Exam 1 Flashcards
(156 cards)
1
Q
Equalization of pressure throughout the arterial system; increased R-handed filling and CO; decreased HR and peripheral vascular resistance
A
Horizontal Cardiac
2
Q
Gravity increases perfusion of dependent (posterior) lung segments; abdominal viscera displace diaphragm cephalad. Spontaneous ventilation favors dependent lung segments, while controlled ventilation favors independent (anterior) segments. Functional residual capacity decreases and may fall below closing volume in older patients.
A
Horizontal Respiratory
3
Q
Activation of baroreceptors, generally causing decreased CO, peripheral vascular resistance, HR, and BP.
A
Trendelenburg Cardiac
4
Q
Marked decreases in lung capacities from shift of abdominal viscera; increased ventilation/perfusion mismatching and atelectasis; increased likelihood of regurgitation.
A
Trendelenburg Respiratory
5
Q
Increase in ICP and decrease in cerebral blood flow because of cerebral venous congestion; increased intraocular pressure in patients with glaucoma.
A
Trendelenburg Other
6
Q
Preload, CO, and arterial pressure decrease. Baroreflexes increase sympathetic tone, HR, and peripheral vascular resistance.
A
Reverse Trendelenburg Cardiac
7
Q
Spontaneous respiration requires less work; functional residual capacity increases.
A
Reverse Trendelenburg Respiratory
8
Q
Cerebral perfusion pressure and blood flow may decrease
A
Reverse Trendelenburg Other
9
Q
Autotransfusion from leg vessels increases circulating blood volume and preload; lowering legs has opposite effect. Effect on BP and CO depends on volume status.
A
Lithotomy Cardiac
10
Q
Decreases vital capacity; increases likelihood of aspiration
A
Lithotomy Respiratory
11
Q
Pooling of blood in extremities and compression of Abdominal muscles may decrease preload, cardiac output, and blood pressure
A
Prone Cardiac
12
Q
Compression of abdomen and thorax decreases total noncompliance and increases work of breathing
A
Prone Respiratory
13
Q
Extreme head rotation may decrease cerebral venous drainage and cerebral blood flow
A
Prone Other
14
Q
Cardiac output unchanged unless venous return obstructed (kidney rest). Arterial blood pressure my fall as a result of decreased vascular resistance (R side> L side)
A
Lateral Decubitus Cardiac
15
Q
Decreased Volume of dependent lung; Increased perfusion of dependent lung. Increase ventilation of dependent long in awake patients (no mismatch); Decreased dilation of dependent long anesthetize patients (mismatch). Further decreases and dependent long ventilation with paralysis is in an open chest.
A
Lateral Decubitus Respiratory
16
Q
Pulling blood in lower body decreases central blood volume. Cardiac output and arterial blood pressure falls bike rides and heart rate and systemic vascular resistance.
A
Sitting Cardiac
17
Q
When the volume is in functional Residual capacity increase; work up breathing increases
A
Sitting Respiratory
18
Q
Cerebral blood flow decreases
A
Sitting Other
19
Q
Positions with complication of air embolism?
A
Sitting
Prone
Reverse Trendelenburg
20
Q
Positions with complication of alopecia?
A
Supine
Lithotomy
Trendelenburg
21
Q
Positions with complication of backache?
A
Any
22
Q
Positions with complication of compartment syndrome?
A
Lithotomy
23
Q
Positions with complication of corneal abrasion?
A
Prone
24
Q
Positions with complication of digit amputation?
A
Any
25
Positions with complication of nerve palsies for brachial plexus?
Any
26
Positions with complication of nerve palsies for common peroneal?
Lithotomy
| Lateral decubitus
27
Positions with complication of nerve palsies for radial?
Any
28
Positions with complication of nerve palsies for ulnar?
Any
29
Positions with complication of nerve palsies for retinal ischemia?
Prone
| Sitting
30
Positions with complication of nerve palsies for skin necrosis?
Any
31
How to prevent brachial plexus?
Avoid stretching or direct compression at neck or axilla
32
How to prevent common peroneal?
Pad lateral aspect of upper fibula
33
How to prevent radial?
Avoid compression of lateral humerus
34
How to prevent ulnar?
Padding at elbow, forearm supination
35
How to prevent retinal ischemia
Avoid pressure on globe
36
How to prevent skin necrosis?
