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The most common causes of postoperative eye pain are?
1.  Corneal abrasion
2.  Acute glaucoma (an emergency) 
What is the most common cause of ventilatory failure?
Increased small airway resistance
The most likely cause of hoarseness after thyroidectomy is?
Unilateral recurrent laryngeal nerve damage
What are complications seen after thyroidectomy?
Recurrent laryngeal nerve damage, tracheal compression from hematoma, tracheomalacia and hypoparathyroidism
What is the most common cause of hypotension in the PACU?
Hypovolemia
In patients receiving supplemental oxygen, the most common cause of significant hypoxia in the PACU is?
Intrapulmonary shunting (due to a decreased FRC relative to closing capacity)
What is a common cause of postoperative apnea?
Intraoperative hyperventilation
How does hypothermia effect emergence?
Decreases MAC, antagonizes muscle relaxant reversal, limits drug metabolism
Which procedures are associated with an increased incidence of postoperative neurological deficits?
Carotid endarterectomy, cardiopulmonary bypass, intracranial procedures, TURP
How do you differentiate somnolence from paralysis?  Paralysis from coma?
Forceful jaw thrust; peripheral nerve stimulation
What tests would be in order for delayed emergence, inability to extubate?
ABG, serum electrolytes (sodium), CT scan
How should a delayed emergence patient be supported?
Supportive ventilation, naloxone, flumazenil, physostigmine, doxapram, or aminophylline
Which two H2 antagonists provide a measure of protection in the recovery room?
Ranitidine and famotidine due to long duration of action
What is the treatment of pulmonary aspiration?
Place patient in a head-down position (to facilitate drainage of gastric contents from mouth).
The pharynx (and trachea) should be suctioned.
PPV for subsequent hypoxia.
Intubation and PEEP application or CPAP.
When is bronchoscopy, pulmonary lavage, and broad-spectrum antibiotic recommended after aspiration?
Only when particulate matter is involved
Should corticosteroids be routinely administered after aspiration?
No
What are the common postoperative problems of OLT?
Persistent hemorrhage
Fluid overload
Metabolic abnormalities: Alkalosis, hypokalemia
Respiratory failure
Pleural effusions
Paralysis of R hemidiaphragm (R phrenic nerve injury)
Renal failure
Systemic infections
Bile leaks or stricture
Thrombosis of hepatic or portal vessels
Seizures
Intracranial hemorrhage
Encephalopathy
Central pontine myelinosis
Immunosuppressant neurotoxicity
What are life threatening infections involved with OLT?
Intraabdominal
Pulmonary: Gram-negative, cytomegalovirus, Candida and Aspergillus, Pneumocystis
Wound
Urinary tract
Catheter-related
Viral hepatitis: CMV, Herpes, Epstein-Barr, adenovirus (children), Hep B and C
When does liver transplant rejection typically occur?
1-6 weeks post-op (diagnosed by biopsy)
Which myesthenia gravis patients are at greatest risk for postoperative respiratory failure (needing MV post thymectomy)?
Those with:
Disease duration > 6 years
PIP < -25 cm H2O
VC < 4 mL/kg
Pyridostigmine dose > 750 mg/d
Which individuals tend to have the lowest survival rates with increasing percentage of body surface area burned?
By age 70+ > 61-70 > 51-60 > 0-2 > 41-50 > 3-20 > 21-40
When should CPR and emergency CV care be considered?
Whenever oxygenation and/or perfusion are inadequate (not just after cardiac or respiratory arrest)
What three components must be available when using transtracheal jet ventilation?
Ready availability, low-compliance tubing, and secure connections
If a patient's airway is maintained by jaw-thrust, should chest compressions and ventilation be interrupted for intubation?
No
How long should intubation attempts take during CPR?
< 30 s
What should be the first response to pulselessness?
Performance of chest compressions
How long after sudden cardiac arrest (with presence of ventricular fibrillation) should a shock be delivered?
Within 3 (+/- 1) min of arrest
Which ACLS drugs may be administered down the ETT?  Which absolutely may not be?

