Term
| What is the assessment of emergency patient? |
|
Definition
consent signed by surgeon or closest relative over 18.
Assume full stomach.
Rapid sequence intubation.
Is blood available.
Allergies
IV access
meds.
history.
system review. |
|
|
Term
|
Definition
color.
heart and lungs sounds.
toleration of anesthesia.
Temperature.
presence of swallow. |
|
|
Term
|
Definition
condition of teeth
assign ASA status
preop medications
height and weight
base line vitals |
|
|
Term
| How much water composes neonates? |
|
Definition
|
|
Term
| How much water are females composed of? |
|
Definition
|
|
Term
| How much water are males composed of? |
|
Definition
|
|
Term
| How much water are new borns composed of? |
|
Definition
|
|
Term
| How much water are the elderly composed of? |
|
Definition
|
|
Term
| how much of body weight is intracellular fluid? Extracellular? |
|
Definition
2/3 of body weight.
20% of body weight. |
|
|
Term
| What are the two part of extra cellular. |
|
Definition
Interstitial: ultrafiltrate of plasma. No protein.
Plasma: Intravascular external to blood and erythrocytes. |
|
|
Term
| What is normal blood value for female? |
|
Definition
|
|
Term
| What is normal blood value for male? |
|
Definition
|
|
Term
| What is normal blood value for neonate? |
|
Definition
|
|
Term
| What is normal blood value for preemie? |
|
Definition
|
|
Term
| What do you see with low sodium? |
|
Definition
| Lethargy, ↑ CVP, ↑ mean, ↑ pulmonary art pressure, convulsions, coma, moist mucous membranes, peripheral edema. |
|
|
Term
| What are the causes of low sodium? |
|
Definition
increased water absorption, endometrial ablations, renal failure, SIADH, vomiting or diarrhea.
Treat below 135. |
|
|
Term
What s/s do you see with high sodium?
When do you treat? |
|
Definition
peripheral edema, thirst, lethargy, myoclonus, seizures
Treat above 145. |
|
|
Term
| What are the causes of high sodium? |
|
Definition
| Water deficiency due to excessive loss, in adequate intake, impaired renal function, cirrhosis, CHF,and edema. |
|
|
Term
| What is treatment for high sodium? |
|
Definition
| Diuretics: Spironolactone, hydrochlorothiazide. |
|
|
Term
| What are s/s of hypopotassium? |
|
Definition
| Increased automaticity of heart, increased muscle weakness, increased contractility. |
|
|
Term
| What are the causes of hypopotassium? |
|
Definition
naso gastric suctioning, vomiting, diarrhea, respiratory alkalosis, metabolic alkalosis.
Avoid hyperventilation. Potassium decreases for each 10mm/hg decrease in CO2. |
|
|
Term
| what are s/s of hyperkalemia |
|
Definition
| Peak T waves, wide QRS, short qt, cardiac arrest. |
|
|
Term
|
Definition
| laryngospasm, bradycardia, seizures. |
|
|
Term
What are causes of hypocalcemia?
What is treatement? |
|
Definition
parathyroid damage, renal failure, citrate during infusion, alkalosis,
15mg/kg of calcium chloride or 1.0ml of 10percent. |
|
|
Term
| what are s/s of to much calcium? |
|
Definition
| Lengthened PR interval, wide QRS, shortened qt. |
|
|
Term
| What are causes of hypercalcemia? |
|
Definition
| hyperparathyroidism, neoplastic disorders with bone metastasis |
|
|
Term
| What is treatement for hypercalcemia |
|
Definition
| Fluids and hyperventilation. |
|
|
Term
|
Definition
8 hours or beyond: Anything.
6 hours: light meal, baby formula, non human milk.
4 hours: breast milk, no fat of any kind.
2 hours: NPO |
|
|
Term
| What is the stomach cocktail? |
|
Definition
| Pepcid 20mg, Reglan 10mg, and Bicitra. |
|
|
Term
|
Definition
| Stage of analgesia or disorientation |
|
|
Term
|
Definition
Stage of excitement or delirium.
