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Anaesthesia > Anaesthesia I and II > Flashcards

Anaesthesia I and II Flashcards

1
Q

What are the 11 points of airway assessment?

A 
Dentition
Mouth open (3/finger or 3cm)
Neck movement (>90 degree)
Thyro mental (7cm)
Jaw protrusion
Laryngoscopy (same pt state?)
Cricoid present
Short neck
BMI
Defect/injury
Mallanpati
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2
Q

What is the mallanpati score?

A

1: sp, fp, uv
2: sp, fp, base of uv
3: sp only
4. Only hard pallet

3&4 indicate difficult

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3
Q

What is the ultimate aim of an airway assessment?

A

Can we ventilate
Can we intubate
Can we crico

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4
Q

What are the signs of a difficult bag mask?

A 
Beard
Obese
Thin
No teeth
Physical defect
Small jaw
Apnoea/snoring
Mallanpati 3&4
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5
Q

What is the cormack and lehane system?

A

1: full cord view
2: cords partially covered by epiglottis
3: epiglottis only
4: pharynx only

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6
Q

What is Cooks modified classification of laryngoscopy?

A

2a: posterior glottis
2b: aretynoids only
3a: epiglottis - can lift
3b: epiglottis - fixed

2b/3a: restrictive - bougee
3b/4: difficult - advanced technique

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7
Q

What are signs of difficult LMA insertion?

A

Limited mouth open
Oral masses
Large tongue
Reduced neck flexion

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8
Q

What are signs of a difficult cricothyroidotomy?

A 
Obese
Neck mass
Deviated trachea
Reduced neck movement
Radiotherapy
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9
Q

Describe cricoid pressure.

A 
C6 level
Full ring occluded oesophagus
Other hand behind neck (lateral, unstable)
30-40N
Reduce insufflation and aspiration
Might hinder view
(Sellicks manoeuvre)
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10
Q

What are the risks of cricoid pressure?

A

Oesophageal rupture
Cspine instability
Bruise
Reduced view

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11
Q

What is BURP?

A

Backward
Upward
Rightward
Improve view by manipulation neck cartilage

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12
Q

What is the ASA system?

A

Health status

1: fit and well
2: mild disease
3: function limiting disease
4: severe/life threatening
5: die without surgery
6: brain dead

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13
Q

What are cardiopulmonary function tests?

A

METs: measure energy cost - normal is 6 (jog)

TUG: sit to stand, walk 3m and return - <10s

Cardiopulmonary exercise testing: cycle or treadmill with increasing resistance until must stop - graphs gases and stats

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14
Q

What is FEV1 and FVC?

A

FEV1: forces expiratory volume in 1 second

FVC: total expiration volume after maximal inhale

FEV1/FVC = 80%

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15
Q

What is FRC and CC?

A

FRC: amount of gas remaining in lungs after expiration

CC: volume of gas in lungs at which small airways start to collapse

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16
Q

What factors increase closing capacity?

A

Age
Disease
Smoking
Supine

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17
Q

What is hypertension and hypotension?

A

> 140/90
Vessel damage/aneurysm

<90/60
Brain injury/stroke

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18
Q

What is MAP?

A

Mean arterial pressure
Sys+(2xdia) / 3

Normal is 60

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19
Q

What is the Glasgow coma score for eyes?

A

(4)

1: none
2: open to pain
3: open to voice
4: spontaneous open

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20
Q

What is the Glasgow coma score for verbal?

A

(5)

1: none
2: incomprehensible sounds
3: inappropriate words
4: confused
5: orientated

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21
Q

What is the Glasgow come score for motor?

A

(6)

1: none
2: extension to pain (decerebrate)
3: flexion to pain (decorticate)
4: withdraw from pain
5: localise to pain
6: obey commands

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22
Q

What is the Glasgow coma score?

A

Conscious state
Score 3-15

<13 poor

E4V5M6

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23
Q

What is AVPU?

A 
Patient response
Alert
Voice
Pain
Unresponsive

Patient can respond via eye, verbal or motor

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24
Q

What are the 7 factors of neurovascular assessment?

