DDx Flashcards
1
Q
DDx: Bradycardia
A
- ↑ ICP
- Cardiac: MI or conduction block
- Hypoxemia
- Hypercarbia/acidosis
- Carotid pressure
- Overdose, βBlockers/anesthetic
2
Q
DDx: Jaundice
A
- Unconjugated: Hemolysis, Crigler/Gilbert
- Conjugated: Biliary tract obstruction, DJ/Rotors
- Viral hepatitis will ↑ both
3
Q
DDx: Mental Status Change in PACU
A
- Pain
- Preexisting Dz
- BMP: ↓Glucose, ↓Na, Uremia, ↑Ca2+
- Medications (narcotics, Ketamine, Scopolamine, Steroids)
4
Q
DDx: Oliguria
A
- Prerenal: Hypovolemia (most common); myocardial failure secondary to infarction, PE, tamponade, CHF; renal artery/vein occlusion secondary to thrombosis, embolism, stenosis, ACE inhibitors
- Renal: ATN, Nephritis, contrast die, malignant HTN
- Postrenal: Ureter stones, Foley kink, ureter injury
5
Q
DDx: Vent Overbreathing
A
- Hypercarbia/Hypoxemia
- Pain/insufficient plane of anesthesia
- Medication or infiltration of paralytic
6
Q
DDx: Postop Stridor
A
- Airway edema
- Hematoma
- b/l RLN injury
- Tracheomalacia
- Laryngospasm, HypoCa2+
7
Q
DDx: PreOp Hypertension
A
- Pain
- Hypoxemia/Hypercarbia
- Fluid Overload
- Essential HTN
- Drugs- MAOis, TCAs, cocaine/meth, not taking anti-hypertensive
- Dz: Pheo, Autonomic Hyperreflexia, Auto Dysfxn
8
Q
DDx: Pulsous Paradoxus
A
Definition: Inspiratory drop of systolic (10mmHg)
- Tamponade
- PE
- RV Failure
9
Q
DDx: Trismus
A
- Pain/light anesthesia
- Excessive SCh
- Ca2+ abnormality
- MH, Myotonic dystrophy
10
Q
DDx: Wheezing
A
- Bronchospasm
- Aspiration
- Allergic/Anaphylactic Rxn
- Airway obstruction
- ARDS/pneumonia
- Pulmonary embolism
- Pulmonary edema/volume overload
- Left heart failure (leading to pulmonary edema)
- Pneumothorax
11
Q
DDx: ↑ ETCO2
A
SO METH
- Stuck valve
- Overfeeding
- MH
- Exhausted CO2 soda lime
- Thyroid storm
- Hyperthermia
12
Q
DDx: ↓ ETCO2
A
- Kinked Tube
- Disconnect
- Cardiopulmonary collapse
13
Q
DDx: Delayed Emergence
A
- Hypoxemia, Hypercarbia
- Residual Anesthetic: volatiles, opioids, benzos, IV, NMBs
- Metabolic: Hypoglycemia, Hyponatremia, DKA
- Hypothermia
- Neuro: global ischemia (not usually focal stroke), cerebral edema
14
Q
DDx: Acute ↓ SpO2 / hypoxemia
A
- Low FiO2
- Hypoventilation:
- ↓Vt or RR, pt bucking ventilator
- Bronchospasm, laryngospasm
- Pulmonary edema
- Circuit leak
- Kinked ETT
- Mainstem intubation or accidental extubation - Residual NMBD, narcotic, anesthetic
- Cardiovascular:
- Arrhythmia
- CHF
- pHTN
- Embolus: PE, fat, air, AFE
- Hypotension - V/Q mismatch or shunt
- Pneumothorax
- Atelectasis
- Mucous Plug
- Pleural effusion
- Aspiration - Diffusion abnormality
- Increased O2 demand
- MH
- Thyrotoxicosis
- Sepsis
- Hyperthermia
- NMS
15
Q
DDx: ST-depression
A
- NSTEMI
- non-infarction subendocardial ischemia (unstable angina)
- Digoxin use (usually with short QT and prominent U waves)
