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thermogegulation Flashcards

1
Q

at what degree in F does brain damage occur? (at or below)

A

80 degree F

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2
Q

what is normal body temp range in F

A

97-100 F

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3
Q

loss of consciousness, slowed reactions and confusion happens at what range in F

A

92-95 F

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4
Q

The site you use for temp. reading depends on procedure. What measure is considered standard of care (most reliable)

A

Esophagus temp. probe in the lower third, reflects core temp.

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5
Q 
problems related to taking temps the following ways. 
skin
axilla
rectum
nasopharynx
bladder
Swanz-Ganz
A

Skin- 3-4 degree C lower than core temp
Axilla- arm needs to be adducted, 1 C below core
Rectum- not reflective of rapid changes.

Nasopharynx- reflective of brain temp. close to internal carotid artery. (epistaxis in pregnant or DIC, contraindicated in head trauma or CSF rhinorrhea)

Bladder- close to core temp IF URINE FLOW IS ADEQUATELY HIGH

Swan-Ganz- accurate core temp, expensive.

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6
Q

Volatile anesthetics cause what by impairing the thermoregulatory center in the hypothalamus.

A

direct vasodilation

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7
Q

Select three things that anesthetics do to the patient in relation to temperature?

A

Alter thermoregulation

Prevent shivering

Cause peripheral vasodilation (causes you to lose heat, BP goes down)

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8
Q

Hypothermia is usually defined as a body temp below?

A

below 36 Celsius (36.1 is normal)

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9
Q

When NO ATTEMPT to actively warm an anesthetized pt. core temp usually decreases by how much in the first hour? (phase one)

A

1-2 Celcius

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10
Q

After the first hour of temp. dropping of the anesthetized patient, how will the temp. drop in the next 3-4 hours?

A

There will be a more gradual decline during the ensuing 3-4 hours. known as phase two.

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11
Q

What normal human reaction to being cold does the anesthetized patient not have anymore bc of the GA

A

Shivering, only occurs when patient is awake and not under GA.

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12
Q

early signs of hypothermia?

A

shivering (when awake)

decreased sweating (you sweat to cool yourself off, you do not need this if cold)

vasoconstriction (trying to hold onto heat by keeping blood inward.)

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13
Q

late signs of hypothermia?

A

alteration in mental status

muscle weakness

arrhythmia

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14
Q

What patients are at RISK for hypothermia?

A

extreme of ages (very young and very old)

long abdominal surgeries

infants have large surface area

old have decreased autonomic vascular control

burns and spinal cord injuries have autonomic dysfunction.

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15
Q

How often does hypothermia occur?

A

may be as frequent as 65% after GETA

33% after epidural anesthesia

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16
Q

what sex is more at risk for hypothermia?

A

MALE (maybe they do not have as much insulation lol)

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17
Q

What drug makes hypothermia more likely?

A

propofol

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18
Q

what is the purpose of shivering and where is it controlled?

A

the purpose is to increase basal metabolic rate

modulated by the hypothalmus

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19
Q

What is the problem with shivering in relation to oxygen?

A

May increase oxygen consumption up to fivefold and decrease arterial oxygen saturation so can be associated with myocardial ischemia

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20
Q

So what is a major risk of shivering?

A

increased oxygen consumption (five fold) and thus could cause myocardial ischemia.

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21
Q

what would you give a patient to prevent shivering?

A

Demerol 12.5mg

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22
Q

If a patient is paralyzed they can not do what that would usually increase heat production?

A

shiver

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23
Q

who would you maybe not give Demerol to? (if the patient is on this drug then don’t give Demerol)

A

if the person is on a MAOI

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24
Q

what is the best way to reduce the likelihood of shivering?

A

by remaining normothermic!

