Anaesthesia IV Week 6-12 Flashcards

Question

What is the treatment of hypoxia?

Answer 1

``` Help 100% o2 - confirm on analyser Ensure circulation remains Hand ventilate Check equipment Auscultation of chest Consider: suction catheter, reintubate, F/O look, X-ray, ABG ```

Answer 2

``` Help 100% o2 - volatile down Check pulse and equipment Head down Open fluids - pressure Vasopressors Consider CPR Find the cause More IV access ```

Answer 3

``` Strider Inspiratory obstruction Tracheal tug Paradoxical breathing Low sats Low HR ```

Answer 4

Strider: abnormal high pitched inspiratory noise Paradoxical: chest moves inward on inspiration instead of out

Answer 5

``` Help 100% o2 Jaw thrust/chin lift Peep/CPAP Deepen anaesthetic Check airway clear Sux/atropine and intubate ```

Answer 6

``` >40cmh2o Help Inform surgeon - stop stimulus 100% o2 Manual ventilation Check equipment Check airway: suction Cath, et position, auscultation Bronchospasm: salb + adren Pulm oedema: GTN + peep ```

Answer 7

``` Tingling of lips and mouth Ringing in ears Confusion Seizure ECG changes Cvs collapse - arrest ```

Answer 8

``` Stop LA Help 100% o2 Consider intubation Treat seizure Control cvs - CPR or drug therapy Give intralipid!!! ```

Answer 9

20% Bolus: 1.5ml/kg over one minute Infusion: 15ml/kg/Hr (0.25ml/kg/min) If still unstable 5min after bolus, repeat bolus every 5 min up to 3 times and double the infusion rate Maximum 12ml/kg cumulative dose

Answer 10

``` Prolonged massater spasm with sux High ETco2 High RR High HR Arrhythmia ```

Answer 11

``` 0.5 degree increase in temperature every 15min Respiratory and metabolic acidosis High potassium Sweating Cvs instability Low sats and mottled skin Muscle rigidity ```

Answer 12

Cola urine - myoglobinuria High CK Coagulopathy Arrest

Answer 13

``` Help Stop trigger agents - remove Switch to TIVA MH box - task cards (Dantrolene is priority) 100% o2, hyperventilate, FGF>15 with vapor free filters Insert additional lines Swap fluids to cold saline Ice pack body Swap soda lime Treat other factors Investigations Dantrolene mixing ```

Answer 14

2.5mg/kg IV bolus every 10-15min and repeat up to 30mg/kg

Answer 15

Acidosis: sodium bicarbonate Potassium: insulin in dextrose Arrhythmia: amiodarone, lignocaine

Answer 16

Family history Diagnosed MH Raised Creatine kinase Rare muscle disorders

Answer 17

Should be first on list Remove vaporisers and sux - Flush circuit for 90sec using 15L/min on the ventilator with test lung attached Insert vapor free filters Replace all consumables while still maintaining a flush of 15L/min Keep FGF above 10L/min for first 90 minutes of the case

Answer 18

MAP > 50 Laboratory goals Other drugs: Calcium Insulin for high potassium Tranexamic acid

Answer 19

Help 100% o2 Start CPR Attach defibrillator (200J) Assess the rhythm Shockable: 1mg adren after second shock and every second cycle, amiodarone 300mg after third shock Non-shockable: adrenaline 1mg and repeat every second cycle During CPR: achieve airway, attach capnography, IV access

Answer 20

``` Hypoxia Hypovalaemia Hyper/hypokalaemia other metabolic disorders Hyper/hypothermia Tension pneumothorax Tamponade Toxins Thromboembolism ```

Answer 21

``` Reevaluate abcde 12 lead ECG Treat cause Paed: Reevaluate oxygen and ventilation Adult: aim for 94-98% O2, normocapnia and normoglycaemia Target temperature management (cool) ```

Answer 22

``` Laryngospasm Obstruction Bronchospasm Crackles Hypo ventilation Dyspnoea Low sats ```

Answer 23

``` Help Intubate Suction, 100% o2, peep Bronchoscope and lavage Bronchodilator X-ray ```

Answer 24

``` Place head down Suction Cricoid Gentle CPAP bag mask Intubate ```

Answer 25

