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NZATS Registration Exam study flash cards > ANZCA Anaesthesia Technician study flash cards > Flashcards

ANZCA Anaesthesia Technician study flash cards

Provide the knowledge to pass the registration exam

1
Q

What are the signs of an air embolism?

A

Decreased CO2

Tachypnoea

Decreased oxygen saturation

Hypotension

Tachycardia

ECG changes

‘Pulmonary wheel murmur’

Pulmonary oedema may develop later

Altered mental status if awake

Cardiopulmonary collapse

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2
Q

What should you do in the event of an Air Embolism?

A

Call for help

Identify a hands-off leader and delegate roles

Turn FiO2 to 100% and stop any nitrous oxide use

Stop the source of air entry

Inform the surgeon to flood surgical field

Use ETCO2 to monitor progression

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3
Q

What are the main risks for air embolism?

A

Operative field above the heart

Spinal surgery

Sitting craniotomy

Large bore IV access

Rapid infusions

C section

Gas insufflation procedures

Head up during central line

RRT, ECMO, Bypass

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4
Q

What are the signs of anaphylaxis?

A

Severe grade reaction

Hypotension

Bronchospasm

High peak airway pressure

Decreased or lack of breath sounds

Tachycardia

Urticara

Cardiac arrest

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5
Q

What should you do in the event of a suspected anaphylaxis ?

A

Call for help

Identify a hands off team leader

Turn FiO2 to 100% and consider reducing anaesthesia depth

Adrenalin bolus of 20-100mcg IV repeat 1-2 minutes

OR

Adrenalin IM 0.5mg every 5 minutes as needed

Remove potential causative agents

Secure the airway with ETT

Ensure large bore IV access

Give 2L fluid bolus and elevate legs

If no pulse or systolic BP <50 start CPR and follow PEA algorithm

Obtain and continue with anaphylaxis box cards

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6
Q

What is the IM adrenalin dose for adults?

A

0.5mg [0.5ml of 1:1000]

Repeat every 5 minutes as needed

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7
Q

What is the IM adrenalin dose for children?

A

10mcg [0.01ml/kg] of 1:1000

[min dose 0.1ml]

[max dose 0.5ml]

Repeat every 5 minutes as needed

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8
Q

What should you next consider with a suspected anaphylaxis ?

A

Adrenalin infusion +/- any other vasopressor

Salbutamol +/- magnesium if bronchospams

Arterial line, central line, blood gases

Tryptase levels test 1 / 4 / 24 afters

Can the operation continue?

Referral to ICU

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9
Q

Main causes of anaphylaxis?

A

Antibiotics

Muscle relaxants

Chlorhexidine

Latex

Colloids

Patient blue

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10
Q

What do you do in the event of an unstable bradycardia?

A

Call for help and the resuscitation trolley and attach defib pads

Identify a hands off leader and delegate roles

Turn FiO2 to 100%

Stop surgical stimulation

Give atropine 600mcg IV repeat up to 3mg

If atropine ineffective start either adrenalin infusion or transcutaneous pacing

Confirm pulse present if no pulse start CPR and follow cardiac arrest aystole/PEA algorithm

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11
Q

What are the signs of bradycardia?

A

HR <50bpm with hypotension

Acutely altered mental state

Shock

Ischaemic ECG or acute heart failure

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12
Q

What are the signs of bronchospasm?

A

Persistant increased peak airway pressure

Wheezing

ETCO2 slowly increasing slope

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13
Q

What should you do during a bronchospasm emergency?

A

Call for help

Identify a hands off leader and delegate roles

Turn FiO2 to 100%

Examine patients chest for wheeze and air entry

Consider other differentials [aspiration, anaphylaxis, ARDS acute respiratory distress syndrome]

Deepen anaesthesia with sevoflurane

Use neuromuscular blocker and consider intubating if LMA

Start drug treatments

Review and adjust ventilator settings [volume control]

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14
Q

What drugs are given during bronchospasm?

A

Salbutamol inhaled 8-12 puffs

Salbutamol IV bolus 250mcg [100mcg/ml]

Magnesium

Adrenalin

Ketamine

Sevoflurane

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15
Q

What are some additional steps to consider during a bronchospasm?

A

ICU review and advice

If concerned about aspiration pass suction catheter down ETT

If haemodynamically unstable may have tension pneumothorax, gas trapping or anaphylaxis

Arterial line and serial ABG’s

Chest X-ray / scan

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16
Q

What are the signs of Cardiac Arrest – asystole / PEA?

A

Non-shockable pulseless cardiac arrest

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17
Q

What should you do in the event of an asystole / PEA?

A

Call for help and the resuscitation trolley

Identify a hands off leader and delegate roles

Turn FiO2 to 100% and turn off anaesthesia

Start CPR and encourage high quality chest compressions

Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]

Secure airway with ETT and ventilate RR 8

Confirm capnography

Attach defibrillator pads in case of change to shockable rhythm

Review reversable causes 4H’s 4T’s

Pulse and rhythm check every 2 minutes

Use ETCO2 to assess CPR quality

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18
Q

What drug do you give for an adult cardiac arrest?

A

Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]

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19
Q

What are the 4 H’s of a cardiac arrest cause stand for?

A

Hypovolemia/ Haemorrhage

Hypoxia

Hyper/hypokalaemia / metabolic disorders

Hyper/hypothermia

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20
Q

What are the 4 T’s of a cardiac arrest cause stand for?

A

Tension pnumothorax

Tamponade

Thrombosis – pulmonary, coronary, air, fat

Toxins [beta blocker, Ca2+ channel blocker, local anaesthetic, drug error]

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21
Q

How do you treat hyperkalaemia?

A

Sodium bicarbonate

Insulin actrapid

Calcium chloride

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22
Q

What is the paediatric dose of adrenaline for a cardiac arrest Asystole/PEA

A

Adrenaline 0.01mg/kg of the 0.1mg/ml concentration

Max dose 1mg

Repeat every 3-5 minutes

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23
Q

What are the steps to take during a Cardiac arrest VF / VT

A

Call for help and the resuscitation trolley

Identify a hands off leader and delegate roles

Turn FiO2 to 100% and turn off anaesthesia

Start CPR and encourage high quality chest compressions

Defibrillate at 200J then recommence CPR

Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]

After 3rd cycle consider giving amiodarone 300mg IV

Secure airway with ETT and ventilate RR 8

Confirm capnography

Attach defibrillator pads in case of change to shockable rhythm

Review reversable causes 4H’s 4T’s

Pulse and rhythm check every 2 minutes

Use ETCO2 to assess CPR quality

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24
Q

What are the Defibrillator Instructions?

A

Attach defibrillator pads to patient in the appropriate way

Select energy 200J and press charge

Once charged stop CPR and assess rhythm

If shock advised ensure all staff stand clear of bed

Pressure shock and immediately restart CPR

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25
Q

What are the non-shockable rhythms?

A

Asystole/ PEA/ Sinus rhythm/ SVT/ AF/ PVC

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26
Q

What are the shockable rhythms?

A

VF / VT

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27
Q

What are the Starting steps to take with an unanticipated difficult airway?

A

Call for help and the difficult intubation trolley

Identify a hands off leader and delegate roles

Turn FiO2 to 100% at high gas flows

Use Vortex approach

Ensure good neuromuscular relaxation and consider TIVA

One person to watch oxygen saturation, declare if <90%

Ask hands off leader to count and say airway attempts

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28
Q

What are the get ready for CICO steps in an uninticpated difficult airway?

A

Open FONA [front of neck access] kit on the side of the anaesthesia machine for scalpel and or needle technique

Contact ENT senior surgeon to help

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29
Q

What are the steps to take during a CICO event during an unanticipated difficult airway?

A

Declare CICO if oxygen saturations <90% or rapidly falling and all 3 lifeline best effort attempts not successful

Options are WAKE UP or FONA

For wake up ensure muscle relaxant reversal is complete

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30
Q

What are the signs of an unanticipated difficult airway?

A

Unsuccessful intubation and oxygenation attempts under optimized conditions

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31
Q

What are the initial steps should you take during a haemorrhage?

A

Call for help and ask for blood warmer or rapid infuser +/- cell saver

Identify a hands off leader and delegate roles

Turn FiO2 to 100% and consider reducing anaesthesia depth

Confirm source control attempted by surgeon ask if help is needed

Get large bore IV access x 2

Give fluid bolus and vasopressors to maintain organ perfusion

Blood request

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32
Q

What are the signs of High airway pressures?

A

Persistant increased peak airway pressure >40cmH20

Hypoxaemia

Inadequate ventilation

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33
Q

What steps should you take during a high airway pressure event?

A

Call for help and ask surgeons to stop stimulation

Identify a hands off leader and delegate roles

Turn FiO2 to 100%

Consider TIVA

Exclude ligh anaesthesia or inadequate relaxation

Switch to manual ventilation

Disconnect LMA/ETT from circuit and squeeze bag to assess if the problem is with the airway, breathing or circuit

If pressure is normal now problem is with the airway or breathing

If pressure is still raised problem is with the circuit

Ensure HME filter checked/excluded

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34
Q

What steps should you take if its an airway problem during a high airway pressure event?

