paradoxical breathing
  • inspiratory retractions
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13
Q

1 intervention for obstruction

A

chin lift, jaw thrust

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14
Q

interventions for obstruction (8)

A
  • Stimulation
  • Chin lift, jaw thrust* —
  • Oral or nasal airway —
  • Repositioning
  • Suctioning
  • CPAP, PEEP
  • Antagonists
  • Intubation
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15
Q

PONV potential causes

A
  • opioids
  • ileus
  • gastric distention
  • pain
  • blood in stomach
  • vagal stimulation
  • motion
  • increased ICP
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16
Q

Most effective PONV prophylaxis

A

hydration+ 5HT3 antagonist+ dexamethasone

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17
Q

Most effective PONV rescue

A

5HT3 antagonist, phenergan, non-opioid analgesics

18
Q

Prevention of aspiration (5)

A
  • Suction after induction and before extubation
  • Minimal PIPs with LMAs and masks —
  • Extubate with airway reflexes intact
  • Recovery position postoperatively
  • Medical prophylaxis
19
Q

If you suspect aspiration has occurred what testing should be done?

A
  • baseline CXR and ABG
  • CXR re-evaluation at 4hrs and if no change then probably didn’t aspirate
20
Q

Interventions for mild aspiration

A

O2 and CPT

21
Q

interventions for major aspiration

A

intubation, mechanical ventilation and probs ICU

22
Q

Causes of pulm edema

A

fluid overload
post-obstructive negative pressure incident

23
Q

pulm edema treatment

A
  • O2
  • diuretics
  • admit until resolved
  • reintubate if severe
24
Q

in a healthy patient, how long does it take for pulm edema to resolve

A

few hours

25
Q

Is hypotension common in peds?

A

nopeee

26
Q

What are the two primary causes of hypotension in peds

A

hypovolemia
CHD

27
Q

treatment for post-op hypotension in peds

A
  • fluid bolus (crystalloid or colloid) if Hct stable
  • PRBCs
  • Factor VII
  • return to OR?
28
Q

most likely cause of HTN post-op

A

pain obvi

29
Q

hypothermia definition

A

core temp < 36 C (96.8 F)

30
Q

Risks associated with hypothermia

A
  • Delayed drug metabolism and awakening
  • Wound infection and delayed healing
  • Sickling crisis
31
Q

Warming methods

A
  • FORCED WARM AIR
  • HMEs
  • Fluid warmers
  • Wrapping (especially the head)
32
Q

behavior seen with emergence delirium

A

disoriented, inconsolable, irrational

33
Q

Which volatiles are more likely to cause emergence delirium

A

sevo and des (faster on/off)

34
Q

age ED is typically seen with and for how long

A

<6 years
5-15min

35
Q

pharmacologic strategies to reduce the likelihood of emergence delirium

A
  • Regional
  • Opioids
  • Dexmedetomidine —
  • Propofol
  • Ketamine
  • Flumazenil
36
Q

causes of laryngeal edema

A
  • Traumatic or repeated laryngoscopy
  • Poorly fitted ETT (cuffed or uncuffed)
  • ETT cuff pressure
  • Prolonged intubation
  • Head and neck procedures
  • Intraoperative positioning
  • Upper respiratory infection
  • Coughing
37
Q

Stridor treatment

A
  • humidified O2
  • IV dexamethasone
  • racemic epi

severe- reintubate
unresolved- admit for observation

38
Q

process of laryngeal edema causing subglottic stenosis

this card sucks srry in advance

A

Pressure at the cricoid ring -> reduced blood flow -> edema ->ulcerated mucosa-> collagen ->fibrous scar
—

Scar contracts -> permanent subglottic stenosis and significant airway narrowing

39
Q

treatment for subglottic stenosis

A

LTR

40
Q

When should all post-op notes be complete according to CMS

A

before discharge

41
Q

What should be evaluated post-op and documented for any case (6 general things)

A
  • VS
  • O2 requirements
  • pain
  • N/V
  • sore throat
  • intake

S5 - Principles III - Test 4 (7 decks)

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