Quiz 3 Flashcards
What is analgesia?
Elimination of pain
What is anesthesia?
Elimination of sensation
What are the inhaled anesthetics?
NO Halothane Isoflurane Enflurane Desflurane Sevoflurane
What are the IV anesthetics?
Benzos (midazolam, lorazepam, diazepam) Opioid analgesics (fentanyl) Propofol Etomidate Ketamine Dexmedetomidine
What are the s/sx of malignant hyperthermia?
Rapid onset of tachycardia HTN Severe muscle rigidity Hyperthermia (107) Hyperkalemia Acidosis
What is the treatment of malignant hyperthermia?
Stop trigger event
Dantrolene
Supportive
What are the supportive cares for malignant hyperthermia: hyperthermia?
Cooling blankets, ice bags, chilled NS
What is the supportive care for malignant hyperthermia: arrhythmias?
BBs (propranolol, metoprolol, esmolol)
Amiodarone
NOT CCBs/dig
What are the indications for neuromuscular blockers?
Facilitate short procedures under heneral anesthesia Facilitate mechanical ventilation ARDS Manage increased ICP Treat muscle spasms Decreased oxygen consumption Surgery
What are the neurmuscular blockers?
Succinylcholine Pancuronium Vecuronium Rocuonium Atracurium Cistracurium
What are the 7 Ps for rapid sequence intubation series?
Pre-event preparation Preoxygenate Pretreatment Premedication Paralyze after sedation Protection/positioning Post-intubation management
What drugs are used for pretreatment?
Lidocaine
Atropine
Esmolol
Fentanyl
What drugs are used for premedication
Midazolam Etomidate Propofol Ketamine Thiopental
What drugs are used to paralyze after sedation?
Succinylcholine
NMBAs (rocuronium
Vecuronium)
What medications are commonly used for post intubation management?
Midazolam, fentanyl, lorazepam
Why is procedural sedation used?
Creates a decreased level of awareness for a patient when maintaining protective airway reflexes and adequate spontaneous ventilation
What is the goal of procedural sedation?
To provide analgesia, amnesia, and anxiolysis during a painful or frightening procedure
What meds are used for procedural sedation?
Ketamine and benzos
How do we monitor sedation: Anesthesiologist/CNR?
HR
BP
How do we monitor sedation: BIS monitor-mini EEG?
BIS < 60 = no recall
How do we monitor sedation: RASS, RAMSEY?
Objective measures of responsiveness
CAM-Confusion Assessment Method-measure delirium
What is a cardioembolic stroke?
Embolic phenomenon
- AFib
- Valvular heart disease
- Other emboli
What is a thrombotic stroke?
Local thrombus formation
- Atherosclerosis
- 30% cryptogenic
How do we manage fere in stroke?
Antipyretics
What is the AHA/ASA goal for glucose in stroke?
140-180
How do we manage hyperglycemia in stroke?
IV insulin
Over what BP does AHA/ASA suggest startingantihypertensives?
SBP > 220
DBP > 120
Which antihypertensives are used in stroke?
Labetalol/nicardipine
What BP must patients have to use tPA?
< 185/110
How does we use tPA?
Associated with improved outcomes
Most benefit if treated w/in 60 minutes of onset
Treatment up to 180 minutes after onset has some benefit
Why is ASA used in stroke?
Reduce long-term death and disability
Why are anticoagulants not used in stroke?
Never use over tPA
Do not administer w/in 24 hours of tPA
What is the calculation for MAP?
((2xdiastolic)+systolic)/3
What is the goal MAP for hemorrhagic stroke?
< 130
What is the acute treatment of hemorrhagic stroke?
Nimodipine (NOT IV)
What is the secondary prevention of non-carbioembolic stroke?
ASA
ASA + dipyramidole
Plavix
What is the secondary prevention of cardioembolic stroke?
Anticoagulant therapy Warfarin Dabigatran Apixaban Rivaroxaban Edoxaban
What does CHADS-VASc stand for?
C = HF H = HTN A2 = Age > 75 D = DM S2 = h/p stroke V = Vascular dz A = age 65 - 75 S = female
What does a CHADS-VASc of 0 stand for?
Low - ASA
What does a CHADS-VASc of 1 stand for?
Low/mod - DOAC/ASA
What does a CHADS-VASc of 2-4 stand for?
Mod - DOAC
What does a CHADS-VASc of 5 stand for?
High - DOAC
What does a CHADS-VASc of 6+ stand for?
Very high - DOAC
If a patient has AFib and a CHADS-VASc 2+, what treatment do they receive?
DOAC