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25
Name some MAO inhibitors...
``` Azilect (ANTIPARKINSONIAN) Zelapar Marplan Nardil Parnate ```
26
MAO Inhibitors are not recommended for use with what three drugs (according to PPT)
Demerol Phenylephrine Ephedrine MAO inhibitors increase your release of norepinephrine!
27
What is the argument for stopping or not stopping MAOI before surgery? if you were going to stop them how long before should you stop? What patients should probably keep taking their MAOIs?
14 days before surgery the reason for not stopping would be because of the month long without use time since it takes two weeks to get out of your system and two weeks to get back into your system. You may not want someone going a month without their antidepressants! CHRONIC use MAOI patients should be able to keep taking but just talk with the prescribing physician before surgery, let him make the call.
28
If patient is on an MAOI what drug is not best for them?
Demerol
29
What is nonshivering thermogenesis? | And who has this ability?
Increases heat production without contraction of muscles. Present in infants less than three months (unable to shiver)
30
what are the sources of nonshivering thermogenesis?
skeletal muscles and brown fat metabolism.
31
in infants who have brown fat in multiple areas, how much heat production increase can it make?
In infants can increase heat production up to 200%
32
what are some effects of hypothermia on the vascular?
vasoconstriction leading to hypoperfusion of tissues, and increased SVR
33
Cardiac issues associated with hypothermia?
shivering increases O2 consumption/CO2 production up to 200-300%, and increases myocardial oxygen demand (obviously if they can not shiver this will not occur- if paralyzed)
34
what would hypothermia do to wound healing?
impair wound healing, decreases coagulation
35
what would hypothermia do to drug metabolism?
delay drug metabolism (inhibit) (reactions occur at a slower rate when cold bc movement slows down)
36
Elderly are susceptible to MI for multiple reasons so what do you want to make sure you do with them?
keep them warm, prevent shivering in order to prevent MI
37
in hypothermia you shift your hemoglobin dissociation saturation curve which way?
shift to the left, which means LOVE of O2, hgb affinity for 02 increases which reduces availability of 02 for the tissues.
38
In hypothermia is their an increase or decrease in ventilatory drive?
decrease
39
for an 8C decrease in temp. that changes the PC02 by how much?
PCO2 drops by 50%
40
if the up lung is less perfused but better ventilated then the down lung is?
is better perfused but less ventilated.
41
hypothermia effects on the renal system?
Decreased renal blood flow and GFR. Increased protein catabolism
42
hypothermia effects on the platelets? | what will you see in the PACU in relation to their dressings?
platelet dysunction, your platelets do not work like they should, more bleeding. in PACU their dressings will already be saturated with blood.
43
hypothermia effect on liver?
decreased hepatic blood flow
44
hypothermia effects on the CNS?
altered mental status
45
what does hypothermia do the neuromuscular blockade?
exacerbates the blockade
46
could hypothermia delay awaakening?
may delay awakening
47
EKG and hypothermia, what will you see, what could occur?
Cardiac arrhythmia and ischemia.
48
mild hypothermia you will most likely see in relation to EKG
sinus bradycardia
49
moderate hypothermia what will you see on the EKG
prolonged PR interval, widened QRS, and prolonged QT interval
50
Below 30 C what EKG issue will you see?
nodal rhythms
51
below 28 C what EKG issues will you see?
PVCs, AV blocks, VF, or asytole
52
major mechanisms of heat loss and what percentage (most to least)
radiation 40% Convection 30% evaporation 20% Conduction 5%
53
what is radiation heat loss?
Loss of heat to cooler surroundings. It depends on cutaneous blood flow and exposed surface area. (baby head is big, more surface area and heat to the head = lots of loss by radiation)
54
What form of heat loss Depends on currents of air over exposed areas. (air currents)
Convection
55
what is evaporation heat loss?
depends on exposed area and the humidity of ambient air. | guts open and exposed
56
what is conduction?
transfer of heat by contact, exposed body on OR table. babies have more surface area thus more conduction.
57
How will you prevent hypothermia in the surgical patient? | and what is the BEST treatment to keep the patient warm in the OR?
