Term
| You won't see a patient become cyanotic on average until a patients sats drop to _____ with a Hb of 15. |
|
Definition
| With a Hb of 15 the patients SATS will have to drop to 80% before clinical signs of cyanosis are present. |
|
|
Term
| What factors will produce falsely low SPO2 levels? |
|
Definition
| Any blue finger nails, if you gave methylene blue, shivering postop, ambient light |
|
|
Term
| The most sensitive lead for detecting ischemic events intraop is? |
|
Definition
| V5, so set up your leads so that the modified 5th lead is in the midaxillary 5th intercostal space. This has a 75% sensitivity for ischemia. IF you include II and V5 its a 80% sensitivity. If you include II, V4 and V5 its a 98% sensitivity. |
|
|
Term
| NIBP most accurately gives you what BP.. the SBP, DBP or MAP? Why? |
|
Definition
| NIBP is most accurate for MAP. The SBP and DBP are numbers produced by a computer and algorithm. |
|
|
Term
|
Definition
|
|
Term
| Raising your transducer 10cm H20 higher than the phlebostatic point will cause a change in your blood pressure of ___ mmHg. |
|
Definition
|
|
Term
| Bronchospasm on the capnography will look like what? |
|
Definition
| upsloping trace. looks like a shark fin |
|
|
Term
| what type of waveform indicates a exhaused CO2 absorbent |
|
Definition
| When the baseline waveform does not return to 0-5. |
|
|
Term
| On capnography what would indicate a pulmonary embolism... |
|
Definition
| Pulmonary embolism you always think V/Q mismatch. So Capnography is a good indicator of ventilation and perfusion can be sampled with an ABG. If you have decrease CO2 on the capnography and a large difference between that number and the ABG then you have a problem. |
|
|
Term
| Name the four phases of capnography |
|
Definition
Phase 1: is dead space gas exhalation. Dead space air comes from the upper airways, and space in the tubing.
Phase 2: Deadspace cleared and now exchange between the alveolar air as it leaves. Co2 # increases
Phase III: Max expiration of CO2 over time. long plateau is expected and all alveoli clear out CO2.
Phase IV: ABrupt end of CO2 plateau due to next inspiration of air (depleted of CO2) enters driving down that waveform to 0-5. |
|
|
Term
| how does temperature effect ETCO2 |
|
Definition
| increase temp means more metabolism which means more ETCO2 and therefore higher number on capnography. Hypothermia means stasis and body going to sleep so less metabolism and less ETCO2. |
|
|
Term
| a ETCO2 will be withing ___ to ___ of PaCO2 when? |
|
Definition
| ETCO2 will be within 2-3 mmHg of PaCO2 in normal individuals with normal plateau pressures. |
|
|
Term
| What are the 5x characteristics you look for during capnography and what do they mean? |
|
Definition
1. Height: reflects ETCO2 Amount
2. Frequency: reflects resp rate
3. Rhythm: reflects type of vent, or other
4. Baseline: Always need to return to 0-5
5. Shape: Only one normal. Everything else indicates something is going on. |
|
|
Term
| what are the four phases of inhalation agents |
|
Definition
1. absorption
2. distribution
3. Metabolism
4. Excretion |
|
|
Term
|
Definition
| MAC is the amount of inhalation agent needed to obtain no movement from patients during incision in 50% of people. |
|
|
Term
| What is the negative effect of inhalation on our resp system? |
|
Definition
| can cause a dose dependent depression of the ventilatory response to hypercarbia and hypoxia. |
|
|
Term
| What are some negative qualities to NO to be used as an inhalation agent |
|
Definition
1. does not produce skeletal muscle relaxation
2. Can contribute to PONV
3. Can diffuse into air filled cavities and cause expansion of air. |
|
|
Term
|
Definition
|
|
Term
| What are some good qualities of sevoflurane |
|
Definition
1. sweet smelling
2. potent bronchodilator |
|
|
Term
| What is a dangerous quality of sevo? |
|
Definition
1. can form CO in desiccated CO2 absorbent and that may cause a fire
2. Forms compound A in CO2 absorbent at slow rates which is nephrotoxic. |
|
|
Term
| MAC is an indicator of what? |
|
Definition
| potency. So The least potent drug we give is NO which has a MAC of 104% and the most potent is Halothane which has a MAC of 0.75%. |
|
|
Term
| How does temperature effect MAC |
|
Definition
1. Hyperthermia = increase MAC. So need more drug to keep sedated
2. Hypothermia: Decrease MAC. Means less % of drug needed to keep pt from moving. |
|
|
Term
| How are pregnant women affected in regards to MAC and inhalation agents |
|
Definition
| Decrease MAC, they need less drug since they have lower Vd and therefore higher concentrations right from the start. |
