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Basics of Anesthesia > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

What are the components of the Aldrete score?

A

activity level, respirations, circulation (BP), consciousness, O2 sat

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2
Q

What is the maximum Aldrete score?

A

10

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3
Q

What Aldrete score is required for discharge?

A

8 according to Greg, 9 according to chart

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4
Q

When should patients have the carbohydrate drink?

A

2 hours prior to surgery

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5
Q

What are some pre-op considerations according to ERAS?

A

optimize pre-op condition, educate and set realistic expectations, emphasize minimizing fasting period and maintaining hydration

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6
Q

Describe pre-op fasting according to ERAS

A

fasting for at least 2 hours for clear liquids, consume 2 glasses of water before bed and 2 glasses of water before leaving for hospital, carb rich drink 2 hours prior to surgery

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7
Q

When should pre-meds be given according to ERAS?

A

2 hours before surgery (Greg says sooner)

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8
Q

What are some common pre-meds for ERAS?

A

Tylenol, Celecoxib, gabapentin, subQ heparin

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9
Q

What routine pre-op med should you avoid according to ERAS?

A

benzos

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10
Q

What does ERAS say according to ketamine?

A

low dose 25-50 mg administered after induction has been reported to improve postop pain relief

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11
Q

What is justice concerned with?

A

equity or fairness in the distribution of scarce healthcare resources

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12
Q

What does nonmaleficence mean?

A

do no harm, not intentionally harm patient

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13
Q

Define beneficence

A

requires that an action be implemented that will bring about good for the patient/responsibility to help patient, to “do good”

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14
Q

What is the “biggest payout” for anesthesia related malpractice?

A

anoxic brain injury/brain damage

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15
Q

What is the most common cause of anesthesia related malpractice claims?

A

damaged teeth

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16
Q

What should you do if you are deposed?

A

answer only the questions asked (Y/N), do not suggest areas of question, detail only when necessary, be medically correct in all answers, do not answer a question you don’t know/understand

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17
Q

Describe selection of council if you’re named in a legal suit

A

your professional liability carrier will appoint you one- use this versus a personal attorney

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18
Q

What should you make sure happens when you drop a patient off in PACU?

A

do transfer of care report to licensed personnel and document

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19
Q

Describe PACU layout

A

located near OR, close to radiology/lab/ICU; open ward with simultaneous patient visibility; must have O2, suction, outlets

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20
Q

What must you consider when discharging a patient?

A

they must have an adult caretaker to take them home and monitor them for 24 hours

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21
Q

What are anesthetist limitations to hypotensive technique?

A

lack of understanding, lack of technical expertise, inability to monitor pt adequately

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22
Q

What are patient limitations to hypotensive technique?

A

cardiac disease, DM, anemia, hemoglobinopathies, polycythemia, hepatic disease, intolerance to hypotensive drugs, ischemic cardiovascular disease, renal disease, respiratory insufficiency, severe systemic hypertension

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23
Q

Describe MAC anesthesia

A

combination anesthetic- surgical anesthesia with LA infiltration, with or without IV meds for sedation/analgesia; meds cause depressed level of consciousness but pt maintains spontaneous ventilation

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24
Q

Is MAC anesthesia the same thing as conscious sedation?

A

no

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25
Q

Describe a patient under minimal sedation

A

pt has normal response to verbal stim; airway, spontaneous ventilation, and CV function is unaffected

26
Q

Describe a patient under moderate sedation

A

pt has purposeful response to verbal/tactile stim, no airway intervention is required, pt maintains adequate spontaneous ventilation, CV function is usually maintained

27
Q

Describe a patient under deep sedation

A

pt has purposeful response to repeated or painful stim, airway intervention may be required, spontaneous ventilation may be inadequate, CV function usually maintained

28
Q

Describe a patient under general sedation

A

pt is unarousable, even with painful stim; airway intervention often required; spontaneous ventilation frequently inadequate, CV function may be imparied

29
Q

What do MAC cases fall under on the continuum of depth of sedation?

A

minimal, moderate, and deep sedation

30
Q

What are benefits of doing a MAC cases?

