Systems Rev 2 Ears-nose-throat, Orthopedics, obstetrics Flashcards
random notes and mostly what dan says which is important
ENT equipment needed?
Tracheostomy equipment need immediately available. kid in closet example dan with oxygen tank
Which paralytic may be used?
SCh if not contra by surgeon or procedure
How to minimize blood loss?
head up position and mild hypotension
What is T&A? When is surgery postponed 7-14 days?
tonsils and adenoids. URIs so reduce laryngospasm risk by delaying
Head and neck surgery what do we want to do in preop?
GREAT airway exam. Consider awake intubation
When is tracheotomy made? Dan’s trick
Comfortable for patients and easier for a pulmonary toilet. do not take the tube out totally until completely confirmed
Airway fire occur, three steps
disconnect circuit, remove ETT, fire continues use saline
Nitrous oxide with ear surgery?
NO
Ear surgery why consider TIVA
PONV
Bone Cement Implantation Syndrome
BCIS is now considered to be caused by the hemodynamic effects of medullary fat embolism, rather than the toxic effects of the cement itself
This embolic load produces acute pulmonary hypertension that can lead to right ventricular dysfunction, ischemia, hypotension, and even sudden death
Dan’s knee surgery what did they use?
pneumatic tourniquet.
The tourniquet system consists of a pressure regulated control unit, hose assembly and an inflatable tourniquet cuff. The cuff inflates with air to a preset pressure to compress the patient’s blood vessels during surgical procedures, thus ensuring a bloodless operative field.
need to be 100mmHg over highest anticipated systolic pressure.
When do tourniquet pain and HTN begin?
over 60 minutes
Cuff deflation immediately does what to CVP and MAP
lowers
Sickle cell disease + tourniquet
usually not. if you do though.. keep well hydrated and normothermic.
How much Heparin for Venous Thromboembolism?
8000 SQ
Fat embolism
when you are putting a broken femur together with your cemet and then the fat is forced into the vascular space,
Hip fracture blood status
hypovolemic typically. use colloids to draw fluid in
Shoulder Surgeryposition? BP?
Usually performed in the “beach chair” position but can also be done in lateral decubitus position
controlled hypotension. ( keep in mind head BP is lower than shoulder)
If block is placed, light general anesthesia with secure airway is appropriate
Cervical spine… consider what intubation technique?
Awake Fiberoptic. use armored tube bc kink risk.
Somatocensory evoked potential SSEP. ( nerve monitoring therapy) Alter plan?
used in cervical spinal surgery. use TIVA. DONT GIVE PARALYTICS
Wake up test?
Toes moved with thoracic surgery. I have lidocaine on tube since they will squirm.
Pregnant what about her blood volume?
increased
Vena caval compression
after first trimester DONT GO ON BACK bc decreased venous return
left uterine displacement avoids what
vena caval compression
Leading anesthesia mortality cause for pregnant?
aspiration. so you need clear liquid to move on the gastric production as well as Metaclopramide &H2 blockers
Smaller or bigger ETT for pregnant woman?
smaller since airway edema
FRC in pregnancy
decrease by 20% FRC so CPAP
WAM BAM THANK YOU MAM
fun saying
Regional anesthesia contraindications
hypovolemia, patient doesnt want it, sepsis, and site infection
Pitocin running in a room?
NO TOUCHY.
Momma pledge of allegiance in
BABY not okay.