A

Review position, check patency by passing suction catheter, consider change of device

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35
Q

What steps should you take if it’s a breathing problem during a high airway pressure event?

A

Review cause by examination

Listen to chest

Consider ultrasound or chest X-ray

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36
Q

What steps should you take if it’s a circuit problem during a high airway pressure event?

A

Ventilate with AMBU bag

TIVA

Review circuit

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37
Q

What common problems could cause a circuit to create high airway pressures?

A

Blocked HME filter

Water in circuit

Kinked/compressed

Valves sticky

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38
Q

What can cause airway or breathing problems?

A

Anaphylaxis

Aspiration

Abnormal anatomy

Bronchospasm

Blocked or displaced LMA/ETT

Inadequate depth of anaesthesia

Inadequate muscle relaxation

Malignant hyperthermia

Pneumothorax

Pulmonary oedema

atelectasis

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39
Q

What is atelectasis?

A

The collapse of part or all a lung

Caused by a blockage of the air passages [bronchus or bronchioles]

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40
Q

What are the signs of hypotension?

A

Unexplained drop in blood pressure refractory to initial treatment

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41
Q

Why is the solution SAGM added to RBC?
{Sodium
Adenine
Glucose
Manitol}

A

It extends the shelf life of RBC up to 42 days of increased functional viability

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42
Q

What steps should you take during a hypotension emergency?

A

Call for help and the resuscitation trolley

Identify a hands off leader and delegate roles

Turn FiO2 to 100% and consider reducing the anaesthesia depth

Check pulse, BP, ECG and equipment

If Bradycardia, Tachycardia or Cardiac Arrest see specific checklist

Open IV / Pressurised fluid bolus / consider blood products

Optimize venous return with Trendelenburg positioning / low PEEP

Vasopressor treatment

Mild hypotension - phenylephrine, ephedrine, metaraminol

Severe / refractory – adrenaline, noradrenaline or vasopressin

Identify cause of hypotension

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43
Q

What additional steps should be taken during a hypotension emergency?

A

Arterial line
CVC
ABG

Hourly urine output monitoring

Consider echo

Referral to ICU

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44
Q

What surgical events can cause a hypotension emergency?

A

Mechanical / surgical manipulation

Insufflation during laparoscopy

Retraction and vagal stimulation

Vascular compression

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45
Q

Can sepsis cause a hypotension emergency event?

A

Yes

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46
Q

What are the signs of hypoxia?

A

Low oxygen saturation <92% or cyanosis

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47
Q

What should you do during a hypoxia emergency?

A

Call for help

Identify a hands-off leader and delegate roles

Turn FiO2 to 100% at high gas flows

Confirm ETCO2 capnography and morphology

Confirm pulse oximeter position and patient colour

Hand ventilate and assess patient / circuit

Check;

Airway – Examine device +/- suction tube, laryngoscopy

Breathing – chest sounds, movement and lung compliance

Circulation – blood pressure, pulse and rhythm

Circuit – HME filter, tubing, one-way valves, anaesthesia machine

Depth and relaxation

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48
Q

What size are the connectors for a breathing circuit?

A

15mm and 22mm

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49
Q

Why is a breathing circuit corrugated?

A

Less prone to kinking and increased flexibility

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50
Q

What are the signs of laryngospasm?

A

Sustained closure of the vocal cords resulting I the partial or complete loss of the patients airway

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51
Q

What steps should you take during a laryngospasm emergency?

A

Call for help

Identify a hands off leader and delegate roles

Turn FiO2 to 100% at high gas flows

Stop any stimulation

If has LMA remove and clear airway using suction if needed

Apply mask, jaw thrust and CPAP 30Cm H20

+/- Oropharyngeal airway

Deeping anaesthesia using propofol

Relaxation using IV suxamethonium

Plan to intubate if sats are <92%

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52
Q

Can laryngospasm break with sufficient time and hypoxia?

A

yes

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53
Q

Does ongoing laryngospasm increase the risk of negative pressure pulmonary oedema, bradycardia, cardiac arrest and aspiration?

A

yes

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54
Q

What is the intubation dose of propofol for adults?

A

1-2mg/kg

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55
Q

What is the intubation dose for suxamethonium IV?

A

2mg/kg

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56
Q

What is the intubation dose for suxamethonium IM?

A

4mg/kg

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57
Q

How much propofol do you give to break a laryngospasm event?

A

20% of an induction dose 0.25-0.5mg/kg

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58
Q

What are the signs of local anaesthetic toxicity?

A

Sudden alteration in mental status

Tonic clonic seizure

Arrhythmias or cardiovascular collapse

Sinus bradycardia

Conductional blocks

Asystole

Ventricular tacharrthymias

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59
Q

What’s steps should you take for a local anaesthetic toxicity emergency event?

A

Stop giving the local anaesthetic

Call for help and the resuscitation trolley and intralipid

Identify a hands off leader and delegate roles

Turn FiO2 to 100%

Assess airway, breathing, circulation and treat accordingly

If haemodynamically unstable consider intralipid

Hyperventilation may be helpful

Treat seizures with propofol

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60
Q

What is the immediate bolus dose of 20% intralipid during a local anaesthetic emergency event?

A

1.5mg/kg over 1 minute [100ml for 70kg]

If remains unstable Repeat 2 more doses at 5-minute intervals max

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61
Q

What is the infusion dose of 20% intralipid?

A

15ml/kg/hr [1000ml/hr for 70kg]

If remains unstable double infusion rate

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62
Q

Is propofol a substitute for intralipid?

A

No

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63
Q

What can trigger a Malignant Hyperthermia?

A

Volatile anaesthetic agents

Suxamethonium

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64
Q

What are the signs for malignant hyperthermia?

A

Unexpected increase in ETCO2

Unexplained tachycardia

Unexplained tachypnoea

Arrhythmias

Prolonged masseter muscle spasm after suxamethonium

Hyperthermia is a late sign

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65
Q

What steps should you take during a Malignant hyperthermia emergency?

A

Call for help and the MH box / Trolley

Identify a hands off leader and delegate roles

Remove precipants

Stop volatile anaesthesia and start TIVA

Hyperventilate with 100% oxygen at high flow of 15L/min

Consider changing soda lime if quick and easy

Do not waste time changing the circuit, machine or filter if event is actively happening

Start dantrolene

Obtain and continue with the MH box cards

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66
Q

What are additional consideration steps to take during a MH event?

A

IV access, central line, arterial line

Blood tests every 30 minutes

Temperature probe and commence active cooling

Catheter – urine output aim should be 2ml/kg/hr

Discuss with ICU

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67
Q

How do you prepare the dantrolene?

A

20mg vial mixed with 60mls sterile water

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68
Q

What is the bolus dose of dantrolene?

A

2.5mg/kg [60kg = 8 vials]

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69
Q

How long after immediate treatment of dantrolene should you consider giving another repeat bolus?

A

10 minutes if still symptomatic

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70
Q

How does dantrolene work?

A

Dantrolene directly interferes with muscle contraction by decreasing calcium in muscle cells

preventing electrical impulses traveling to muscles and preventing muscle contractions

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71
Q

What complications can MH cause?

A

Acidosis – treat with hyperventilation, sodium bicarbonate

Arrhythmias

Disseminated intravascular coagulation [DIC] -abnormal blood clotting

Hyperkalaemia – high potassium levels in blood

Hyperthermia – cold fluids, ice

Hypotension – fluid bolus, vasopressor

Cardiovascular collapse and cardiac arrest

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72
Q

What are the signs of unstable tachycardia?

A

Shock

Syncope – loss of consciousness

Severe heart failure

Myocardial ischaemia [obstructed blood flow to heart]

Altered mental status

Heart Rate > 150 BPM

Mean arterial pressure <65

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73
Q

What are the signs of stable tachycardia?

A

Mean arterial pressure >65 and no adverse features

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74
Q

What steps should you take with a tachycardia emergency?

A

Call for help and the resuscitation trolley

Identify a hands off leader and delegate roles

Turn FiO2 to 100%

Stop surgery and perform DRABCDE review

Identify any reversible causes and tailor treatment to patient

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75
Q

What steps should you take with an unstable tachycardia emergency?

A

If conscious use gentle sedation

Cardioversion with synchronised shock

Review rhythm and confirm cardiac output

If problem persists repeat cardioversion up to 3 times

Amiodarone 300mg IV over 10-20 minutes

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76
Q

What steps should you take with a stable tachycardia emergency?

A

Review rhythm and check underlying causes

Arterial line and bloods

Consider drug treatment

Seek expert help from cardiology or ICU

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77
Q

How to set up a cardioversion with synchronised shock

A

Apply pads and select DEFIB

Select 50-150J energy

Press SYNC button

Check SYNC success – confirm marking ^ on R waves

Charge and deliver shock safely

If synchronisation not possible use high energy unsynchronised shocks

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78
Q

What is SVT?

