Quiz 3

Question 1

top 3 (in order) closed claims

Answer 1

Death
Nerve injury
Brain damage

Question 2

Airway injuries

Answer 2

Sore throat (Most common side effect)
Arytenoid dislocation 
Dysphagia
Dental injury (most common injury)
TMJ
Esophageal perforation
Vocal cord paralysis (forceful intubation)
Vocal cord granuloma (large tubes/long intubation)

Question 3

Role of positioning

Answer 3

Patient
position
procedure

Question 4

complication related to positioning for nerve injuries

Answer 4

hypotension

Question 5

Complication for sitting, prone, reverse trend? Prevention?

Answer 5

Air embolism

maintain venous pressure above zero at the wound

Question 6

complication for supine, lithotomy, trend? Prevention?

Answer 6

Alopecia

Normotension, padding, head turning

Question 7

Complication of particularly Lithotomy

Answer 7

Compartment syndrome

Maintain perfusion pressure, avoid external compression

Question 8

High risk cases of awareness

Answer 8

Trauma
Open Heart
OB

Question 9

Risk factors for awareness

Answer 9

Female
Previous awareness
Age (younger adults)
Clinician experience
Emergency procedures
After normal hours of operation
Obesity
Use of nondepolarizing relaxants

Question 10

what level MAC for amnesia?

Answer 10

1/3 MAC

Question 11

Most common cause of post operative loss of vision? Etiology?

Answer 11

Ischemic Optic Neuropathy

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

Question 12

contributing Pt conditions r/t eye injuries?

Answer 12

HTN
DM
CAD
Smoking

Question 13

Surgical factors to ION (Ischemic Optic Neuropathy)

Answer 13

• Intraoperative deliberate hypotension
• Anemia
• Prolonged surgical time in position that compromises venous outflow (Prone, Head down, Compressed abdomen)

Question 14

Prevention of ION:

Answer 14

• Enhance venous outflow by positioning the patient head up.
• Minimize abdominal constriction.
• Monitor blood pressure carefully with arterial line.
• Limit degree and duration of deliberate hypotension
• Avoid anemia in patients at risk for ION.
• Consider staging long surgical procedures in patients at risk for ION

Question 15

s/s prior to arrest?

Answer 15

• Gradual decline in heart rate and BP (20% below baseline values)
• Bradycardia
• Hypotension
• Cyanosis

Question 16

treatment for bradycardia unresponsive to Atropine?

Answer 16

Small doses Epi (5-10 ug)

Question 17

how much intravascular volume can you lose to anaphylaxis response?

Answer 17

up to 50% to capillary leaking

Question 18

Type I reaction (immediate)

Answer 18

• Atopy
• Urticaria
• angioedema
• Anaphylaxis

Question 19

Type II reaction (Cytotoxic)

Answer 19

• Hemolytic transfusion reactions
• Autoimmune hemolytic anemia
• Heparin-induced thrombocytopenia

Question 20

Type IV reaction (Delayed, cell-mediated)

Answer 20

Contact dermatitis

Graft rejection

Question 21

Type III reaction (immune complex)

Answer 21

Rheumatoid Arthritis

Serum sickness

Question 22

chance of anaphyaxis in OR?

Answer 22

1 in 5k - 1 in 25k

Question 23

mediators of anaphylaxis

Answer 23

Histamine
Leukotrienes
BK-A
Platelet-activating factor

Question 24

clinical manifestations of anaphylaxis

Answer 24

• Cardiovascular - hypotension, tachycardia, arrhythmias
• Pulmonary - bronchospasm, cough, dyspnea, pulmonary edema, laryngeal edema, hypoxia
• Dermatologic - urticaria, facial edema, pruritus

Question 25

Risk factors associated with hypersensitivity to anesthetics

Answer 25

Female gender d/t cosmetics Atopic history Preexisting allergies Previous anesthetic exposure

Question 26

first thing to do if anaphylaxis occurs?

Answer 26

d/c drug administration

Question 27

Treatment of anaphylactic and anaphylactoid reactions:

Answer 27

Discontinue drug administration first thing to do Administer 100% oxygen Epinephrine (0.01-0.5mg IV or IM) Consider intubation or tracheostomy Intravenous fluids (1-2 liters Lactated ringers) Diphenhydramine (50-75mg IV) H1 blocker Ranitidine (150mg IV) H2 blocker Hydrocortisone (up to 200 mg IV) or methylprednisolone (1-2mg/kg)

Question 28

what makes ppl susceptible to a muscle relaxant allergy?

Answer 28

Over the counter drugs, cosmetics, and food products that contain tertiary or quaternary ammonium ions may sensitize susceptible individuals

Question 29

most common to least common muscle relaxant drug that causes anaphylaxis?

Answer 29

Rocuronium succinylcholine atracurium

Question 30

other anesthetic drugs that can cause anaphylaxis?

Answer 30

Pentothol (1 in 30k) | Propofol (1 in 60k)

Question 31

antibiotics that cause anaphylaxis?

Answer 31

B-lactam antibiotics - Penicillin, Cephalosporin Sulfonamides Vancomycin - “Red man’s syndrome”

Question 32

second most common cause of anaphylaxis during anesthesia?

Answer 32

Latex allergy

Question 33

Occurance of MH? adults and peds

Answer 33

Pediatrics 1:15k | Adults 1:40k

Question 34

s/s MH

Answer 34

``` Increased carbon dioxide production ETCO2 Increased oxygen consumption Low mixed venous oxygen tension Metabolic acidosis Cyanosis Mottling Tachycardia some books say most sensitive, but not specific enough to MH Initial hypertension Arrhythmias ```

Question 35

S/S muscle damage of MH

Answer 35

``` Masseter spasm Generalized rigidity Elevated serum creatine kinase Hyperkalemia Hypernatremia Hyperphosphatemia Myoglobinemia Myoglobinuria ```

Question 36

S/S MH hyperthermia

Answer 36

Fever Sweating core temperature can rise as much as 1*C every 5 minutes* LATE SIGN

Question 37

what receptor issue for MH

Answer 37

Ryanodine

Question 38

what does Bicarb do for MH

Answer 38

Pushes K back into cells

Question 39

S/S Bronchospasm?

Answer 39

Prolonged expiration High inflation pressures Expiratory wheezes Decreased oxygen saturation