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*Health Assessment > Weak Points > Flashcards

Weak Points Flashcards

1
Q

Name the 5 genetic d/o that contribute to a difficult a/w.

A
  1. Down - large tongue/sm mouth
  2. Goledenhar
  3. Klippel-Feil
  4. Pierre Robin - large tongue/sm mouth
  5. Treacher Collin
  6. Turner
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2
Q

Name surgical hx that contribute to a difficult a/w.

A
  1. tracheostomy/old scar
  2. uvuloplasty
  3. neck dissection
  4. cervical neck instrumentation
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3
Q

Name comorbidities that contribute to a difficult a/w.

A
  1. thyroid d/o
  2. laryngeal lesion
  3. DM
  4. GERD
  5. Obesity
  6. OSA
  7. Genetic d/o
  8. Musculoskeletal
  9. RA
  10. Scleroderma
  11. Cancer
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4
Q

6 purposes for pre-op interview

A
  1. obtain medical hx
  2. formulate anesthesia plan
  3. informed consent
  4. patient education
  5. improve efficiency
  6. motivate pt to more optimal health status
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5
Q

describe surgery types of invasiveness

  1. minimally
  2. moderately
  3. highly
A
  1. little tissue trauma, min blood loss
  2. modest disruption of norm physio, anticipate some blood loss
  3. significant disruption of normal physio, require transfusions and ICU care
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6
Q

ASA Classification

A 
I - healthy, no systemic dz
2 - controlled mild to mod system dz, no fxnal limit
3 - severe system dz with fxnal limit
4 - severe system dz threatening life
5 - not expected to survive, dying
6 - brain dead (organ harvesting)
E - emergent operation
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7
Q

Supine: CV changes

A
  • minimal
  • initial inc VR/preload/CO/BP, baroreceptors activate and compens dec HR/PVR
  • dec LE venous drainage (uncross legs, pillow under knees, SCDs/Teds)
  • IVC compression d/t abd mass, ascites, pregnancy, obesity = dec VR
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8
Q

Supine: Resp changes

A
  • dec FRC by 800 ml d/t abd contents cephalad

- more severe w/ anesthetics, can overcome w/ + pressure vent

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9
Q

Supine: CBF changes

A

minimal

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10
Q

Trendelenberg purposes

A
  • CVC placement
  • remove air embolism
  • trx hypotension
  • ABD/LAPARASCOPIC procedures
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11
Q

Trendelenberg: CV changes

A
  • inc VR + 1L
  • baroreceptors activate = compens dec HR/PVR
  • dec BL to LE - SCDs/Teds
  • abd contents may compress heart
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12
Q

Trendelenberg: Resp changes

A
  • dec FRC and lung compliance
  • inc WOB/PIP
  • V/Q mismatch - apex = perfusion > ventilation
  • ETT can shift
  • aspiration
  • facial edema can cause a/w obstruction
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13
Q

Trendelenberg: CBF changes

A

-inc vascular congestion = inc ICP/IOP

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14
Q

Reverse trendelenberg: procedures

A
  • lap chole
  • intracranial
  • neck
  • shoulder
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15
Q

Reverse trendelenberg: CV changes

A

(like sitting position)

  • dec preload/CO/BP w/ comp inc HR/SVR but may be blunted by anesthetics
  • activates Renin ystem
  • LE venous pooling (SCDs/Teds)
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16
Q

Reverse trendelenberg: Resp changes

A

-inc FRC

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17
Q

Reverse trendelenberg: CBF changes

A
  • dec CBF proportional to head tilt angle
  • dec ICP
  • *place a-line at CIRCLE of WILLIS**
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18
Q

Lithotomy: procedures

A

Gyn/GU/Rectal

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19
Q

Lithotomy: injuries

A

common peroneal - most common LEI; lat knee compressed against stirrup&raquo_space; foot drop, loss of foot eversion or toe extension

sciatic - stretching and excessive external rotation of hips&raquo_space; foot drop/numbness, weakness below knee, lateral calf numbness

femoral - pelvic brim compressed against retractor
-excessive angle of thigh
-abduction of thighs and ext rotation of hips
» no hip flexion/knee extension/thigh sensation

saphenous - medial LL compressed against support bar
»numbness of medial calf

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20
Q

Lithotomy: CV changes

A

-LE compartment syndrome for > 2-3 hr procedure
d/t elevated legs:
-inc VR/Preload w/ transient inc CO/BP
-dec LE perfusion (-2 mmHg per 2.5 cm above heart)

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21
Q

Lithotomy: resp changes

A
  • dec lung compliance/TV/VC d/t abd contents

- aspiration risk

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22
Q

Lithotomy: CBF changes

A

d/t elevated legs:

transient inc venous CBF, inc ICP

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23
Q

Prone: proceudres

A

back

24
Q

Prone: CV

A
  • IVC/aorta compression = HYPOTENSION
  • venous pooling = HYPOTENSION (SCDs/Teds)
  • prolonged hypotn + ischemia = blindness!
25
Q

Prone: Resp changes

A

-dec lung compliance
-inc peak a/w press/WOB
-V/Q mismatch - ant = perfusion > ventilation
post = ventilation > perfusion