A 
Pain
Pallor
Pulse
Parasthesia
Paralysis
Poikilothermia
Pressure
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25
What are the positives for oxygen therapy?
``` Increase reserve Reduce effort and strain on heart, energy Increase perfusion/circ Increase healing Reduce anaerobic - lactate Assist with sedated/opioid ```
26
What are the cons of oxygen therapy?
``` Dries airway Free radicals damage tissue Increase atelectasis due to wash out of N which remains in the alveoli Bad with laser High cost ```
27
How much oxygen is inspired and expired normally?
21% in | 18% out
28
What is the FiO2 for nasal prongs?
25-45% 1-6L Dries nostrils
29
What is the FiO2 for Hudson mask and with reservoir bag?
40-60% 6-10L Reservoir bag contains valve which prevents CO2 entry 60-95% 6-max L
30
What is a Venturi mask?
``` Fixed conc mask Based on Bernoulli principle (^speed decreases pressure so more space) Entrains gas via Venturi effect Dial % and FR Up to 90% ```
31
Define hypoxia.
<94%
32
What are the 9 symptoms of hypovalaemia?
``` >15% loss Low systolic High diastolic then low High HR Capillary refill >2s High RR Low urine Pale/cold Reduced alert: anxious, confused, reduced conscious ```
33
What is a PCA?
``` Push button, lockout or basal rate Need IV and fluid One way valve on fluid line to prevent opioid travelling and bolusing O2 and pulse ox Additives: clonidine, naloxone, antiem Normal rate: 1ml, 5min, 12ml/hr max ```
34
What are the steps of an incorrect count?
``` Recount Inform team Search Magnet? X-ray Close Inform patient, document Incident form and refer patient ```
35
What are the minimum count items in an emergency?
Swabs Sponges Sharps Incident form Complete count ASAP
36
What must purposely retained items have?
X-ray detectable Well documented Hand over
37
What is the practitioners assurance act 2003?
Protect public by having mechanisms to ensure competence and fitness of practitioner ``` Mechanisms: Valid qualification Annual registration Practise within SOP Ongoing education Tribunal for discipline ```
38
What is the HDC Code of Health and Disability services consumer rights regulations 1996 for?
Promote and protect rights | Pt rights vs provider responsibilities
39
What are the 10 patient rights under the HDC Code of Health and Disability services consumer rights regulations 1996?
``` Respect (privacy, culture) Fair treat (no discrim, no coercion) Dignity and independence Proper standards (care, skill, quality) Communication (in way pt understand, fair enviro, Qs) Info (risk/ben, options, result) Consent/decision (accept/refuse) Support Teaching/research Complaint ```
40
What are the three aspects of the treaty?
Partnership - working with to develop Participation - involved at all levels Protection - ensure level care, safe guard concepts
41
What are the 12 points of the Privacy Act 1994?
``` Purpose: necessary, relevant Source: from pt or reasonable Collection: pt aware and consent Manner: lawful, fair Storage: protect from loss, others Access: pt allowed Correction: attach statement Accuracy: regular check/update Retention: no longer than needed Limit use: primary purpose only Limit disclosure: can't give to others Unique ID: not unless needed for org ```
42
What are the exceptions to the privacy act?
``` If patient can't consent If secondary purposes relate to the consent If urgent care is needed If it lessens public risk If it is known public information ```
43
Who monitors the privacy act?
The privacy commissioner | Monitors, develops and investigates issues
44
What drug acts relate to technicians?
Medicines act - only give under direct supervision - follow direction Misuse of drugs act - only give under direct supervision
45
What is important about the theatre layout?
Double door to keep privacy, separate areas and maintain environment Dirty - exit Clean - entry
46
What are the different areas of restriction in the theatre block?
Unrestricted: public access Semi: peripheral support area, storage, limited access, special attire Restricted: OR, strict access and attire
47
What are the conditions of the theatre environment?
``` Laminar flow from centre ceiling out 20-24.4 degrees (comfort, microbes) Positive pressure (air out only) 55% humid (spark, humid) 20 air change per hour (3 fresh; other recycled - filtered, warmed) Scavenging to remove gases ```
48
What is an RCD?
Residual current device Cut power if leak detected Compares active to neutral line
49
What's a LIM?
Line isolation overload monitor On all critical equipment Alarm and display leaked current Does not cut power
