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Miscellaneous Topics > Apex- Misc: Thermoregulation/Airway Fires/Lasers/Burns > Flashcards

Apex- Misc: Thermoregulation/Airway Fires/Lasers/Burns Flashcards

1
Q

What is the BEST method of minimizing intraoperative heat loss?

A. Forced air warmer
B. Circulating water mattress
C. Warm blankets
D. Fluid warmer

A

A. Forced Air warmer

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2
Q

Rank the four mechanisms of heat transfer in order of importance:

Convection, Evaporation, Radiation, Conduction

A
  1. Radiation
  2. Convection
  3. Evaporation
  4. Conduction

  1. You love to radiate in the sun- thats your primary preference of warming
  2. convection oven would be second warmest compared to the sun
  3. Evaporation - sweating
  4. Conduction ….. idk
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3
Q

Hypothermia is defined as a core body temp less than what

who’s at greatest risk of developing perioperative hypothermia?

A

< 36 degrees celsius

extremes of age

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4
Q

1 source of heat loss

A

Radiation

-heat follows a temp gradient. If pt is warmer than the enviornment, the heat is lost to the envionrment in the form of infrared radiation
-most heat is lost thru the skin and covering hte patient reduces radiant heat loss

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5
Q

T/F: most of the heat is lost through the skin

A

True

radiation*

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6
Q

T/F: covering the patient reduces radiant heat loss

A

true

most heat is lost through skin

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7
Q

What kind of heat loss is the transfer of heat by the movement of matter

A

Convection - Air

second mort important source of heat loss

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8
Q

What kind of heat loss describes when air movement over the body whisks awary the heat that has radiated from the body

A

Convection

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9
Q

Does laminar or turbulent flow increase the amount of heat lost to convection

A

laminar

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10
Q

what kind of heat loss is a function of the exposed surface area and the relative humidity of the envionrment

A

evaporation

water can be lost by evaporation from respiration, wounds, and exposure of internal organs during surgery

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11
Q

What kind of air loss describes when heat is lost when the patient comes into direct contact with a cooler object

examples?

A

conduction

cold OR table, IVF, irrigation fluids

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12
Q

Which temp monitoring site offers the BEST combination of accuracy and safety over an extended period of time?

  1. Rectal
  2. Esophageal
  3. Tympanic membrane
  4. Esophageal
A

B. Esophageal

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13
Q

Shivering increases O2 consumption by how much?

what does this increase the risk of?

A

400-500%

myocardial ischemia and infarction

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14
Q

Where should esophageal temp be monitored?

how many cm pas the incisiors?

A

distal 1/3 - 1/4 of esophagus

38-42 (~40)cm passt incisiors

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15
Q

T/F- skin temp does not correlate with core body temp

A

true

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16
Q

Temp is (directly/inversely) related to solubility of anesthetic agents

A

inversely related

-decreased temp = increased solublity (longer wakeup)

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17
Q

O2 comsumption is reduced by what % for every 1 degree C reduction in body temp?

A

7%

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18
Q

Skin temp is often how many degrees less than core temp?

A

2-4 degrees celsius

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19
Q

Anesthetic considerations for removal of vocal cord papilloma with a carbon dioxide laser include:

A. reducing the FiO2 by adding nitrous
B. applying reflecting tape to a red rubber ETT
C. using amber goggles
D. adding saline instead of air to the cuff of the ETT

A

D.

2 benifits:

  1. acts as a heat sink for the thermal energy produced by the laser
  2. if the laser breaks the balloon, then the surgeon will see the salline in the surgical field- adding dye to the saline makes it more obvious
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20
Q

When should you add saline to your ett cuff instead of air and why?

A

airway surgery with a laser

  1. acts as a heat sink for the thermal energy prodduced by the laser
  2. if the laser breaks the balloon, then the surgeon will see the saline in the surgical field
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21
Q

When a laser is in use, air should be blended with o2 to maintain an fio2 < what

can nitrous be used?

A

< 30%

no- nitrous supports combustion

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22
Q

What color glasses for CO2 laser?

A

clear

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23
Q

Fire triad and 2 examples of each

A
  1. ignition source- cuatery, laser
  2. oxidizer: oxygen, nitrous
  3. fuel: ETT, drapes, surgical supplies
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24
Q

What color goggles for each laser:

CO2
Nd: YAG
Ruby
Argon

A

CO2 = Clear
Nd: YAG = Green
Ruby = Red
Argon = Amber

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25
Q

5 key points regarding laser safety

A
  1. keep FiO2 < 30%
  2. No nitrous
  3. Laser resistant ETT
  4. Fill cuff with saline
  5. Protect pt’s eyes by taping eylind closed, covering them with saline-soaked gauze, and using protective glasses specific to the laswer used
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26
Q

