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Intro To AA > Exam 3- Dan's Jazz > Flashcards

Exam 3- Dan's Jazz Flashcards

(75 cards)

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1
Q

Who has higher incidence of awareness under GA?

A

Children

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2
Q

What are the 9 risk factors for having awareness under GA?

A
  1. Routine use of paralytics
  2. TIVA
  3. Production pressure
  4. Hemodynamic instability
  5. Obstetric/Cardiac/Trauma
  6. Patient age
  7. Difficult airway
  8. Limited cardiac reserve
  9. Substance abuse
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3
Q

What type of substance abuse is a risk factor (3)

A

Chronic ETOH
Anxiolytics
Cocaine

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4
Q

Experiences with awareness during GA and percentages (4)

A

Audio (48%)
Not being able to breath (48%)
Pain (30%)
PTSD (30%)

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5
Q

4 classes of etiologies for patient awareness:

A

Class 1: pt specific altered increase in anesthetic receptors
Class 2: pt can’t tolerate anesthetic
Class 3: pt hemodynamics mask awareness
Class 4: anesthetic delivery failure

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6
Q

Hemodynamic; 5 typical indicators of physiologic and motor response:

A
  1. High BP
  2. HR
  3. Movement
  4. Lacrimation
  5. Dilated pupils
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7
Q

Major criteria for high risk awareness under GA (7):

A
  1. Longer term use of narcotics/ETOH/cocaine
  2. EF <40%
  3. H/O anesthesia awareness
  4. H/O difficult airway
  5. ASA 4/5
  6. Aortic stenosis/ open heart surgery
  7. End stage lung disease
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8
Q

Minor criteria to be high risk of awareness under GA (4)

A
  1. Periop use of Beta Blockers
  2. COPD
  3. BMI >30
  4. Tobacco 2 packs/day
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9
Q

Prevention for awareness under GA (5)

A
  1. Premed with versed
  2. Frequent machine checks
  3. Insure pt is asleep prior to intubation
  4. Concerned when giving BB or antiHTN
  5. Avoid paralysis unless needed
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10
Q

Is assist-control ventilation (ACV) desirable for patients who breathe rapidly, why?

A

NO because may induce both hyperinflation and respiratory alkalosis

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11
Q

Each breath is either an assist or control breath, bu they are all of the same volume

A

Assist control ventilation (ACV)

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12
Q

Guarantees a certain number of breaths, but pt breaths are partially their own, reducing the risk of hyperinflation or alkalosis

A

Synchronized intermittent-mandatory ventilation (SIMV)

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13
Q

Disadvantage of SIMV:

A

Increased work of breathing and tendency to reduce CO (which prolong ventilator dependency)

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14
Q

Which ventilator should be used for pt who has LV dysfunction:

A

ACV

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15
Q

When is pressure-control ventilator preferred:

A

Pt with neuromuscular disease

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16
Q

Variation of CPAP that releases pressure temporarily on exhalation that results in high average airway pressures

A

Airway pressure release ventilation

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17
Q

Does APRV require more or less sedation?

A

More

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18
Q

Volume target backup is added to a pressure assist-control mode

A

Pressure regulated volume control (PRVC)

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19
Q
  • Clinician sets the percentage of work of breathing
  • Positive feedback loop
  • Compliance and resistance calculated using intermittent end-inspiratory and end-expiratory Pasteur maneuvers
A

Proportional assist ventilation

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20
Q

Low levels of PEEP are most dangerous in with pts:

A

Hypovolemia and cardiac dysfunction

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21
Q

PEEP is indicated clinically for (3):

A
  1. Low volume ventilation cycles
  2. FiO2 requirements >.60 (stiff, diffuse lay injured lungs; ARDS)
  3. Obstructive lung disease
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22
Q

Who do you NOT use PEEP on?

A

Pneumonia; affect healthy tissue and worsen oxygenation

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23
Q

How to see effect on PEEP?

A

Peak inspiratory pressure (PIP)

-if PIP increases less than added PEEP=PEEP improved compliance of lungs

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24
Q

Ways PEEP can be monitored (2)

A

PIP

PaO2/FiO2 ratio (increase)