A

Supraventricular tachycardia

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79
Q

What is PEA?

A

Pulseless electrical activity

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80
Q

When is amiodarone given and what dose?

A

After third shock for VF and VT that is unresponsive to shock delivery, CPR and vasopressor

300mg

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81
Q

How can you raise concerns of ideas during the crisis?

A

Your input may be crucial

Probe – make observation or ask clarifying question

Alert – suggest problem and offer possible alternative

Challenge – address person using their name, directly question plan or decision

Emergency – get their attention – say you must listen. Give direct order to avoid immediate harm to patient

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82
Q

What should your checks be during any crisis?

A

Oxygen delivery FiO2, FGF, bellows or bag moving

Airway – ETT or LMA patent

Breathing – Sats ETCO2 waveform, tidal volumes and rate

Circulation – Rate, rhythm, ischaemia, BP, Peripheries

Depth – MAC or TIVA value, BIS or entropy

Surgery – ask how is the operation going? Review blood loss

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83
Q

What does BCIS stand for?

A

Bone cement implantation syndrome

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84
Q

What are the patient signs of BCIS?

A

Hypoxia

Hypotension

Or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion

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85
Q

What are the 7 layers of tissue to cut through for a c-section?

A

Skin

Subcutaneous fat

Fascia

Muscle

Peritoneum

Uterus

Amniotic sac

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86
Q

What are the preliminary checks before starting a level 2 machine check?

A

Wash hands

Check bulk gas warning lights and medical gas alarm panel

Turn machine + monitor on

Check machine is plugged into a UPS

Check service dates on machine and patient monitor

Check scavenging is on, and ball float is in the green zone

Depress condenser drain

Check machine moves freely

Attack circuit and gas sampling line

Check sampling line and d-fend are clean and free of defects

Confirm gas analyser registers 21% +/- 3% oxygen

Check low oxygen alarm is set to 21%

Check Aladdin cassettes are full and ports are closed and locked in vaporiser bay and correct agent is identified on the ASD

Check AMBU bag

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87
Q

What does UPS stand for?

A

Uninterruptible power supply

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88
Q

What level should you replace the emergency reserve oxygen cylinder on the back of the anaesthetic machine?

A

<5000 kPa

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89
Q

Residual Current Device

A

An electrical device that monitors current leakage and shuts off if excess, unexpected current is detected

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90
Q

Line insulation Monitor

A

An electrical device that monitors a decrease in electrical resistance and alerts to any change

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91
Q

True or False: a small current may be sufficient to induce ventricular fibrillation

A

True

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92
Q

True or false: body protection is sufficient protection from micro shock

A

False

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93
Q

True or false: micro shock requires a conducting pathway to the heart

A

True

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94
Q

True or false: macro shock cannot cause ventricular fibrillation

A

False

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95
Q

True or false: Cardiac protection is sufficient protection from both micro shock and macro shock

A

True

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96
Q

An operating theatre should be equipped with electrical ________ protection

A

Cardiac

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97
Q

What is the size of the cylinder on our anaesthetic machines?

A

Size E

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98
Q

What is the pin index for medical air

A

1, 5

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99
Q

What is the pin index for oxygen?

A

2, 5

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100
Q

What is the pin index for nitrous oxide?

A

3, 5

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101
Q

What is the pin index for cardon dioxide

A

1, 6

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102
Q

What is the pin index for Entonox?

A

7

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103
Q

What cylinder has blue and white shoulders?

A

Entonox

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104
Q

What cylinder has black and white shoulders?

A

Medical Air

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105
Q

What cylinder has white body and white shoulders?

A

Oxygen

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106
Q

What cylinder has blue body and blue shoulders?

A

Nitrous oxide

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107
Q

What is the name for the combination of nitrous oxide and oxygen?

A

Entonox

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108
Q

What is the Bodox seal made of?

A

Neoprene

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109
Q

True or false – serial number is engraved on the medical gas cylinder BODY

A

True

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110
Q

True or false – owner identification is not engraved on the medical gas cylinder BODY

A

False

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111
Q

True or false – tare weight is engraved on the medical gas cylinder BODY

A

True

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112
Q

True or false – test pressure is on the medical gas cylinder SHOULDER LABEL

A

False

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113
Q

True or false – dangerous goods classification is listed on the medical gas cylinder SHOULDER LABEL

A

True

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114
Q

True or false – the gas content is not listed on the medical gas cylinder SHOULDER LABEL

A

False

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115
Q

True or false – manufacturers perform a visual endoscopic examination of cylinders

A

True

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116
Q

True or false – Manufacturers do not perform impact test on cylinders

A

False

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117
Q

True or false -tensile strength and/or bending tests are performed by the manufacturer

A

True

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118
Q

What are cylinders traditionally made of?

A

Molybenum Steel

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119
Q

After how many years of use must a cylinder be tested?

A

5

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120
Q

True or false – cylinder’s ability to not be flattened will be tested

A

True

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121
Q

Plasmalyte is ______ compared to body water

A

Isotonic

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122
Q

Sodium chloride 0.9% is ______ compared to body water?

A

Isotonic

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123
Q

0.45% sodium chloride is ______ compared to body water?

A

Hypotonic

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124
Q

What is the adult blood volume per kg in mls?

A

70

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125
Q

What is the paediatric blood volume per kg in mls?

A

80

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126
Q

True or false – hypotonic fluids might be used to treat diabetic ketoacidosis

A

True

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127
Q

True or false – Hypertonic fluids are not used in treatment of oedema

A

False

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128
Q

True or false – Albumin must be given through a pump set?

A

False

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129
Q

Fresh frozen plasma is used to treat coagulopathies and what other purpose?

A

increase circulating volume

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130
Q

Untreated haemorrhage or dehydration could lead to which of the 4H’s and 4T’s

A

Hypovolaemia

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131
Q

True or false – platelets are stored in the fridge

A

False

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132
Q

What is the micron size range for a blood filter?

A

170-200

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133
Q

Who is the universal blood donor?

A

O Negative

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134
Q

What does SAGM stand for?

A

Saline, adenine, glucose and mannitol

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135
Q

Who is the universal blood recipient?

A

AB positive

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136
Q

Who is the universal plasma donor?

A

AB

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137
Q

Who is the universal plasma recipient?

A

O

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138
Q

In normal use, how many units of blood should be given through a blood filter?

A

4

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139
Q

true or false – in a massive transfusion, it is acceptable to give more units than 4 through a filter

A

True

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140
Q

Can rhesus positive blood be given to rhesus negative patients?

A

No

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141
Q

What blood products should not be given in the same line as RBC’s

A

Platelets

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142
Q

A haemolytic transfusion reaction causes destruction of what?

A

Haemoglobin

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143
Q

What is the adult cardiac arrest adrenaline dose? Include units

A

1mg

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144
Q

What is the adult anapahylaxis adrenaline dose? Include units

A

0.5mg

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145
Q

What is the paediatric cardiac arrest adrenaline dose? mcg/kg

A

10 mcg/kg

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146
Q

What is the paediatric amiodarone cardiac arrest dose? mg/kg

A

5 mg/kg

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147
Q

What is the energy dose for paediatric defibrillation? J/kg

A

4 J/Kg

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148
Q

What is the energy dose for adult defibrillation?

A

200J

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149
Q

What is the intralipid bolus dose in ml/kg?

A

1.5ml/kg

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150
Q

Stridor is associated with inspiration or expiration?

A

Inspiration

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151
Q

Wheeze is associated with inspiration or expiration?

A

Expiration

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152
Q

true or false – albumin is included in the massive transfusion protocol

A

False

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153
Q

Which emergency causes tachycardia, hypotension, urticaria and bronchospasm?

A

Anaphylaxis

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154
Q

Which emergency causes visual disturbances, confusion, bradycardia and hypotension?

A

Local toxicity

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155
Q

What emergency causes tachycardia, tachypnoea, hypotension, and hyperkalaemia?

A

Malignant hyperthermia

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156
Q

Which medication can be used to increase potassium uptake in malignant hyperthermia, reducing hyperkalaemia?

A

Insulin

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157
Q

Which medication can be given to reduce metabolic acidosis in malignant hyperthermia?

A

c

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158
Q

True or false – nitrous oxide is a triggering agent for malignant hyperthermia

A

False

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159
Q

Which blood test is used to confirm anaphylaxis after the incident?

A

Tryptase

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160
Q

When should tryptase be taken after an anaphylaxis event?

A - Immediately and after 24 hours

B- 1 hour, 4 hours and 24 hours

C - Immediately, 2 hours and 6 hours

D - When I can be bothered doing a blood gas

A

B

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161
Q

MTP box 1 contains what?

A) 4 RBC, 4 FFP

B) 2 RBC, 2 FFP

C) 4 RBC, 4 FFP, 3 Cryo

D) 4 RBC, 4 FFP, 1 Platelets

A

B

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162
Q

MTP box 2 contains what?