BEST TREATMENT is warming blankets, forced air warmers BAIR HUGGER! HME humidification of gases (kids or long cases) increase the temp in OR COVER patients exposed areas to decrease losses due to conduciton and convection. warm IV fluids and blood radiant warmers and heat lamps especially in pediatric patients irrigation with warm fluids - NOT hot
58
HYPERthermia what is it defined as?
Increase in body temperature at a rate of 2 ºC per hour Normal temp is 36.1-37.7 C
59
at what temp. in F does tissue damage, liver, brain cell death occur?
105-110 F
60
Causes of hyperthermia? | OR conditions associated with hyperthermia? (another way to say it)
``` Transfusion reactions fever secondary to the stress of surgery fever bactermia thyroid storm pheochromocytoma MH NMS hypothalamic lesion hyperthyroidism catecholamine surges ```
61
what do you wait for in order to turn on the Bair hugger?
until the drapes are up, and ask if ready for it to be turned on.
62
what environmental factors make it harder to sweat?
low wind, high humidity
63
if you can not sweat what will happen?
your body temp will increase (net heat gain) and heat stroke may occur.
64
complications of heat stroke?
brain swelling, convulsions, coma , death is possible. | heart failure, high blood pressure, kidney failure and liver failure.
65
what will HYPERthermia look like in the AWAKE pt?
``` Malaise Nausea Lightheadedness Tachycardia Sweating Vasodilation Increased basal metabolic rate ```
66
HYPERthermia in the anesthetized patient, what will you see?
``` Tachycardia Hypertension Increased end tidal CO2 Increased drug metabolism Dehydration (decreased U/O) Increased O2 consumption Increased minute ventilation ```
67
you have increased 02 consumption in hyper or hypo thermia?
BOTH
68
difference between drug metabolism in hypo and hyperthermia?
patients eat up your drugs when HYPERthermia, metabolism is increased In hypothermia drug metabolism is delayed or inhibited.
69
NMS what is it basically?
Imbalance of neurotransmitters in the CNS
70
What situations can cause NMS?
drug therapy with antidopaminergic agents (phenzothiazines, butyrophenones, thioxanthenes, or metoclopramide) or less commonly following the withdrawal of dopaminergic agonists (levodopa or amantadine) in pts. with Parkinson's disease.
71
what is the mortality rate of NMS and who does it more commonly happen to?
20-30% | young males
72
what does NMS look like s/s? | looks a lot like MH, difference is less CO2 production
hyperthermia (causing diaphoresis) muscle rigidity with extrapyramidal signs (dyskinesia), altered consciousness, and autonomic labiality labile BP Tachycardia Dysrhythmias you DO NOT get a dramatic increase in CO2 may develop rhabdo, =myogobinuria and renal failure CK level are increased urinary incontinence increased secreations
73
NMS mimics what ?
MH and NMS look alike in s/s
74
what is the difference between NMS and MH? (how would you tell the difference, what could you do?)
The difference is that administration of nondepolarizer muscle relaxants in NMS causes flaccid paralysis, but not on patients with MH
75
With NMS what is the specific NT deficiency? | and what does that deficiency cause?
dopamine | results in hyperactivity of excitatory amino acids in the basal ganglia and hypothalamus
76
Drugs that can increase your risk of hyperthermia? (they increase your BMR and heat production)
``` Sympathomimetics MAO inhibitors Cocaine Amphetamines Tricyclic antidepressants ``` (these work by increasing your release of norepinephrine)
77
Drugs that can increase your risk of hyperthermia? (unopposed vasodilation and suppression of sweating)
antiholinergics (atropine) | antihistamines
78
Treatment of NMS?
Oxygen therapy tube them for resp. distress or altered consciousness. muscle rigidity can be controlled with muscle paralysis, dantrolene or a dopaminergic agonist (levodopa) bromocriptine.
79
many clinicians believe that NMS may predispose someone to?
MH
80
thus if someone has had NMS what should you not give them or at least talk to the surgeon about before giving? what could you do instead of giving these drugs?
sux volatile anesthetic you can do TIVA (total IV anesthesia)
81
what med do you need to have available if someone is at risk for NMS or MH?
Dantrolene
82
How would you treat hyperthermia in the OR?
``` Expose skin surfaces cooling blankets cooling fluids antipyretics rule out other causes ```

Basics exam 2 (6 decks)

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