Random Questions Flashcards
1
Q
Factors that increase expired CO2
A
- reduced RR
- reduced tidal vol
- increased equipment dead-space
- fever
- hypermetabolic states
2
Q
Factors that decrease expired CO2
A
- increased RR
- increased tidal vol
- hypothermia
- hypometabolic states
3
Q
Mechanism of neostigmine
A
Inhibits acetyl cholinesterase: there will be more ACh around to compete with non-deloparisers for receptors
4
Q
Ventilator settings for a child
A
- Tidal vol: 6-8ml/kg
- RR: 30-40
- O2 consumption: 6-9ml/kg/min
- Inspiratory time: 0.5 sec
- PEEP: 3-5hPa
5
Q
Fluids to give to a child intra-op
A
Ringers lactate + 5% dextrose
6
Q
RSI steps
A
- preparation
- preoxygenation
- pretreatment
- paralysis with induction
- protection
- placement
- post-intubation management
7
Q
Anticholinergic drugs
A
- glycopyrrolate
- atropine
8
Q
5 safety checks for anaesthetic machine
A
- is there constant flow of oxygen from O2 flow meter and flush button?
- is there enough O2 in reserve cylinder?
- is the self-inflating resuscitator present and funcitoning?
- are there no leaks in the breathing system with the pressure testing and vapouriser open?
- is the suction working with tubes/catheter present?
9
Q
Name of the curved laryngoscope
A
Macintosh
10
Q
LMA sizes for children
A
<5kg = 1 5-10kg = 1.5 10-20 = 2 20-30 = 2.5 >30 = 3
11
Q
Script for pain management in a child
A
- paracetamol 15mg/kg PO 6 hrly
- tilidine drops 1mg/kg PO 6 hrly
- Ibuprofen 10mg/kg PO 8 hrly
12
Q
Drugs you need for a c-section spinal
A
- fentanyl 10ug
- bupivicaine 0.5% with dextrose 8%
- lignocaine 2%
- phenylephrine 50ug/ml
- ephedrine 5mg/ml
13
Q
Drug classes used for PONV
A
- butyrophenone
- phenothiazine
- serotonin-3 antagonist
- steroids
14
Q
Risk factors for PONV
A
- child
- history of PONV
- history of motion sickness
- obesity
- emetic drugs
- prolonged starvation
- intra-abdominal surgery
15
Q
Factors affecting alveolar concentration of anaesthetic agent
A
- inspired concentraiton
- uptake
- alveolar ventilation
16
Q
Things that affect uptake of anaesthetic agent
A
- solubility in blood
- cardiac output
- alveolar to mixed venous partial pressure difference
17
Q
Factors affecting inspired concentration of anaesthetic agent
A
- volume of breathing circuit
- fresh gas flow rate
- absorption of agent by breathing circuit
18
Q
Amount of air needed to fill size 4 LMA
A
30ml
19
Q
Shockable rhythms
A
- ventricular fibrillation
- ventricular tachycardia
20
Q
Unshockable rhythms
A
- pulseless electrical activity
- asystole
21
Q
Joules recommended for adults on defib
A
- monophasic: 360J
- biphasic: 150J
22
Q
Definition of MAC
A
The steady-state minimum alveolar concentration at seal level that prevents the movement to a standard surgical stimulus in 50% of non-premedicated adults
23
Q
Factors that increase MAC
A
- infancy
- hyperthermia
- hyperthyroidism
- catecholamines and sympathomimetics
- chronic opioid use
- chronic alcohol use
- hypernatraemia
24
Q
Factors that decrease MAC
A
- neonates
- elderly
- pregnancy
- hypotension
- hypothermia
- hypothyroidism
- a2 agonists
- sedatives
- acute opioid/alcohol use
- lithium
25
Factors that potentiate muscle relaxants
- drugs (inhalational/aminoglycosides)
- electrolytes (dec Ca, incr Mg/K)
- temperature (hypo=sux, hyper=non-depol)
- acidosis
- muscle disorders (myaesthenia, dystrophies)
26
Approach to patient with post-op weakness/hypoventilation
- ABCS, continue IPPV
- exclude cental cause
- reverse possible potentiators
- exclude renal dysfunction
- use PNS to see if there is persistent NM block
- can give 1 further dose of reversal (not more than 5mg neostigmine)
- continue supportive management
27
How to treat systemic toxicity from local anaesthetic
- stop LA
- call for help
- ABCs
- give 100% oxygen
- hyperventilate them
- control convulstions (diazepam 0.1mg/kg)
- address hypotension with fluids and vasoconstrictors
- use intralipid 20%, 1.5mg/kg over 1min, repeated every 3-5 min x2