- Hypokalemia
Note: elevated cardiac enzymes differentiates NSTEMI from unstable angina
16
Q
DDx: Post-Op Vision Loss
A
- Corneal abrasion: worsened by blinking, foreign object sensation
- Acute glaucoma: severe/diffuse periorbital pain, dry/pale eye, dilated pupil
- Glycine Toxicity: dilated/non-reactive pupils, otherwise normal exam
- Cortical blindness: unilateral or bilateral; absent optokinetic nystagmus; absent response to visual threat
- Hemorrhagic retinopathy: aka “valsalva retinopathy”; retinal edema, hemorrhages, and “floaters”
- Retinal ischemia: branch and central retinal artery occlusion; painless vision loss
- Ischemic optic neuropathy (anterior or posterior): painless visual loss, afferent pupil defect, visual field defects, or complete visual loss
17
Q
DDx: pre-op stridor (PEDS)
A
- Epiglottitis
- Foreign body
- Peritonsillar abscess
- Pharyngitis
- Pharyngeal abscess
18
Q
DDx: Hyperthermia
A
- Neuroleptic malignant syndrome
- Thyroid storm (no rigidity)
- Pheochromocytoma (no rigidity)
- Cocaine (no severe acidosis)
- Sepsis (no HTN or hypercarbia)
19
Q
DDx: increased PVR
A
- Hypercarbia/acidosis
- Hypoxia
- Light anesthesia
- Catecholamine surge
- Hypothermia
20
Q
DDx: HTN in Pregnancy
A
- Pre-E: >140/90 with proteinuria OR signs of end-organ dysfunction at >20 weeks gestation
- Chronic HTN: HTN at < 20 weeks gestation
- Gestational HTN: HTN without proteinuria or end organ dysfunction at >20 weeks gestation
- Drug use (cocaine, methamphetamine)
21
Q
DDx: Pacemaker Loss of Capture
A
- Myocardial ischemia
- E- abnormalities (K, Ca, Mg can increase threshold)
- Lead failure
- Acid-Base disturbances
22
Q
DDx: Postpartum Hemorrhage
A
- Uterine atony
- Uterine rupture
- Placenta accreta
- Coagulopathy
- Retained placental parts
23
Q
DDx: Seizure in Preeclampsia
A
- Ecclamptic seizure
- Hypoglycemia
- Hypotension / Hypoxia
- Amniotic fluid embolism
- Intracranial hemorrhage
- Local anesthetic toxicity (if epidural placed)
24
Q
DDx: Pulmonary Edema
A
Cardiogenic:
- Heart failure
- CAD / MI
- Valvular disease
- Cardiomyopathy
Non-Cardiogenic:
- Aspiration
- Neurogenic pulmonary edema
- Negative pressure pulmonary edema
- ARDS / TACO / TRALI
- Pulmonary embolism
- Allergic reaction
25
DDx: Acute hypotension in the trauma bay
1. Hemorrhagic shock
2. Neurogenic shock (c- and upper-t-spine injury)
3. Tension pneumothorax
4. Cardiac tamponade
5. Fat embolism from long bone fracture
6. Anaphylaxis
7. Abdominal compartment syndrome
26
DDx: Masseter Muscle Rigidity
1. SCh-induced MMR (overdose)
2. Undiagnosed myotonic syndrome
3. TMJ dysfucntion
4. Undiagnosed muscular dystrophy
5. MH reaction
Note that masseter muscle spasm can range from mild (trismus) to severe (rigidity). Rigidity is more likely associated with MH.