Padding over bony prominences
37
How to prevent air embolism?
Maintain venous pressure above 0 at the wound
38
How to prevent alopecia?
Normotension, padding, and occasional head turning
39
How to prevent backache?
Lumbar support, padding, and slight hip flexion
40
How to prevent compartment syndrome?
Maintain perfusion pressure and avoid external compression
41
How to prevent corneal abrasion?
Taping and/or lubricating eye
42
How to prevent digit amputation?
Check for protruding digits before changing table configuration
43
Common adverse events related to anesthesia (5):
```
Vomiting
Nausea
Sore throat
Incisional site pain
Emergence delirium (peds)
```
44
Physical examination of airway (5):
```
Mouth opening
Loose or problematic dentition
Limitations in neck range of motion
Neck anatomy
Mallampati presentations
```
45
Full visibility of tonsils, uvula, and soft palate
class 1 of mallampati
46
Visibility of hard and soft palate, upper portion of tonsils and uvula
Class 3 mallampati
47
Soft and hard palate and base of uvula are visible
Class 3 mallampati
48
Only hard palate visible
Class 4 mallampati
49
Clear liquids NPO
2 hours
50
Breast milk NPO
4 hours
51
Infant formula NPO
6 hours
52
Non-human milk NPO
6 hours
53
Light meal NPO
6 hours
54
Full meal NPO
8 hours
55
Medications to stop taking for surgery (6):
```
Anticoagulants
Oral hypoglycemias
Monoamine oxidase inhibitors
Certain anti-hypertensive agents
Beta blocker therapy
Non-prescribed, herbal, vitamins
```
56
DAMMIS
```
Drugs
Airway
Machine
Monitor
IV
Suction
```
57
Delays in inducing anesthesia (5):
```
Slow arm-brain circulation (elders)
CVD
Patient anxiety
Recreational drug use
Extravasation (leak in fluids)
```
58
Does Propofol, a non-barbiturate IV anesthetic have less postoperative nausea and vomiting and more rapid, clear-headed recovery?
Yes
59
Why include time of draw up on label?
Because can be a medium for rapid bacterial growth if not handled using meticulous aseptic precautions
60
What should be done if person, for anatomical reasons, are likely to be difficult to intubate?
Use a flexible or rigid video scope or another advanced airway tool
61
Indications for ETT (5):
Potential air contamination (full stomach, GERD, GI or pharyngeal bleeding)
Predictable difficulty with ETT or airway access (later or prone)
Surgery of mouth or face
Prolonged procedure
Need muscle relaxant
62
Succinylcholine is not degraded by AChE so it remains in NM junction to cause continuous end plate depolarization and subsequent muscle relaxation
Phase I block
63
How is Succinylcholine metabolized?
By plasma cholinesterase (pseudocholinesterase)
64
Why is there muscle flaccidity rather than tetany following fasciculations from Succinylcholine in phase I block?
Ca+ is removed from muscle cells cytoplasm independent of repolarization and as Ca+ is taken up by the sarcoplasmic reticulum, the muscle relaxes
65
What factors affect plasma cholinesterase? (7)
```
Pregnancy
Liver disease
Kidney failure
Heart failure
Thyrotoxicosis (excessive thyroid hormone)
Cancer
Number of other drugs
```
66
Sux’s can cause uncontrolled increase in skeletal muscle oxidative metabolism that overwhelms the body’s capacity to supply oxygen, remove CO2, and regulate body temp (leading to circulatory collapse and dead
Malignant Hyperthermia (MH)
67
How is MH treated?
Dantrolene sodium
68
What can important agents, including sevo cause?
Neurotoxic to the developing brain
| -cause neurobehavioral abnormalities long term
69
Are FGF less than 2 L/mm recommended?
