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apa 1 /sim S. Horvath > complications > Flashcards

complications Flashcards

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1
Q

anesthesia related death rate

A

1 per 100,000

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2
Q

awareness rate

A

.2-.4%

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3
Q

which 3 settings are associated with awareness

A

major trauma, obstetrics, cardiac surgery

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4
Q

amnesia MAC when gas is used alone

A

0.8-1

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5
Q

amnesia MAC when gas is used with opioids and N2O

A

.6

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6
Q

scopolamine has what kind of effect

A

retrograde amnesia

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7
Q

most common eye injury

A

corneal abrasion

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8
Q

most common cause of post op loss of vision

A

ischemic optic neuropathy

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9
Q

ischemic optic neuropathy

A

optic nerve infarction due to decreased oxygen delivery via one or more arterioles supplying the optic nerve

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10
Q

ION is commonly reported after which surgeries

A

cpb, radical neck dissection, and and hip procedures, spinal surgeries in prone

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11
Q

contributing patient factors to ION

A

htn, DM, CAD, smoking

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12
Q

3 positions that compromise venous outflow

A

prone, head down, compressed abd

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13
Q

onset of ION

A

immediately and through 12 post op day

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14
Q

prevention of ischemic optic neuropathy: enhance venous outflow by positioning the patient

A

head up

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15
Q

belly button is at the level of

A

T10

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16
Q

xiphiod is at the level of

A

T7

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17
Q

nipple is at the level

A

T4

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18
Q

pinky is at the level of

A

C8/T1

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19
Q

treatment for hearing loss after spinal anesthesia

A

blood patch

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20
Q

4 types of hypersensitivity reactions

A

type 1 immediate, type 2 cytotoxic, type 3 immune complex, type 4 delayed, cell-mediated

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21
Q

anaphylaxis

A

exaggerated response to an allergen that is mediated by a type 1 hypersensitivity reaction

