Final Flashcards
(55 cards)
Name a situation where you do NOT need to give a patient an induction agent during RSI
Benzo overdose
What is etomidate and why is it the preferred induction agent?
Non-barbiturate hypnotic-sedative
Rapid onset
Brief DOA
Causes minimal respiratory and myocardial depression
Cerebroprotective!
- Reduces cerebral blood flow and cerebral metabolic O2 demand without affecting cerebral perfusion pressure
What is etomidate’s affect on analgesia?
No effect on analgesia!
What is ketamine and when is it indicated?
Dissociative anesthetic that causes a cataleptic state rather than true unconsciousness
Indicated in hypotensive, hypovolemic and bronchospastic pts requiring intubation
(Ketamine increases HR, BP, bronchodilation, etc)
Which induction agent causes an emergence phenomenon characterized by hallucinations and nightmares in the first 3 hours after awakening?
Ketamine
What is pretreatment during RSI and what medications are indicated?
RSI and using succinylcholine can cause
- ICP
- Increased ocular pressure
- Increased intragastric pressure
- Bronchospasm
- Increased sympathetic discharge
- Bradycardia
Give lidocaine or fentanyl -
Can use atropine in children
Describe how a pt should be positioned in RSI
Small pillow under head aligns pharyngeal and laryngeal airway
Sniffing position aligns pharyngeal, laryngeal and oral axis
Place in neutral position if pt cervical concerns
More people die from sepsis each year compared to AMI or Lung or breast cancer. T/F?
True
What is carnett’s sign?
Carnett’s sign is increased tenderness to palpation when the abdominal muscles are contracted, as when the patient lifts his or her head or legs off the bed, and may be useful to distinguish abdominal wall from visceral pain.
When would you use CT vs ultrasound in suspected appendicitis?
CT is first choice US if there is concern for radiation - Children - Women of reproductive age - Pregnant women
Given concern of masking/altering abdominal signs, what can you give a pt who presents with abdominal pain for pain control?
Narcotics (IV morphine or fentanyl)
- no evidence that narcotics masks peritoneal signs of acute abdomen
- can add ketorolac for pain relief for pts with biliary or renal colic
BUT:
- Ketorolac is NOT recommended for undifferentiated abdominal pain because it can mask abdominal findings and increase bleeding times
What is mittelschmerz?
ovulation pain
lower abdominal/pelvic pain
Ddx: appendicitis
Other than an obstruction, AAA, and appendicitis, what other dx would require surgery consult?
Perforated ulcer
Acute cholecystitis
How do you define “massive transfusion”? What’s a complication and how is it addressed?
10 or more units if RBCs in 24 hours
- replacing that much blood can dilute platelets and coag factors –> coagulopathy
- correct by using 1:1:1 ratio; 1 RBC: 1 plasma : 1 platelets
Individuals over 85 years of age are the fastest growing segment of the population. T/F?
True
Airway obstruction results in part from decreased muscle tone of the _____ muscle, which contracts to move the tongue forward during inspiration and dilate the pharynx.
Genioglossus
When would you use a nasopharyngeal airway, other than when the pt is intoxicated or semiconscious?
Trismus “clenched teeth”
Trauma
Other obstacle like wiring of teeth
How is a nasopharyngeal airway measured? Oropharyngeal airway?
NPA = tip of nose to tragus OPA = corner of mouth to angle of mandible
Which O2 delivery technique may promote CO2 retention at lower flow rates?
Simple face mask
Which O2 delivery technique is used in pts with chronic hypercarbia?
Venturi face mask
Which O2 delivery technique is dependent on the pt’s tidal volume?
Nasal cannula
Which two O2 delivery techniques provide the highest inspired O2 concentration?
Bag mask - most (15L, 90-97%)
Face mask - (12-15L, 65-75%)
Which O2 delivery technique is used for an infant/young child when they can’t tolerate a face mask or NC?
Blow-by
LEMON? MOAN?
LEMON - anticipating difficult airway: Look (BONES - beard, obesity, no teeth, elderly, sleep apnea) Evaluate 332 Mallampati Obstruction Neck mobility
MOAN - anticipating difficult BMV
Mask seal
Obstruction/obesity
Age (>55 have decreased muscle and tone)
No teeth (so keep dentures in for BMV but remove for intubation)
Stiff lungs (high airway resistance or decreased compliance; COPD, asthma, PNA, etc)
