Rachel's Midterm Study Guide

Question 1

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

Answer 1

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

Question 2

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 ___)

Answer 2

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)

Question 3

Obese patients ___ventilate, which leads to ___carbia and ___osis

Answer 3

Obese patients HYPOventilate, which leads to HYPERcarbia and acidosis

Question 4

Obese patients have ___ (increased/decreased) FRC, ERV, VC, TLC; ___ (increased/decreased) dead space; ___ (increased/decreased/no change) in RV, CC, FVC, and FEV1

Answer 4

Obese patients have DECREASED FRC, ERV, VC, TLC; increased dead space; no change in RV, CC, FVC, and FEV1

Question 5

What volumes/capacities are decreased in obese patients?

Answer 5

Decreased

• FRC
• VC
• TLC
• ERV

Question 6

What volumes/capacities show no change in obese patients?

Answer 6

No change

• RV
• CC
• FVC
• FEV1

Question 7

Respiratory–obese patients have ___ (increased/decreased) lung compliance; why?

Answer 7

Obese patients have DECREASED lung compliance; d/t pressure from abdominal, diaphragmatic, and thoracic fat

Question 8

Obese patients have a ___ F/V loop pattern

Answer 8

Obese patients have a RESTRICTIVE F/V loop pattern

Question 9

Pulmonary function is decreased in burn patients, even without inhalation burns–T/F?

Answer 9

True

Question 10

What (3) pulmonary things are reduced in burn patients?

Answer 10

• FRC

- Lung and chest wall compliance

Question 11

Ventilation can increase from ___ L/min to ___ L/min in burn patients

Answer 11

Ventilation can increase from 6 L/min to 40 L/min in burn patients

Question 12

If trach is dislodged in early postop period, what is indicated?

Answer 12

Reintubation through larynx is indicated–try a smaller size tube

Question 13

If there is an emergent need to ventilate the patient with an uncuffed trach tube in place, what can you do?

Answer 13

Pass a small 5.5 ETT through plastic trach tube to establish positive pressure

Question 14

Increased cardiac output of ___ L/min for each kg of fat

Answer 14

Increased CO of 0.1 L/min for each kg of fat

Question 15

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

Answer 15

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

Question 16

Parkland formula for burn patients–in the second 24 hours, ___ maintenance fluid

Answer 16

In the second 24 hours, D5W maintenance fluid

Question 17

What is the first priority of anesthetic management in a burn patient?

Answer 17

Diagnose and treat airway injury

EARLY intubation if necessary–may be extremely difficult, consider awake/fiberoptic, surgical airway, succs?

Question 18

What is the denervation-like phenomenon that occurs during the resuscitative phase of burn patients?–proliferation of ___ receptors, ___ release

Answer 18

Proliferation of acetylcholine receptors, K+ release

Question 19

Do NOT give succs to a burn patient after ___ hours

Answer 19

Do NOT give succs to a burn patient after 24 hours

Question 20

When is it okay to give succs to a burn patient?

Answer 20

When the wound is closed and the patient is gaining weight

Question 21

If you are using a NDNMB in a burn patient, you have to give ___-___x the ED95 dose for proper intubating conditions

Answer 21

2-3x the ED95 dose

Question 22

Fluid loss/shifts are greatest in the first ___ hours in burn patients; begin to stabilize after ___ hours

Answer 22

fluid loss/shifts are greatest in the first 12 hours in burn patients; begin to stabilize after 24 hours

Question 23

Fluid shifts from ___ to ___

Answer 23

Fluid shifts from intravascular to interstitial

Question 24

Result of fluid shifts in burn patients–severe depletion of ___; marked increase in ___ volume

Answer 24

severe depletion of plasma (hypovolemia); marked increase in extracellular volume (edema)

Question 25

The hypermetabolic/hyperdynamic phase usually occurs after ___ hours

Answer 25

after 48 hours Increased CO, tachycardia, lower SVR

Question 26

CV changes in burn patients--immediate IV fluid loss can occur for up to ___ hours; after ___ hours, get hypermetabolic

Answer 26

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

Question 27

What is the hallmark of burn shock?