50
What is a UPS?
Uninterrupted power supply Back up hospital battery comes on if power cuts out For essential equipment
51
What is body protected and cardiac protected?
Body - for procedures where skin is compromised Uses RCD and LIM Cardiac - for procedures where a conductor is near the heart Uses RCD, LIM and equipotential earth
52
What is micro and macro shock?
Micro 10-100micro amp When electrodes near heart Macro Large current through skin Fibrillation occur at 100mA
53
What are the methods to manage a spill?
``` Stop work, turn off risky equipment, ventilate area, report Turn on PPE Contain spill using kit medium Collect spill in bucket Label and take to unit Ensure workplace safe before resuming ``` - incident form
54
What are the 8 pieces of equipment in a spill kit?
``` Absorbent Respirator Goggles Gauntlet glove Plastic apron Large plastic bag Bucket Neutraliser ```
55
What is sterilisation?
Complete destruction of all microbes and spores Must decontaminate first Correct method for equipment
56
What is disinfection?
Process of destroying microbes on non-living object; spores remain (Antiseptic does the same but on living tissue)
57
What is decontamination?
Removal of bio burden and contaminants | Must occur first!
58
What is autoclave?
Steam and pressure 121 degrees 15psi 15min Cheap, non-toxic, quick, enviro friendly
59
What is dry heat?
Hot air 160-170 degrees 2 hour Item must be heat stable - glass
60
What is ethylene oxide?
``` Chemical/biocide Delicate items 500mg/L 58 degrees 40% humid 4 hour ``` High cost, long time, toxic Need bio indicator
61
What is ionising radiation, UV light and U/S wave?
IR High energy EM waves disrupt DNA eg a teddy UV Waves penetrate surface only US (decontamination) In solvent tank, waves vibrate liquid to remove debri
62
What are the 5 disinfectant factors?
``` Correct time Correct conc Temp pH Relevant to microbe ``` Must decontaminate first!!
63
What are 8 important factors for storage of equipment?
``` Room temp Good ventilation Secure Clean Well Ventilated Dry No sunlight Above ground level ```
64
What are the 5 moments of hand hygiene?
``` Before pt contact After pt contact Before a procedure After body fluid exposure After leaving pt surroundings ```
65
What is diathermy?
Mono: current from device to electrode pad Bi: both electrodes mounted on device Pad: large, hairless, flat, non-bony, close to site, not through heart
66
What are safety concerns or features of diathermy?
``` Bi is safer and ok for use with pacemaker Heat up internal metal work Patient touching metal may burn Poor pad contact - burn Electrical fault Fire risk High current Microshock risk ```
67
What are the layers from skin to subarachnoid space?
``` Skin Subcutaneous tissue Supraspinus ligaments Interspinus ligaments Ligamentum flavum Epidural space Dura mater Arachnoid mater Subarachnoid space ```
68
What is a spinal injection?
One off injection into subarachnoid space Placed below L2 - ideally L3/4 to avoid spinal cord Continuous spinal anaesthesia with a catheter is possible
69
What is the spinal needle?
26G pencil point Atraumatic tip to side Clear hub to see CSF Stylet to avoid tissue core occlusion and strengthen shaft Quinke: cutting bevel
70
Describe the spinal space.
Subarachnoid space Inject at L3/4 Spinal cord ends L1 in adult and L3 in infants Iliac crests indicate L4 (Tuffier's line or intercristine)
71
What LA is used in spinals?
Bupivicaine 0.5% Isobaric (plain) Hyperbaric (heavy) with 8% glucose Hyperbaric can produce a higher block by positioning the patient accordingly
72
What are the contraindications to a spinal anaesthetic?
``` Hypotensive problems eg aortic stenosis, hypovalaemia Back surgery Neurological disease Systemic sepsis Local sepsis Anticoagulant use ```
73
What are common complications of spinal anaesthesia?
``` Hypotension Bradycardia Total spinal Urinary retention Nerve damage PDPH Infection - abscess Bleeding - haematoma ```
74
What is the cause of a PDPH?
Caused by leaking CSF causing pressure to drop and the brain to sink Proportional to needle gauge and number of punctures Less likely with atraumatic needle 24-48hr post procedure Pain worse on standing, maybe absent in the morning and return on moving Usually front with neck stiffness
75
What's an epidural?
Placement of catheter into epidural space Up to 3 days Analgesia via top ups, continuous infusion or PCEA Anywhere along vertebral column
76
Describe the epidural space.
Aka extradural | Potential space
77
How is an epidural placed?