A - 4 RBC, 4 FFP, 3 Cryo

B - 2 RBC, 2 FFP

C - 4 RBC, 4 FFP, 1 Platelets

D - 4 RBC, 4 FFP

A

A

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163
Q

MTP box 3 contains what?

A 2 RBC, 2 FFP

B 4 RBC, 4 FFP, 1 Platelets

C 4 RBC, 4 FFP, 3 Cryo

D 4 RBC, 4 FFP, 1 Cryo

A

B 4 RBC, 4 FFP, 1 Platelets

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164
Q

Which boxes are repeated in an MTP?

A - 1 & 2

B - 3 & 4

C - 1 & 4

D - 2 & 4

A

B

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165
Q

What are the 4 H’s related to an emergency?

A

Hypovolemia,

Hypoglycaemia/Hyperkalaemia,

Hypo/Hyperthermia,

Hypoxia

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166
Q

What are the 4 T’s related to an emergency?

A

Tension pneumothorax,

Tamponade,

Thrombosis,

Toxins

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167
Q

What does DRSABCD stand for?

A

Check for DANGER

Check for a RESPONSE

SEND for help

Check the AIRWAY

Check for BREATHING

Start CPR

DEFIBRILLATION

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168
Q

What does VIE stand for?

A

Vacuum Insulated Evaporator

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169
Q

What are 3 safety features of a Bulk Gas?

A

Colour coded Pipelines

Non-interchangeable screw thread hose

Colour coded wall connectors

Gas pressure and contents visible on the front of the machine

Second stage regulators: control pipeline pressure surges

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170
Q

Continuous Positive Airway Pressure, Propofol and Suxamethonium is textbook treatment for what emergency?

A - Bronchospasm

B - Laryngospasm

C - Difficult intubation

D - Anaphylaxis

A

B

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171
Q

Bronchospasm may be treated with:

A -Salbutamol via ETT or IV

B - Adrenaline

C - Volatile anaesthetics (increased MAC)

D - All the above

A

D

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172
Q

What are the 4 tests done on a reserve cylinder?

A

Internal endoscopic exam

Impact, Bend, and flattening test

Pressure test at 22000kPa

Tensile test: Strips cut and stretched

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173
Q

What are 5 labels on the reserve cylinder?

A

Name, Chemical and symbol

Substance identification number

Batch number

Hazards warning and safety instructions

Max contents (Litres)

Pressure

Cylinder size code

Storage and Handling

Filing date, shelf life and expiration date

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174
Q

What are 5 safety features of a flowmeter on the anaesthetic machine?

A

Gas knobs are colour coded for each gas

Oxygen knob is positioned on the left and is fluted and larger than the other knobs as it will now be easily recognised.

Oxygen is the last gas to be added to the common gas manifold

One knob for each gas

Each knob is calibrated for that specific gas

Doesn’t allow N2O to be given without O2

O bobbin will rise with N2O: anti-hypoxic device

Does not allow oxygen to have a concentration of less than 25% when giving N2O

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175
Q

What are 4 safety features of a vaporiser?

A

Colour coded

Vapour specific

Specific key filling port

Ani-spill/antipollution cap on bottles

Bottles only opens when full inserted into the vaporiser

Content window

Interlock system

Magnetic coding

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176
Q

What does MAC stand for?

A

Minimum alveolar concentration

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177
Q

What does APL stand for?

A

Adjustable Pressure limiting valve

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178
Q

What are 5 safety features of an anaesthetic machine?

A

Anti-static wheels

Colour coded pipeline

Recessed oxygen flush with spring loaded activation

Cover on the on/off switch to prevent accidental on/off

Anti-Hypoxic device

Oxygen failure alarm/nitrous cut off

Universal connectors for a breathing system are 22mm and 15mm

Scavenging has a different connector to breathing system which is 30mm

Back-up power supply

High pressure relief valve which prevents high airway pressure

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179
Q

What are the 5 must haves of monitoring during anaesthesia?

A

SpO2

EtCO2

Oxygen analyser

Agent Analyser

Ventilator alarms

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180
Q

What are the 10 patient rights?

A

Right to be treated with respect

Right to fair treatment and freedom from discrimination

Right to dignity and independence

Right to service of an appropriate standard

Right to be listened to and understood

Right to receive information: benefit and risks of treatment

Right to make informed choice

Right to support

Right to teaching and research

Right to complain

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181
Q

What is involved in the ‘Sign in’?

A

Confirm surgeon available

Before induction of anaesthesia, confirm with patient: Identity, Site and side, Procedure, Consent

Site marked or not applicable

Does the patient have: Known allergies, Difficult airway or aspiration risk, Risk of >500 ml blood loss recorded.

Anaesthesia safety checklist completed

Check and confirm prothesis/ special equipment to be used

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182
Q

What is involved in the ‘Sign out’

A

Verbally confirm with the team after final count:

The name of the procedure recorded

That instrument, needle, sponge, and other counts are correct

How the specimen is labelled (including patient name)

The plan for ongoing VTE prophylaxis

Whether there are any equipment problems to be addressed

Postoperative concerns/plan for recovery and management of this patient

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183
Q

What is CO2 measured in?

A

kPa and mmHg

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184
Q

What is side stream CO2?

A

Connected to adapter at patient end

Small increase of dead space

Time delay

Moisture trap

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185
Q

What is Mainstream CO2?

A

Sample chamber positioned within patient’s gas stream

Increased dead space

Heated to prevent condensation

No time delay

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186
Q

What are 7 features of an Endotracheal tube?

A

Radio opaque lines

Single use

Latex free

Sterile

Anatomical shape

Internal diameter on tube

Outer diameter on tube

Pilot balloon with self-seal valve

Low-pressure, high-volume cuff

Depth in CM

Black line to position vocal cords

PVC clear

15mm connector

Murph’s eye

Left bevelled edge

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187
Q

Five common causes of anaphylaxis?

A

Latex

Colloid

Antibiotics

Muscle relaxant

Chlorhexidine

Patient blue

sugamadex -[likelihood appears to be dose-related]

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188
Q

What are 5 symptoms of anaphylaxis?

A

Difficult/noisy breathing

Wheeze/Persistent cough

Swelling of the face and tongue

Swelling/tightness in the throat

Difficulty talking

Persistent dizziness/ loss of consciousness

Abdominal pain and vomiting

Hives, welt and body redness/rash

Hypotension

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189
Q

What are the signs and symptoms of Local Anaesthetic Toxicity?

A

Tingling on the lips and fingers, metallic taste, ringing in the ears, confusion, and dizziness

Convulsions and loss of consciousness

Hypotension, bradycardia, and respiratory arrest

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190
Q

What are the early signs and symaptoms of Malignant hyperthermia?

A

Prolonged muscle spasm after Suxamethonium

Tachycardia

Tachypnoea in a spontaneous breathing patient

Increased CO2

Cardiac arrhythmias

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191
Q

What are the Developing Signs and Symptoms of Malignant hyperthermia?

A

Rapid increase in temperature (0.5 degrees every 15 minutes)

Respiratory and metabolic acidosis

Hyperkalaemia

Profuse sweating

Decrease SpO2

Mottled skin

Cardiac instability

Muscular rigidity

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192
Q

What are the Late Signs and Symptoms of Malignant hyperthermia?

A

Cola coloured urine

Increase CK serum

Coagulopathy

Severe muscle ache

Cardiac Arrest

193
Q

What is the definition of Decontamination?

A

Process of removal of unwanted matter or infectious tissue on an object or area

194
Q

What is the definition of Disinfection?

A

Process of elimination of all or many micro-organisms not including spores

195
Q

What is the definition of Sterilisation?

A

Process of elimination of all micro-organisms including spores

196
Q

What is the definition of Contact precautions?

A

To prevent transmission of infectious agents which are spread by direct or indirect contact with a patient, their environment, or patient care items

197
Q

What is the definition of Droplet precautions?

A

Prevent transmission of infectious agents which are spread by close respiratory or mucous membrane contact with respiratory secretions

198
Q

What is the definition of Airbourne Precautions?

A

Prevent transmission of infectious agents that remain infectious over long distances when suspended in the air and are transmitted person to person by inhalation of airborne particles

199
Q

What are 4 methods of sterilisation?

A

Autoclaving

Ionising radiation

Dry heat

Ethylene oxide

200
Q

What is Moment 1 in the 5 Moments of Hand Hygiene?

A

Before patient contact

When: before approaching and touching a patient

Why: To protect the patient from harmful germs on your hands

201
Q

What is Moment 2 in the 5 Moments of Hand Hygiene?

A

Before performing a procedure

When: Immediately prior to performing a procedure

Why: To protect the patient from harmful germs, including their own from entering their body

202
Q

What is Moment 3 in the 5 Moments of Hand Hygiene?

A

After procedure or exposure to bodily fluid

When: Immediately are procedure or exposure of bodily fluid and after removal of gloves

Why: to protect you and the health care environment against harmful patient germs

203
Q

What is Moment 4 in the 5 Moments of Hand Hygiene?