Eyelash reflex disapeers. |
|
|
Term
|
Definition
Stage of surgical anesthesia.
Onset of automatic respiration to resp. paralysis.
Consists of four planes. |
|
|
Term
| Describe Guedel Stage 3 - Plane 1 |
|
Definition
| Eyelid reflex is lost, swallowing reflex disappears |
|
|
Term
| Describe Guedel Stage 3 - Plane 2 |
|
Definition
| From cessation of eyeball movements to beginning of paralysis of intercostal muscles. |
|
|
Term
| Describe Guedel Stage 3 - Plane 3 |
|
Definition
| Diaphragmatic respiration persists but there is progressive intercostal paralysis, pupils dilated and light reflex is abolished. The laryngeal Reflex lost in plane II can still be initiated by painful stimuli arising from the dilatation of anus or cervix. |
|
|
Term
| Describe Guedel Stage 3 - Plane 4 |
|
Definition
| from complete intercostal paralysis to diaphragmatic paralysis (apnea). Pupils dilate and no longer react. No muscle tone even in a robust individual. |
|
|
Term
|
Definition
| from stoppage of respiration till death. Anesthetic overdose cause medullary paralysis with respiratory arrest and vasomotor collapse. Pupils are widely dilated and muscles are relaxed. |
|
|
Term
| What are the common drugs used for induction and their doses? |
|
Definition
Pentothal: 3mg/kg (rarely used).
Etomidate: 0.3mg/kg.
Propofol: 2mg/kg.
Ketamine: 1mg/kg. |
|
|
Term
| What does balanced anesthesia consist of? (BAAAH). |
|
Definition
| Analgesia, Areflexia, Hypnosis. |
|
|
Term
| What medications are most commonly used for regionals? (BLT). |
|
Definition
Bupivicain – 3 hours. (gold standard)
Lidocaine – 1 hour, 1.5 hours with epi.
Tetracaine – 3 hours. (rare). |
|
|
Term
| What deficit is typically needed to show a decrease in blood pressure? |
|
Definition
|
|
Term
| What kind of loss is needed to see a increase in heart rate? |
|
Definition
| A minimum of 15 – 30% loss of volume to see increase in HR. B-blockers may mask this effect. |
|
|
Term
| What are the indications for a urinary catheter? |
|
Definition
| Complicated obstetrics, C-section always, Hypovolemia, major trauma, kidney failure, laproscopic procedure (want bladder empty incase of puncture), anticipated transfusion, thoracic, by pass, sepsis, etc…. |
|
|
Term
When to place a foley?
Maintain urine output greater than___? |
|
Definition
1) In cases where large fluid shifts are anticipated.
2) usually cases over 4hrs. Always for C-section.
maintain UO > 0.5ml/kg/hr |
|
|
Term
| What does a Raytex sponge hold wet and dry? |
|
Definition
|
|
Term
| What does a Minilap sponge hold wet and dry? |
|
Definition
|
|
Term
| What does a Regular Lap sponge weigh wet and dry? |
|
Definition
|
|
Term
| What does a Gyn lap sponge hold in terms of blood both wet and dry? |
|
Definition
|
|
Term
| What are the two most common sponges? |
|
Definition
|
|
Term
| Give examples of minimal trauma and how much to replace? |
|
Definition
breast biopsy or superficial surgery.
Replace 2ml/kg/hr |
|
|
Term
| Examples of moderate surgical trauma and how much should be replaced? |
|
Definition
Appendectomy, laproscopic surgery, hysterectomy.
Replace: 2-4 ml/kg/hr. |
|
|
Term
| Examples of extreme surgical trauma and how much should be replaced? |
|
Definition
Bowel resection, highly invasive, prolonged.