T/F: you should squeeze the reservior bag when extubating the patient for an airway fire

A

false

can create a blow-torch effect at the distal end of hte ETT and push debris in to the lower airway

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27
Q

5 steps for airway fire

3 steps to take after fire is controlled

A
  1. stop ventilation and remove ETT –> AKA: Disconnect and pull
  2. turn off all flows
  3. remove other flammable materia lfrom the airway -> throw down drapes
  4. pour water or saline into airway
  5. if still not extinguished - use a CO2 fire extinguisher

  1. re-establish ventilation by masking on RA
  2. check ETT for damage - fragments may still be in airway
  3. bronch to inspect for airway injury or retained fragments
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28
Q

T/F: short wavelength lasers penetrate DEEPER into tissue

A

true- bc they absorb LESS water

opposite of what you would think

-long wavelength laswers absorb more water and do NOT penetrate deep into tissue

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29
Q

4 C’s of CO2 lasers

A

CO2
Clear goggles
Cords (vocal cord surgery)
Cornea at risk for damage

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30
Q

Most lasers pose risk to which eye structure

what’s the exception

A

Retina

CO2 = CORNEA

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31
Q

Match Laswer with type of surgery:

Nd:Yag, Ruby, Argon, CO2

retinal, tumor debulking/tracheal, oropharyngeal/vocal cords, vascular lesion

A

CO2 = cords
Nd: YAG = tumor debulking/tracheal
Ruby = Retinal
Argon = Vascular lesion

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32
Q

which of these ETTs are flammable, those madefrom:

-polycinyl chloride, red rubber, or silicone

A

all of them!

33
Q

T/f: laser reflective tape is no longer advised

A

true

better to use a laswer resistant ETT (its not laser proof though)

34
Q

what is the most vulnerable part of the ETT to laswer

A

the cuff

35
Q

T/f: laser resistant tubes have laser resistant cuffs

A

FALSE- the cuffs are not laswer resistant

36
Q

ETT for a co2 laser vs Nd:Yag laswer

A

CO2 = LaserFlex
Nd:Yag = Lasertubus

37
Q

laser resisant tube - 2 cuffs, distal and proximal - which one do you fill with saline and why

A

saline goes in proximal cuff - it helps absorb theral energy produced by the laser, making it less likely to ignite

distal cuff = air

hopefully if the proximal cuff perf’s , the distal cuff will remain intact and permit continued PPV

38
Q

Why is gas embolus a risk with laser surgery?

A

Bc gas may be used to cool the tip of the laswer probe

highest risk in laparoscopic uterine surgery

39
Q

T/F: laser resistant ETT also reduce the risk of fire when electrosugical cautery is used

A

False

40
Q

How should the patien’ts eyes be protected when laswer are in use (3)

what type of lubricants should be avoided

A
  1. type eyelids closed
  2. cover eyelids with saline-soaked gauze
  3. appropriate glasses

no petroleum-based lube

41
Q
A

37%

I dont understand how this computes but okay
—->full arm =9 + front = 18 + head = 10

Rule of nines:
Head = 10
Trunk = 36%
Arm = 9%
Leg = 18%
Perneum= 1%

42
Q

4 Classes of burn injury: name and what parts

A

1- Superficial- Epidermis only
2- Partial-thickness- Extends to dermis
3- Full thickness - Complete destruction of both epidermis and dermis (subq)
4th - Full-thickness- Extends to muscle and bone

43
Q

At which classification does a burn not hurt because the nerve endings are obliterated?

A

3rd and 4th

44
Q
A
45
Q

What is the BEST IVF to administer in the intial 24hrs after a major burn:

A. D5W
B. 3% NaCl
C. 5% Albumin
D. LR

what about 24 hours AFTER a major burn

A

D. LR for first 24hrs

D5W for 2nd 24

*Albumin should be avoided during the first 24 hours bc it’s lost to the intersistal space

46
Q

How long should albumin be avoided after a major burn and why

A

first 24 hrs bc it’ll be lost to the intersistial space

47
Q

Why are burn pts at risk for hypovolemic shock

A

bc immediately after a burn, microvascular permeability increases –> capillarly leak –> edema, hypovolemia, and shock

48
Q

T/F- fluid requirements are higher in the 2nd 24 hours following a burn

A

False -

*fluid shifts and edema are greatest in the first 12 hrs and begin to stabllize by 24 hours

49
Q

2 most common fluid resusitation formulas for the acutely burned patient

These formulas are used for adults and kids > what

A

Parkland and Modified Brooke

adults and kids > 20kg

both use LR in the 1st 24hrs and D5W thereafter

50
Q

What does a rising hemoglobin in the first few days after a major burn suggest?