A

After patient contact

When: Immediately after touching the patient and touching patient surroundings once leaving the patient’s side

Why: to protect you and the health care environment against harmful patient germs

204
Q

What is Moment 5 in the 5 Moments of Hand Hygiene?

A

After contact with patients’ surroundings

When: immediately after contact with objects that have been in the same area as the patient, even if you have not touched the patient

Why: to protect you and the health care environment against harmful patient germs

205
Q

What does TACO stand for and what is it?

A

Transfusion Related Circulatory Overload

Pulmonary oedema primarily caused by volume excess

Symptoms = acute respiratory distress, cough, pink sputum, decreased SpO2, nausea, pulmonary oedema, raised CVP.

206
Q

What does TRALI stand for and what is it?

A

Transfusion Related Acute Lung Injury

Repaid onset of excess fluid in the lungs.

Symptoms = acute respiratory distress, fever, bilateral infiltrates on chest

207
Q

What is Acute Haemolytic Transfusion Reaction

AHTR

A

A life-threatening reaction to receiving a blood transfusion that results from the rapid destruction of donor red blood cells by host antibodies (Can be delayed)

208
Q

HELLP

A

Haemolysis Elevated Liver Enzyme and Low Platelets

209
Q

HME

A

Heat, Moisture Exchange

210
Q

ESBL

A

Extended Spectrum Beta-Lactamase

211
Q

IPPV

A

Intermittent Positive Pressure Ventilation

212
Q

LIM

A

Line Isolation Monitor

213
Q

PEEP

A

Positive End Expiratory Pressure

214
Q

THJR

A

Total Hip Joint Replacement

215
Q

VSD

A

Ventricular Septal Defect

216
Q

MI

A

Myocardial Infarction

217
Q

RIC

A

Rapid Infusion Catheter

218
Q

SAH

A

Subarachnoid Haemorrhage

219
Q

TEG

A

Thromboaelastogram

220
Q

LMWH

A

Low Molecular Weight Heparin

221
Q

EUA

A

Examination under Anaesthesia

222
Q

CSE

A

Combined Spinal Epidural

223
Q

CLAB

A

Central line Associated Bacteraemia

224
Q

ITM

A

Intrathecal Morphine

225
Q

IVC

A

Inferior Vena Cava

226
Q

ASA

A

American Society of Anaesthesiologist

227
Q

DAS

A

Difficult airway Society

228
Q

GIK

A

Glucose, Insulin, Potassium

229
Q

AAA

A

Abdominal Aortic Aneurysm

230
Q

ACF

A

Activated Charcoal filters

231
Q

FiO2

A

Fraction Inspired Oxygen

232
Q

MRSA

A

Methicillin Resistant Staphylococcus Aureus

233
Q

PCA

A

Patient controlled Analgesia

234
Q

RAE

A

Ring, Adair, Elwyn

235
Q

TIVA

A

Total Intravenous Anaesthesia

236
Q

VT

A

Ventricular Tachycardia

237
Q

PPE

A

Personal Protective Equipment

238
Q

MUA

A

Manipulation under Anaesthesia

239
Q

NOF

A

Neck of Femur

240
Q

OSA

A

Obstructive Sleep Apnoea

241
Q

What is the relationship between standard preacautions and infection control?

A

Universal precautions are in place to prevent infections and contamination

Following standard precautions, we can minimise infection spreading which allows for better infection control

242
Q

Define microshock

A

A small electric current passing directly through the heart and directly sending the patient into ventricular fibrillation

243
Q

Define macroshock

A

Larger electrical current passes through the body

244
Q

What is the formula for estimating the size of both cuffed and uncuffed ETT for a paediatric patient?

A

Cuffed – age/4 + 3.5

Uncuffed age/4 + 4

245
Q

What is ROSC?

A

Return of spontaneous circulation

Generally detected by arterial pulse palpation and end tidal CO2 monitoring

246
Q

What is the triad of anaesthesia

A

Amnesia

Analgesia

Muscle relaxation

247
Q

What is sodalime composed of?

A

94% calcium hydroxide

5% sodium hydroxide

1% potassium hydroxide

248
Q

What is the flow rate of a 14g cannula?

A

Just gravity - 250ml/min

Pressurized – 380ml/min

249
Q

What is the flow rate of a RIC line?

A

1000ml/min

250
Q

What are some examples of colloid substances?

A

RBC

Albumin

FFP

251
Q

What are some crystalloid fluids

A

Heartmans

Sodium Chloride

Plasmalyte

Dextrose saline

manitol

252
Q

Do crystalloids have high or low cell permeability?

A

High

253
Q

Do colloids have high or low cell permeability

A

Low

254
Q

What temperature is FFP stored at?

A

-30’C

255
Q

What temperature is RBC stored at?

A

2- 6’C

256
Q

What are the signs and symptoms of a blood transfusion reaction?

A

Increased temperature

Hypotension

Tachycardia

Anaphylaxis

Elevated ventilation pressure

257
Q

List fractionated blood products available;

A

Plasma

Cryoprecipitate

Platelets

Immunoglobins

Albumin

Irradiated and leuko depleted red blood cells

258
Q

What are leukocytes and what is their main purpose?

A

White blood cells

Main immune system cell

259
Q

Name a depolarising muscle relaxant;

A

Suxamethonium

260
Q

Name non-depolarising muscle relaxants;

A

Rocuronium

Vecuronium

Atricurium

261
Q

What are the 5 R’s of drug administration?

A

Right drug

Right patient

Right dose

Right route

Right time

262
Q

What are some induction agents?

A

Propofol

Thiopentone

Etomidate

263
Q

What medications can provide analgesia?

A

Fentanyl

Alfentanil

Remifentanil

Morphine

Paracetamol

Parecoxib

264
Q

What are some antiemetics?

A

Ondansetron

Dexamethasone

265
Q

Define a half-life regarding medications;

A

It is the time taken for half of the drug to be broken down by biological processing

266
Q

Define agonist;

A

Is a chemical that binds to a receptor on a cell to cause activation thus causing a response

267
Q

Define antagonist;

A

A chemical substance that binds to and blocks the activation of receptors on cells preventing a biological response

268
Q

Define toxicity;

A

Chemicals or drug concentrations are at such high levels in the body that they can damage organs and tissues

269
Q

Define bioavailability;

A

The rate and extent to which the rate a drug is absorbed and reaches circulation

IV administration has a bioavilability of 100%

270
Q

State CVC insertion sites

A

Internal jugular

Subclavian vein

Femoral vein

271
Q

Why are patients in Trendelenburg for an internal jugular central line insertion?

A

To prevent causing an air embolism

To increase the cross sectional area of the jugular vein

272
Q

What pressure should a tourniquet be set to?

A

Inflated to above 100mmHg above systolic pressure for lower limbs

Inflated to above 50mmHg for upper limb

273
Q

What are some complications associated with tourniquet use?

A

Post tourniquet syndrome – 2-4 hours afterwards of muscle stiffness, weakness, paleness, joint stiffness and tingling sensation are experienced

Ischemia – necrosis

Pressure sores

Nerve damage

Compartment pressure syndrome

274
Q

Define scatter regarding radiation;

A

Radiation that spreads out in different directions from a radiation beam when it encounters an object or tissue

275
Q

What are three methods of radiation protection/

A

Time

Distance

Shielding

276
Q

Expand the acronym LASER

A

Light

Amplification

Stimulated

Emission

Radiation

277
Q

What items can contain latex in operating theatres?

A

Some surgical gloves

Some catheters and other tubing

Sticky tape or electrode pads

278
Q

What items can contain chlorhexidine in operating theatres?

A

Skin antiseptic wipes

Hand gels and hand wash solutions

Surgical skin disinfectants

Pre-surgery wash sponges and wipes

Lubricant preparations

Central venous lines

Surgical dressings and mesh

Mouth wash

279
Q

Regarding paediatric airways what is the position of the larynx, is it more anterior or posterior?

A

Anterior

280
Q

What is the normal heart rate range for a child?

A

70-160 BPM

281
Q

List four methods of heat loss;

A

Conduction

Convection

Radiation

Evaporation

282
Q

Why do children have a difficult time regulating their temperature?

A

They have thin skin and less body fat

High body surface area to volume ratio and loose heat quicker

They have a high metabolic rate which consumes more oxygen and energy

They are not as developed to develop shivering/vasoconstriction/piloerection/sweating.

283
Q

Outline the guidelines for fluid maintenance relating to body weight in paediatric anaesthesia;

A

0-10kg = 4ml/kg/hr

10-20kg = 2ml/kg/hr

> 20kg = 1ml/kg/hr

4-2-1 rule

284
Q

Do children require higher weight-adjusted doses of most medications compared to adults?

A

Yes

Children have higher rates of metabolism and elimination than adults which means they require a higher weight-adjusted dose of medication

285
Q

Define pharmacodynamics;

A

The study of the molecular, biochemical and physiologic effects and actions on the body

286
Q

Define pharmacokinetics;

A

The study of how the body interacts with administered substances for the entire duration of exposure

287
Q

What are the fasting requirements for children for surgery?

