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KLowe-Advanced Anes 2 (Rachel's Class) > Rachel's Midterm Study Guide > Flashcards

Rachel's Midterm Study Guide Flashcards

1
Q

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

A

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

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2
Q

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 ___)

A

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)

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3
Q

Obese patients ___ventilate, which leads to ___carbia and ___osis

A

Obese patients HYPOventilate, which leads to HYPERcarbia and acidosis

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4
Q

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

A

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

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5
Q

What volumes/capacities are decreased in obese patients?

A

Decreased

  • FRC
  • VC
  • TLC
  • ERV
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6
Q

What volumes/capacities show no change in obese patients?

A

No change

  • RV
  • CC
  • FVC
  • FEV1
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7
Q

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

A

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

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8
Q

Obese patients have a ___ F/V loop pattern

A

Obese patients have a RESTRICTIVE F/V loop pattern

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9
Q

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

A

True

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10
Q

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

A
  • FRC

- Lung and chest wall compliance

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11
Q

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

A

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

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12
Q

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

A

Reintubation through larynx is indicated–try a smaller size tube

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13
Q

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

A

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

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14
Q

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

A

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

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15
Q

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

A

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

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16
Q

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

A

In the second 24 hours, D5W maintenance fluid

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17
Q

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

A

Diagnose and treat airway injury

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

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18
Q

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

A

Proliferation of acetylcholine receptors, K+ release

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19
Q

Do NOT give succs to a burn patient after ___ hours

A

Do NOT give succs to a burn patient after 24 hours

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20
Q

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

A

When the wound is closed and the patient is gaining weight

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21
Q

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

A

2-3x the ED95 dose

22
Q

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

A

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

23
Q

Fluid shifts from ___ to ___

A

Fluid shifts from intravascular to interstitial

24
Q

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

A

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

25
Q

The hypermetabolic/hyperdynamic phase usually occurs after ___ hours

A

after 48 hours

Increased CO, tachycardia, lower SVR

26
Q

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

A

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

27
Q

What is the hallmark of burn shock?

A

Decreased cardiac output–occurs within minutes of burn

28
Q

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

A

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

29
Q

Obese patients have a ___ F/V loop pattern

A

Obese patients have a RESTRICTIVE F/V loop pattern

30
Q

YAG laser = ___ lens goggles

A

YAG laser = green lens goggles

31
Q

Argon laser = ___ lens goggles

A

Argon laser = amber lens goggles

32
Q

CO2 laser = ___ lens goggles

A

CO2 laser = clear lens goggles

33
Q

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

A

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

34
Q

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

A
  • Preanhepatic phase
  • Anhepatic phase
  • Neohepatic phase
35
Q

What is one absolute contraindication to ECT?

A

Pheochromocytoma

36
Q

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

A

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

37
Q

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

A

Ocular cardiac reflex (OCR)

38
Q

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

A

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

39
Q

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

A

Medial rectus traction

40
Q

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

A

OCR is trigeminovagal

***Memorize

41
Q

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

A

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

***Memorize

42
Q

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

A

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

43
Q

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

A

Efferent limb of the OCR is vagus nerve to the heart

***Memorize

44
Q

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

A

FALSE–OCR occurs more frequently in peds than adults

***Memorize

45
Q

OCR response is worsened by ___emia and ___carbia

A

OCR response is worsened by hypoxemia and hypercarbia

46
Q

What should you do FIRST if OCR occurs?

A

Ask the surgeon to stop manipulation of the eye

47
Q

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

A

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

48
Q

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

A

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

49
Q

Know rule of nines

A

.

50
Q

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

A

.

51
Q

Be able to label airway anatomy

A

.

KLowe-Advanced Anes 2 (Rachel's Class) (16 decks)

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