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Sim Lab > 17. IV Tubing, Warming, Positioning, NG/OG, Albuterol, Misc > Flashcards

17. IV Tubing, Warming, Positioning, NG/OG, Albuterol, Misc Flashcards

1
Q

primary tubing

A

standard set for IV
10 drops/mL

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2
Q

secondary set

A

“piggyback”
no one-way valve
- backing up is common

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3
Q

secondary set hanger

A

allows primary set to hang lower

secondary = faster flow
primary = slower flow

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4
Q

microdrip tubing

A

60 drops/mL
peds/slow IV drips
metal tube in chamber

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5
Q

buretrol

A

60 drops/mL
used for neonates
grad cylinder for exact volume

limits inadvertent fluid administration

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6
Q

Alaris pump tubing

A

20 drops/mL
slower than primary (50%)
less ports

peristaltic compress tubing can tear

limit bubbles for pump

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7
Q

Alaris pump common drug uses

A

sypathomimetics
- phenylephrine
- levophed
- epinephrine
- vasopressin

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8
Q

microbore syringe pump tubing

A

conduit for syringe pumps
NOT used as IV tubing extension

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9
Q

liberty alaris syringe pump refill

A

make sure you press “Restart” to avoid pt sedation becoming too light

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10
Q

IV extension tubing

A

7” extension w/clave
- IV J-loop
20” extension
- extension between J-loop and primary set

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11
Q

Ports

A

stopcocks
multi-port extensionp

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12
Q

ports uses

A

allow infusions to enter primary set w/o taking up luer lock ports

allow meds to reach pt faster

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13
Q

which port should you push drugs into?

A

the port most proximal (close) to the pt

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14
Q

IV filter

A

prevents particulate injection
slows rate of administration
- incr resistance = decr flow rate

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15
Q

drugs commonly needed to filter

A

mannitol
phenytoin
intralipid
antithymocyte globulin
buminate formulation of albumin
etc

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16
Q

blood tubing

A

y-spike
filter
warming required
hand pump

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17
Q

y-spike

A

allows normal saline and blood product to be in line at the same time

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18
Q

blood tubing filter size and use

A

170 micrometer
used for:
- transfusion PRBC
- FFP
- platelets

removes coagulated blood

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19
Q

thermoregulation

A

Afferent Input
Central control
Efferent Responses

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20
Q

Afferent Input

A

Arriving signals to CNS
cold sensing Adelta neve fibers
heat sensing C fibers
pre-processed in spinal cord

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21
Q

central control

A

hypothalamus impacts
- anesthetics impair hypothalamic reflex to thermoregulation

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22
Q

Efferent Responses

A

autonomic
Exiting signals from CNS

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23
Q

Efferent Responses Order

A
  1. vasoconstriction of capillary beds
  2. AV shunting / Incr MAP ~15mmHg
  3. nonshivering metabolic incr
    • best in infants
    • meh in adults
  4. shivering metabolic incr
    • 50-100% incr req f/heat product
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24
Q

poilkiothermic

A

intrinsic thermoregulation failure

state pt is in during anesthesia

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25
Q

Approx Heat loss: Radiation

A

40%

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26
Q

Approx Heat Loss: Convection

A

30%

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27
Q

Approx Heat Loss: Evaporation

A

20%

28
Q

Approx Heat Loss: Respiration

A

10%
- 8% water evap
- 2% heating of air

29
Q

radiation

A

infrared energy emitted from any object in reference to another

the body emits energy to the air

30
Q

conduction

A

transfer of energy from one solid body to another

conduction of heat to operating table

requires air current for higher impact

31
Q

convection

A

air expands due to incr in energy

hot air rises
cold air sinks below

final transfer of energy

32
Q

evaportaion

A

causes energy to phase change
liquid –> gas

energy is pulled form the body

sweating

33
Q

respiration

A

energy is expended to heat the cool air as it enters lungs

34
Q

heat redistribution

A

volatile agents cause vasodilation
inhibits thermoregulatory vasoconstriction
(inhibits shunting)

core heat spread through body, including peripherals

35
Q

Heat loss

A

heat loss > heat production

36
Q

anesthetics reduce metabolic rate by

A

20-30%

37
Q

steady state

A

heat loss > heat production
core hypothermia induces vasoconstriction

38
Q

how much heat can you lose in the 1st hr of anesthesia without warming pt?