|
|
Term
| What are some signs of light anesthesia? |
|
Definition
1. increase HR 20% above baseline
2. Tearing
3. Pupil dilation (Fight or flight kicking in and patient scared, waking up.
4. coughing or bucking vent
5. Increase BIS score. |
|
|
Term
| NORMAL BIS Score for general anesthesia |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is MAC for desflurane |
|
Definition
|
|
Term
| What is the induction dose for propofol |
|
Definition
|
|
Term
| What is the induction dose for versed |
|
Definition
|
|
Term
| What is the induction dose for ketamine |
|
Definition
|
|
Term
| what is the induction dose for etomidate |
|
Definition
|
|
Term
| What induction agent has nausea properties? Which one has antiemetic properties |
|
Definition
propofol: antiemetic
etomidate: nausea s/e |
|
|
Term
| Which induction agent is best for a pt with unk cardiac disease |
|
Definition
| etomidate. less cardio depressant |
|
|
Term
| What is a major draw back to etomidate |
|
Definition
| one induction dose is enough to supress the adrenocortex for 5-8 hours after |
|
|
Term
| what is the name for the side effect associated with decrease ventilation after fast administration of an opioid |
|
Definition
| chest wall rigidity. Can be an emergency. Can't ventilate. Give narcan stat or muscle relaxant. |
|
|
Term
| Why is morphine not a great drug for pain |
|
Definition
| Morphine may take effect in 15 minutes with 80% but true peak analgesic effect takes 90 minutes. It also has an active metabolite called morphine 6-glucuronide which in renally cleared. |
|
|
Term
| what is the potentcy relationship between morphien and dilaudid |
|
Definition
| dilaudid is 8x more potent |
|
|
Term
| what is the potency relationship between fentanyl and morphine |
|
Definition
| fentanyl is 100x more potent |
|
|
Term
| What are the risks/ S/E of demerol |
|
Definition
1. releases histamine
2. anticholinergic effects
3. lower's seizure threshold due to its active metabolite normeperidine |
|
|
Term
| what opioids do you need to be careful about using in renal patients? |
|
Definition
| be careful with morphine and demerol. Both have active metabolites |
|
|
Term
| blood pressure is determined by what two things? |
|
Definition
1. cardiac output
2. vascular tone |
|
|
Term
| Cardiac output = ___ x ___ |
|
Definition
|
|
Term
| Why are kids fixed on HR for BP drive? |
|
Definition
| Kids have a fixed Stroke volume in their little tinnie tiny hearts. So for increase cardiac output demand they have to respond with HR increases. So when you give them drugs that supress their heart drive you effectively drop their CO since their SV can't compensate as well as an adult |
|
|
Term
| SV is dependent on what three things |
|
Definition
1. preload
2. afterload
3. contactility |
|
|
Term
| afterload is mostly comprised of? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| The dicrotic notch on your aline represents what? |
|
Definition
| the closure of the aortic valve |
|
|
Term
| narrow pulse pressure means what? |
|
Definition
1. aortic stenosis
2. tension pneumo
3. mycocardial failure
4. shock
5. |
|
|
Term
| wide pulse pressure may indicate |
|
Definition
1. aortic regurg
2. atherosclerotic vessels
3. high output state
4. pregnancy
5. SNS response to something |
|
|
Term
| Normal pulse pressure is? |
|
Definition
|
|
Term
| what are three emergent thigns that may cause a hypermetabolic state |
|
Definition
1. Malignant hyperthermia
2. thyrotoxicosis
3. neuromalignant syndrome. |
|
|
Term
| you suspect increase ICP..what is cushing's triad |
|
Definition
1. HTN
2. bradycardia
3. irregular resp |
|
|
Term
| hydralazine peaks in how long |
|
Definition
|
|
Term
| What can you do with your ventilation settings to optimize a patient experiencing acute hypotension |
|
Definition
1. decrease or turn off PEEP
2. reduce inspiratory:expiratory ratio so there is less inspiratory time
3. rule out pneumo |
|
|
Term
| What bolus dose of neo can you give for acute hypotension? What are a possible s/e to be concerned about |
|
Definition
| 100 mcg of neo. Will cause reflexive bradycardia. |
|
|
Term
| a bolus dose of epi for acute hypotension is how much |
|
Definition
|
|
Term
| when should you consider steroids in a hypotensive patient |
|
Definition
| if patient has been on steroids in last 6 months you should consider a bolus dose of 100mg hydrocortisone |
