Lec 4 - preOP
risk factors of stroke
PFO (patent foramen ovale)
Atrial Fibrillation
Carotid Stenosis
what is PaO2, SaO2, PAP, and CVP?
PaO2 = partial pressure of O2 in arterial blood
SaO2 = arterial Oxygen saturation (ABG)
PAP = pulmonary Artery Pressure
CVP = central venous pressure
how does LA effects change with acidotic pts?
very slow onset, if they work at all
ex. septic/infection
SLUD acronym for poisoning/overdose of cholinergic agents
S - salivation
L - lacrimation
U - urination
D - defecation
name the 5 ASA monitors for anesthesia and their normal amount
Pulse Ox - 95-100%
blood pressure (NIBP) - 120/80
ECG, electrocardiogram - HR 60-100bpm
Temperature - 36-38 C
capnograph - 35-45mmHg
explain what drives breathing and how narcotics affect this. How much does CO2 increase per min in apnea?
Sole driver is CO2 threshold - want CO2 out of body. Narcotics increase our CO2 threshold
1st minute increase 6 pts, 3pts/min after that
what does the pulmonary artery wedge reflect?
what is a sign you went past epidural space and into spinal space?
CSF on the tip of the needle
2 pops
alpha 2 agonist actions
anxiolysis, sedative, analgesic
name MS MAIDS machine set up acronym
M - machine
S - suction
M - monitors
A - airway
I - IV
D - drugs
S - special setup/seat
name STOPBANG to assess Obstructive sleep apnea
S = snoring h/o
T = tired throughout day - daytime somnolence
O = observed
P = pressure - history of hypertension
B = BMI over 35
A = age over 50
N = neck size
G = gender - men
in coronary blood flow, when are the RV and LV myocardium perfused?
RV = both systole and diastole
LV = perfused during diastole
compare Spinal vs Epidural (onset, duration, block, region)
spinal = rapid onset (3-5min), single shot, short duration, dense motor block (cant move legs/foley), lumbar region
epidural = long onset and duration (10-15 min), redosable, adjustable block level, thoracic/lumbar
Beta 1 agonist actions
increase chronotropy (HR), dromotropy (conduction speed through AV Node), and inotropy (contractility)
anesthesia machine checklist
check emergency equiment
check ecylinder level
check central pipeline supply
check fill of vaporizers
perform low pressure leak test (bulb)
turn on machine and verify O2
test flow meters
check scavenging
calibrate O2 monitor
perform high pressure leak test (Y-piece occuled)
test ventilator and ventilation system (put on breathing bag)
check monitors and alarm limits
Management for asthma
Take albuterol before surgery - bring for end of case into ETT - bronchodilate - beta 2 agonist
Volatile (minus des) anesthetics - bronchodilate
Epi - big beta 2 agonist - bronchodilator
IV ketamine - bronchodilator
oculocardiac reflex - how is it stimulated? what does it cause? how we fix it?
Triggered by traction or pressure on the extra ocular muscles
vagal reflex causes bradycardia
tell surgeon to stop, give atropine or glycopyrrolate
how long should you pre-oxygenate? what does it do?
8 vital capacity breaths over 1 min OR tidal volume breaths for 3 min (100% O2)
replaces nitrogen in FRC, delays hypoxemia
beta 2 agonist actions
bronchodilation, vasodilation (increase myocardial and skeletal muscle perfusion)
name all the things you should grab to start an IV
tourniquet, alcohol swab, flush syringe, "pigtail", angiocath, tegaderm, tape, gauze
Name all physical airway assessment check
Mallampati, incisor gap, overbite test, thryomental distance, teeth status documented, neck size/thickness, neck mobility
what pulmonary measurement reflects true compliance?
plateau pressure (Pplat) = alveolar pressure at no-flow
N - naloxone
A - atropine
V - vasopressin
E - epinephrine
L - lidocaine
alpha 1 agonist actions
name all you should check to confirm airway placement
chest rise
condensation in OETT/LMA
sustained positive end tidal CO2 (gold standard)
bilateral breath sounds
adequate TV