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My APA Anesthesia 1 > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

top 3 (in order) closed claims

A

Death
Nerve injury
Brain damage

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2
Q

Airway injuries

A 
Sore throat (Most common side effect)
Arytenoid dislocation 
Dysphagia
Dental injury (most common injury)
TMJ
Esophageal perforation
Vocal cord paralysis (forceful intubation)
Vocal cord granuloma (large tubes/long intubation)
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3
Q

Role of positioning

A

Patient
position
procedure

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4
Q

complication related to positioning for nerve injuries

A

hypotension

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5
Q

Complication for sitting, prone, reverse trend? Prevention?

A

Air embolism

maintain venous pressure above zero at the wound

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6
Q

complication for supine, lithotomy, trend? Prevention?

A

Alopecia

Normotension, padding, head turning

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7
Q

Complication of particularly Lithotomy

A

Compartment syndrome

Maintain perfusion pressure, avoid external compression

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8
Q

High risk cases of awareness

A

Trauma
Open Heart
OB

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9
Q

Risk factors for awareness

A 
Female
Previous awareness
Age (younger adults)
Clinician experience
Emergency procedures
After normal hours of operation
Obesity
Use of nondepolarizing relaxants
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10
Q

what level MAC for amnesia?

A

1/3 MAC

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11
Q

Most common cause of post operative loss of vision? Etiology?

A

Ischemic Optic Neuropathy

Optic nerve infarction due to decreased oxygen delivery via one or more arterioles supplying the optic nerve

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12
Q

contributing Pt conditions r/t eye injuries?

A

HTN
DM
CAD
Smoking

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13
Q

Surgical factors to ION (Ischemic Optic Neuropathy)

A
  • Intraoperative deliberate hypotension
  • Anemia
  • Prolonged surgical time in position that compromises venous outflow (Prone, Head down, Compressed abdomen)
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14
Q

Prevention of ION:

A
  • Enhance venous outflow by positioning the patient head up.
  • Minimize abdominal constriction.
  • Monitor blood pressure carefully with arterial line.
  • Limit degree and duration of deliberate hypotension
  • Avoid anemia in patients at risk for ION.
  • Consider staging long surgical procedures in patients at risk for ION
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15
Q

s/s prior to arrest?

A
  • Gradual decline in heart rate and BP (20% below baseline values)
  • Bradycardia
  • Hypotension
  • Cyanosis
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16
Q

treatment for bradycardia unresponsive to Atropine?

A

Small doses Epi (5-10 ug)

17
Q

how much intravascular volume can you lose to anaphylaxis response?

A

up to 50% to capillary leaking

18
Q

Type I reaction (immediate)

A
  • Atopy
  • Urticaria
  • angioedema
  • Anaphylaxis
19
Q

Type II reaction (Cytotoxic)

A
  • Hemolytic transfusion reactions
  • Autoimmune hemolytic anemia
  • Heparin-induced thrombocytopenia
20
Q

Type IV reaction (Delayed, cell-mediated)

A

Contact dermatitis

Graft rejection

21
Q

Type III reaction (immune complex)

A

Rheumatoid Arthritis

Serum sickness

22
Q

chance of anaphyaxis in OR?

A

1 in 5k - 1 in 25k

23
Q

mediators of anaphylaxis

A

Histamine
Leukotrienes
BK-A
Platelet-activating factor

24
Q

clinical manifestations of anaphylaxis

A
  • Cardiovascular - hypotension, tachycardia, arrhythmias
  • Pulmonary - bronchospasm, cough, dyspnea, pulmonary edema, laryngeal edema, hypoxia
  • Dermatologic - urticaria, facial edema, pruritus
25
Q

Risk factors associated with hypersensitivity to anesthetics

A

Female gender d/t cosmetics
Atopic history
Preexisting allergies
Previous anesthetic exposure

26
Q

first thing to do if anaphylaxis occurs?

A

d/c drug administration

27
Q

Treatment of anaphylactic and anaphylactoid reactions:

A

Discontinue drug administration first thing to do
Administer 100% oxygen
Epinephrine (0.01-0.5mg IV or IM)
Consider intubation or tracheostomy
Intravenous fluids (1-2 liters Lactated ringers)
Diphenhydramine (50-75mg IV) H1 blocker
Ranitidine (150mg IV) H2 blocker
Hydrocortisone (up to 200 mg IV) or methylprednisolone (1-2mg/kg)

28
Q

what makes ppl susceptible to a muscle relaxant allergy?

A

Over the counter drugs, cosmetics, and food products that contain tertiary or quaternary ammonium ions may sensitize susceptible individuals

29
Q

most common to least common muscle relaxant drug that causes anaphylaxis?

A

Rocuronium
succinylcholine
atracurium

30
Q

other anesthetic drugs that can cause anaphylaxis?

A

Pentothol (1 in 30k)

Propofol (1 in 60k)

31
Q

antibiotics that cause anaphylaxis?

A

B-lactam antibiotics - Penicillin, Cephalosporin
Sulfonamides
Vancomycin - “Red man’s syndrome”

32
Q

second most common cause of anaphylaxis during anesthesia?

A

Latex allergy

33
Q

Occurance of MH? adults and peds

A

Pediatrics 1:15k

Adults 1:40k

34
Q

s/s MH

A 
Increased carbon dioxide production ETCO2
Increased oxygen consumption
Low mixed venous oxygen tension
Metabolic acidosis
Cyanosis
Mottling
Tachycardia some books say most sensitive, but not specific enough to MH
Initial hypertension
Arrhythmias
35
Q

S/S muscle damage of MH

A 
Masseter spasm
Generalized rigidity
Elevated serum creatine kinase
Hyperkalemia
Hypernatremia
Hyperphosphatemia
Myoglobinemia
Myoglobinuria
36
Q

S/S MH hyperthermia

A

Fever
Sweating
core temperature can rise as much as 1C every 5 minutes LATE SIGN

37
Q

what receptor issue for MH

A

Ryanodine

38
Q

what does Bicarb do for MH

A

Pushes K back into cells

39
Q

S/S Bronchospasm?

A

Prolonged expiration
High inflation pressures
Expiratory wheezes
Decreased oxygen saturation

My APA Anesthesia 1 (8 decks)

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