Rachel's Midterm Study Guide Flashcards
RBB–arterial injection leads to high brain levels via retrograde flow in internal carotid artery; CNS ___ and ___ are possible, but are usually ___ d/t redistribution
RBB–arterial injection leads to high brain levels via retrograde flow in internal carotid artery; CNS excitation and seizure are possible, but are usually transient d/t redistribution
RBB complications–injection into optic nerve sheath (which is continuous with the ___ space) leads to…contralateral ___; ___ation; ___ arrest (occurs within ___ minutes, resolves within ___ hour); vascular ___ from depressant effect on the medulla (total ___)
RBB complications–injection into optic nerve sheath (which is continuous with the subarachnoid space) leads to…contralateral amaurosis (complete lack of vision), obtundation, respiratory arrest (occurs within 20 minutes, resolves within 1 hour), vascular collapse from depressant effect on the medulla (total spinal)
Obese patients ___ventilate, which leads to ___carbia and ___osis
Obese patients HYPOventilate, which leads to HYPERcarbia and acidosis
Obese patients have ___ (increased/decreased) FRC, ERV, VC, TLC; ___ (increased/decreased) dead space; ___ (increased/decreased/no change) in RV, CC, FVC, and FEV1
Obese patients have DECREASED FRC, ERV, VC, TLC; increased dead space; no change in RV, CC, FVC, and FEV1
What volumes/capacities are decreased in obese patients?
Decreased
- FRC
- VC
- TLC
- ERV
What volumes/capacities show no change in obese patients?
No change
- RV
- CC
- FVC
- FEV1
Respiratory–obese patients have ___ (increased/decreased) lung compliance; why?
Obese patients have DECREASED lung compliance; d/t pressure from abdominal, diaphragmatic, and thoracic fat
Obese patients have a ___ F/V loop pattern
Obese patients have a RESTRICTIVE F/V loop pattern
Pulmonary function is decreased in burn patients, even without inhalation burns–T/F?
True
What (3) pulmonary things are reduced in burn patients?
- FRC
- Lung and chest wall compliance
Ventilation can increase from ___ L/min to ___ L/min in burn patients
Ventilation can increase from 6 L/min to 40 L/min in burn patients
If trach is dislodged in early postop period, what is indicated?
Reintubation through larynx is indicated–try a smaller size tube
If there is an emergent need to ventilate the patient with an uncuffed trach tube in place, what can you do?
Pass a small 5.5 ETT through plastic trach tube to establish positive pressure
Increased cardiac output of ___ L/min for each kg of fat
Increased CO of 0.1 L/min for each kg of fat
Parkland formula for burn patients–in the first 24 hours, give ___ ml LR/% burn/kg; give 1/2 in the first ___ hours, give 1/2 in the next ___ hours; ___ (yes/no) colloid
In the first 24 hours, give 4 ml LR/% burn/kg; give 1/2 in the first 8 hours, give 1/2 in the next 16 hours; no colloid
Parkland formula for burn patients–in the second 24 hours, ___ maintenance fluid
In the second 24 hours, D5W maintenance fluid
What is the first priority of anesthetic management in a burn patient?
Diagnose and treat airway injury
EARLY intubation if necessary–may be extremely difficult, consider awake/fiberoptic, surgical airway, succs?
What is the denervation-like phenomenon that occurs during the resuscitative phase of burn patients?–proliferation of ___ receptors, ___ release
Proliferation of acetylcholine receptors, K+ release
Do NOT give succs to a burn patient after ___ hours
Do NOT give succs to a burn patient after 24 hours
When is it okay to give succs to a burn patient?
When the wound is closed and the patient is gaining weight
If you are using a NDNMB in a burn patient, you have to give ___-___x the ED95 dose for proper intubating conditions
2-3x the ED95 dose
Fluid loss/shifts are greatest in the first ___ hours in burn patients; begin to stabilize after ___ hours
fluid loss/shifts are greatest in the first 12 hours in burn patients; begin to stabilize after 24 hours
Fluid shifts from ___ to ___
Fluid shifts from intravascular to interstitial
Result of fluid shifts in burn patients–severe depletion of ___; marked increase in ___ volume
severe depletion of plasma (hypovolemia); marked increase in extracellular volume (edema)
The hypermetabolic/hyperdynamic phase usually occurs after ___ hours
after 48 hours
Increased CO, tachycardia, lower SVR
CV changes in burn patients–immediate IV fluid loss can occur for up to ___ hours; after ___ hours, get hypermetabolic
Immediate IV fluid loss can occur for up to 36 hours (most in first 12 hours, usually stabilize after 24 hours); after 48 hours, get hyper metabolic
What is the hallmark of burn shock?