No
70
Minimal rest of the patient independent of the anesthesia
Little to no blood loss
Done an office setting
Category one
71
Minimal to moderately invasive procedure
Blood loss Less than 500 cc
Mild risk to patient
Category two
72
Moderately to significantly invasive procedure
Blood loss 500 to 1500Cc
Moderate risk to patient
Category three
73
Highly invasive procedure
Blood loss greater than 1500Cc
Major risk to patient
Category four
74
Highly invasive procedure
Blood loss greater than 1500Cc
Critical risk to patient
Postop ICU
Category five
75
A normal healthy patient
ASA 1
76
Patient with mild systemic disease with no functional limitations (Hypertension, tobacco, age, DM)
ASA 2
77
A patient with severe systemic disease that results in functional limitations (uncontrolled HTN or DM with vascular complications, MI)
ASA 3
78
Patient with severe systemic disease that is a constant threat of life (CHF, angina, pulmonary dysfunction, ESRD (end stage renal disease))
ASA 4
79
Patient who is not expected to survive without the operation (ruptured AAA, PE, head injury with ICP)
ASA 5
80
Organ procurement on a brain dead patient
ASA 6
81
Patient on whom an emergency procedure is required
E
82
When should stop Street/illegal drugs?
72 hours
83
When should stop alcohol?
48 hours
84
When should stop tobacco?
24 hours
85
Symptoms for malignant hyperthermia? (10)
```
Hypercarbia
Tachycardia
Tachypnea
Hyperthermia
HTN
Cardiac dysrhythmias
Hypoexmia
Hyperkalemia
Skeletal muscle rigidity
Myoglobinuria
```
86
Diagnosis test for MH
Halothane-caffeine contracture test
| Future - genetic testing of ryanodine receptor
87
What does pseudocholinesterase do?
Breaks down ACh
88
Ischemic Heart Disease (4)
Age (male 45 female 55)
Family history of premature CHD (male 55 female 65)
Current smoker
HTN
89
Your blood pressure and pulse rate drops in normal levels how long after last cigarette?
20 min
90
Circulation improves and lung function increases by after 30% and breathing becomes noticeably easier after how long of last cigarette?
2-12 weeks
91
Risk of heart disease drops half that of a current smoker after how long of last cigarette?
Within a year
92
Death rate from lung cancer for the average former pack a day smoker decrease by almost 50% how long after last cigarette?
5 years
93
Death rate from lung cancer is similar to that of a non-smoker after how long of a cigarette?
10 years
94
Risk of heart disease is the same as that of a non-smoker after how long of last cigarette?
15 years
95
No dyspnea while walking at a normal pace
Grade 0
96
Able to walk as far as I like provided I take my time
Grade 1
97
Specific Street block limitations
Grade 2
98
Dysnpea on mild exertion
Grade 3
99
Dyspnea at rest
Grade 4
100
4 D’s of airways evaluations
Dentition
Distortion
Disproportion
Dysmobility
101
Patient fully extend neck and measure distance from mandible to thyroid notch (3fingers)
Thyromental distance
102
3 axis of airway?
Axis of cavity of mouth (oral)
Axis of cavity of pharynx (pharyngeal)
Axis of larynx and trachea (laryngeal)
103
What joint is being measured when patient flex and then extension neck? (>35degrees)
Atlanto-axial joint mobility
104
Difficulties of mouth opening (6):
```
Less than 2 fingers between teeth
Loose teeth
Protruding upper teeth
High arched palate
Long narrow mouth
TMJ problems
```
105
Difficult mask ventilation (OBESE+)
```
Obese
Bearded
Elderly (55)
Snorers
Edentulous
Thick neck
Sleep apnea
BMI >30
```
106
<18.5 BMI
Underweight
107
18.5-24.9 BMI
Normal
108
25-29.9 BMI
Overweight
109
30-34.9 BMI
Obesity
110
35-39.9 BMI
Morbid obesity
111
>40 BMI
Extreme obesity
112
Systolic sound heard over the carotid artery area that may occur as result of carotid artery stenosis
Carotid bruit
113
Testing neurological extremities:
Hand grip
Head lift
Numbness
Tingling
114
Normal Na level:
135-145
115
Normal K levels
3.6-5.2
116
Normal Cl levels
96-106
117
Normal Co2 level
23-29
118
Normal BUN levels
7-20
119
Normal Cr levels
.84-1.21
120
Normal Glu levels
