Quiz 3 (Greg Study Guide)

Question 1

What are some complications of thoracic injury?

Answer 1

tension pneumo, pericardial tamponade, cardiac rupture, thoracic aorta rupture, tracheal injuries, massive hemothorax

Question 2

What are some symptoms of a tension pneumo?

Answer 2

hypotension, tracheal shift, unilateral breath sounds, subQ emphysema, distended neck veins, hyperresonace

Question 3

Treatment for tension pneumo

Answer 3

needle chest decompression (2nd intercostal space above 3rd rib along midclavicular line)

Question 4

What happens during pericardial tamponade?

Answer 4

restricted filling of cardiac chambers during diastole, creates fixed low cardiac output

Question 5

What is the recommended induction agent for someone with pericardial tamponade?

Answer 5

ketamine

Question 6

What should you ensure before placing chest tube for hemothorax?

Answer 6

adequate fluid restoration

Question 7

What are some anesthesia management strategies in a pt with thoracic aorta rupture?

Answer 7

large bore IV access, arterial line, SBP above 100 mmHg

Question 8

What is considered Class 1 in ATLS shock classification?

Answer 8

blood loss <15%, HR <100, SBP normal, pulse pressure normal or increased, RR 14-20, slightly anxious

Question 9

What is considered Class 2 in ATLS shock classification?

Answer 9

blood loss 15-30%, HR >100, SBP normal, decreased pulse pressure, RR 20-30, mildly anxious

Question 10

What is considered Class 3 in ATLS shock classification?

Answer 10

blood loss 30-40%, HR >120, decreased SBP, pulse pressure decreased, RR 30-40, pt is anxious/confused

Question 11

What is considered Class 4 in ATLS shock classification?

Answer 11

blood loss >40%, HR >140, decreased SBP, decreased PP, RR >35, pt is confused/lethargic

Question 12

What are the 6 P’s correlated with suspicion for SCI?

Answer 12

paralysis, pain, position (holding hands up or in prayer position), paresthesias, ptosis, priapism (penile erection)

Question 13

What are some risk factors for ischemic optic neuropathy associated with spine surgery?

Answer 13

male, obese, use of Wilson frame, anesthesia duration >6 hours, large blood loss, colloid as percent of nonblood fluids

Question 14

Most cases of POVL occurring after spinal surgery are ? and occurs within ?

Answer 14

bilateral; 24-48 hours

Question 15

What are some ways to prevent POVL during spine surgery?

Answer 15

use foam headrest, use head pins if necessary, do not use eye goggles when proned on a square headrest, document eye checks every 20 minutes, do not use horseshoe headrest, maintain adequate Hgb and Hct, keep head above heart if possible

Question 16

When using a pneumatic tourniquet, what is the timer usually set for and what is the maximum allowable time?

Answer 16

60 min; 2 hours

Question 17

What can the release of metabolic waste after releasing a tourniquet cause?

Answer 17

metabolic acidosis, hyperkalemia, myoglobinemia, myoglobinuria, renal failure

Question 18

After deflating a tourniquet, what might you see on the monitor?

Answer 18

transient changes in hemodynamics or pulse oximetry readings (usually resolves on its own except for patients with extreme cardiac/vascular conditions)

Question 19

What pressure should pneumatic tourniquets be inflated to?

Answer 19

upper extremity: 70-90 above SBP, lower extremity: 2x SBP, Bier block: minimum 250 mmHg

Question 20

What are some neurologic effects of limb tourniquets?

Answer 20

abolition of SEPs and nerve conduction in 30 minutes, tourniquet pain and hypertension, postop neurapraxia, nerve injury

Question 21

What are some muscle changes caused by limb tourniquets?

Answer 21

cellular hypoxia in 2 minutes, cellular creatinine value declines, progressive cellular acidosis, endothelial cap leak after 2 hours

Question 22

What are systemic effects on tourniquet inflation?

Answer 22

elevations in arterial and PAP (only slight to moderate)

Question 23

What are systemic effects of tourniquet release?

Answer 23

transient decrease in core temp, metabolic acidosis, transient decrease in central venous oxygen, acid metabolites are released, transient fall in pulmonary and systemic arterial pressures, transient increase in EtCO2

Question 24

What is tourniquet pain?

Answer 24

starts dull aching that progresses to burning/excruciating pain that often requires general anesthesia- often resistant to analgesics

Question 25

What are the nerves responsible for tourniquet pain?

Answer 25

slow unmyelinated C fibers (burning/aching), faster myelinated A-delta fibers (pinprick, tingling, buzzing)

Question 26

What are some drugs that may help alleviate tourniquet pain?

Answer 26

melatonin, ketorolac, opioids, dexmetetomidine, clonidine

Question 27

What are significant factors for developing bone cement implantation syndrome?

Answer 27

preexisting cardiovascular disease, pulmonary hypertension, ASA III or higher, NYHA class 3-4, Canadian heart association class 3-4, surgical technique, pathologic fracture, intertrochanteric fracture, long stem arthroplasty

Question 28

What is bone cement implantation syndrome (BCIS)?

Answer 28

hypoxia, hypotension, cardiac arrhythmias, increased PVR, loss of consciousness, cardiac arrest during during seating of prosthesis

Question 29

What is usually the first indication of clinically significant BCIS under general anesthesia?

Answer 29

abrupt decrease in EtCO2

Question 30

What is usually the first indication of clinically significant BCIS in the awake patient?

Answer 30

dyspnea, altered sensorium

Question 31

What should you do if you suspect bone implantation syndrome?

Answer 31

increase FIO2 to 100%, aggressive fluid resuscitation, treat hypotension with alpha agonists

Question 32

“It’s not the speed that hurts you, it’s the…”

Answer 32

sudden stop