Decreased cardiac output–occurs within minutes of burn
In rigid bronchs, you assess adequacy of ventilation by observing patient for ___ because ___ and ___ will not be steady or accurate
In rigid bronchs, you assess adequacy of ventilation by observing patient for chest rise because tidal volume and ETCO2 will not be steady or accurate
Obese patients have a ___ F/V loop pattern
Obese patients have a RESTRICTIVE F/V loop pattern
YAG laser = ___ lens goggles
YAG laser = green lens goggles
Argon laser = ___ lens goggles
Argon laser = amber lens goggles
CO2 laser = ___ lens goggles
CO2 laser = clear lens goggles
Max cold ischemic times–heart and lungs = ___-___ hours; liver = ___-___ hours; kidneys = ___ hours
Heart and lungs = 4-6 hours; liver = 12-24 hours; kidneys = 72 hours
What are the (3) phases of liver transplantation surgery?
- Preanhepatic phase
- Anhepatic phase
- Neohepatic phase
What is one absolute contraindication to ECT?
Pheochromocytoma
Relative contraindications to ECT–increased ___ pressure; recent ___; CV ___ defects; high-risk ___; ___ and ___ aneurysms
Relative contraindications to ECT–increased intracranial pressure; recent CVA; CV conduction defects; high-risk pregnancy; aortic and cerebral aneurysms
What is the term used to describe a variety of arrhythmias resulting from manipulation of the eye?
Ocular cardiac reflex (OCR)
Ocular cardiac reflex (OCR) manifests as ___cardia, ___ block, ventricular ___ and ___ (rarely)
Ocular cardiac reflex (OCR) manifests as bradycardia, AV block, ventricular ectopy and asystole (rarely)
OCR is seen especially with traction of what particular muscle of the eye?
Medial rectus traction
OCR is ___ (from what cranial nerves does it originate?)*** Memorize
OCR is trigeminovagal
***Memorize
___ (afferent/efferent) impulses of the OCR originate in orbital contents (via long and short ciliary nerves)***Memorize
AFFERENT impulses of the OCR originate in orbital contents (via long and short ciliary nerves)
***Memorize
Afferent impulses from the OCR travel to the ___ ganglion, to the ___ division of the ___ nerve, to the ___ (sensory/motor) nucleus of the ___ nerve near the ___ ventricle, to visceral motor nuclei of the ___ nerve***Memorize
Afferent impulses from the OCR travel to the ciliary ganglion, to the ophthalmic division of the trigeminal nerve, to the sensory nucleus of the trigeminal nerve near the fourth ventricle, to visceral motor nuclei of the vagus nerve
***Memorize
Efferent limb of the OCR is ___ nerve to the ___***Memorize
Efferent limb of the OCR is vagus nerve to the heart
***Memorize
The OCR occurs more frequently in adults than peds–T/F?***Memorize
FALSE–OCR occurs more frequently in peds than adults
***Memorize
OCR response is worsened by ___emia and ___carbia
OCR response is worsened by hypoxemia and hypercarbia
What should you do FIRST if OCR occurs?
Ask the surgeon to stop manipulation of the eye
Other steps in treatment of OCR–assess adequacy of ___; ___ localization or ___ anesthetic may help; for persistent bradycardia, treat with ___
Other steps in treatment of OCR–assess adequacy of ventilation; lidocaine localization or deepening anesthetic may help; for persistent bradycardia, treat with atropine
Pretreatment with what (2) medications can be effective in preventing OCR? What patient populations should you consider this for?
Pretreatment with glyco or atropine can be effective in preventing OCR; consider this in patients with conduction block or on beta blocker
Know rule of nines
.
Know the standards of care for in the operating room vs. outside the operating room
.
Be able to label airway anatomy
.