- start intralipid infusion at 0.25mg/kg
- total dose 8mg/kg
28
Absolute contra-indications to neuraxial block
- local infection
- coagulopathy
- severe hypotension
- increased ICP/IOP
- fixed CO
- allergy to drug
- patient refusal
29
Relative contra-indications to neuraxial block
- sepsis
- un-cooperative patient
- pre-existing neurology
- severe spinal deformity
- prior back surgery
- complicated surgery
30
Post-op pain plan for post C/S
```
Paracetamol 1g PO 6 hrly
Tramadol 50mg PO 6 hrly
OR Morphine 10mg IM 6 hrly
Ibuprofen 400mg PO 8hry
Stemetil 12.5mg IM 8 hrly
```
31
Factors to look at for discharge to ward
- activity (limb movement)
- respiration
- circulation
- consciousness
- sats
32
Factors to look at for home discharge
Postanaesthetic discharge scoring system (PADSS)
- ambulation and mental state
- pain or N/V
- bleeding
- vital signs
- intake/output
33
Causes of postop respiratory depression and hypoventilation
- residual anaesthetic agents
- incomplete muscle relaxant reversal
- partial airway obstruction
- severe pain
- hypoglycaemia
- high blockade after spinal
- central depression (stroke)
34
Which analgesics to avoid in asthma
- NSAIDS
| - B-blockers
35
Drugs used in CPR
- adrenaline
- atropine
- amiodarone
- magnesium
- bicarbonate
- calcium
- lignocaine
36
Contributing causes to cardiac arrest
- hypoxia
- hypothermia
- hypovolaemia
- hypo/hyperkalaemia
- hypo/hyperglycaemia
- acidosis
- tension
- trauma
- tamponade
- toxins
- thrombosis
37
Features of ideal inhalational agent
- cheap
- stable
- no metabolism
- potent
- no longterm effect
- non-irritant
- no resp/cvs depression
- hypnotic and analgesic
- readily reversible
38
Best inhalational agent for liver disease
Isoflurane
39
Which inhalational agent should be avoided in patients with renal problems?
Sevoflurane
40
Which inhalational agent to avoid in epileptic patients
Enflurane (raises intracrainial pressure)
41
Describe the Frank-Starling principle
Increasing the ventricular end-diastolic volume will increase myocardial stretch
- thus increasing contractility
- thus increasing stroke volume
42
Factors reducing FRC
- supine
- lithotomy, trendelenburg
- loss of muscle tone
- GA
- intubation
- abdo distension
- abdominal pain
- pregnancy
- restrictive lung disease
- upper abdo surgery
43
Device that produces volume-time curve
Vitalograph
44
Axis in flow-volume loop
- flow in l/sec
| - volume in %FVC
45
Types of hypoxia
- stagnant
- anaemic
- hypoxic
- cytotoxic
46
Consequences of giving a large amount of stored blood
- dilutional thrombocytopaenia
- dilutional coagulopathy
- acidosis, then alkalosis
- reduced temp
- reduced WBC function
- hyper then hypokalaemia
- citrate toxicity
- microemboli
- increased extracellular Hb
47
Factors influencing the activity of local anaesthetics
- lipid solubility
- intermediate chain
- protein binding
- ph
- pka
48
Complications of neuraxial technique
- high block
- hypotension
- post dural puncture headache
- meningitis
- epidural abscess
- epidural haematoma
- neurology
- urinary retention
- backache
- prurutis
- shivering
49
Progressive loss of reflexes
- voluntary eye movement
- eyelash
- eyelid
- swallowing, vomiting
- conjunctival reflex
- muscular tone
- corneal reflex
- glottic reflex
- loss of pupillary light reflex
50
Problems with hypothermia
- platelet dysfunction
- dysrhythmias
- slow drug metabolism
- delayed emergence
- poor ventilatory efforts
- shivering
51
Clinical features of malignant hyperthermia
- tachycardia
- tachypnoea
- increased O2 consumption
- hypercapnia
- masseter muscle spasm
- muscle rigidity
- dysrhythmias
- acidosis
- hyperkalaemia
- myoglobinuria
52
Treatment of malignant hyperthermia
- stop agents
- call for help
- hyperventilate
- dantrolene sodium 2.5mg/kg asap
- start cooling
53
ICU care
FASTHUG
- feeding
- analgesia
- sedation
- thromboprophylaxis
- head up
- ulcer prophylaxis (sucrulfate)
- glucose control
