Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
88 Cards in this Set
- Front
- Back
|
early sign of MH
|
et CO2
|
|
|
what can trigger MH
|
volatile agents
succ |
|
|
what is not triggers for MH
|
ketamine
propofol non-depolarizers opiods iv agents anxiolytics nitrous |
|
|
what is a late sign for MH
|
temp
|
|
|
what are some specific signs of MH
|
muscle rigidity
increased CO2 Rhabdomyolysis Temp elevation |
|
|
What are some non specific signs of MH
|
tachycardia
tachypnea acidosis hyperkalemia |
|
|
what lab can you check if suspecting MH
|
CK
|
|
|
what to do if Masseter rigidity is noted
|
stop inhalation agent
no more succs stop surgery or continue if needed with non-triggering agent use dantrolene if signs of mh persue |
|
|
what is a muscle wasting disorder that affects males with an absence of dystrophin protein (die around 20yrs)
|
Duchenne Musc. Dystrophy
signs begin age 2-6 |
|
|
what is a muscle weakness disorder that affects males with an abnormal dystrophin protein (normal life span)
|
Becker's Muscular dystrophy
|
|
|
when a child develops cardiac arrest after succs treatment for what should be instituted
|
hyperkalemia-
calcium, bicarb, glucose, insulin and hyperventilation |
|
|
what receptor is often found different in those affected by MH
|
RYR-1
|
|
|
disorders that are assoc. with MH susceptibility- 4
|
Central Core Disease
Evans Myopathy Hypokalemic Periodic Paralysis |
|
|
what can mimic MH fever (without rigidity)- 7
|
thyrotoxicosis
Sepsis Pheochromocytoma Iatrogenic overheating Anticholinergic syndrome Fautly equipment Tourniquet (children) |
|
|
what can mimic MH fever and muscle symptoms- 4
|
Neurolept Malignant Syndrome
Hypoxic encephalopathy Ionic contrast agents in CSF Cocaine, amphetamine, ecstasy |
|
|
what is an idiopathic hypermetabolic response that in which changes occur in the CNS that is not inherited
|
NMS
|
|
|
how to treat NMS
|
dantrolene, benzos, dopamine agonist
|
|
|
drugs that may precipitate NMS
|
antipsychotics
neuroleptics acute withdrawl of anti parkinson drugs dopamine blocking agents (reglan, phenergan) |
|
|
what is the gold standard for testing for MH
|
Halothane, caffeine contracture test
|
|
|
is MH autosomal dominant or recessive
|
dominant
|
|
|
immediate treatment of MH
|
stop inhalation agent, succs
hyperventilate 100% O2 bicarb 1-2 mg/kg as needed Dantrolene 2.5 mg/kg cool, labs treat arrhythmias (no CCB) |
|
|
how much dantrolene in a bottle
|
20mg/ dissolve in 60 mls
1mg/3mls |
|
|
what is the repeat dose of dantrolene
|
10mg/kg until crisis is controlled then 1mg/kg every 4-6hrs for 24 hrs
|
|
|
when do you see DIC in MH pts
|
temp >41.5C
|
|
|
how long should you flow O2 through the circuit if doing a suspected MH case
|
at 10 l for 20 min
|
|
|
how long should you continue dantrolene after MH case
|
24-48 hrs
|
|
|
how much mannitol in dantrolene
|
3gms/bottle
|
|
|
what is an idiopathic hypermetabolic response that in which changes occur in the CNS that is not inherited
|
NMS
|
|
|
how to treat NMS
|
dantrolene, benzos, dopamine agonist
|
|
|
drugs that may precipitate NMS
|
antipsychotics
neuroleptics acute withdrawl of anti parkinson drugs dopamine blocking agents (reglan, phenergan) |
|
|
what is the gold standard for testing for MH
|
Halothane, caffeine contracture test
|
|
|
is MH autosomal dominant or recessive
|
dominant
|
|
|
lidocaine max
|
w/o- 4
w/- 7 |
|
|
prilocaine max
|
w/o - 6
w/- 8.5 |
|
|
mepivacaine
|
w/o- 4
w/- 7 |
|
|
etidocaine
|
w/o- 4
w/- 6 |
|
|
bupivicaine
|
w/o- 2.5
w/- 3.5 |
|
|
ropivacaine
|
w/o- 2.5
w/- 3.5 |
|
|
procaine
|
w/o- 7
w/- 8.5 |
|
|
chloroprocaine
|
w/o- 6
w/- 14 |
|
|
upper ext blocks are what type of blocks
|
high volume blocks with 20-50 mls of LA
|
|
|
2 most common hazards assoc. with high blood levels of LA
|
CNS excitation- seizures
myocardial depression |
|
|
brachial plexus
|
C5-T1
|
|
|
what 3 major cords are picked up by interscalene block
|
lateral
posterior medial |
|
|
what nerves do we get with axillary block
|
ulnar
median radial |
|
|
what nerve is missed with axillary block
|
musculocutaneous
|
|
|