A

inadequate fluid volume resuscitation

51
Q

Burn pts:

consider transfusion if Hct < what in the thealhy patient or < what in the pt with cardiovascular disease

A

Healthy- HCt < 20
CVD- Hct < 30

52
Q

Parkland and Modified brooke formula main difference

other aspects that are the same

A

Parkland = 4ml LR x %TBSA burned x kg
Modified Brooke = 2ml LR x %TBSA burned x kg

in the first 24 hours

both say no to colloids for first 24 hours

2nd 24 hours:
both say D5W maintenance rate
& Colloids at 0.5ml x %TBSA burned x kg

53
Q

Burn Resusitation:

Urine output:
Adult-
Child (<30kg)
High voltage electrial burn:

A

Adult > 0.5ml/kg/hr
Child (<30kg) > 1ml/kg/hr
High voltage electrical injury > 1-1.5ml/kg/hr

54
Q

Burn Resusitation:

Goal BP:

Adult:
Infant:
Child:

A

Adult- MAP > 60
Infant- SBP > 60
Child- SBP - 70– 90 + (2 x age in years)

gimme a break

55
Q

Burn Resusitation: HR goal

A

80-140

age depedent

56
Q

Burn Resusitation: Base deficit goal

A

<2

57
Q

Burn Resusitation: O2 delivery index

A

600ml 02/min/m2

never gonna use that

58
Q

Burn Resusitation: mixed venous oxygen tension (PvO2)

A

35-40mmHg

59
Q

T/f: electrical burns often leave little visible damage on the skin

A

True- but can cause great damage to the viscera

60
Q

Why would an electrical burn necessitate a greater fluid volume resusitation

A

myoglobinemia

from extensive muscle damage - it’s nephrotoxic and needs to be washed out

61
Q

What might Abdominal Compartment Syndrome happen in the burn patient?

criteria

treatment (4)

A

Aggressive fluid resuscitation

IAP > 20mmHg AND evidence of organ dysfunction

Neuomuscular blockade
Sedation
Diuresis
Abdominal decompression via lapartomy

62
Q

CO binds to hemoglobin with an affinity of _ x that of oxygen

A

200x

63
Q

T/F- why is the pulseox inaccurate in the pt with CO poisioning

A

bc it cant differentiate between oxyhemboglobin and carboxyhemoglobin resulting in a falsely levated result

64
Q

tx for carboxyhemoglobin

A

100% FiO2 or hyperbaric o2

65
Q

What is the first priority in all burn patients

A

administering a high FiiO2

66
Q

What is the gold standard for diagnosing hte extent of airway injury

A

Fiberoptic bronchosocpy

67
Q

T/F: tracheal intubation should occur early in burn patietns

A

true

*the fiberoptic approach is prob the safeest method

But at the same time it says a surgical airway increases the risk of pulmonary sespsi and later pulmonary complications and should only be used as a last resort

68
Q

Discuss the use of Sux and NDMR’s after a burn

A

After 24 hours, upregulation of receptors:

No sux - massive hyperkalemia
NDMR- increase 2-3 fold (to cover the increased receptors)

69
Q

Difference in order of importance of heat loss mechanisms in burn pts compared to non-burn patients

A

Burns : Radiation > Evaporation > Convection > Conduction

Non- Burn: Radiation > Convection > Evaporation > conduction

70
Q

Abdominal compatement syndrome is defined as an IAP greater than what

A

20mmHg

+ signs of end organ damage (hd instability, oliguria, ect)

71
Q

What causes Neuromalignant syndrome?

A

dopamine depletion in the* basal ganglia *and hypothalamus

Tx: bromocriptine, dantrolene

72
Q

What is Bromocriptine used for?

A

To treat neuroletpi malginant syndrome

*dopamine depletion in basal ganglia and hypothalmus

73
Q

T/F: Dantrolene can be used to treat neuroleptic malignant syndrome

A

True

dantrolene, bromocriptine, and ECT

74
Q

T/F: Sux is contrainndicated in NMS

A

false -it’s safe

75
Q

Which has muscle rigidity:

Serotonin syndrome, Anticholineregic Syndrome, or NMS?

A

SS & NMS;

not anticholinergic syndrome

76
Q

What is chlorpromazine ?

what can it cause

what can it treat?

A

Thorazine- dopamine antagonist (antiemetic/antipsychotic)

NMS

supportive care for serotonin syndrome (main tx- cypohepatadine)

77
Q

4 main serotonergic drug classes that can cause serotonin syndrome

6 other drugs that can cause it

A
  1. SSRI’s
  2. SNRI’s
  3. MAOI’s
  4. TCA’s

  1. methylene blue
  2. mmeperidine
  3. fentanyl
  4. tramadol
  5. sibutramine - appetite suppress (NE + SSRI)
78
Q

Is serotonin syndrome more likely to cause right or left sided heart failure?

why

A

right sided

it’s metabolized in the lungs and spares the left heart

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