27
DDx: Hypotension after induction
The timing of hypotension suggests the cause may be:
1. Excessive anesthesia
2. Hypovolemia
3. Dysrhythmia
4. Anaphylactic reaction (NMBD or Abx)
5. Myocardial ischemia / heart failure
6. Valvular abnormality (if present)
7. Autonomic neuropathy (diabetes)
8. Rx (eg the patient took lisinopril day of surgery)
9. Tension pneumothorax (if stem suggests possibility)
10. Brain herniation -> autonomic dysfunction (if stem suggests it)
28
DDx: Delayed emergence following intracranial surgery
1. Hematoma
2. Tension pneumocephalis (esp posterior fossa surg)
3. Cerebral edema
4. Cerebral ischemia/infarction
5. Hypoxia
6. Hypercarbia
7. Seizure
8. Obstructive hydrocephalus
9. Other DDx associated with routine anesthetic
29
DDx: increased airway pressure
- PE
- Bronchospasm
- PTX
- Pulmonary Edema
- Pleural Effusion
- Pulmonary aspiration
- Intraperitoneal insufflation
- Kinked ETT
- Stuck expiratory valve
- Mucous Plug
- Chest wall rigidity (narcotic or ↓paralytic)
- Abdominal compartment syndrome, abdominal insufflation
30
DDx: Seizure
- Epilepsy
- Intracranial hemorrhage or mass lesion
- Elevated ICP / cerebral edema
- Local anesthetic toxicity*
- Drug effect
- Hypoglycemia, hypernatremia, hypomagnesemia
- Hypoxemia / hypercarbia
- Alcohol withdrawal
- Syncope or TIA may look like seizure to an observer
31
DDx: syncope / sudden loss of consciousness
- Neuro: Seizure, stroke, intracranial hemorrhage/mass, viral encephalopathy
- Cardiac: arrhythmia, cardiac arrest, vasovagal, orthostatic hypotension, hypoxia/hypercarbia
- Endo: hypoglycemia, hyperglycemia, electrolyte
32
DDx: Laryngospasm
1. Light anesthesia
| 2. Blood, secretions, debris or pain in the distribution of the superior laryngeal nerve
33
DDx: Wide-Complex Tachycardia
1. Ventricular Tachycardia (VT): more likely if pt age >35, hx of structural or ischemic heart disease, previous MI, CHF, cardiomyopathy, family hx of sudden death. Can be monomorphic or polymorphic (tDP). More likely if fusion/capture beats or AV dissociation is seen.
2. SVT with abberancy due to ΒBB: EKG shows BBB pattern
3. SVT with abberancy due to WPW: previous EKG show evidence of WPW (short PR, broad QRS, delta wave)
4. AFib/Flutter/ATach with abberancy (due to WPW, will be irregular)
5. Ventricular Fibrillation
34
DDx: Suspected AFE (what could look like AFE but isn't)
1. Eclampsia
2. Hemorrhage
3. Air embolism
4. Aspiration
5. Anaphylaxis
6. PE
7. Cardiomyopathy/Valvular abn/MI
8. LAST
9. Total Spinal
35
DDx: Hypotension
Rapidly Lethal causes: hemorrhage, vasodilators, tension pneumothorax, anaphylaxis, cardiac event, pneumoperitoneum, IVC compression.
1. Decreased preload: hypovolemia/hemorrhage, arrhythmias, IVC compression, embolism (air, fat, AFE, blood), pneumothorax, tamponade, venodilators
2. Low SVR: vasodilation (Rx, neuraxial block), shock, sepsis, endocrine abnormalities, adrenal insufficiency
3. Decreased contractility: medications, low EF, myocardial ischemia, valvular disease, increased afterload, hypoxemia/hypercarbia, anesthetic toxicity
4. Low HR: vagal stimulus
36
DDx: Acute IONM changes
* True cerebral or spinal cord ischemia/infarct
* Hypotension
* Extremes of hypoxemia or hypercarbia (change in O2 delivery)
* Hypothermia
* Increased volatile anesthetic depth
* Positioning (if it affects blood supply)
37
DDx: Hs and Ts
* Hypoxia
* Acidsosis (H+)
* Hypovolemia
* Hyper/hypokalemia
* Hypothermia
* Tamponade (cardiac)
* Tension pneumothorax
* Toxins (drugs)
* Thrombosis (coronary or pulmonary)
38
DDx: ↓ SpO2 during OLV
* Atelectasis
* Malpositioned ETT
* Mucous/blood plug
* Low FiO2 leading to HPV in dependent lung
* High mean airway pressures (peep, hyperventilation, peak inspiratory pressures)
* PE
* Vasoconstrictors