100 after 8 hours of fasting
| 140 after 2 hours of fasting
121
Normal WBC level
4500-11000
122
Normal Hgb level
Men: 13.5-17.5
Women: 12-15.5
123
Normal Hct level
Men: 38.3-48.6
Women: 35.5-49.9
124
Normal PLT level
150,000-450,000
125
measures the integrity of the extrinsic system as well as factors common to both systems
Prothrombin Time (PT)
126
measures the integrity of the intrinsic system and the common components
Partial Thromboplastin Time (PTT)
127
calculation based on results of a PT and is used to monitor individuals who are being treated with the blood-thinning medication (anticoagulant) warfarin
international normalized ratio (INR)
128
makes it harder for your clots to break up
Factor 5 Leiden
129
fibrinogen functions in helping to form a blood clot. Measures the amount of fibrinogen in the blood
Fibrinogen level
130
What is anesthesia (6):
```
Analgesia
Amnesia
Immobility
Unconsciousness
Skeletal muscle relaxation
Block autonomic responses (BP HR)
```
131
What are the 5 monitors:
```
BP
Pulse ox
EKG
Temp
ETCO2
```
132
3-3-2 rule
Mouth opening of 3 fingers
Mental and hyoid bone of 3 fingers
Thyroid cartilage to hyoid bone of 2 fingers
133
```
Between initial administer of induction meds and loss of consciousness:
Conscious
Voluntary movements
Sense of unreality
Increased sense of hearing
```
Stage 1 analgesia (induction phase)
134
```
Loss of consciousness and marked by excited and delirious activity:
Uncontrolled movements
Pupillary dilation
Irregular respirations, HR
Breath holding
Vomiting
Delirium
Stimulation
Respond violently (peds)
```
Stage 2 Excitement (delirium stage)
135
Return of regular respiration’s:
Plane 1-return of regular respiration’s to the cessation of REM
Plane 2-cessation of REM to onset of paresis of intercostal muscles
Plane 3-onset to complete paralysis of intercostal muscles
Plane 4-from paralysis of intercostal, the patient will be apneic
Stage 3 surgical (operative phase)
136
```
Toxic or danger stage:
Impending death
Dilated and non reactive pupils
Hypotension
Bradycardia
Complete circulatory arrest
```
Stage 4 overdose (Bulbar paralysis)
137
Who do you RSI? (7)
```
No NPO
Trauma victims
Unknown NPO
Long-standing DM
Pregnant 9-12weeks (morning sickness)
GERD
Morbidly obese
```
138
How much pressure for cricoid pressure (selleck’s maneuver) is applied?
20-44N (2-3kg)
139
Less time to perform
Rapid onset
Better quality motor and sensory block
Less pain during surgery
Advantages to spinal:
140
Lower risk of PDPH
Slower onset of hypotension
Controlled, prolonged analgesia with indwelling catheters
Postoperative analgesia
Advantages to epidural:
141
Failure of block
Decrease in systemic BP
Patient awake +/-
Disadvantages to spinal/epidural
142
```
Hypovolemia
Increased ICP
Coagulopathy (thrombocytopenia)
Sepsis
Infection at cutaneous puncture site
Preexisting neurological disease
Patient refusal
```
Spinal/epidural contraindications
143
3 pillars of documentation:
Legibility
Consistency
Accuracy
144
Initial preop anesthesia assessment was done to the time the patient arrives for surgery there must be no longer than...
48 hours time limit
145
Repeated regularly and frequent lay in steady rapid succession
Continually
146
Prolonged without any interruption at any time
Continuous
147
Charting drugs/doses must have order:
Drug
Dose
Route (IV,IM,SubQ)
Time
148
2 lights to analyze hemoglobin (1 red of 650 and 1 infrared of 950)
Pulse ox
149
SeXy DARLing...
At SiX hundred, wavelength Deoxy hb Absorbs Red Light
150
BP reading too high and error can be as much as 50mmHg
Undersized BP cuff
151
Low BP reading because...
Too large BP cuff
152
MAC awake:
Volatile: .3MAC
N2O: .6MAC
153
MAC-BAR (blunt the autonomic response)
1.6MAC
154
MAC-EI (prevent laryngeal response to ETT)
1.3MAC
155
What is the fluids 4-2-1 rule?
```
100kg= 40 (bc 4x10)+20 (bc 2x10)+80 (bc 1x80)= 140cc/hr
20kg= 40 (1x10) + 20 (2x10) + 0= 60cc/hr
```
156
Pathologic state of DM affect the airway management:
May decrease mobility of atlanto-occipital joint
