Week 3.2 and 3.3 Objective Examination and Effects of Anaesthesia Flashcards
When doing observations what should you look at?
- General Appearance
- Position/posture
- Colour - may be indicative of cyanosis
- Clubbing - (in the finger)
- Thoracic shape
- Accessory muscle use
- Breathing pattern
- Attachments
The inspiration to expiration ratio is approximately?
1:2
Associated with O/E of the chest and leads to increase AP diameter associated with increase resting lung volumes (FRC, RV - hyperinflation)
Barrel chest
This is the loss of angle between nail and the nail bed and is typically associated with chronic respiratory conditions.
Digital clubbing (affects the hands)
Accessory muscles shouldn’t be used on quiet breathing. True or false?
True
What is Pectus carinatum?
- pigeon chest
- Associated with hyperinflation
- May be congenital
Happens when a section or part of the ribcage moves in on inspiration. - can be due to #ribs, flail segment. There is a loss of structural integrity of the chest wall.
Local rib cage paradox
What is pectus excavatum?
“funnel chest”
- congenital
A restrictive type of pattern for breathing
O/E - chest shape, this is an increased flexion of the thoracic spine +/- lateral curvature of the spine
Kyphosis/kyphoscoliosis
What do you call when intercostal spaces sucked in during inspiratory due to forceful inspiration?
Costal Indrawing
Happens when abdomen moves in on inspiration. Diaphragm gets fatigue (Really really short of breath)
Abdominal Paradox
What is the normal rate of breathing?
12-16 breaths/min
Part of O/E abnormal breathing patterns. It is adopted spontaneously by some patients and is also used as a treatment by physios. Usually happens in expiration.
Pursed lip breathing
The bottom ribs is drawn in by diaphragm contraction is called?
- Occurs in patients with COPD - hyperinflation causes low flat diaphragm - can’t actively contract and descend.
“Hoovers sign”
Rib indrawing
what are the O/E you can find in an ADULT patient with respiratory distress?
- SOB
- increased RR
- Abnormal breathing pattern eg abdominal paradox
- use of accessory muscles
- leaning forward
- sitting up
- single word sentences
- stridor
what are the O/E you can find in a CHILD patient with respiratory distress?
- indrawing of sternum, intercostal spaces, abdomen
- Nasal flaring
- Grunting
- Stridor
Puts the underlying structures in motion and results in resonance
- can help localise a pathology in the thorax
Percussion Note
This is the transmission of sound through the chest wall
- Vibration felt on the chest wall as the patient speaks - a buzzing sensation
Vocal (Tactile) Fremitus
When palpating and there is air under the skin what do you call this? it may also be palpated as a popping or crackling sensation.
Subcutaneous emphysema (SCE)
“A drug-induced reversible depression of the CNS that results in the loss of physiologic response and perception to all external stimuli.”
General Anaesthesia
A component of General Anaesthesia which reduces stress and anxiety, and increases sedation. Eg midazolam
Premed
What is induction? (component of General anaesthesia)
- its aim is to quickly initiate anaesthesia.
- IV short acting coma-inducing drug (Eg Propofol, barbiturates)
- can be induced via intubation and mechanical ventilation (or laryngeal mask airway in some cases)
A component of General Anaesthesia were the anaesthesia is maintained for the duration of the surgical process.
- a combination of inhaled anaesthetic agents, neuromuscular blockade, and analgesics
Maintenance
A component of general anaesthesia were the concentration of anaesthetic agents are reduced, patient is given drugs that reverse muscle blockade.
Reversal
A regional anaesthesia where a catheter is inserted into subarachnoid or epidural space.
- Blocks motor, sensory, pain and spymathetic
Spina/epidural anaesthesia
What is local anaesthesia?
- can be used for peripheral procedures
- for short term procedures of extremities
may block a bundle of nerves
A surgical complication wherein the wound ruptures due to failure proper wound healing
Dehiscence
Is a significant cause of mortality and morbidity. Prolongs stay in the hospital and affects 20-30% of patients after a major UAS (upper abdominal surgery) and CT (cardiothoracic) surgery.
PPC (Postoperative Pulmonary Complication)
What is a clinically significant PPC?
- respiratory failure
- pneumonia
- collapse/consolidation
- secretion retention
An Intraop factor that affects the respiratory system by reducing the FRC by 30-40% when induced by ________.
Anaesthesia
Is always assumed to be the major factor in post op pulmonary dysfunction.
It reduces the ability to increase tidal volume and take deep breath - it may also change the breathing pattern and may reduce one’s ability to cough
Pain