Answer 27

Decreased cardiac output--occurs within minutes of burn

Question 28

In rigid bronchs, you assess adequacy of ventilation by observing patient for ___ because ___ and ___ will not be steady or accurate 

Answer 28

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

Question 29

Obese patients have a ___ F/V loop pattern

Answer 29

Obese patients have a RESTRICTIVE F/V loop pattern

Question 30

YAG laser = ___ lens goggles

Answer 30

YAG laser = green lens goggles

Question 31

Argon laser = ___ lens goggles

Answer 31

Argon laser = amber lens goggles

Question 32

CO2 laser = ___ lens goggles

Answer 32

CO2 laser = clear lens goggles

Question 33

Max cold ischemic times--heart and lungs = ___-___ hours; liver = ___-___ hours; kidneys = ___ hours

Answer 33

Heart and lungs = 4-6 hours; liver = 12-24 hours; kidneys = 72 hours

Question 34

What are the (3) phases of liver transplantation surgery?

Answer 34

- Preanhepatic phase - Anhepatic phase - Neohepatic phase

Question 35

What is one absolute contraindication to ECT?

Answer 35

Pheochromocytoma

Question 36

Relative contraindications to ECT--increased ___ pressure; recent ___; CV ___ defects; high-risk ___; ___ and ___ aneurysms

Answer 36

Relative contraindications to ECT--increased intracranial pressure; recent CVA; CV conduction defects; high-risk pregnancy; aortic and cerebral aneurysms

Question 37

What is the term used to describe a variety of arrhythmias resulting from manipulation of the eye?

Answer 37

Ocular cardiac reflex (OCR)

Question 38

Ocular cardiac reflex (OCR) manifests as ___cardia, ___ block, ventricular ___ and ___ (rarely)

Answer 38

Ocular cardiac reflex (OCR) manifests as bradycardia, AV block, ventricular ectopy and asystole (rarely)

Question 39

OCR is seen especially with traction of what particular muscle of the eye?

Answer 39

Medial rectus traction

Question 40

OCR is ___ (from what cranial nerves does it originate?)*** Memorize

Answer 40

OCR is trigeminovagal ***Memorize

Question 41

___ (afferent/efferent) impulses of the OCR originate in orbital contents (via long and short ciliary nerves)***Memorize

Answer 41

AFFERENT impulses of the OCR originate in orbital contents (via long and short ciliary nerves) ***Memorize

Question 42

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

Answer 42

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

Question 43

Efferent limb of the OCR is ___ nerve to the ___***Memorize

Answer 43

Efferent limb of the OCR is vagus nerve to the heart ***Memorize

Question 44

The OCR occurs more frequently in adults than peds--T/F?***Memorize

Answer 44

FALSE--OCR occurs more frequently in peds than adults ***Memorize

Question 45

OCR response is worsened by ___emia and ___carbia

Answer 45

OCR response is worsened by hypoxemia and hypercarbia

Question 46

What should you do FIRST if OCR occurs?

Answer 46

Ask the surgeon to stop manipulation of the eye

Question 47

Other steps in treatment of OCR--assess adequacy of ___; ___ localization or ___ anesthetic may help; for persistent bradycardia, treat with ___

Answer 47

Other steps in treatment of OCR--assess adequacy of ventilation; lidocaine localization or deepening anesthetic may help; for persistent bradycardia, treat with atropine

Question 48

Pretreatment with what (2) medications can be effective in preventing OCR? What patient populations should you consider this for?

Answer 48

Pretreatment with glyco or atropine can be effective in preventing OCR; consider this in patients with conduction block or on beta blocker

Question 49

Know rule of nines

Answer 49

.

Question 50

Know the standards of care for in the operating room vs. outside the operating room 

Answer 50

.

Question 51

Be able to label airway anatomy 

Answer 51

.