Quiz 3 (Greg Study Guide) Flashcards
What are some complications of thoracic injury?
tension pneumo, pericardial tamponade, cardiac rupture, thoracic aorta rupture, tracheal injuries, massive hemothorax
What are some symptoms of a tension pneumo?
hypotension, tracheal shift, unilateral breath sounds, subQ emphysema, distended neck veins, hyperresonace
Treatment for tension pneumo
needle chest decompression (2nd intercostal space above 3rd rib along midclavicular line)
What happens during pericardial tamponade?
restricted filling of cardiac chambers during diastole, creates fixed low cardiac output
What is the recommended induction agent for someone with pericardial tamponade?
ketamine
What should you ensure before placing chest tube for hemothorax?
adequate fluid restoration
What are some anesthesia management strategies in a pt with thoracic aorta rupture?
large bore IV access, arterial line, SBP above 100 mmHg
What is considered Class 1 in ATLS shock classification?
blood loss <15%, HR <100, SBP normal, pulse pressure normal or increased, RR 14-20, slightly anxious
What is considered Class 2 in ATLS shock classification?
blood loss 15-30%, HR >100, SBP normal, decreased pulse pressure, RR 20-30, mildly anxious
What is considered Class 3 in ATLS shock classification?
blood loss 30-40%, HR >120, decreased SBP, pulse pressure decreased, RR 30-40, pt is anxious/confused
What is considered Class 4 in ATLS shock classification?
blood loss >40%, HR >140, decreased SBP, decreased PP, RR >35, pt is confused/lethargic
What are the 6 P’s correlated with suspicion for SCI?
paralysis, pain, position (holding hands up or in prayer position), paresthesias, ptosis, priapism (penile erection)
What are some risk factors for ischemic optic neuropathy associated with spine surgery?
male, obese, use of Wilson frame, anesthesia duration >6 hours, large blood loss, colloid as percent of nonblood fluids
Most cases of POVL occurring after spinal surgery are ? and occurs within ?
bilateral; 24-48 hours
What are some ways to prevent POVL during spine surgery?
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
When using a pneumatic tourniquet, what is the timer usually set for and what is the maximum allowable time?
60 min; 2 hours
What can the release of metabolic waste after releasing a tourniquet cause?
metabolic acidosis, hyperkalemia, myoglobinemia, myoglobinuria, renal failure
After deflating a tourniquet, what might you see on the monitor?
transient changes in hemodynamics or pulse oximetry readings (usually resolves on its own except for patients with extreme cardiac/vascular conditions)
What pressure should pneumatic tourniquets be inflated to?
upper extremity: 70-90 above SBP, lower extremity: 2x SBP, Bier block: minimum 250 mmHg
What are some neurologic effects of limb tourniquets?
abolition of SEPs and nerve conduction in 30 minutes, tourniquet pain and hypertension, postop neurapraxia, nerve injury
What are some muscle changes caused by limb tourniquets?
cellular hypoxia in 2 minutes, cellular creatinine value declines, progressive cellular acidosis, endothelial cap leak after 2 hours
What are systemic effects on tourniquet inflation?
elevations in arterial and PAP (only slight to moderate)
What are systemic effects of tourniquet release?
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
What is tourniquet pain?
starts dull aching that progresses to burning/excruciating pain that often requires general anesthesia- often resistant to analgesics
What are the nerves responsible for tourniquet pain?
slow unmyelinated C fibers (burning/aching), faster myelinated A-delta fibers (pinprick, tingling, buzzing)
What are some drugs that may help alleviate tourniquet pain?
melatonin, ketorolac, opioids, dexmetetomidine, clonidine
What are significant factors for developing bone cement implantation syndrome?
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
What is bone cement implantation syndrome (BCIS)?
hypoxia, hypotension, cardiac arrhythmias, increased PVR, loss of consciousness, cardiac arrest during during seating of prosthesis
What is usually the first indication of clinically significant BCIS under general anesthesia?
abrupt decrease in EtCO2
What is usually the first indication of clinically significant BCIS in the awake patient?
dyspnea, altered sensorium
What should you do if you suspect bone implantation syndrome?
increase FIO2 to 100%, aggressive fluid resuscitation, treat hypotension with alpha agonists
“It’s not the speed that hurts you, it’s the…”
sudden stop
