Quiz 9 Flashcards
Lower lung?
Dependent
Upper lung?
Non-dependent
Axillary roll placed on _________, NOT in the _______.
upper chest wall
axilla
In the ___________ position the dependent lung is better ______ & ________ During ________?
awake & lateral
perfused (gravity) & ventilated
V/Q mismatch
________________ favors the upper lung because it is more compliant in
Positive pressure ventilation
In an ______________ upper lung is not ventilated but is still perfusing (although less than dependent lung), this causes a large _______ intrapulmonary shunt (20-30%)
Open Pneumothorax
right to left
Factors that inhibit hypoxic pulmonary vasoconstriction?
- Hypocapnia
- Vasodilators: nitroglycerin (NTG), nitroprusside (SNP), b-adrenegic agonists (dobutamine), calcium channel blockers
- Inhalation agents
During apnea: PCO2 increases ______ for the first minute and then ______ for each additional minute of apnea
5mmHg
3mmHg
Measures for one lung ventilation if getting hypoxic
- FIO2 of 0.8 to 1.0
- Fiberoptic scope to ensure proper ETT placement
- 10cc/Kg, suction ETT
- Adjust RR to keep PaCO2 at 40mmHg
- Add 5cm H2O CPAP to nondependent lung – warn surgeon
- Add 5cm H2O PEEP to dependent lung – tx’s atelectasis but may increase vascular resistance
- Increase both CPAP and PEEP slowly
- Ask surgeon to clamp or ligate nondependent PA
- Return to two lung ventilation always an option
which double lumen tube is easier to place?
Left
What will labs be during MH?
- myoglobinuria
- initial metabolic acidosis then a combined metabolic & respiratory acidosis
- creatinine kinase (CK) > 1000 IU
- hyperkalemia
- hypercalcemia
- hyperphosphatemia
- hypoxemia
S/S MH?
- Tachycardia
- Increased ETCO2 (2-3x)
- decrease in SaO2 & SpO2
- rigidity despite muscle relaxant onboard
- dysrhythmias
- tachypnea
- cyanosis
- sweating
- unstable BP
- mottling of skin
- trismus (masseter spasm) after succinylcholine
- darkening of blood in surgical field
- decreased mixed venous saturation
- cola-colored urine
- heating and exhaustion of CO2 absorber
- hyperthermia (up to 2 degrees C per hour)
Treat hyperkalemia from MH with?
-Bicarb
or
-Dextrose (25-50g) and insulin (10-20 units)
Continue dantrolene how long and dose?
1 mg/Kg IV Q6hrs for 72 hrs to prevent a recurrence
What should not be given while on dantrolene due to life-threatening hyperkalemia and myocardial depression that may occur
Ca-channel blockers
How does Dantrolene work?
- inhibiting Ca release from the sarcoplasmic reticulum
- Intracellular dissociation of excitation-contraction coupling
does Prior uneventful general anesthetic rule out the possibility of MH?
no, can undergo many surgeries before having MH reaction
when do signs of MH start occuring?
one hour
Characteristics of King Denborough Syndrome?
- short stature
- lumbar lordosis and thoracic kyphosis (deformity of the spine)
- unusual facial characteristics
- myopathy
- pectus carinatum (a chest wall deformity)
- cryptorchidism (undescended testicles)