Replace: 4-8 ml/kg/hr. |
|
|
Term
| What are most common procedures for blood loss? |
|
Definition
| Orthopedic, vascular, colorectal, cardiac, liver transplant, and trauma. |
|
|
Term
| What is the equation for blood replacement taking into account hemoglobin? |
|
Definition
| EBV x (start HCT – End HCT) / Start HCT. |
|
|
Term
| Classes of shock: Class I |
|
Definition
| Minimal blood loss (<15% or 750ml), HR normal, pules normal, BP normal. |
|
|
Term
| Classes of shock: Class II |
|
Definition
| Mild Blood Loss (15-30% or 750-1500ml), tachy, mild tachypnea, diminished pulses, oliguria. |
|
|
Term
| Classes of shock: Class III |
|
Definition
| Moderate blood loss (30-40% or 2000ml), significant tachycardia, thready peripheral pulses, hypotension, moderate tachypnea, metabolic acidosis, increase BUN, oliguria. |
|
|
Term
| Classes of shock: Class IV |
|
Definition
| Severe Blood Loss > 40%, severe tachycardia, thready central pulses, significant hypotension, significant acidosis, severe tachypnea, cold extremities, anuria. |
|
|
Term
| How many IVs for elective case and what size? |
|
Definition
|
|
Term
| How many IVs for shock case and what size? |
|
Definition
|
|
Term
| How many IVs for extensive case (bowel, cardiac, hyst)case and what size? |
|
Definition
|
|
Term
| How many IVs for local sedation case and what size? |
|
Definition
|
|
Term
| Most common nerve injury? |
|
Definition
|
|
Term
| What are the signs of a successful intubation? |
|
Definition
Tube through the cords.
Chest rise and tube fog.
Good co2 after 4-6 breaths. |
|
|
Term
| What are three techniques for arterial catheter insertion? |
|
Definition
Direct.
Guidewire.
Transfixioin-withdrawl. |
|
|
Term
| What are the indications for direct arterial monitoring? |
|
Definition
Trauma.
Cardiac Surgeries.
Thoracic or abdominal.
Inability to monitor directly.
Large blood or fluid loss. |
|
|
Term
| What are the contraindications of a swan? |
|
Definition
Left bundle branch block.
Wolf Parkinson White.
Epsteins Malformation. |
|
|
Term
What is the formula for compliance?
How are they related? |
|
Definition
Compliance = volume/pressure.
They are inversely related. |
|
|
Term
| In terms of capnometry, what are the five basic characteristics? |
|
Definition
| Height, frequency, rhythm, baseline value, and shape (only one normal). |
|
|
Term
| In terms of capnometry, what could be the cause of co2 dropping to zero? |
|
Definition
| Kinked tube or vent malfunction. |
|
|
Term
| What are the causes of high pressure? |
|
Definition
| Secretions, kinked tube, bronchospasm, peneumo, or surgeon leaning. |
|
|
Term
| What are the causes of low pressure? |
|
Definition
| Disconnect, major leak (cuff or breathing system). |
|
|
Term
| What does ventilometer measure? |
|
Definition
| Located on expiratory limb. Measures gas moving out of lungs. |
|
|
Term
What is ventilation volume for adult?
What is ventilation volume for pediatric? |
|
Definition
Should ventilate 8-10cc /kg for adult.
Pediatrics 1cc/lb. |
|
|
Term
Describe this capnography patter.
[image] |
|
Definition
Patient is taking own breaths (inspiring) during ventilation.
May need more goodies! |
|
|
Term
What does this capnography curve tell us?
[image] |
|
Definition
| Obstruction (kinked tube) or a disease process such as COPD. |
|
|
Term
Name that capnograhy curve!
[image] |
|
Definition
|
|
Term
Name that capnography curve.
[image] |
|
Definition
|
|
Term
What does this capnography curve indicate?
[image] |
|
Definition
Tidal volumes are getting larger.
Patient is recovering and taking breaths on own. |
|
|
Term
Label capnography curve
[image] |
|
Definition
A . beg of exhalation.
