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Thermoregulation
CAPA Hypothermia / Hyperthermia / Malignant Hyperthermia
| Question | Answer |
|---|---|
| What is the most accurate method of ,easuring core temperature? | Pulmonary artery by use of a pulmonary artery catheter |
| What is the best method to monitor brain temperature? | Nasopharynx |
| What is the definition of hypthermia? | Core temperature less than 36 degrees C (98.6) |
| What is the definition of hyperthermia? | Core temperature greater than 38 degrees (100.4) |
| How is most of the body's heat provided? | Through basal metabolic rate |
| True/False: The body's core temperature may vary with environmental changes. | FALSE - Core temperature remains faily constant. Skin and extremity temperatures may vary with environmental changes. |
| What is the primary temperature control center? | Hypothalamus |
| What is the only natural internal source of heat? | Metabolism |
| How do body tissues produce heat? | In proportion to their metabolic rates. |
| Shivering can increase heat production by up to what percentage? | 500% |
| How is nonshivering heat produced? | Through catabolism of brown fat cell by the newborn |
| How does heat flow? | From warmer to cooler. |
| How is 40-60% of heat lost? | Radiation (from warmer to cooler) |
| What account for 25-35% of heat loss? | Convection (loss of heat from transfer to the surrounding cooler air) |
| Heat loss from transfer through direct contact between objects is called what? | Conduction |
| True/False: Almost all patients receiving an anesthetic become hypthermic unless they are actively warmed. | True |
| Anesthetic cause a drop in temperature due to what? | core-to-peripheral redistribution of body heat (anesthesia reduced the vasoconstriction threshol and causes peripheral vasodilation) |
| How much does core temperature drop in the first hour of surgery? | 1-1.5 degrees C (primarily caused by core-to-peripheral redistribution) |
| Why would hypothermia during surgery be planned? | To prevent cardiac or cerebral ischemia |
| What are the most common times planned perioperative hypothermia would occur? | Cardiac or Neurosurgical procedures |
| What effect does hypothermia have on the brain? | Decreased intracranial pressure and amount of bleeding |
| What are risk factors for perioperative hypothermia? | extreme ages, female, room temp, length/type of surgery, cachexia |
| What effect does hypothermia have on coagulopathy? | platelet function is reduced and clotting cascade is slowed; blood loss is increased |
| What effect does hypothermia have on drug metabolism? | Elimination of injectable drugs is prolonged; Duration of anesthestic agents are prolonged |
| What impact does hypothermia have on wound healing? | Impaired wound healing; tissue oxygenation is decreased, immunity and collagen production is impaired, and infection rates increase. |
| What causes Malignant Hyperthermia? | muscular hypercatabolic reaction in ehich the level of intracellular calcium reuptake is impaired. |
| What does MH cause? | Muscle tetany, increased prduction of heat, CO2, and lactate |
| What population is MH more common in? | children |
| What are triggering agents of MH? | Succinylcholine, ALL volative inhalation agents, d-Tubocurarine, IV potassium if given rapidly |
| What are POSSIBLE MH triggers? | Phenothiazines (Chlorpromazine, Prochlorperazine) and Haloperidol |
| What are safe anesthetic agents to use with patients at risk for MH? | Nitrous oxide, opioids, Barbiturates, Droperidol, Propofol, Benzodiazepines, Etomidate, Ketamine, NONdepolarizing muscle relaxants,amides, and esters |
| What diseases/disorders place patient at a higher risk of MH? | Duchenne muscular dystrophy, Central Core Disease, Myotonia, Myopathies |
| What is the most reliable way to diagnose MH? | Caffeine-halothane contracture test |
| What is a test that can help identify potential for MH, but is unreliable? | CK (Creatinine Phosphokinase) |
| What are EARLY signs of MH? | Muscle rigity, tachycardia and dysrhythmis, tachypnea, hyperkalemia |
| What are LATE signs of MH? | Pyrexia, Coagulopathy, Thabdomyolysis, Lt Ventricular failure |
| What is the immediate treatment for MH? | Immediate discontinuation of anesthesia and surgery, 100% Oxygen, Dantrolene |
| How do you reconstitute Dantrolene? | 60mL of preservative-free sterile water |
| What is the recommended dose of Dantrolene? | 2.5mg/kg up to a total of 10 mg/kg body weight. May exceed if syndrome not under control |
| After initial treatment of MH what actions do you take? | Initiate patient cooling, maintain fluid and electrolyte balance, and monitor cardiac output |
| Once MH is under control what is treatment for the patient? | Move to ICU and repeat dantrolene every 4-6 hours for up to 48 hours, monitor for DIC, Follow CK for several days until normal. |
| How may a Duchenne muscular dystrophy patient present if not identified as at risk for MH? | Ventricular tachycardia and fibrillation, sudden hyperkalemia or possible sudden cardiac arrest in a child or young adult in PACU with no other risk factors |
| How do you treat a muscular dystrophy patient who was given succs or a volatile inhalation agent and is symptomatic? | Glucose, insulin, and bicarbonate IV and calcium chloride if ventricular tachycardia |
| How does MH and Thyrotoxicosis differ? | Thyrotoxicosis has no muscle rigidity, little to no acidosis, and no myoglobinuria. |
| In what disease that mimics MH is dantrolene of little or no value? | Pheochromocytoma |
| Hypoxic brain damage with periods of hypoxia that lead to hyperthermia are treated with what? | Mannitol and steroids |
| Ascending tonic-clonic syndrome occurs after what procedure? | Myelogram |
| What occurs with ascending tonic-clonic syndrome? | jerking of muscles in legs progress to whole body tonic activity and leads to seizures and hyperthermia |
| Neuroleptic malignant syndrome occurs in patients taking what? | antipsychotic medications |
| What is the treatment for Neuroleptic melignant syndrome? | Cooling, Dantrolene, Bromocriptine (a dopamine agonist), and syptomatic therapy |
Created by:
keviannk
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