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28 Cards in this Set
- Front
- Back
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Describe the ASA classifications
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I
Healthy patient II Mild systemic disease - no functional limitations Example: controlled hypertension III Severe systemic disease - definite functional limitations Example: emphysema IV Severe systemic disease - constant threat to life Example: unstable angina V Moribund patient - not expected to survive with/without an operation for > 24 hours E Suffix E is added to denote an emergency procedure |
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Objective indications for endotracheal intubation.
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GSC < 8
RR > 35 Failure to ventilate (PaCO2 > 55) Failure to oxygenate (PaO2 < 70) Vital capacity < 15 ml/kg Inability to generate inspiratory pressure of -20 mmHg Airway protection from aspiration Airway obstruction Maintain tracheo-bronchial toilet Need to deliver PPV in the OR |
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Physical exam findings predicting difficult BVM ventilation.
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Beard
Obese No teeth Elderly Sleep apnea/snoring |
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What is the def of MAC?
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The concentration of an inhaled anesthetic in the alveoli at 1 atm that prevents movement in response to a painful stimulus (e.g. surgical cut) in 50% of patients.
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Indications for intubation in perioperative setting.
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Patient factors
• GCS ≤ 8 • Reflux • Trauma • Anyone with a full stomach • Small bowel obstruction Surgery factors • Abdominal surgery • Laparoscopic surgery • Thoracic surgeries • Head and neck surgeries • Neurosurgery • Positioning of patient • Long duration of surgery |
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What is the concentration of 1% lidocaine?
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1 gram / 100 ml
Same as saying 10 mg/ml |
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Contraindication to the use of nitrous oxide.
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Pneumothorax - closed air spaces expand 2x rapidly with NO2 use
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What is the formula to calculate MABL for a pediatric patient undergoing surgery?
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MABL = EBL x (patient HCT - min acceptable HCT) / patient HCT
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4 major factors in pediatric population that alters the pharmacokinetics and dynamics.
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1. Altered protein binding
2. Larger volume of distribution 3. Smaller proportion of fat and muscle 4. Immature renal and hepatic function |
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5 major differences in a neonatal airway.
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1. Tongue is larger
2. Larynx is higher (C3-4 instead of C4-5) 3. Epiglottis is floppier 4. Vocal cords are angled 5. Subglottis is narrowest at the cricoid cartilage |
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What is the correct ETT size for pediatric patients?
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Neonates - 6 months - 3.0-3.5
6 months - 1 year - 3.5-4.0 Others: Uncuffed ETT size = (age/4) + 4 Cuffed: use tube which is 0.5-1 size smaller |
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Why use an uncuffed ETT in children younger than 8 years of age?
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Prevent tissue ischemia at level of cricoid ring
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Size of laryngoscope blade for pediatric population. Both Miller and MacIntosh.
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Neonate - 2 years
0-1, 1 2-6 years 1-2, 2 6-12 2, 2 > 12 2-3, 3 |
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Complications of intra-operative hypothermia
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Infection susceptibility increases.
Increased bleeding due to impaired platelet function and enzymatic function. |
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Observations that predict difficult bag-mask ventilation.
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Beard
Obese No teeth Elderly Sleep apnea/snoring |
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Sizing of LMA.
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Size 1 for weight < 6.5 kg
Size 2 for 6.5-25 kg Size 3 for 25-70 kg Size 4 for 70-100 kg |
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Treatment for post-op atelectasis.
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Physiotherapy and incentive spirometry to clear secretions
Anesthesia for adequate pain control so that he can cough adequately Bronchodilators Antibiotics for chest infection Arterial line for frequent ABGs If PT doesn't succeed: PEEP (positive end expiratory pressure) |
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What is the basal rate of O2 consumption in an average person?
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3.5 ml O2/kg/minute
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Preop cardiac investigations.
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Non-invasive
• ECG • Exercise stress test (ECG or MIBI) • Echo • Persantine MIBI • Dobutamine stress ECG Invasive • Angiography |
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Complications of local anesthetic overdose.
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Tinnitus
Tingling in lips Seizures Arrhythmias |
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What does FFP contain?
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Clotting factors
Fibrinogen |
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What does cryoprecipitate contain?
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VIII, XIII
vWF Fibrinogen |
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What is considered a normal ETCO2?
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33-45 mmHg
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Which nerves are most commonly used to test depth of neuromuscular blockade?
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Ulnar
Facial Common peroneal |
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What is the "train of four" goal when using a non-depolarizing neuromuscular blocker?
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Maintain one twitch present.
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Other uses of thiopental
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Seizures
Reducing ICP |
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What is a normal CVP?
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1-10 mmHg
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Differences in neuromuscular testing between depolarizing and non-depolarizing neuromusclar blockades.
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Non-depolarizing NMB:
- slower onset. - train of four / tetanus fade. - post-tetanic facilitation present (ie after a tetanus stim, both single twitch and TOF are increased) - reversible (anticholinesterase) - TOF ratio < 0.7 |
