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Anesthesia and Airway Management
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Anesthesia and Airway Management
Anesthesia and Airway Management
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1
Question
How do you determine if a patient is acidotic or alkalotic?
Answer
First, check the patient's pH level. The normal pH range is 7.35 to 7.45. If the pH is below 7.35, the patient is considered acidotic; if it is above 7.45, the patient is alkalotic.
2
Question
What are the normal values for pCO2 and Base Excess (BE) in the assessment of acid-base status?
Answer
The normal value for pCO2 is approximately 40 mmHg, and for Base Excess (BE), it typically ranges from -2 to +2.
3
Question
What indicates uncompensated respiratory acidosis?
Answer
In uncompensated respiratory acidosis, the pH is low (indicating acidemia), pCO2 is elevated (indicating respiratory acidosis), and the BE is normal.
4
Question
How can you identify compensated respiratory acidosis?
Answer
Compensated respiratory acidosis occurs when the pH is low, pCO2 is elevated, and the BE is elevated as well, indicating that the body has started to compensate for the acidosis.
5
Question
What indicates metabolic acidosis and its compensation status?
Answer
In metabolic acidosis, the pH is low, both BE and pCO2 are low. If the pCO2 is low along with a low pH and low BE, it is referred to as compensated metabolic acidosis.
6
Question
What is the capacity and pressure of a full O2 E cylinder?
Answer
A full O2 E cylinder contains approximately 660 liters of oxygen at a pressure of 2000 psi.
7
Question
What is the capacity and pressure of a full N2O E cylinder?
Answer
A full N2O E cylinder contains 1590 liters of nitrous oxide at a pressure of 745 psi.
8
Question
What is unique about the pressure in a full N2O E cylinder?
Answer
The pressure in a full N2O E cylinder remains constant until the liquid phase of nitrous oxide is exhausted. Once the liquid is gone, the pressure will begin to drop, often indicating that the tank is about a quarter full.
9
Question
What cartilage do the vocal cords attach to posteriorly?
Answer
The vocal cords are attached posteriorly to the arytenoid cartilages.
10
Question
How would you classify a patient's airway if the uvula is not visible?
Answer
If the uvula is not visible, the Mallampati class is 4.
11
Question
Which type of anesthesia is contraindicated for a sickle cell patient undergoing a finger amputation revision?
Answer
A bier block is contraindicated due to the risk of acidosis and low flow states associated with the tourniquet.
12
Question
What conditions favor the formation of deoxyhemoglobin in sickle cell anemia?
Answer
Conditions favoring formation of deoxyhemoglobin include hypoxemia, acidosis, intracellular hypertonicity or dehydration, increased 2,3 DPG levels, or increased temperature.
13
Question
What effect does hypothermia have on sickle cell anemia?
Answer
Hypothermia is detrimental because it leads to vasoconstriction, which can provoke sickling.
14
Question
How does lactated ringers solution (LR) prevent acidosis?
Answer
The lactate in lactated ringers solution is metabolized by the liver to bicarbonate, which helps to neutralize acid and thus prevent acidosis.
15
Question
What is converted to bicarbonate by the liver?
Answer
Solution (such as carbon dioxide in the blood) is converted to bicarbonate by the liver as part of the buffering system to maintain pH balance.
16
Question
When placing a pillow under the knees in the beach chair position, which nerve is being protected?
Answer
Padding or pillows under the knees prevent pressure injuries to the peroneal nerve.
17
Question
What level of block is needed for a C-section?
Answer
A T5-T4 level of sensory block is required for adequate anesthesia during a C-section.
18
Question
How do you rule out a hematoma in a post-thyroidectomy patient in the PACU?
Answer
To rule out a hematoma in a post-thyroidectomy patient, a visual examination is performed to look for signs of swelling or abnormal contours.
19
Question
What dose of IV epinephrine would you give a 1000g neonate?
Answer
A 1000g neonate would receive a dose of 10-20 mcg of intravenous epinephrine.
20
Question
What should be avoided in a patient with pulmonary hypertension?
Answer
Nitrous oxide (N2O) should be avoided in patients with pulmonary hypertension, as it can increase pulmonary vascular resistance.
21
Question
What is the best way to heat a hypothermic patient?
Answer
The most effective method to heat a hypothermic patient is by using a Bair Hugger or forced air warming system.
22
Question
What is the best way to heat a hypothermic patient?
Answer
The warmer is the best way to heat a hypothermic patient.
23
Question
What rule is used to calculate pediatric IV fluid rates?
Answer
The 4-2-1 rule is used to calculate pediatric IV fluid rates: 4 mL/kg/hr for the first 10 kg, 2 mL/kg/hr for the second 10 kg, and 1 mL/kg/hr for each remaining kg. Half of the total volume should be given in the first hour, 25% in the second hour, and 25% in the third hour.
24
Question
How is the 4-2-1 rule applied for pediatric IV fluid calculation?
Answer
To apply the 4-2-1 rule: For the first 10 kg of body weight, give 4 mL/kg/hr. For the next 10 kg (from 11 to 20 kg), give 2 mL/kg/hr. For every kg above 20 kg, give 1 mL/kg/hr. Once you calculate the total fluid requirement, administer half in the first hour, 25% in the second hour, and the remaining 25% in the third hour.
25
Question
What should you be aware of when inducing general anesthesia in an OB patient receiving magnesium?
Answer
When inducing general anesthesia in an OB patient receiving magnesium, be aware that magnesium potentiates nondepolarizing muscle relaxants, which may require a decrease in their dose by 25-50%. Additionally, magnesium enhances the vasodilating effects and negative inotropic properties of anesthetics.
26
Question
What is the most common side effect of Zofran in an awake patient?
Answer
The most commonly reported side effect of Zofran in an awake patient is headaches.
27
Question
Where do you make an incision for a cricothyrotomy?
Answer
An incision for a cricothyrotomy should be made through the skin over the cricothyroid membrane, which is located between the thyroid and cricoid cartilages, typically 1-2 cm below the Adam's apple.
28
Question
What is the significance of the cricothyroid membrane in emergency airway access?
Answer
The cricothyroid membrane is significant in emergency airway access because it provides a quick route to the airway through cricothyrotomy, especially in cases of upper airway obstruction.
29
Question
What are the indications for performing a cricothyrotomy?
Answer
Indications for performing a cricothyrotomy include acute respiratory failure, severe trauma to the face or neck creating airway obstruction, inability to intubate through conventional means, and in cases of massive swelling of the airway.
30
Question
What are the potential complications of cricothyrotomy?
Answer
Potential complications of cricothyrotomy include bleeding, injury to surrounding structures (such as the esophagus or major blood vessels), pneumothorax, subcutaneous emphysema, and improper placement of the tube.