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25
Prone ventilation may improve what?
Oxygenation by redistributing pulmonary blood flow
26
When is prone not good?
Neurosurgery
27
2 absolute contraindications of prone positioning:
1. Unmonitored or increased ICP | 2. Unstable vertebral fractures
28
Respiratory rate greater than 4x the normal value (>150breaths/min) and very small tidal volumes
High frequency oscillatory ventilation
29
What is high frequency oscillatory ventilation referred to as and why?
Lung protective ventilation | -reduce vent associated lung injury (ARDS and acute lung injury)
30
Combines conventional cycles with high frequency percussion | -conventional ventilation and HFPV with a high frequency of 400-800 cycles/min
High frequency percussive ventilation
31
When is high frequency percussive ventilation used?
Burn ICU
32
Step wise reduction from ventilator in superior to intermittent mandatory ventilation (3)
1. Mechanical support 2. Pressure support mode 3. Multi daily T-piece trails
33
What is good for trails of unassisted breathing with weaning off vent:
Low levels of pressure support
34
Successful first trial, followed by discontinuation of mechanical ventilation
Simple transition
35
3 spontaneous-breathing trials but fewer than 7days between the first unsuccessful trial and successful discontinuation of mechanical ventilation
Difficult transition
36
At least 3 unsuccessful spontaneous-breathing trial or 7days or more of mechanical ventilation after the initial unsuccessful trial
Prolonged transition
37
3 reasons why trials of spontaneous breathing do not succeed:
1. Respiratory mechanics worsen during spontaneous breathing trial 2. Deterioration of respiratory mechanics can result from - increased respiratory resistance (asthma and obstructive pulmonary) - decreased lung compliance (pulmonary fibrosis, edema, acute lung injury, ARDS) - air trapping (COPD) 3. Challenge the circulation
38
3 things with respiratory load:
1. Lung disease 2. Cardiovascular dysfunction 3. Chest-wall disease
39
3 things with respiratory capacity:
1. Muscle weakness 2. Diminished respiratory drive 3. Impaired neuromuscular function
40
2 big things during weaning from ventilator:
1. SBT for 30min | 2. Assess airway, cough, airway secretions and mentation
41
When can respiratory distress develop after extubation?
Up to 48 hrs
42
What reduce the need for reintubation after discontinuation of mechanical ventilation:
Noninvasive positive pressure ventilation
43
Risk factors for unsuccessful discontinuation of mechanical ventilation: age
>65 yr
44
Risk factors for unsuccessful discontinuation of mechanical ventilation: APACHE II score
>12 on day of extubation
45
Risk factors for unsuccessful discontinuation of mechanical ventilation: partial pressure of arterial CO2 after extubation
>45 mmHg
46
Hypotension due to peripheral vasodilatation but also by a poor response to a therapy with vasopressors drugs
Vasodilators shock
47
What is vasodilator shock due to hemorrhage also known as:
‘Irreverisible’ or late phase hemorrhagic shock
48
4 other things that are characterized by cardiovascular collapse and that are likely to be associated with vasodilatation:
1. Lactic acidosis due to metformin intoxication 2. Certain mitochondrial diseases 3. Cyanide poisoning 4. Cardiac arrest with pulse less electrical activity
49
What is nitric oxide in both septic shock and decompensated hemorrhagic shock:
Increased
50
Inhibits NO preventing SM relaxation by nitrogen-based vasodilators:
Methylene blue
51
As shock worsens, the initial very high concentration of vasopressin in plasma does what?
Decreases
52
Vasodilator shock has no effect with what (4)
Vasopressor Norepinephrine Angiotensin II Endothelin
53
Vasopressin max dose for post cardiotomy shock
.1untis/min
54
Vasopressin max does for septic shock:
.07units/min
55
How long should Sux not be given after burns, trauma, and denervation:
24-72hrs
56
What should be used to test for TOF
Double burst
57
What test to use to test for TOF >.7:
Tetanus for 5 seconds of 50Hz
58
4 twitches:
0-75%
59
3 twitches?
75%
60
2 twitches?
80%
61
1 twitch?
90%
62
0 twitches?
>90%
63
How long does neostigmine take to peak?
10min
64
Initial dose of neostigmine?
1mg
65
Shallow medium block vs deep block dosage of sugammadex?
2mg/kg | 4mg/kg
66
Immediate reversal dose of sugammadex 3 min after giving max 1.2 mg/kg of Roc?
16mg/kg
67
Is there a dose adjustment needed for sugammadex?
Not when pt is >65yr, obese, or gender
68
Trigger CO2 <35
Pt needs narcotics
69
Trigger CO2 >50:
Pt do NOT need narcotics
70
CO2 between 35-50:
Wait and titrate to effect later
71
When are colloids (volume expanders) used (2):
1. Hyperproteinemia | 2. Malnourished pts who can’t tolerate large infusions of crystalloids
72
3 times to use colloid:
1. Renal failure 2. Large trauma 3. Microsurgical
73
When should crystalloid fluids be used:
Pts with dehydration (loss of ISF and IVF)
74
When should crystalloid fluids be limited:
Replaced of deficits and ongoing clear-fluid losses
75
Where are colloid fluids designed to stay?
In IV space

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