A

6 hours – milk and food

4 hours – breastmilk

2 hours – clear fluids

288
Q

List 5 different places a patient’s temperature can be measured from;

A

Nasal

Oral

Rectal

Catherter

Skin

Ear

289
Q

Explain the advantages and disadvantages of the use of a Jackson Rees modification of a T-Piece;

A

Low resistance with minimal dead space and acts as a manual ventilator

Allows for spontaneous breathing and controlled ventilation

No pressure relief valve

No scavenging

Inaccurate capnograhy

No rebreathing and requires higher fresh gas flow

290
Q

What is the formula for estimating body weight?

A

2 x [age x 4]

291
Q

What is the formula for estimating ET tube depth to both lips and nostril?

A

Lips - [age/2] + 12cm

Nasal - [age/2] + 15cm

292
Q

Discuss the immediate management of an airway fire;

A

Stop laser immediately

Turn O2 off

Call for help

Establish a hands-off team leader and delegate roles

Use saline swabs to put out fire

Get the fire extinguisher and fire blanket and attempt to extinguish the fire

Turn off medical gases and disconnect ventilator

Remove ETT and remove flammable material from airway

Pour saline into airway

After fire extinguished re-establish tube and reintubate and reestablish ventilation

Using AMBU bag with room air

Assess airway for injury

Emergency tracheostomy if intubation failed

293
Q

Define the coroner’s clot

A

Occult hidden clot of blood remaining in the nasopharynx behind the soft palate following surgery or trauma which can cause a fatal airway obstruction following extubation

294
Q

Define epistaxis;

A

nosebleed

295
Q

Give three medical reasons why a women might be offered a LSCS;

A

Birth Defects

Abnormal positioning

Chronic health conditioning

296
Q

What is a LSCS?

A

Lower segment caesarean section

297
Q

Give 5 reasons why a women would require an emergency LSCS

A

Prolonged labour

Foetal distress

Cord prolapses

Exhaustion

Placenta problem

298
Q

What is the reason for the 15’ left tilt for a LSCS?

A

Reduces aortocaval compression and inferior vena cava compression

299
Q

Define reaming;

A

Technique used with rotational cutting tools known as reamers. Used to remove cartilage from the acetabulum

300
Q

List equipment required for an intravenous regional block;

A

Double cuff tourniquet

Sterile preperation pack

IV access equipment

Standard monitoring

Local anaesthetic agent [lidocaine or prilocaine]

Fluids primed and ready

Emergency drugs available

Intralipid to treat local anaesthetic toxicity

Syringe and needles

301
Q

Define diagnosis of compartment syndrome;

A

Increased pressure in a confined space that causes significant pain and can decrease blood flow

302
Q

Discuss 3rd spacing in relation to fluid shifts during a major laparotomy;

A

3rd spacing describes the movement of bodily fluid from the blood into the spaces between the cells

This can lead to problems such as oedema, reduced cardiac output and hypotension

3rd space fluid shifts are calculated as 4-6ml/kg/hr which can be compensated with fluids

303
Q

Define anastomosis;

A

Surgical connection between two structures usually between tubular structures

304
Q

Define vasovagal;

A

Over activity of the vagus nerve resulting to a temporary fall in blood pressure, heart rate, fainting

305
Q

List common post operative complications;

A

Wound infection

Deep vein thrombosis

Pulmonary embolism

Lung pulmonary complications

Anaesthesia reaction

Shock

Nerve damage

Pressure sores

306
Q

Discuss first degree burn;

A

Effect the outer layer of skin – superficial

307
Q

Discuss second degree burn;

A

Involves the epidermis and part of the lower layer of skin - dermis

308
Q

Discuss third degree burn;

A

Destroys the epidermis and dermis

This may go into the subcutaneous tissue

309
Q

Discuss fourth degree burn;

A

Go through both layers of skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone

310
Q

Explain the rule of nines and how it is used to estimate the extent of a burn’s injury;

A

Dividing the bodies surface area into percentages to calculate the extent of the burns injury

Front + back of head and neck = 9%

Front + back of each arm = 9%

Chest = 9%

Stomach = 9%

Upper back = 9%

Lowerback = 9%

Front and back of each leg and foot 9% each side

Genital area = 1%

311
Q

Explain common complications associated with burns surgery;

A

Blood loss – debrided tissue bleeds freely

Hypothermia

Infection

Breathing problems

Fluid loss

Difficult placement of monitoring and IV

312
Q

Define GCS;

A

Glasgow coma scale

313
Q

Define ACVPU;

A

Alert

Confusion [new onset or worsening] confusion

Voice

Pain

Unresponsive

314
Q

What are the 3 consciousness ratings of the Glasgow coma scale?

A

Severe - 3-8

Moderate - 9 - 12

Mild - 13-15

315
Q

What are the 3 assessments for the Glasgow coma scale?

A

Eye opening

Spontaneous – 4
To sound – 3
To pressure – 2
None - 1

Verbal response

Orientated – 5
Confused – 4
Words – 3
Sounds – 2
None - 1

Motor response

Obey commands -6
Localising - 5
Normal flexion - 4
Abnormal flexion - 3
Extension - 2
None - 1

316
Q

State normal range of an ICP measurement;

A

5-12mmHg

317
Q

State normal range of a CVP measurement;

A

8-12mmHg

318
Q

Define CBF;

A

Cerebral blood flow

319
Q

State the relationship between CSF, CBF and ICP;

A

CSF, CBF, ICP are constant so an increase in one should cause a reciprocal decrease in one both remaining two

Vice versa

320
Q

Briefly explain the relationship between CPP, MAP and ICP

A

Cerebral perfusion pressure is the effective pressure that results in blood flow to the brain

CPP = Mean Arterial Pressure – Intracranial Pressure

321
Q

Define CPP;

A

Cerebral perfusion pressure

322
Q

Explain Cushing’s triad;

A

Refers to a set of signs that are indicative of increased intracranial pressure

Consists of bradycardia

Irregular respirations

Widened pulse pressure

Increase between systolic and diastolic pressure

323
Q

What muscle relaxant produces a rise in ICP and is commonly avoided for neurosurgical patients?

A

Suxamethonium

324
Q

Define RCD;

A

Residual control device

325
Q

What is the normal range for CO2?

A

35-45 mmHg

326
Q

List two reasons why the CO2 may be increasing?

A

Hypercapnia can be caused by;

Hypoventilation

Increased CO2 production such as a MH event

327
Q

What are some components of a VIE?

A

Thermally insulated double walled steel tank with a layer of perlite in a vacuum

Pressure regulators allow gas to enter a pipeline and maintain pressure of 410 Kpa

Safety valve opens at a pressure of 1700kpa

Control valves

328
Q

What size are the gas cylinders in a cylinder manifold?

A

Size J

329
Q

What are some safety features of a bulk gas?

A

Colour coded pipelines

Non-interchangeable screw thread hose

Colour coded wall connectors

Gas pressure and contents visible on the front of the machine

Second stage regulators which controls pipeline pressure surges

330
Q

Why might a pipeline fail?

A

High demand of oxygen

Fault in the Schrader valve connector

Fault in the manifold room

Broken/failure in the pipeline

331
Q

What markings are engraved on a cylinder?

A

Test pressure

Date the test was performed

Chemical symbol and name

Tare weight when empty

332
Q

What are the 4 tests performed on a gas cylinder?

A

Internal endoscopic exam

Impact, bend and flattening test

Pressure test at 22,000 kPa

Tensile test – strips cut and stretched

333
Q

What are some labelling featured on a gas cylinder?

A

Name, chemical symbol

Substance identification number

Batch number

Hazards warning and safety instructions

Max contents in litres

Pressure

Cylinder size code

Storage and handling

Filling date, shelf life and expiration

direction

334
Q

What are some safety features of a flowmeter?

A

Gas knobs are colour coded for each gas

Oxygen knob is always positioned on the left and is larger than the other knobs with a different tactile feel

Oxygen is the last gas to be added to the common gas manifold

Each knob is calibrated for that specific gas

Doesn’t allow N2O to be given without O2

O2 will rise with N2O – anti hypoxic device and ensures no less than 25% oxygen can be delivered when running N2O

335
Q

What are some types of anti-hypoxic devices?

A

Mechanical chain link

Pneumatic pressure sensitive device

Paramagnetic oxygen analyser

336
Q

What are some characteristics of an ideal vaporiser?

A

Performance is not affected by change in FGF

Low resistance to flow

Light weight and economical

337
Q

What are some characteristics of an ideal breathing system?

A

Simple and safe to use

Delivers intended inspired gas mix

Permits spontaneous manual and controlled ventilation

Use low fresh gas flow

Protects patient from barotrauma

Sturdy and light weight

Permits easy removal of gas

338
Q

What are some safety features of a breathing system?