A

quicker recovery, shorter PACU time, less N/V, less cost, high patient satisfaction

31
Q

What are contraindications to MAC?

A

pt discomfort, surgeon cannot operate safely, pt positioning (prone), inability to effectively medicate, pt cannot maintain airway, skill of surgeon and anesthetist

32
Q

What does Greg say about MAC cases?

A

they are harder then general anesthesia case with secured airway

33
Q

What are some drugs that are commonly used in MAC cases?

A

amnestics (benzos), analgesics (fentanyl, ketamine), propofol, STP/methohexital, precedex, zofran, NSAIDs, decadron

34
Q

What percentage of TBW do ICF and ECF make up?

A

ICF is 2/3, ECF is 1/3

35
Q

What is normal osmolarity and how is it calculated?

A

280-290; 2(Na) + glucose/18 + BUN/2.8

36
Q

What’s the difference between absolute fluid loss and relative loss?

A

absolute loss is from increased fluid loss or decreased intake, while relative loss is redistribution of water within the body leading to reduced circulating volume (burns, third spacing)

37
Q

What does a 10% variation in A-line tracing mean?

A

patient is dry

38
Q

When correcting for hypernatremia, one should not lower the Na level more than ?

A

1-2 mEq/hr

39
Q

What is the formula for TBW deficit?

A

(0.6x body weight in kg) x [(Na-140)/140]

40
Q

What is a finding of hyperkalemia on EKG?

A

narrow peaked T wave

41
Q

What are two hallmark signs of hypocalcemia?

A

Trousseau’s- carpopedal spasm

Chvostek’s- masseter spasm

42
Q

What are EKG findings in hypocalcemia?

A

prolonged QT and ST segment

43
Q

What’s a neuromuscular and CNS finding of hypomagnesemia?

A

hyperactivity

44
Q

What is the replacement in mL for crystalloid and colloids for every 1 mL loss?

A

crystalloid is 3 mL, colloid is 1 mL

45
Q

How do you calculate maintenance fluid requireements?

A

4,2,1 rule (4 ml/kg/hr for first 10 kg, 2 ml/kg/hr for next 10 kg, 1 ml/kg/hr for each kg above 20)- shortcut: if over 20 kg, take weight and add 40

46
Q

How do you calculate NPO deficit?

A

_ hrs NPO x _ ml/kg/hr maintenance rat

47
Q

What procedures are considered minimally invasive and what is the additional fluid requirement?

A

short superficial procedures like lower abdomen, hernia repair, small plastics procedures (2 ml/kg)

48
Q

What procedures are considered moderately invasive and what is the additional fluid requirement?

A

uncomplicated intraabdominal or orthopedic procedures like upper abdomen, appy, cholecystectomy (4 ml/kg)

49
Q

What procedures are considered severely invasive and what is the additional fluid requirement?

A

prolonged highly invasive procedures like upper and lower abdomen, total hip, bowel resection (8 ml/kg)

50
Q

How do you calculate fluid replacement for the 1st hour?

A

1/2 NPO deficit + 3rd space loss + maintenance rate

51
Q

How do you calculate fluid replacement for the 2nd and 3rd hours (each)?

A

1/4 NPO deficit + 3rd space loss + maintenance rate

52
Q

How do you calculate fluid replacement for the 4th hour and beyond?

A

3rd space loss + maintenance rate

53
Q

What is the estimated blood volume of premature neonates?

A

90-100 ml/kg

54
Q

What is the estimated blood volume of full term neonates?

A

80-90 ml/kg

55
Q

What is the estimated blood volume of infants?

A

80 ml/kg

56
Q

What is the estimated blood volume of adults?

A

70 ml/kg

57
Q

Does a serial Hct reflect acute blood loss?

A

no

58
Q

How do you calculate allowable blood loss (ABL)?

A

EBV x (starting Hct - target Hct)/starting Hct

59
Q

How much does 1 unit of pRBCs raise Hct and Hgb?

A

Hct by 2-3% and Hgb by 1 g/dL

60
Q

What are the most to least likely transmitted diseases from blood products?

A

CMV > Hep B > Hep C > HIV

Basics of Anesthesia (8 decks)

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