Anaesthetics

Question 1

What do preoperative investigations depend on

Answer 1

Patient medication and comorbidites
Severity of surgery
Elective or emergency

Question 2

Scoring systems for health of patient pre surgery

Answer 2

ASA

Question 3

ASA scoring

Answer 3

1- healthy
2- minor systemic condition that enables them to walk up 2 flights of stairs
3- major systemic disease that is a threat to life
4- major disease that is constant threat to life
5- patient wont make it oast 24 hours

Question 4

Scoring system for risk to patient of surgery

Answer 4

POSSUM

Question 5

How does possum score work

Answer 5

Use patient physiological and operative variables to give risk of mortality or morbidity of surgery. This then determines what sort of mid operative monitoring is done or where the patient needs to be monitrored after surgery. For example if mortality rate over 5% then would end up post operatively on ICU

Question 6

What to do with diabetes perioperatively

Answer 6

Ensure Hba1c is well controlled

Question 7

What to do pre operatively with HTN

Answer 7

Check most recent at GP as before surgery very high, if over 160/80 need to treat

Question 8

What to do intra-operatively with HTN

Answer 8

Keep within 20% of their normal

Question 9

What to do with IHD pre operatively

Answer 9

Make sure no recent deterioration and is well controlled. If has been a change then refer to cardiology or do ECG to check for anomaly

Question 10

What to do with IDH intra operatively

Answer 10

Check for HR and BP constantly

Question 11

What to do with IHD post operatively

Answer 11

Consider taking to HDU

Question 12

What to do with asthma or COPD perioperatively

Answer 12

Ensure taking medication and no exacerbating symptoms or signs recently

Question 13

What is INR range for surgery perioperatively

Answer 13

Less than 1.5

Question 14

What should be considered with anticoagulants

Answer 14

Why are they taking it

Should they be stopped?

Question 15

What needs to be done to optimise SCD patients for surgery

Answer 15

Haematology review

Question 16

What should be done peroperatively for SCD patients

Answer 16

Ensure good care so warm, hydrated, analgesia and infection free

Question 17

What is criteria for suitability for day stay surgery

Answer 17

Social- patient consent and is there suitable care situation at home
Medical- fitness and are they stable chronically
Surgical- mobile?, complication risk needs monitoring?

Question 18

Why do NBM pre surgery

Answer 18

Reduce risk of aspiration as paralysed swallowing reflex

Question 19

Usual guidance on ceasing fluid and food

Answer 19

Food 6 hours

Water 2 hours

Question 20

What to include when recording on controlled drug register

Answer 20

Dose
Form of administration
Strength
Instalment prescription

Question 21

Whats included on instalment prescription

Answer 21

Amount of medicine per instalment

Interval between instalments

Question 22

What is another name for oropharangeal airways

Answer 22

Guedel

Question 23

How to do sizing of oropharyngeal airways

Answer 23

Side of mouth to angle of mandible

Question 24

Who do you use bag-mask-valves in

Answer 24

Apnoeic patients

Question 25

What FiO2 can be achieved in bag mask valves

Answer 25

60-90

Question 26

What does supraglottic device look like

Answer 26

A cobra

Question 27

What are 3 aiway adjuncts we need to know

Answer 27

Endotracheal tubes Supraglottic device Bag mask valves

Question 28

What are the 5 steps to safer surgery

Answer 28

``` Briefing Sign in Time out Sign out De brief ```

Question 29

What is done in briefing in 5 steps to safer surgery

Answer 29

All the team meet to introduce themselves, discuss order and each persons role

Question 30

What is done in sign in in 5 steps to safer surgery

Answer 30

Lead by anaesthetist to patient pre any anaesthetic Confirm patient details, the procedure and the side Check allergies Prophylaxis

Question 31

What is done in time out in 5 steps to safer surgery

Answer 31

Lead by surgeon pre incision Check anaesthetic side all fine and details All equipment sterile

Question 32

What is done in sign out in 5 steps to safer surgery

Answer 32

Lead by anaesthetist where do equipment check to see if any left in body, prescriptions and any prophylaxis given

Question 33

What should be considered for VTE prophylaxis

Answer 33

Their mobility Risk factors such as cancer, prophylaxis Bleeding risk

Question 34

What is the WHO pain ladder

Answer 34

Determies level of pain relief given post operatively

Question 35

3 tiers to WHO pain ladder

Answer 35

Step 1- non opioid Step 2- weak opioid Step 3- strong opioid

Question 36

What enables you to move up WHO pain ladder

Answer 36

Increasing or persisting pain

Question 37

What anti emetics are given alongside pain relief

Answer 37