A

High pressure relief valve

Soda lime changes colour when exhausted

Airways pressure gauge present

Breathing circuit 22mm and 15mm

339
Q

What does NIM stand for?

A

Neural integrity monitor

340
Q

What does the acronym HEAMP represent regarding bariatric airway set up?

A

H-hand hygiene

A – anaesthetic type

E - Environment positioning devices e.g. supports

M – level 2 or 3 machine check

P – sniffing the morning air position

341
Q

What does MALES BIT MOA represent?

A

M- mask, Magill’s
A – airway oropharyngeal, nasopharyngeal, Ambu bag, agent
L – laryngoscope, LMA
E – ET tube, emergency drugs
S – Suction under the pillow, syringe, stylet, stethoscope

B – Bag of fluid, bougie
I – IV cannulation
T – tapes, ties

M – Monitoring
O – oxygen cylinder
A – Accessory equipment – air warmers, infusion pumps, fluid warmer

342
Q

What is Einthoven’s triangle?

A

Used to determine the electrical axis of the heart in the frontal plane

343
Q

What are some considerations for an elective case for a type 1 diabetic patient?

A

First on the list to minimise starvation time

Stop short and immediate acting insulin on morning of surgery

Test blood sugars on arrival to hospital

344
Q

What is a LIM?

A

Line isolation monitor

Detects leakage of current within equipment however, instead of cutting off the power supplied

345
Q

Define AHTR

A

Acute haemolytic transfusion reaction

346
Q

Define asepsis;

A

It is a process in which microbial agents on a living surface are either killed or their growth is arrested

347
Q

Define antiseptic;

A

These are the substances applied on the living tissues to reduce the possibility of infection and growth of microorganisms

348
Q

Define aseptic processing;

A

It is defined as the processing and packaging of sterile product into sterilised containers followed by proper sealing with sterilised closure in a manner to control microbiological recontamination

349
Q

Define microorganism;

A

Microscopic organisms which may exist in its single celled form or in a colony of cells

350
Q

Define pathogen;

A

A pathogen is a tiny living organism such as a bacterium or virus that can produce disease in an individual

351
Q

Define disinfection;

A

Antimicrobial process to remove, destroy or deactivate microorganisms on surfaces or in liquids

352
Q

Define decontamination;

A

The process by which a person or a surface is made free from all the agents that contaminate the surface and lead to the surface and lead to the spread of infection

353
Q

Define cleaning;

A

It is the process of removing all forms of foreign material by employing the mechanical action of washing or scrubbing

354
Q
A

Defibrillator Proof

355
Q
A

Double insulation

356
Q
A

Protection Earthing

357
Q
A

Equipotential Earthing

358
Q
A

Body Protected

359
Q
A

Cardiac Protected

360
Q
A

Hazard

361
Q
A

Radioactive/ X-Ray

362
Q
A

Biohazard

363
Q
A

Oxidising

364
Q
A

Explosive

365
Q
A

Corrosive substance

366
Q
A

Dangerous for the environment

367
Q
A

Flammable

368
Q
A

Toxic

369
Q
A

AED

370
Q
A

Sterilised by Ethylene Oxide

371
Q
A

Lot Number

372
Q
A

Manufacturer Date

373
Q
A

Expiry Date

374
Q
A

MRI Safe

375
Q
A

MRI unsafe

376
Q
A

Laser

377
Q
A

Reference Number

378
Q
A

Sterilized by Radiation

379
Q
A

Single use only

380
Q
A

Conforms to European standards

381
Q
A

Keep Dry

382
Q
A

Contains Latex

383
Q
A

Consult Instructions

384
Q
A

Non-Sterile

385
Q
A

Autoclavable

386
Q
A

Storage Temperature Range

387
Q
A

Storage Humidity range

388
Q
A

Protect from sunlight

389
Q
A

Mapleson A

390
Q
A

Mapleson B – rebreathing circuit

391
Q
A

Mapleson C – rebreathing circuit

392
Q
A

Mapleson D

393
Q
A

Mapleson E – valveless breathing system

394
Q
A

Mapleson F – valveless breathing system

395
Q

What Position is this? Risks and Considerations.

A

Supine

Risks: Pressure points including heels, scapula, or vertebrae. Neural injuries caused by flexion and extension

Considerations: Padding to the heels, elbows, and spine. Ensure occiput alignment of the hips and legs are parallel and are not crossed over. Ensure that the arm boards are at a less than 90-degree angle and are the height of the bed.

396
Q

What Position is this? Risks and Considerations.

A

Prone

Risk: Compression on the eyes and forehead. Kink age or disconnection of tube. Decrease chest movement, genital torsion and pressure injuries to the knees and feet.

Considerations: ensure that the head support is padded, and the eyes are free and that there is easy access to the tube. Place chest roll supports to free up the chest area to allow chest movement and decrease abdominal pressure. Keep genitals free and place pillows underneath the knees and feet.

397
Q

What Position is this? Risks and Considerations.

A

Lithotomy

Risk: Hip and knee damage due to over extension and flexion. Pressure injuries on the lumbar and sacrum region, restricted diaphragm movement, crushing of digits due to equipment and poor venous flow to the legs.

Consideration: Place the stirrups at even height and elevate the legs slowly and simultaneously. Padding on the spin and protection of the hands to prevent crushing. Place hands on the side or on arm boards and not on chest as this will increase the restrictive chest movement.

398
Q

What Position is this? Risks and Considerations.

A

Lateral

Risk: bony prominences on knees and ankles and pressure on the dependant axilla, risk of neural injuries if neck and spine are not in alignment.

Considerations: Place a pillow in between the knees and the ankles. Place an axillary roll on the dependant axilla and maintain spinal alignment during surgery and ensure that the ear is free

399
Q

Is this arterial waveform normal, under or over damped?

A

Normal

400
Q

Is this arterial waveform normal, under or over damped? And what can cause it?

A

Overdamped

Loose connections

Air bubbles

Kinks

Clots

Spasms

No volume or low pressure in pressure bag and tubing

401
Q

Is this arterial waveform normal, under or over damped?

A

Underdamped

Increased vascular resistance

Hypothermia

tachycardia

Excessive movement of the catheter within the artery leading to false high systolic or a false low diastrolic pressure

402
Q

What is this capnography trace?

A

Oesophagus intubation

Low level ETCO2 that quickly tapers off

403
Q

What is this capnography trace?

A

ETT in the right main bronchus

Irregular plateau the initial right lung ventilation followed by CO2 escaping from the left lung

Sometimes it can appear as normal capnography

404
Q

What is this capnography trace?

A

Bronchospasm

Due to delayed exhalation often seen in airway obstruction

COPD

Asthma exacerbation

405
Q

What is this capnography trace?

A

Normal waveform

406
Q
A

Sudden loss of waveform

407
Q

What is this capnography trace?

A

CPR

408
Q

What is this capnography trace?

A

ROSC

Return of spontaneous circulation

409
Q

What is this capnography trace?

A

Hypoventilation

Low respiratory rate

High EtCO2 value

410
Q

What is this capnography trace?

A

Airway obstruction or apnoea

Interrupted breaths

411
Q

What is this capnography trace?

A

Hyperventilating

High respiratory rate and relatively low EtCO2

412
Q

What is this capnography trace?

A

Apnoea

413
Q

What is this capnography trace?

A

Mechanical airway obstruction

414
Q

What is this capnography trace?

A

Reversal of alveolar slope in emphysema

[emphysema is one of the diseases that comprises COPD]

415
Q

What is this capnography trace?

A

Cardiac oscillations

416
Q

What is this capnography trace?

A

The curare cleft

Patient making an attempt to breathe

417
Q

What is this capnography trace?

A

Recirculated CO2 due to saturated CO2 absorber

418
Q

What is this capnography trace?

A

Tube displacement

Airway obstruction

Loss of circulatory function

419
Q

What is this capnography trace?

A

Hypoventilation

Increasing ETCO2

Caused by;

decreasing respiratory rat

Decreased in tidal volume

Increase in metabolic rate

Rapid rise in body temperature

420
Q

What is this capnography trace?

A

Hyperventilation

Decreasing ETCO2

Caused by;

Increase in respiratory rate

Increase in tidal volume

Decrease in metabolic rate

Fall in body temperature

421
Q

What is this ECG trace?

A

Sinus Arrhythmia

422
Q

What is this ECG trace?

A

Normal sinus Rhythm

423
Q

What is this ECG trace?

A

Sinus tachycardia

424
Q

What is this ECG trace?

A

Sinus bradycardia

425
Q

What is this ECG trace?

A

Paroxysmal supraventricular tachycardia PSVT

Rate changes abruptly and unexpectedly

426
Q

What is this ECG trace?

A

Ventricular tachycardia

427
Q

What is this ECG trace?

A

Ventricular Fibrillation

428
Q

What is this ECG trace?

A

asystole

429
Q
A

Contains phthalates

430
Q
A

Mapleson circuits

431
Q

What is an ectopic heartbeat?