A

1-2C

39
Q

Phase 1 of Hypothermia

A

redistribution
1-2 C lost (w/o warming pt)

40
Q

Phase 2 of hypothermia

A

heat loss
1C over 3 hours (just from anesthesia)

this will increase for:
– open abdome
– cold irrigation fluid

41
Q

Phase 3 hypothermia

A

steady state

hypothermia induces vasoconstriction so heat loss levels off

42
Q

Mild Hypothermia temp

A

1-2 C heat loss

43
Q

Mild Hypothermia physiological changes

A
  • shivering: 5x metabolic demand
  • decr enzymatic function
    – EBL incr by 20%
  • cardiac arrythmia/ischemia: 3x risk
  • incr PVR
  • left shift hb-O2 dissociation curve
  • incr stress response
  • altered mental status
  • impaired renal function
  • delayed drug metabolism
  • impaired wound healing
44
Q

Hypothermia risk factos (8)

A

elderly
infant
BMI
surgery duration
pre-op hypothermia
lg fluid/blood infusion
open surgery
ambient temp

45
Q

passive warming

A

high ambient temp
insulation mattress/covers
closed/semi-closed ventilation
low airflow circuit

46
Q

active warming

A

forced air warmers
heated mattress
esophageal heat exchangers
warming of IV/irrigation fluids
warming of inspiratory gases

47
Q

most effective way to warm

A

IV fluid warmingI

48
Q

IV fluid warming

A

most effective
reqs lg volume of fluids

ranger
hot line
enflow
warming cabinets (40C)

49
Q

most common warmer

A

bair hugger

50
Q

bair hugger

A

most common warming
built in HEPA filter
43C initially, reduce to 38C once pt adequately warmed

do not turn on until surgical drapes are up and surgery has started

51
Q

hotdog system

A

electric blanket
43C initially, reduce to 38 once pt adequately warmed

decr potential surgical site infection (SSI)

52
Q

blanketrol

A

under-body fluid warmer
warmed water circulates and heats from below pt

53
Q

Bair hugger/hot dog/blanketrol contraindication

A

do not use on ischemic (cold) limbs
do not use on lower body during aortic cross-clamping
do not place over transdermal med pts

BH:
do not turn on prior to surgical draping
do not use hose alone

54
Q

supine positioning: head/neck

A

neutral position on 3 axis
- extension/flexion
- lateral flexion
- lateral rotation
no compression

55
Q

ETT positioning

A

avoid fishhooking.
- can cause facial-buccal neuralgia
– bell’s palsy

56
Q

brachial plexus positioning

A

no external compression
arm boards less than 90 degrees

57
Q

ulnar nerve positioning

A

supinate arm (palm up)
- rotates cubital tunnel to avoid external compression

58
Q

median nerve positioning

A

support under hand/forearm w/blankets/padding to avoid compressing/stretching median nerve

59
Q

albuterol

A

B-2 agonist
bronchodilation
(excessive use can induce B1 agonism)

60
Q

albuterol dosage

A

nebulized/inhaler
1.25-2.5mg in 2ml NaCl

61
Q

albuterol adminstration

A

syringe method
ETT adapter

62
Q

albuterol for awake pt

A

normal inhaler
nebulizer (more effective0

63
Q

nebulizer

A

allows for SV pts to actively withdraw medication
more effective

64
Q

steroid w/nebulizer

A

ipratropium Br (anticholinergic bronchodilator

65
Q

pediatric nebulizer

A

nebulizer chamber

66
Q
A

Sim Lab (23 decks)

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