A-B. Anatomic dead space exhaled.
B-C. Ascending limb represents ↑ CO2 from distal airways.
C-D. Alveolar plateau containing mixed alveolar gases.
D. End Tidal CO2
D-E. Descending limb and inspiratory phase of respiration showing rapidly ↓ CO2. |
|
|
Term
| What method of heat transfer has the largest loss? |
|
Definition
|
|
Term
| What method of heat loss describes heat lost to the operating table? |
|
Definition
|
|
Term
| What method of heat loss describes heat lost to air moving by? What is the percentage? |
|
Definition
|
|
Term
| What method of heat loss accounts for 25% of heat loss? |
|
Definition
|
|
Term
| What way do narcotics shift the oxygen hemoglobin dissociation curve? |
|
Definition
Shift toward the right. A higher pO2 is needed in order to maintain an adequate saturation. Most likely due to accumulation of CO2 which has a higher affinity for hemoglobin than oxygen.
Note: X axis pO2 and y axis hgb saturation. |
|
|
Term
| What are the two forms of neuromuscular blockaide? |
|
Definition
Depolarizing.
Non-depolarizing. |
|
|
Term
| What is the only depolarizing medication listed in the notes? |
|
Definition
|
|
Term
| What are the consequences of hyperthermia? |
|
Definition
| Increased ventilator work, increased cardiac work, hypovolemia due to evaporation, hypoglycermia |
|
|
Term
| What are some indications that a patient needs more muscle relaxation? |
|
Definition
| Rigidity of abdomen, decreased lung compliance, increased response to PNS, increase resp. rate, swallowing, coughing, respiratory effort. |
|
|
Term
| What are signs of adequate reversal? |
|
Definition
| Normal tidal volume and ventilator rate, ability to open eyes, coughing, strong hand grasps, sustained head lift, NIF greater than 20, and full train of four. |
|
|
Term
| Signs of incomplete reversal? |
|
Definition
| Pitosis, tracheal tug, jerky movements, ineffective coughing, incomplete response on PNS, decreased tidal volumes and increased rate. |
|
|
Term
| What is a mentioned nerve injury in the supine position? |
|
Definition
|
|
Term
Nerve Injury - Name that grade!
response to blunt force or compression. Temporary. |
|
Definition
Grade 1 - Neuropraxis
P for perfect because it can be fixed. |
|
|
Term
Nerve Injury - Name that grade!
destruction of myelin sheath but without injury to supporting matrix. Axon can regenerate depending on the proximity of the injury to the cell body. Wallerian degeneration occurs distal to the injury site. Nerve is intact and sheath are not disrupted. |
|
Definition
|
|
Term
Nerve Injury - Name that grade
Game over. Nerve crushed, servered. Complete disruption small chance of repair. |
|
Definition
|
|
Term
| What are the three mechanisms of nerve injury? |
|
Definition
| Compression, traction or stretch, and ischemia (common component). |
|
|
Term
| What kind of patient male/female more often gets a ulnar nerve injury? |
|
Definition
Males, due to muscle around nerve.
Women with low b.m.i., cardiac surgeries. |
|
|
Term
| What is the most common brachial plexus injury? |
|
Definition
|
|
Term
| When turning somone from supine to prone what things should be thought of / done? |
|
Definition
Check breath sounds.
Placement of IV lines (above head) IV poles.
Disconnect patient, turn, and reconnect.
Listen for bilateral breath sounds and confirm CO2 after 4-6 breaths.
Emergence should be supine. |
|
|
Term
| In what position is a peroneal nerve injury common? |
|
Definition
|
|
Term
| What are the complications of Lateral Decubitis? |
|
Definition
Brachial plexus injury.
VQ mismatch. Upper hyperventilation/lower congestion.