How does the dosage change by this route?
Lidocaine, epinephrine, atropine, vasopressin

Sodium bicarbonate may not be

Dose is 2-2.5 x the IV dose, diluted in 10 mL of NS or distilled water
How may emergency vascular access be obtained in children?
IO
Explain the relationships between the BBB, CO2 and bicarbonate?
CO2 readily crosses the BBB, but bicarbonate does not.  Therefore arterial hypercapnia will cause intracellular tissue acidosis
What signifies electrical capture?  What signifies mechanical (ventricular) capture?
A wide QRS following a pacing spike; Improving pulse or BP
What are the essentials of emergency cardiac care (ECC)?
1.  Recognition of an impending event
2.  Activation of the emergency response system
3.  Basic life support
4.  Defibrillation
5.  Ventilation
6.  Pharmacotherapy
What is the dosage of epinephrine during resuscitation?
1 mg IV, every 3-5 minutes
What is the dosage of vasopressin during resuscitation?  When may it be administered?
40 U IV, in place of the first or second dose of epinephrine only, one time only
What are the 5 H's & 5 T's?
Hypovolemia
Hypoxia
Hydrogen ion - acidosis
Hyper/hypokalemia, other metabolic
Hypothermia
"Tablets" (drug OD, accidents)
Tamponade, cardiac
Tension pneumothorax
Thrombosis, coronary (ACS)
Thrombosis, pulmonary (embolism)
When is the Heimlich maneuver performed in a child (what age)?
> 12 months
Where is the best place to palpate a pulse in an infant (< 12 mos)?  In a child or adult?
Brachial artery; Carotid artery
What confirms correct needle placement through the cricothyroid membrane?  What size needle should be used?
Aspiration of air; 14 G
What are the two methods of transtracheal jet ventilation?
A jet injector and pressure regulator can be attached to wall suction, or a low compliance piece of tubing with 15 mm ETT adapter from a 4 mm ET tube luer-locked on one end, with other end luer-locked to 14-gauge cricothyroid catheter is attached to the fresh gas outlet of the anesthesia machine
A patient is in ventricular fibrillation.  How much does chance of successful resuscitation decrease per minute?
7-10%
What is the appropriate cardioversion energy requirement to terminate unstable a-fib?
50-100 J
What is the appropriate cardioversion energy requirement to terminate unstable a-flutter/tachycardia?
30-50 J
What is the appropriate cardioversion energy requirement to terminate monomorphic ventricular tachycardia?
100 J
What is the appropriate cardioversion energy requirement to terminate polymorphic ventricular tachycardia or ventricular fibrillation?
120-200 J
How does IO placement allow access to the venous system?
By way of the large medullary venous channels.  The needle is directed away from the epiphyseal plate to minimize the risk of injury.
How does adenosine work?  What is it used to treat?
Slows AV nodal conduction; Narrow complex tachycardias, stable SVT and wide complex tachycardias if supraventricular in origin.
What are the adult and pediatric dosages of adenosine?
Adult: 6 mg over 1-3 sec; 12 mg repeat dose
Peds: 0.1-0.2 mg/kg; subsequently doubled to max of 12 mg.
What are the special considerations for adenosine?
Used to diagnose or therapeutically manuever SVT; given as a rapid IV bolus.  Vasodilates, may decrease BP.  Risk of angina, bronchospasm, proarhythmic action.  It interacts with theophylline and dipyridamole.
How does atropine work and what is it used to treat?
Anticholinergic (parasympatholytic).  Increases sinoatrial node rate and automaticity; increases AV node conduction; Symptomatic bradycardia, AV block, Ventricular asystole
What is the adult and pediatric dose of atropine?
Adult: 0.5-1.0 mg repeated every 3-5 min (1 mg for asystole)
Peds: 0.02 mg/kg
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