``` High pressure Low sats Wheeze Low tv High co2 ```

Answer 26

``` Help 100% o2 Stop any stimulation Deepen Check tube or intubate Adren or salbutamol Find and treat cause ```

Answer 27

Anaphylaxis Irritation Aspiration Differential: pneumothorax, oesophageal intubation, too light

Answer 28

Reversible airflow obstruction Smooth muscle construction Inflamed bronchial wall Increased mucus production

Answer 29

Chronic bronchitis or emphysema Obstruction of airflow Non reversible From prolonged exposure to irritant Narrowing from inflammation, scar tissue and multiplying epithelial cells Reduced elasticity causes collapse on expiration causing gas trapping Enlarged mucus glands and reduced cilia function creates cough and mucus plugs

Answer 30

A productive cough on most days for over 3 years Inflamed bronchi Productive cough for more than 3 months each year for 2 consecutive years

Answer 31

Dilatation and destruction of alveolar which weaken and rupture causing reduced surface area for exchange Alpha1 anti trypsin deficiency: allow WBC to attack lung tissue

Answer 32

Smoking Occupational hazards Pollution Repeated infections

Answer 33

``` Emphysema Thin Breathless High RR Hypoxic Barrel chest Pursed lips ```

Answer 34

``` Bronchitis Overweight Poor respiratory effort Hypoxic - blue Peripheral oedema Co2 retention ```

Answer 35

Enlargement of right heart from lung disease | High pressure in lung vessels means difficult to pump here therefore it backs up in the right heart so it works harder

Answer 36

Ph 7.35-7.45 O2 85-100 mmHg Co2 35-45 Be +3/-3 mmol/L

Answer 37

``` Pre optimise (neb) Avoid H1 drugs Not for SV Not ideal to lie flat RV failure? Suction catheter Extubate awake ```

Answer 38

``` Low FRC (quick hypoxia) Low Cc (collapse before end expiration - gas trap) Atelectasis V/q mismatch Reduced pharyngeal tone Increased secretions Low MV Infection risk ```

Answer 39

``` Autoimmune inflammatory More common females Reduced movement due to joint swelling, pain and stiffness Chronic pain Symmetrical ```

Answer 40

Temporomadibular: mouth opening reduced larynx obstructed by nodules Atlantoaxial subluxation: neck motion limited, movement may compress cord

Answer 41

``` Cardiac: CAD, HD, aortic regurgitate Resp: pleural effusion, reduced chest compliance Chronic anaemia - monitor Neuropathy, dry eye, cord compression Immunosuppressants!! Renal failure DI ```

Answer 42

Insulin stimulates glucose uptake into cells Type 1: immune mediated, IDDM, pancreas doesn't produce insulin, deficiency, Tx: insulin Type 2: NIDDM, cells don't respond to insulin or not enough is produced, resistance, Tx: diet, exercise, oral, insulin

Answer 43

CAD, PVD, poor circulation, HTN, IHD Neuropathy, autonomic neuropathy - vessels can't constrict to compensate - hypotensive easily High infection risk Kidney failure, high creatinine Retinopathy Delayed gastric emptying, reflux (RSI) Thickened soft tissues: limited joint mobility syndrome - DI

Answer 44

Contains lactate which is converted to glucose in the fasted state which could Potentiate hyperglycaemic state

Answer 45

``` Weight loss Thirst (polydypsia) Polyuria (frequent urine) Polyphagia ( hunger) Blurred vision Headache Fatigue Reduced healing ```

Answer 46

Deficiency of pituitary hormone ADH which regulates kidney function. Creates thirst and increased urine

Answer 47

Development of high blood sugar during pregnancy. Foetus creates higher need and hormones may disrupt normal insulin. Mother has higher risk of developing T2DM later in life

Answer 48

``` Deliver through same line Fluid through volumetric pump Insulin through syringe driver Anti reflux valve on glucose line to prevent bolus of insulin Check regularly ```

Answer 49

<4mmol/L Cause brain death 50ml of 50% glucose IV 1mg glucagon IM/IV

Answer 50

Dextrose/insulin can cause low potassium levels so needs replacing. Usually added to dextrose bag

Answer 51

Diabetic ketoacidosis Not enough insulin to use glucose so fat gets metabolised for energy which produces poisonous ketones Fluid shifts to ECF Caused by missed insulin, infection, first presentation of DM

Answer 52

``` Reduce alertness High RR Fruit breath Nausea and vomiting Dehydration ``` Insulin and fluid; add potassium later

Answer 53

Weight/height2

Answer 54

``` High blood volume High CO, SV, BP CAD, IHD, HTN Atherosclerosis LV hyper trophy ```

Answer 55

``` High oxygen consumption from more tissue and supporting muscles High CO2 Low FRC and CC Low compliance Osa ```

