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Anaesthesia > Trouble shooting > Flashcards

Trouble shooting Flashcards

1
Q

Causes for hypercapnia

A
  1. Hypoventilation
  2. Increased production of CO2
  3. Rebreathing of exhaled gases
  4. Physiologic dead space ventilation
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2
Q

Minute volume =

A

tidal volume x RR

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3
Q

capnography findings consistent w/ hypoventilation

A

capnograph shows a slow increase in ETCO2 over time

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4
Q

when can rebreathing of exhaled gases cause hypercapnia?

A

inspiratory CO2 >2mmHg

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5
Q

causes of airway dead space ventilation?

A

shallow breathing/small TV

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6
Q

capnography findings consistent w/ airway dead space ventilation

A

the ETCO2 will be low whilst the PaCO2 builds up as animal not actually ventilating blood-gas exchange regions to remove CO2

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7
Q

possible cause of alveolar dead space ventilation

A

Pulmonary thromboembolism (ventilated but not perfused lung)

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8
Q

reasons for rebreathing in a non-rebreathing system

A
  • inner limb disconnected at patient site
  • fresh gas flow too low
  • panting
  • XS dead space
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9
Q

reasons for rebreathing expired gases in a rebreathing system

A
  • XS equipment dead space
  • unidirectional valves
  • exhausted soda lime
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10
Q

Causes of hypoxaemia

A
  1. Low FiO2 <30%
  2. Hypovent: severe OR mild/mod and FiO2 <30%
  3. Diffusion impairment: thickening of alveolar-capillary wall causes impairment of gas diffusion
  4. Vent/perfusion mismatch + FiO2 <30%
  5. Shunt = full lung collapse/atelectasis
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11
Q

causes of diffusion impairment

A

interstitial/pulmonary oedema

Other: lung fibrosis, carcinomatosis, blood/pus in alveoli

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12
Q

Trouble shooting hypoxaemia

A
  1. O2 connected and on
  2. O2 flow >10ml/kg/min (metabolic requirement)
  3. FiO2 >30%
  4. Breathing system connected to common gas outlet
  5. Patient apnoeic
  6. Fresh gas cannot reach lung: obstructed ETT? - give manual breath to check patient chest rises
  7. Atelectasis
  8. Minimal vent. w/ normal perfusion
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13
Q

causes of atelectasis in GA

A
  1. direct compression of alveoli dt GDV, colic, obese, pleural effusion, horse…
  2. decreased FRC dt muscle relaxation of anaesthetics
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14
Q

timeframe of apnoea to hypoxaemia

A

hypoxaemia starts w/in 3-4mins of patient apnoea

once SpO2 <95 % –> rapidly life threatening

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15
Q

will rebreathing of expired gases cause hypoxaemia

A

no - rebreathing of expired gases will occur if fresh gas flow is <200ml/kg/min but since using 100% O2 as carrier gas the O2 content of rebreathed gas is still >90%

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16
Q

causes of minimal ventilation w/ normal perfusion

A
  • interstitial oedema + pulmonary oedema
  • pneumonia
  • severe bronchoconstriction
17
Q

actions if patient suddenly wakes up

A
  1. Propofol 1mg/kg IV bolus OR

2. Alfaxalone 0.5mg/kg IV bolus

18
Q

trouble shooting sudden wakening

A
  1. Low fresh gas flow?
  2. Insufficient inhalant?
  3. Decrease inhalant delivery? ET cuff not inflated?
  4. No inhalant delivery? Oesophageal intubation?
  5. Apnoeic patient?
  6. Sudden stimulus increase
19
Q

Hypotension investigations

A
  1. Depth?
  2. Hypovolaemic?
  3. Bradycardic? (Dog <60bpm, Cat <80bpm)
  4. Ventilation?
  5. Contractility?
  6. Vasodilation?
  7. Lytes? pH?
20
Q

treatment of hypotension secondary to hypovolaemia

A

Fluid bolus @ 3ml/kg over 3 minutes
Can repeat 3 times - if responsive
Increase fluid rate to 10ml/kg/hr

21
Q

Drugs to tx bradycardia

A
  1. Atropine

2. Glycopyrrolate

22
Q

Drugs to treat contractility issues

A
  1. Dopamine (low dose)

2. Dobutamine

23
Q

drugs to treat vasodilation

A
  1. Phenylephrine

2. High dose dopamine

24
Q

mild hypothermia -

A

38.5-36.5

25
Q

mod hypothermia

A

36.5-34

26
Q

severe hypothermia

A

<34

27
Q

complications in hypothermic patients

A
  • decrease MAC
  • decrease HR –> BP
  • coagulopathy + increased blood loss
  • prolonged recovery
  • increased wound infections
  • shivering (inc. O2 demand by 400%)
28
Q

reasons for hypothermia during GA

A
  1. Central effects: compensatory mechanisms do not occur until much later
  2. Direct vasodilation of drugs
29
Q

types of heat loss

A
  • radiation
  • convection
  • conduction
  • evaporation

Anaesthesia (4 decks)

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