General POS

Question 1

Enteral feeding complications

Answer 1

• aspiration
• catheter malpositioning
• HONK
• bowel necrosis (dehydration and hypoperfusion)
• pneumotosis intestinalis with perforation
• solute overload –> diarrhea, dehydration, lyte imbalances, hyperglycemia (loss of K+, Mg++, other ions)

Question 2

Airway fire (what to do)

Answer 2

1) Shut off oxygen
2) remove burning material and put out the fire
3) maintain airway for patient, establish airway and ventilate with air until confirmed there is no more burning material (then can vent with FiO2 at 100%)

Question 3

Malignant Hyperthermia triggers (3)

Answer 3

• inhalational anaesthetic gases
• depolarizing muscle relaxants (succinylcholine, decamethonium)
• amide based local anaesthetic

Question 4

Malignant Hyperthermia S&S (11)

Answer 4

Can occur minutes to hours after contact with triggering agents

1. fever, diaphoresis
2. tachycardia/dysrhythmia
3. HTN
4. rigidity
5. tachypnea/cyanosis with decreased ventilation (hypercapnia can be first sign)
6. hyperK+
7. hyperCa++
8. metabolic acidosis
9. increased CK
10. myoglobinemia/myoglobinuria
11. trismus

Question 5

Malignant Hyperthermia Treatment

Answer 5

Stop anaesthetic

Hyperventilate with 100% O2

active cooling

Dantrolene (2-10mg/kg to block Ca++ release from SR, given in 1mg/kg increments)

Correction of lyte and acid-base abnormalities