Answer 56

``` High abdominal pressure More gastric acid High aspiration risk Low liver function Likely NIDDM DI Poor IV access Increased infection ```

Answer 57

Changed Vd due to less water and more fat Higher plasma cholinesterases Lipophilic drugs have a higher Vd and duration - anaesthetic LA in central blocks need reduced dose as less space (more fat) LA and GA drugs based on ideal weight

Answer 58

Circulation disorder caused by narrowing, blockage or spasms in blood vessels. From athersclerosis/plaques Reduce flow and O2 to tissue Can be functional: no damage to structure, change from other factors eg temp Organic: changed structure - plaque

Answer 59

``` 60% will have CAD Difficult to manage BP as hardened vessels are less compliant - art line Cardiac events/stroke risk - invos or RA Optimise pre op DVT care Pressure area care 5 lead ECG? Warming ```

Answer 60

Change I:E | Peep

Answer 61

Frequent episodes of apnoea during sleep >5/hr or >30/night 10 seconds is apnoea

Answer 62

Condition of pregnancy Symptoms: HTN, oedema, proteinuria Can cause seizures and coagulopathy Treatment: hypotensives and bed rest, deliver baby in unstable

Answer 63

Retained placenta preventing the uterus from contracting

Answer 64

Previa: placenta attached to wall close to or covering cervix Accretia: placenta grows through to myometrium Increta: grows into myometrium and muscle layer Percreta: grows through myometrium onto surrounding structures

Answer 65

Amniotic fluid or fetal cells enter mothers circulation and cause an allergic-like response

Answer 66

Maximum 2+1 attempts intubation Maximum 2 attempts at supraglottic It is an RSI

Answer 67

Anaphylaxis: 50-100mcg IV or 0.5mg IM Cardiac arrest shockable: 1mg every second cycle Cardiac arrest non-shockable: 1mg immediately then every second cycle

Answer 68

2 breaths: 15 compressions Charge to 4J/Kg Shockable: 10mcg/Kg 2nd loop 5mg/kg amiodarone 3rd shock Non-shockable: 10mcg/Kg immediately and every 2nd loop

Answer 69

Adrenaline 10mcg/kg IM of 1:1000 Repeat 3-5 minutes 20ml/kg fluid bolus

Answer 70

1: <15% 2: 15-30% 3: 30-40% 4: >40%

Answer 71

Shock: hypotension Upper airway: strider, swelling Lower airway: wheeze

Answer 72

Ring blood bank Ensure X match Alpha: 0-10Kg Bravo: 11-20Kg Charlie: 21-45Kg Each weight tare has different products arriving in each box with a certain volume to be given of each. Remember tranexamic acid, warming and lab checks

Answer 73

``` Box1: 2xRBC, 2xFFP Lab check, tranexamic Box2: 4xRBC, 4xFFP, 3xCryo Box3: 4xRBC, 4xFFP, 1xPlate Lab check Box4: 4xRBC, 4xFFP, 3xCryo Alternate box 3&4, lab check/30min ```

Answer 74

``` Overseas safe management of the box IV certified nurse/tech/MO May be theatre coordinator Guardian initials box when arrived Check pt ID on form against that on box Select one at a time for checking ```

Answer 75

Sug reverses vecuronium and rocuronium Neo reverses all non-depolarises except mivacurium

Answer 76

``` Aspiration Spasm Pulmonary oedema Tension pneumothorax Kinked tube Tube moved and against trachea Tube in too far; one bronchi Filter blocked Tubing occluded by a FB Run over tubing Valve stuck Ventilator malfunction Pressure relief valve failure (Disconnect circuit, on bag, squeeze to eliminate machine and circuit) ```

Answer 77

1. Massive bleeding and shock or coagulopathy 2. Initiate 777: MTP, location. This will contact relevant ppl Correct forms with either emergency blood or box 1. Send via runner; wait 3. Give 3 units of RBC 4. Activate: Call blood bank: MTP, clinician and guardian Ensure X match sent Request each box as needed by form Consult the additional treatment thresholds with lab results Cancel MTP ASAP Warming, lines, fluid, level1, testing

Answer 78

IR: balloon catheters into internal iliac vessels prior to case and inflated at time of delivery Intrauterine tamponade with a saline filled Bakri balloon Cross match prior Cell salvage with care Uterotonics Hysterectomy Bimanual compression of uterus

Answer 79

It is used to control an initial seizure and an infusion is used to prevent any more

Anaesthesia IV Week 6-12 Flashcards

(105 cards)