``` Ondensatron Prochlorperazine Cyclizine Dexamethasone Metoclopramide ```

Question 38

Dose and administration of ondensatron

Answer 38

4-8mg TDS | PO IV

Question 39

Dose and administration of cyclizine

Answer 39

50mg TDS | PO IV

Question 40

Dose and administration of dexamethasone

Answer 40

4-8mg | PO/slow IV/IM

Question 41

Dose and administration of metoclopramide

Answer 41

10mg TDS | PO IV

Question 42

Dose and administration of propchlorperazine

Answer 42

12.5mg BD | IM

Question 43

SEs ondensatron

Answer 43

Bradychardia | Long QT

Question 44

SEs cyclizine

Answer 44

Tachycarida | Anti-cholinergic

Question 45

SEs dexamethasone

Answer 45

Hyperglycaemia | Perineal burning

Question 46

SEs metoclopramide

Answer 46

Extrapyramidal SEs

Question 47

SEs prochlorperazine

Answer 47

Extrapyramidal SEs | Long QT

Question 48

Aim of temperature control in anaesthesia

Answer 48

36C

Question 49

What is always given for heat control if surgery over 30mins

Answer 49

Bair hugger

Question 50

Methods used to warm up patients

Answer 50

Bair hugger Warming IV fluids Heat moisturiser exchangers

Question 51

Method of warmth control for very long surgeries

Answer 51

Warming IV fluids

Question 52

What is effect anaesthesia on temp control

Answer 52

Makes you colder

Question 53

What is management of severe bronchospasm outside of theatre

Answer 53

``` Start high flow O2 Salbutamol nebulisers Hydrocortisone Ipatropium bromdie Theophylline Magnesium ```

Question 54

Pnemonic for control of severe bronchospasm

Answer 54

OSHITM

Question 55

How would you treat a tension pneuomthorax

Answer 55

16 gauge needle decompression in 2ics MCL

Question 56

Resp emergencies need to be aware of in anaesthetics

Answer 56

Asthma attacks Hameo/pneumothorax Anaphylaxis Foreign body aspiration

Question 57

Anaphylaxis triggers

Answer 57

``` Stings Nuts Foods Antibiotics Anaesthetic drugs Contrast media ```

Question 58

Recognising anaphylaxis ABC

Answer 58

``` Airway SOB and swallowing Stridor Hoarse voice Breathing Wheeze Confusion from hypoxia SOB- tachypnoea Accessory muscle involvement Circulation shock signs Tachycardia Hyoptension Loss of conciousness Can arrest ```

Question 59

What is main management of anaphylaxis

Answer 59

Adrenaline | Then supportive measures such as airway establishment, O2, hydrocortisone, IV fluid and chlorphenamine

Question 60

When should you give blood transfusion

Answer 60

Tranfusion guideline

Question 61

Post operatively what scores do you use to monitor recovery and if theyre getting worse

Answer 61

NEWS

Question 62

Early warning signs of detioration of patient

Answer 62

Tachycardia Hypotensive HR above SBP

Question 63

How to define SIRS

Answer 63

``` 2 of Temp out of 36-38 HR above 90 RR above 20 or Pa CO2 below 4.3kPa WBC abnormal ```

Question 64

What is common after surgery

Answer 64

SIRS

Question 65

What are indications for ABG

Answer 65

``` Interpret oxygenation levels Assess resp derangements Assess metabolic derangements Acid base status Assess lactate CO poisoning ```

Question 66

Contraindications to ABG

Answer 66

``` Local infection Distorted anatomy Presence of fistulas Peripheral vascular disease Severe coagulopathy Recent thrombolysi ```

Question 67

What can lead to errors with ABG measurements

Answer 67

Presence of air in sample Venous as opposed to arterial blood Improper heparin amount Delay in transportation

Question 68

Complications of ABG

Answer 68

``` Haematoma Nerve damage Arteriospasm Aneurysm Syncope vasovagal ```

Question 69

What are goals of oxygen therapy

Answer 69

Relieve hypoxaemia Prevent CO2 accumulation Reduce work of breathing such as CPAP Ensure adequate clearance of secretions and limit effects of hypothermia

Question 70

Oxygen delivery methods

Answer 70

Nasal cannula Hudson facemask Venturi Non-rebreather

Question 71

When do you nasal cannulae

Answer 71

Non-acute setting | Mild hypoxia

Question 72

What FiO2 are nasal cannulae

Answer 72

24-30

Question 73

Flow rate of nasal cannulae

Answer 73

1-4

Question 74

FiO2 venturi

Answer 74

24-60

Question 75

FiO2 hudson facemask

Answer 75

30-40

Question 76

Flow rate hudson

Answer 76

5-10

Question 77

Flow rate of venturi

Answer 77

Fixed depending on colour

Question 78

What oxygen therapy preferred in COPD

Answer 78

Venturi

Question 79

Who are non-rebreather mask used for

Answer 79

Apnoeic

Question 80

Flow rate of non rebreather

Answer 80

15

Question 81

FiO2 of non rebreath

Answer 81

60-90

Question 82

What is purpose of non-rebreather

Answer 82

Stop breathing expired air

Question 83

What are 2 non-invasive modes of ventilation

Answer 83

CPAP | BiPAP

Question 84

Who do you use CPAP for

Answer 84

Type 1 RF in order to splint open airways

Question 85

What is CPAP

Answer 85

continuous positive air pressure that occurs all the time

Question 86

What is device used for CPAP

Answer 86

Tight fitting mask

Question 87

What is BiPAP

Answer 87

Bilevel positive airways pressure

Question 88

How does BiPAP work

Answer 88

High positive pressure on inspiration and lower positive pressure on expiration

Question 89

Who do you use BiPAP for

Answer 89

T2 RF such as COPD exacerbation

Question 90

Treatment for anaphylaxis

Answer 90

IM adrenaline