A

An ectopic heartbeat is a type of arrhythmia that occurs when your heart contracts too soon

Fells as though your heart has skipped a beat or is racing all of a sudden

Most of the time they are harmless

Atrial ectopic

Ventricular ectopic

432
Q
A

type b applied part

433
Q
A

type bf applied part

434
Q
A

Defibrillation proof type B applied part

435
Q
A

Defibrillation proof type BF

436
Q
A

Pyrogenic

437
Q

List two drugs used for gastric emptying;

A

Ranitdine

Metoclopromide

sodium Citrate

438
Q

why is oxytocin given in an obstetric case and what is the infusion dose?

A

Oxytocin prevents excessive postpartum bleeding by helping the uterus contract.

The medication works immediately when given IV

40IU Oxytocin in a 500 ml saline bag running at 125 ml/hr for 4 hours

439
Q

What medication is commonly given for preeclampsia?

A

Magnesium sulfate

440
Q

what is preeclampsia?

A

pregnancy complication characterised by high blood pressure

441
Q

why should GTN spray be available in an obstetric theatre?

A

GTN is a smooth muscle relaxant and vasodilator

442
Q

what is the correct position for a lower segment caesarean section?

A

supine

15’ left lateral tilt until baby is gone

gels under feet

side support

armboards out on a 90’

to reduce aortocaval compression

to reduce inferior vena cava compression

443
Q

List this type of surgical anatomy location;

Nephro

A

Kidney

444
Q

List this type of surgical anatomy location;

Derma

A

Skin

445
Q

List this type of surgical anatomy location;

Laryngo

A

Layrnx

445
Q

List this type of surgical anatomy location;

Oophro

A

Ovary

446
Q

List this type of surgical anatomy location;

Oculo

A

Eye

447
Q

List this type of surgical anatomy location;

Salpingo

A

Fallopian tubes

448
Q

List this type of surgical anatomy location;

Gastro

A

Stomach

449
Q

List this type of surgical anatomy location;

Orchid

A

Testicles

450
Q

List this type of surgical anatomy location;

Thoracic

A

Chest

451
Q

List this type of surgical anatomy location;

Pneumo

A

Lungs

452
Q

List this type of surgical anatomy location;

Cysto

A

Bladder

453
Q

List this type of surgical anatomy location;

Hyster

A

Uterus

454
Q

List this type of surgical anatomy location;

Colpo

A

Vagina

455
Q

List this type of surgical anatomy location;

Myo

A

Muscle tissue

456
Q

List this type of surgical anatomy location;

Angio

A

blood vessel

457
Q

Arthr

A

Joint

458
Q

Colono

A

large intestine / colon

459
Q

Encephal

A

Brain

460
Q

Lamino

A

Laminar

461
Q

Rhino

A

Nose

462
Q
A

Do not enter

463
Q

What are the side effects of suxamethonium?

A

Bradycardia

Hypotension

Increased intracranial / Intraocular pressure

MH

464
Q

What are three side effects of suxamethonium?

A

Neurosurgery due to increase in intracranial pressure is not ideal

Muscular disorders

MH history

465
Q

PS03 - What is the purpose for the guidelines for the ANZCA PS03 management of major regional analgesia?

A

to facilitate management of major regional blocks including major regional blocks including;
epidural, subarachnoid, plexus and nerve blocks

to reduce the likelihood of adverse outcomes and complications which may be associated with such nerve blocks including;
cardiovascular collapse, seizures, hypotension, allergic reactions, ventilatory impairment, impaired consciousness, infection and nerve damage

466
Q

PS03 - what are some principles of the PS03 management of major regional analgesia?

A

Requires a medical practioner
systems and protocols to eliminate complications
informed consent
appropriate assistance
environment consistent with PS55
infection control
coagulation status
IV access prior to regional anaesthesia
monitoring BP, RR, consciousness ECG available, if sedating use O2 source EtCO2 and SpO2
Block time out; name, site and reconfirm this prior to needle insertion
procedure list to remain available
can delegate to another practioner
record and document technique, drug, dose
protocols and procedure to continue post op

467
Q

PS03 - what are some equipment required for the PS03 management of a major regional analgesia?

A

Ultrasound
nerve simulator
Liquid emulsion; Intralipid

468
Q

PS08 - what is the purpose of the ANZCA document PS08 statement of assistant for anaesthetist?

A

to recognize the importance of and to promote the development of quality assistants to the anaesthetist and to guide training of assistants

Scope - applies whenever there is a GA, regional or local / sedation is administered by an anaesthetist

469
Q

PS08 - what are some principals of the PS08 statement of assistant for anaesthetist

A

present of a trained assistant to the anaesthetist during the preparation, induction, maintenance and conclusion of anaesthesia

service which ensures equipment is available, clean, maintained and serviced

staff properly trained assistance must be wholly and exclusively responsible to that anaesthetist

informed consent
informed on risks of sedation of decreased airway patency and decreased RR
patient assessment
staffing
facilities and equipment; ambu bag, ability to call for help, adequate lighting, ability to tild head down, sharps bin, stethoscope, suction, tourniquet/IV equipment, monitoring, emergency airway equipment, emergency drugs

470
Q

what are the guidelines on sedation on analgesia?

A

to optimise patient care in the management of procedural sedation

to identify the competencies that sedationists should possess

Minimal sedation; a drug induced state during which patients respond purposefully to verbal commands or light tactile stimulation

moderate sedation; a druge induced state of depressed consciousness during which patients retain the abilityt to respond purposefully to verbal commands and tactile stimulation

deep sedation; a druge induced sate of depression consciousness during which patients are not easily roused and may respond only to noxious stimulation

471
Q

PS18 - What is the purpose of PS18 monitoring during anaesthesia?

A

The purpose of this guideline is to guide practioners on monitoring standards that should be applied to clinical management in order

monitoring defined as observing and checking progress and quality over a period of time

472
Q

what are the 5 must haves of monitoring?

A

SpO2
EtCO2
oxygen analyser
agent analyser
ventilator alarms

monitoring available; ECG, NIBP, NMT, EEG, temp, invasive monitoring,

Circulation where arterial pulse is checked every 10 minutes
Ventilation is continuously monitored
Oxygenation observe the colour of the patient with adequate lighting

473
Q

PS54 - what are 10 minimum safety requirements for an anaesthetic machine?

A

Pin index
Reserve oxygen supply
Non-interchangeable gas hose connectors both inlet and outlet
Gas supply line and cylinder pressures displayed on front of machine
Oxygen failure alarm - generates automatically, cuts off gas supply except air or oxygen cant be cancelled until supply restored above preset pressure
Oxygen must enter gas manifold last and be the first knob from the left on the rotameter
One gas flow knob per gas
Mechanical knob is tactically different from other gas knobs
No less than 25% oxygen can be delivered in the presence of N2O
a vaporiser interlock system must prevent more than one from being used at a time
Vapour can only be increased by turning dial anti-clockwise
Fresh gas outlet must have an outer diameter of 22mm and inner 15mm
High pressure relief valve must be present
Gas scavenging connection must be a different diameter than other breathing systems - 30mm
Monitor alarm functions must activate automatically
High priority high airway pressure alarm
High priority low airway pressure alarm - less than 10cmH20 for more than 1 second
Emergency oxygen flush cannot be unintentionally activated
On/Off switch should not be unintentionally activated or deactivated
Backup power supply should be present and permit at least 30 minutes of operation

474
Q

PS55 minimum facilities for anaesthesia in OT or other location

A

The minimum requirements to be provided by healthcare facilites when designing upgrading and equipping and staffing clinical areas where anesthesia is delivered

Anaesthesia delivery system capable of delivering measure oxygen flow
Calibrated vaporisers for inhalation agents
Infusion devices capable of giving an intravenous anaesthetic
Range of suitable breathing system
Separate means of inflating the lungs
Oxygen source independent of the anaesthetic machine
Exclusive suction

475
Q

PS55 what are 10 things that must be present in every location for anaesthesia?

A

Appropriate PPE
Stethoscope
Monitoring
Range of face mask
OPA and NPA
LMA / SAD device
ET tube and connection
Two laryngoscope blades
Range of tube introducers
Syringe
Magills
Tapes
Scissors
Tourniquet
IV cannualation equipment
IV infusion equipment
Sharps bin
Equipment for savanging

476
Q

PS55 what must be available in every location for anaesthesia?

A

Managing difficult intubation
Automatic ventilation
Rapid infuser
Arterial line and central line
Cool the patient
Regional block
Safe positioning

Additionally;
Appropriate lighting
Ability to communicate
Refrigeration facilities
Mean maintaining room temperature
Patient trolley and slide equipment with a minimum of 3 people

477
Q

Health and disability patient rights - What are the 10 patient rights?

A

Right to be treated with respect
Right to fair treatment and freedom from discrimination
Right to dignity and independence
Right to service of an appropriate standard
Right to be listened to and understood
Right to receive information benefit and risks of treatment
Right to make informed choice
Right to support
Right to teaching and research
Right to complain

NZATS Registration Exam study flash cards (8 decks)

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