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Yr 5 - A&E > Revision - Anaesthetics & Cardiology > Flashcards

Revision - Anaesthetics & Cardiology Flashcards

1
Q

IV vs IM naloxone in opioid overdose?

A

IV > IM if the patient has IV access

If no IV access then IM naloxone

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2
Q

How long prior to surgery should diclofenac be stopped?

A

48h before

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3
Q

How long prior to major surgery should aspirin be stopped?

A

7 days

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4
Q

How long prior to elective surgery with spinal anaesthesia should aspirin be stopped?

A

Can continue aspirin throughout the perioperative period as it does not pose a significant risk for spinal or epidural haematoma.

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5
Q

When patients are positioned prone for lumbar decompression surgery, what is the most appropriate anaesthesia technique?

A

GA with ETT intubation

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6
Q

What type of anaesthesia is often preferred in patients with severe COPD?

A

Regional anaesthesia e.g. spinal or epidural (where possible e.g. elective knee surgery)

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7
Q

Is there a higher risk of bleeding with COX-1 or COX-2 inhibitors?

A

COX-2 inhibitors

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8
Q

Mx of diabetics patients prior to elective surgery with poorly controlled blood glucose levels?

A

Delay surgery until satisfactory glycemic management is achieved.

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9
Q

Role of pre-oxygenation?

A

Preoxygenation replaces nitrogen in the functional residual capacity of the lungs with oxygen, extending the time before arterial oxygen desaturation occurs during periods of apnea, such as during intubation.

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10
Q

In patients with a recent MI, what investigation is advisable prior to surgery?

A

A preoperative coronary angiography.

To assess the state of coronary arteries and guide further management, including the possibility of revascularisation, which might reduce the risk of perioperative cardiac events.

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11
Q

Post-op complications can be classified by time.

What defines a:

a) immediate
b) early
c) late/long-term complications?

A

a) <24h

b) <30 days

b) >30 days (or after discharge)

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12
Q

What is atelectasis?

A

A common post-op complication in which basal alveolar collapse can lead to respiratory difficulty.

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13
Q

Cause of post-op atelectasis?

A

It is caused when airways become obstructed by bronchial secretions.

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14
Q

When should atelectasis be suspected?

A

In the presentation of dyspnoea and hypoxaemia around 72 hours postoperatively.

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15
Q

Mx of post-op atelectasis?

A

1) positioning the patient upright

2) chest physio & breathing exercises

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16
Q

What should the skin be prepared with to reduce the risk of surgical site infections?

A

alcoholic chlorhexidine

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17
Q

What complication are patients post pneumonectomy at risk of?

A

Pulmonary oedema: loss of lung volume makes these patients very sensitive to fluid overload.

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18
Q

How can a post-op anastamotic leak present?

A

Generalised sepsis causing mediastinitis or peritonitis depending on site of leak.

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19
Q

What surgery is the long thoracic at risk of being damaged in?

A

Axillary node clearance

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20
Q

In post-op ileus, does hypovolaemia and electrolyte disturbances occur before or after N&V?

A

Before

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21
Q

What is a potential, and serious, cause of new onset AF following gastrointestinal surgery?

A

Anastomotic leak

22
Q

How soon post-op does an anastomotic leak usually present?

A

5-7 days post-op

23
Q

How can an anastomotic leak be diagnosed?

A

Abdo CT

24
Q

What is Charcot joint?

A

AKA neuropathic joint.

It describes a joint which has become badly disrupted and damaged secondary to a loss of sensation.

Commonly seen in diabetics.

25
Q

What are the risk factors for pseudogout?

A

1) Increasing age (main risk factor)

2) Haemochromatosis

3) Hyperparathyroidism

4) Wilson’s disease

5) Acromegaly

6) Low Mg, low phosphate

26
Q

Xray features in pseudogout?

A

Chondrocalcinosis –> can be seen as linear calcifications of the articular cartilage

27
Q

Mx of VT?

A

300mg amiodarone (loading dose)

Followed by 24h infusion

28
Q

If patient with broad complex regular tachycardia has previously confirmed SVT with bundle branch block, what is management?

A

Treat as for regular narrow complex tachycardia (i.e. vagal maouevres –> adenosine –> verapamil or beta blockers –> synchronised DC shocks).

29
Q

If tachycardia is broad complex with IRREGULAR rhythm, what are the possibilities of causes?

A

1) AF with BBB (most likely in stable patient)

2) Torsades de pointes

3) AF with ventricular pre-excitation

30
Q

If tachycardia is broad complex with IRREGULAR rhythm, what is the management?

A

Seek expert help!

If AF with BBB –> treat as for irregular narow complex (beta blocker & anticoagulate if duration >48h)

Polymorphic VT (e.g. tosades de pointes) –> IV magnesium sulphate

31
Q

What is 3rd line mx of SVT if 18mg of adenosine has not been effective?

A

Verapamil or beta blocker

32
Q

Contraindications of adenosine?

A

1) asthma
2) COPD
3) long QT
4) decompensated HF
5) 2nd or 3rd degree AV block

33
Q

What is alternative to IV adenosine in asthmatics?

A

IV verapamil

34
Q

Why are ACEi contraindicated in HOCM?

A

ACEi reduce afterload which may worsen the LVOT gradient.

35
Q

What murmur is heard in pulmonary stenosis?

A

Ejection systolic that is louder on inspiration

36
Q

Is an ejection systolic murmur characteristic of aortic stenosis louder on inspiration or expiration?

A

Expiration

Think RILE

37
Q

Why is moderate to severe aortic stenosis a contraindication to ACEi?

A

As the vasodilator effect of ACEi might lead to a reduction in coronary perfusion pressure, leading to cardiac ischaemia.

38
Q

What is the site of action of furosemide?

A

Ascending loop of Henle –> inhibits the K-Cl co-transporter

39
Q

Management of infective endocarditis causing HF?

A

Indication for emergency valve replacement

40
Q

What is the 2nd line drug treatment for angina pectoris if 1st line drugs (beta blockers or CCBs) are contraindicated or not tolerated?

A

Nicorandil

41
Q

Contraindication of nicorandil?

A

LV failure

42
Q

What is the JVP increasing with inspiration known as?

A

Kussmaul’s sign

Seen in constrictive pericarditis

43
Q

What cardiac defect are alcoholics at risk of?

A

Dilated cardiomyopathy

This would cause a reduction in LV EF, with a dilated LV.

44
Q

What are J waves?

A

A small hump at the end of the QRS complex (seen in hypothermia)

45
Q

What should patients on warfarin undergoing emergency surgery receive?

A

PCC

46
Q

How can ACEi affect BNP levels?

A

Can give falsely low BNP levels

47
Q

What class of drug is digoxin?

A

Cardiac glycoside

48
Q

Mechanism of digoxin?

A

1) Decreases conduction through the AV node which slows the ventricular rate in atrial fibrillation and flutter.

2) Increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump. Also stimulates vagus nerve

49
Q

What is the classic precipitating factor for digoxin toxicity?

A

Hypokalaemia

50
Q

What investigation should all patients with suspected acute pericarditis have?

A

Echo

51
Q
A

Yr 5 - A&E (14 decks)

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