``` Position patient Locate anatomy (Ensure IV; foetal monitor) Insert needle until resistance met Connect roulsen syringe and continue insertion until loss of resistance Introduce 4-5cm of catheter Check for blood/CSF Test dose Secure ```
78
What is an epidural test dose?
Checking for IV injection, spinal injection and production of a expected block
79
Why choose an epidural/spinal over GA?
Post op atelectasis and infection reduced Pain relief = better breathing Reduced post op MI Reduced hypercoagulable response Increased mobility reduced DVT Improves intestinal mobility so eating sooner
80
What are the common complications of epidurals?
``` Dural puncture Headache Nerve injury Catheter migration Hematoma/abscess Respiratory depression Hypotension Pruritis Urinary retention Motor block IV injection ```
81
Compare a spinal drug dose with a epidural drug dose.
Spinal: 3ml of 0.5% bupivicaine 0.2 morphine 10-25mcg fentanyl Epidural: 10-15ml of 0.1% bupivicaine 50-100mcg fentanyl (2mcg/ml)
82
Why might pethidine be the drug of choice for a spinal?
Has both opioid and LA properties so can be used as the sole drug
83
How is a PDPH treated?
Blood patch Seals the leak and compresses dural space thereby raising pressure Lateral position - minimise pressure at the site Aseptic technique Perform epi at same or lower space Obtain 20ml blood Inject slowly until given or pain which doesn't ease occurs (in back) Rest for 2 hours
84
What are the complications of a blood patch?
``` Backache Repeated dural puncture Neurological deficits Epileptiform fits Cranial nerve damage ```
85
What is the needle for an epidural?
``` Touhy 10cm needle 1cm markings Stylet to prevent tissue core 20degree atraumatic bevel (huber) to prevent dural puncture and trauma Normally 18G ```
86
What are the other components of an epidural pack?
``` Nylon/Teflon catheter Rounded distal end Side ports 5cm markings (1cm between 5-15cm) Proximal connects to lure lock and filter 0.22 micron filter Loss of resistance syringe ```
87
Compare a spinal block and epidural block.
``` Spinal: Excellent/dense block One off/catheter Less drug needed so less side effects Faster onset Higher PDPH Epidural: Patchy block Catheter allows ongoing relief/top up High infection risk Can titrate the drugs Can block higher High volume used so greater risk of total spinal, toxicity if misplaced ```
88
What is a CSE?
Combined spinal epidural Touhy needle in place as per epidural Spinal needle through - give dose Remove spinal needle Place epidural catheter and continue as per epidural Gives fast onset, good block and ability to top up
89
How is an IVRA placed?
``` Measure BP IV into non surgical limb and one into surgical limb Apply tourniquet to limb - exsanguinate Inflate 50-100mmHg > systolic Inject LA Don't deflate for 15-20min ``` (If double cuff and tourniquet pain occurs; use proximal cuff to do block then change to distal cuff as this should be asleep)
90
What are the contraindications of IVRA?
Circulation problems Crush injury Sickle cell disease PVD
91
What is a block needle?
``` Short/blunt bevel for minimal nerve trauma Lure lock Clear hub to detect IV Nerve stimulator connection 22G normally ```
92
How is a nerve stimulator used to assist regional blocks?
Introduce needle to skin Attach to stimulator High output (1-3mA) advance until nerve stimulated Lower output (0.2mA) until maximal stimulation with minimal mA so that tip is close to nerve (if stim <0.2 might be intraneural) As LA injected stimulation should stop (failure to stop might be intraneural)
93
What's an insulated needle?
Teflon coated with exposed tip | Current passes from tip only to ensure accurate stimulation
94
What is a caudal extradural block?
Injection into epidural space of sacral spine for a block below the umbilicus in children Can place catheter
95
What is the anatomy for a CEA?
Position left lateral with legs flexed Sacral hiatus: tip of a triangle with base at posterior superior iliac spine Sacral hiatus is also a triangle with base at sacral cornu and tip at 4th vertebra
96
How is a CEA placed?
``` Left lateral Define boundaries Nick the skin 22/20G cannula 60degree to skin from midpoint of sacral cornu Small give indicates penetration of membrane Flatten needle then advance Aspirate and inject LA Normal block 4-8hours ```
97
Why can't a CEA be used in adults?
Difficult to find space Sacral bones fused Adipose reduces spread so not reliable Spinal/epidural easier and better

Anaesthesia (8 decks)

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