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22
Q

anaphylaxis appears within

A

minutes of exposure

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23
Q

prevention of ION - minimize ___ constriction

A

abd

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24
Q

prevention of ION: limit degree and duration of ___

A

deliberate hypotension

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25
prevention of ION: avoid ___ (think blood)
anemia
26
s/s prior to cv arrest
gradual decline in HR/BP. bradycardia, hypotension, cyanosis
27
cardiac accelerators are
T1-T4
28
when you place a spinal in the low back first you will get ___ problems
cardiac
29
3 drugs for CPB arrest after spinal
ephedrine, atropine, epi
30
what causes hearing loss after spinal
CSF leak
31
what do you treat hearing loss due to csf leak with
blood patch
32
what is an allergic reaction
eggaterated immunologic response to antigenic stimulation a previously sensitized individual
33
antigen or allergen is typically
a protein, a polypeptide, or smaller molecule that is covalently bound to a carrier protein
34
first exposure in anaphylactic reaction what happens
antigen - b cell- IgE binds to surface of mast cell
35
second exposure of antigen
causes the cell to release histamine and histamine increases the permeability and distention of the blood capillaries
36
allergic reaction: pt can lose up to 50% of ___ volume into the ____ space
intravascular , extravascular
37
type 1 immediate allergic reaction
atopy, urticaria, angioedema, anaphylaxis
38
type 2 cytotoxic allergic reaction
hemolytic transfusion reactions, autoimmune hemolytic anemia, heparin induced thrombocytopenia,
39
type 4 delayed, cell-mediated
contact dermatitis
40
latex is type
4
41
graft rejection is type
4
42
RA is type
3
43
blood type incompatibilities is type
2
44
anaphylaxis presents as
acute resp distress and/or circulatory shock
45
incidence of anaphylactic reactions during anesthesia
1:500 to 1:25000
46
mediators of anaphylaxis
histamine, leukotrienes, BK-A, platelet-activating factor
47
CV anaphylaxis
hypotension, tachycardia, arrhythmias
48
anaphylaxis pulmonary
bronchospasm, cough, dyspnea, pulm edema, laryngeal edema, hypoxia
49
dermatologic manifestation of anaphylaxis
uticaria, facial edema, pruritis
50
anaphylactoid reactions
resemble anaphylaxis but doe not depend on IgE antibody interaction with antigen (pt doesnt have to be exposed to the antigen prior)
51
4 risk factors associated w hypersensitivity to anesthetics
female, atopic history, preexisting allergy, previous anesthetic exposure
52
treatment of anaphlaxis - epi dose
0.01-0.5mg IV or IM
53
treatment of anaphlaxis - drugs
diphenhydramine (H1 blocker),Ranitidine (H2 blocker), hydrocortisone or methylpred
54
what are the most common cause of anaphylaxis during anesthesia
muscle relaxants
55
what is the mechanism for allergic reaction to muscle relaxants
anaphylaxis - IgE antibody directed against tertiary or quaternary ion epitope
56
hypotic agent that cause allergic reaction
pentothal propofol
57
ester local anesthetic allergic reaction
IgE mediated, share common antigenicity with PABA
58
amide local anesthetic allergic reaction
paraben or methylparabel
59
second most common cause of anaphylaxis d/t anesthesia
latex
60
foods that cross react with latex
mango, kiwi, chestnut, avocado, passion fruit and banana
61
how do you pre-treat someone for latex allergy
h1 and h2 histamine
62
occurane of MH in bed
1:15,000
63
occurrence of MH in adult
1: 40,000
64
MH causes what acid bace imbalance
metabolic acidosis
65
signs of Mh -jaw
masseter spasm
66
electrolyte imbalance in MH
hyper K, NA, Phos, CK, myoglobinemia, myogloinuria
67
late sign of MH -
core temp rise 1 degree C every 5 min
68
MH hyperkalemia caused by
efflux of K from muscle cells and systemic acidosis
69
drug that trigger MH
halogenated agent and depolarizing muscle relaxant (succs)
70
dantrolene doe
2.5mg/kg
71
max dose of dantrolene
10mg
72
how to treat hyperkalemia
dextrose 25-50g IV, regular insulin 10-20units IV
73
what does insulin do to K
forces it into the cell
74
albuterol in treatment of hyperk
beta 2 agonist, pushes K into the cell
75
bicarb
pushes K back into cell
76
how does dantrolene work
interfere with muscle contraction by binding ryr1, inhibit CA ion release from sarcoplasmic reticulum
77
side effects of dantrolene
muscle weakness, resp insufficiency, risk of aspiration, phlebitis
78
larynogospasm
complete spasmodic closure of the larynx as a consequence of an outside stimulus. closer of the glottis as a result of reflex obstruction of the laryngeal muscles
79
complete larynogospasm
silent paradoxical movement of the chest, tracheal tug, and no ventilation
80
partial larynogospasm
crowing noise
81
laryngospasm treat with
deepen patient, CPAP
82
signs of bronchospasm
prolonged expiration, high inflation pressures, exp wheezes, decreased O2 sat
83
increasing circuit pressure is a sign of
bronchospasm
84
wheezing is a sign of
bronchospasm
85
bronchospasm best tx with
anesthetic gas
86
bronchospasm tx med
epi, albuterol
87
3 things on the fire triangle
heat, fuel, oxygen
88
maximum acceptable trace concentration of N20
<25ppm
89
maximum acceptable trace concentration of N20 and halogenated agent
<25 ppm and 0.5HA
90
maximum acceptable trace concentration of halogenated agent only
~2 ppm
91
inverse square law
amt of radiation changes inversely with the square of the distance.
92
exposure at 4m will be ___ of that at 1m
1/16
93
maximum occupational whole body exposure annually is
5rem/year
94
maximum occupational whole body exposure annually is
5rem/year
95
sensory innervation (afferent) apex
SNL internal
96
motor innervation (efferent)
SLN external + RLN
97
bronchospasm will give you prolonged
expiration
98
bronchospasm will give you high ___ presures
inflatoin
99
STPC
standard color, tall man lettering. technology (scanning), pharmacy (pre-mixed/pre-filled), culture (nonpunative)

apa 1 /sim S. Horvath (17 decks)

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