Axillary nerve
|
comes off high at shoulder
|
|
|
medial cutaneous nerve of the arm
|
Inside of upper arm
|
|
|
medial cutaneous nerve of the forearm
|
medial side of forearm
|
|
|
lateral cutaneous nerve of forearm (musculocutaneous nerve)
|
lateral side of forearm
|
|
|
ulnar nerve
|
pinkie finger and back of last 2 1/2 fingers
|
|
|
median nerve
|
palm of hand and part of thumb with tips of 1st 2 fingers
|
|
|
radial nerve
|
thumb side and half fo back of hand and area up the middle of the forearm
|
|
|
nerves anesthetized with interscalene block
|
axillary
musculocutaneous radial |
|
|
how do you increase chances of anesthetizing median, ulnar medial cutaneous with interscalene approach
|
increase dose to 50 cc
|
|
|
pt position in interscalene
|
supine with head to opposite side and shoulder dropped towards hip
|
|
|
what is interscalene groove
|
between anterior and middle scalene muscle at level of C6 or cricoid
|
|
|
what needle is commonly used for interscalene
|
22 gauge- 1.5inch
|
|
|
if induce parasthesia with PNS what will radial nerve do?
median nerve do? |
radial- hand will extend
median- hand will flex |
|
|
what angle do you maintain with needle when doing interscalene
|
downward posterior and caudad
|
|
|
once nerve is located what is done
|
aspirate and inject in small increments to detect intraneural or intra-arterial placement
|
|
|
must knows when doing a local block
|
toxic levels of LA
location of needle |
|
|
for supraclavicular approach where is needle inserted
|
@middle of the clavicle
|
|
|
what needs to be done if surgery requires tourniquet
|
sub q ring of anesthetic across the axilla- blocking the intercostobrachial nerve
|
|
|
what is horner's syndrome
|
dropping of eye and lip- vasodialtion of one pupil
|
|
|
7 listed complications of interscalene approach
|
pneumo
spinal/epidural anesthesia systemic toxicity hemidiaphragmatic paralysis horner's syndrome neuropathy of C6 Inadequate anesthesia |
|
|
position for supraclavicular approach
|
same as interscalene-
|
|
|
what block has highest incidence of pneumo
|
supraclavicular
|
|
|
common anesthetic for a supra- block
|
1% lidocaine (25-40ml)
|
|
|
sign of intraarterial injection from supra block
|
burning in hand
|
|
|
least chance of a pneumo
|
axillary approach
|
|
|
nerves anesthetized with axillary approach
|
medial cutaneous nerve of arm and forearm
median nerve Ulnar nerve |
|
|
nerves missed with axillary approach
|
musculocutaneous
radial axillary |
|
|
pt position for axillary approach
|
supine, with arm extended 90 degrees from the side and flexed at the elbow
|
|
|
technique for axillary approach
|
straddle artery with non-dominant hand and put distal pressure to encourage cephalad spread and massage up toward shoulder
|
|
|
where is ulnar nerve blocked at elbow performed
|
proximal to groove formed by medial condyle of the humerous and the olecranon with joint flexed 30 degrees (1-4ml)
|
|
|
where is the median nerve in the forearm
|
runs with brachial artery
|
|
|
at wrist ulnar nerve is
|
between ulnar artery and flexor capri ulnaris tendon
|
|
|
at wrist median nerve lies
|
just to the radial side of palmaris longus tendon
|
|
|
at wrist radial nerve
|
requires broader injection extending over dorsum of the wrist
|
|
|
how to test musculocutaneous nerve block
|
flexion of the arm
|
|
|
how to test median nerve block
|
flexion of fingers and wrist
|
|
|
how to test ulnar nerve block
|
adduction of thumb to little finger
|
|
|
how to test radial nerve block
|
extension of the fingers and the wrist (pushing away)
|
|
|
injection of LA into the venous system below an occluding toruniquet
|
bier block
|
|
|
technique of bier block
|
apply tourniquet- test both cuffs
exsanguiate arm with esmark inflate tourniquet (distal first then proximal) to 300 or 2.5 times bp (deflate distal) return arm horizontal inject local |
|
|
usual LA for bier block
|
.5% preservative free lidocaine
|
|
|
tourniquet must be inflated how long for bier block
|
20 minutes
after 40 minutes- no worries between 20-40 deflate in increments to avoid sudden absorption of LA |