Rhabdomyolosis. |
|
|
Term
| What is the order of the pressure gradiants in zone 1 of the lung? |
|
Definition
| alveolar > arterial > venous. |
|
|
Term
| What is the order of the pressure gradiants in zone 2 of the lung? |
|
Definition
| arterial > alveolar > venous. |
|
|
Term
| What is the order of the pressure gradiants in zone 3 of the lung? |
|
Definition
| arterial > venous > alveolar. |
|
|
Term
| What are the complications of the sitting position? |
|
Definition
Postoperative Macroglossia
Midecervial Flexion Myelopathy |
|
|
Term
| Define Postoperative Macroglossia |
|
Definition
| Due to venous and lymphatic obstruction caused by prolonged, marked neck flexion. Instances of post op trach. |
|
|
Term
| Define midcervical flexion myelopathy |
|
Definition
| Caused by marked flexiion of he neck and is attribueted to stretching of the spinal cord. Compromise of the spinal vasculature. Leads to paralysis below 5th vertebrae (rare). |
|
|
Term
What is ventilation for adult?
What is ventilation for peds patient? |
|
Definition
Adult: 8-10cc/kg.
Pediatric Patient: 1cc /lb |
|
|
Term
| What can cause a sudden increase in CO2? |
|
Definition
| increased pulmonary blood flow, sodium bicarb, release of touniquet, hyperthermia, and CO2 insuflation. |
|
|
Term
| In what postion does mechanical constriction of chest motion occur? |
|
Definition
|
|
Term
| What are the complications of prone position? |
|
Definition
Hypoxia.
Inadequate ventilation.
Compromised blood pressure.
pressure to eyes and face
pressure to soft tissue. |
|
|
Term
| What vasoconstrictor is shown to cause ischemia in ocular vessels? |
|
Definition
|
|
Term
| What should be done to prevent injuries in the prone position? |
|
Definition
Support axilla (brachial plexus from sagging)
Diaphragm must move freely.
Ted hose on lower extremities.
Check eyes, ears, and nose after repositioning. |
|
|
Term
| What should be done to relieve pressure on the neurovascular bundle and provide adequate flow to hand? |
|
Definition
| A thoracic roll placed caudal to the axilla in the lateral decubitus position. |
|
|
Term
| What is the biggest risk to the sitting position? |
|
Definition
|
|
Term
| What is midcervical flexion myelopathy. |
|
Definition
Marked flexion of the neck attributed to stretching the spinal cord.
Compromise of vasculature.
Leads to paralysis below 5th vertebrae. |
|
|
Term
| What should the pressure be kept above in the sitting position? |
|
Definition
| Mean of 80mmhg or higher. |
|
|
Term
| What things should be documented in the chart in terms of positioning? |
|
Definition
Positioned to comfort.
Pulses palpable.
Eyes, ears, no pressure.
• What equipment was utilized.
Breath sound before and after any position change. |
|
|
Term
| Quick facts about ulnar injury - from slides |
|
Definition
most frequently reported injury following surgery and anesthesia
cardiac surgery
long nerve
more frequent in males, preexisting asymptomtic neuropathy, prolonged hospitalization,
Extremes of body habitus
Women with low BMI |
|
|
Term
| Quick facts about brachial plexus injury - from slides |
|
Definition
C5-T1
Susceptible to stretch because it is fixed between its origins and its terminal branches
Clavical, first rib, and humeral head may compress or stretch as it passes
Susceptible during abduction |
|
|
Term
| What type of post operative vision loss has the highest vision loss? |
|
Definition
| Ischemic Optic Neuropathy 89% |
|
|
Term
| What are the risk factors for POVL? |
|
Definition
Hypertension, glaucoma, carotid artery disease
Smoking
Diabetes
Prolonged procedures; > 6.5 hours
Preoperative anemia
Substantial blood loss; >44%
Combination of length and blood loss |
|
|
Term
| What can the axillary roll cause in the lateral decubitus position? |
|
Definition
| Damage to suprascapular nerve |
|
|