26
Q

Prone: CBF

A
  • turning head obstructs venous drainage = inc CBV/ICP

- excessive flexion/turning can obstruct vertebral flow

27
Q

Lateral: procedures

A

kidney, hip. thoracotomy, shoulder

28
Q

Lateral: injuries

A

saphenous - knee compressing dependent LL

common peroneal - dependent leg compressing table

29
Q

Lateral: CV changes

A
  • LE compartment syndrome
  • minimal (unless kidney rest obstructs VR)
  • NIBP higher in dependent arm
30
Q

Lateral: resp changes

A

-awake/spontaneous - better perfusion/ventilation in dependent lung; dec lung volumes
V/Q mismatches:
-anesthetized/spontaneous - dependent lung > perfusion, non-dependent lung > ventilated
-anesthetized/mechanical - dependent lung > OVERperfusion, non-dependent lung > OVERventilated

31
Q

Lateral: CBF changes

A

minimal

32
Q

Sitting: procedures

A
  • cranial, shoulder, humerus

- promotes venous drainage

33
Q

Sitting: injuries

A
  • cervical roots - cervical flexion stretching roots
  • BP - traction pulling/stretching shoulders
  • sciatic - stretching knees/hips
34
Q

Sitting: CV changes

A
  • LE pooling = dec preload/CO/BP
  • baroreceptors activate but blunted by anesthetics
  • HYPOTENSION!!
    trx: pressors, IVF, adjust anesthetic, SCDs/Teds
35
Q

Sitting: resp changes

A

-inc lung volume/VC/compliance

36
Q

Sitting: CBF changes

A
  • dec CBP/ICP

- positioning can obstruct art/ven flow = hypoperfusion and venous congestion

37
Q

Venous air embolism
s/s
trx

A
  • risk anytime site is above heart level
  • prevents venous sinus collapse
  • s/s: heart murmur via doppler (windmill murmur) over parasternal border (ICS 2-6), new murmur, hypotension, desat, dysrhythmia, dec ETCO2, +N2 exhalation, circ compromise, cardiac arrest
  • trx: flood surfical field w/ NS, put wax around cut/bony structures, close vessels, trendelenberg, d/c NO, PEEP, 100% FiO2, aspirate air from RA via catheter
38
Q

Obesity: What happens to respiratory when placed in supine/trendelenberg?

A

-rapid decrease in O2 sats w/ anesthesiai

39
Q

Obesity: What do lung volume deviations lead to?

A

V/Q mismatch
hypoxemia
right to left shunting

40
Q

Obesity: CV changes

A
  • inc CO (+ .01 L/min per kg of fat)
  • then inc circulating blood volume that strains myocardium&raquo_space; cardiomegaly
  • inc risk of arterial HTN
  • inc risk of CAD (causing angina, CHF, MI, death)
  • inc L heart pressure and LV hypertrophy
  • hyperlipidemia leading to CAD, prem vasc dz, pancreatitis
41
Q

Obesity: What does hyperlipidemia lead to?

A

-hto CAD, prem vasc dz, pancreatitis

42
Q

Risk factors for OSA

A

middle-aged, obese, male, + ETOH, sleep aids, abd fat, neck girth >40 cm

43
Q

OSA results in…

A
  • hypoxemia
  • hypercapnia
  • R heart failure
  • pulm/system vasoconstriction/HTN
  • polycythemia
  • resp acidosis
44
Q

What happens when obese pt changed from sitting to supine? (CV)

A

-sig changes in CO, PAP, O2 consumption

45
Q

What is the best position for longest safe apnea period in obese pts?

A

reverse trend

46
Q

What effect does prone have on obese pts?

A
  • inc IVC/aorta compression d/t abd pressure and dec FRC

* lateral preferred if possible

47
Q

What causes false high NIBP?

A
  • cuff is too small
  • cuff is too loose
  • extremity below level of heart
  • arterial stiffness (HTN/PVD)
48
Q

What causes false low NIBP?

A
  • cuff is too big
  • extremity above level of heart
  • poor perfusion
  • quick deflation
49
Q

What does IABP provide?

A
  • real time beat to beat BP
  • arterial blood samples
  • CO/CI/SVR
50
Q

What can cause exaggerated variations in Arterial waveform w/ respirations

A

-hypovolemia

51
Q

What does PAP assess?

A
  • intracardiac pressures
  • LV function/filling pressure
  • Pulm VR/SVR
  • CO
  • mixed venous O2 sat (SvO2)
  • pacing options
52
Q

Distance from right IJ to:

  1. IVC/RA junction
  2. RA
  3. RV
  4. PA
  5. PCWP
A
  1. 15 cm
  2. 15-25 cm
  3. 25-35 cm
  4. 35-45
  5. 40-50 cm
53
Q

Types of CO monitoring

A
  1. thermodilution
  2. continuous thermodilution
  3. mixed venous oximetry
  4. ultrasound
  5. pulse contour
54
Q

What does TEE assess?

A
  1. CO
  2. EF
  3. coronary blood flow
  4. ventricular wall
  5. valve function
  6. air
  7. mass
55
Q

What do we use TEE for? indications

A
  1. valvular dysfunction
  2. unsual hypotension
  3. PE
  4. myo ischemia
  5. pericardial tamponade
  6. aortic dissection
56
Q

What are causes for large a waves on CVP/PAP waveform?

A

(insufficiency issues)

  1. diastolic dysfunction
  2. mitral stenosis
  3. junctional
  4. complete heart block
  5. myo ischemia
  6. ventr hypertrophy

*Health Assessment (3 decks)

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