|
|
Term
| The intubating dose of sux is? |
|
Definition
|
|
Term
| What happens if you give a defasiculating dose prior to sux? |
|
Definition
| you need to give more SUX!! |
|
|
Term
|
Definition
|
|
Term
| What previous diseases result in upregulation of AcH receptors and hence making giving Sux a very bad thing |
|
Definition
1. burn injury 24-48 hours after
2. muscular dystrophy
3. myotonias
4. prolonged immobility
5. stroke
6. upper motor neuron disease |
|
|
Term
| What are the side effects of sux |
|
Definition
1. myalgias from fasiculations
2. increased ICP
3. Increased IOP
4. increased Intragastric pressure
5. |
|
|
Term
| What is the defasiculating dose given for sux |
|
Definition
| Roc of 0.03mg/kg 3 minutes prior to Sux |
|
|
Term
| what is the intubating dose of a NMBA |
|
Definition
|
|
Term
| If you can't give sux and want to give ROC for RSI what is the dose |
|
Definition
|
|
Term
| Cisatracurium is broken down how? |
|
Definition
1. plasma esterases
2. hoffman elimination |
|
|
Term
| atropine is paired with what acetylchoinesterase inhibitior? Why? |
|
Definition
| atropine paired with edrophonium because both are rapid acting. |
|
|
Term
| Describe the different Mallampati scores |
|
Definition
There are four scores to assess a person's airway difficulty
Class 1: Is a good airway. You can visualize the hard palate, soft palate, uvula, and pillars.
Class II: You can visualize only hard palate, soft palate and part of the uvula
Class III: You can only visulaize the hard palate and soft palate
Class IV: You can only visualize the hard palate. |
|
|
Term
| Name the two cartilages that are above and below the area you would perform an emergency cricothyroidotomy |
|
Definition
| The thyroid cartilage is superior to the cricothyroid ligament while the cricoid cartilage is inferior. |
|
|
Term
| Ramp obese patients may present as a difficult intubation due to their oral, pharyngeal and laryngeal airways being very misalligned. What allignment should you attempt? |
|
Definition
| Line their tragus with their sternum |
|
|
Term
| In your preevaluation and history what things in the patient report would indicate that they are likely hypovolumic? |
|
Definition
1. vomiting
2. diarrhea
3. fever
4. sepsis
5. trauma |
|
|
Term
| During hypovolumia you may see a BUN/Cr ratio of? |
|
Definition
|
|
Term
| Why is UOP decrease during or after surgery not always indicative of hypovolumia? |
|
Definition
| b/c surgery causes stress response. Stress response in body results in increase ADH production. ADH tells kidney's to retain water. Therefore decrease UOP. May not be from hypovolumia. |
|
|
Term
| What tool would be a very good indicator of hemodynamics in patients. (not a swan..) |
|
Definition
|
|
Term
| what are some disadvantages of NS compared to LR |
|
Definition
NS can cause hyperchloremic metabolic acidosis and hyperchloremia can decrease GFR.
LR has Ca which may promote clotting with pRBC administration. It also has K which is potentially dangerous for Renal pts. |
|
|
Term
| Where is albumin made from? |
|
Definition
| Extracted from blood. Minimal risk for viral infection. It is expensive |
|
|
Term
| What are the two different albumin % and when would you give each one. |
|
Definition
| There is a 5% and 25%. The 25% obviously is more concentrated. Both are for hypovolumic patients that may benefit from oncotic pressure support due to low plasma proteins or risk for overload / poor response to crystalloid. 25% is reserved for pts with CHF, renal disease or who need less volume. |
|
|
Term
| What is the maintenance IVF rule |
|
Definition
| 4-2-1 rule. 4mL/hr for first 10KG, then 2mL/hr for 10-20Kg, and 1mL/kg for every KG above that. |
|
|
Term
| how much blood does a surgical lap account for? How much blood do you give a 4x4 sponge. |
|
Definition
| 100-150mL each for surgical laps, 10mL for each 4x4. |
|
|
Term
| why do neuro doctors prefer NS over LR for their patients |
|
Definition
| NS has a higher osmolality then LR so less risk for cerebral tissue edema. |
|
|
Term
| The parkland formula is used for burn patients and give % for area burned. What are the corresponding %'s for all areas |
|
Definition
| 9% given for each arm, head is 9%, groin is 1%, each hand is 1%, then torso from and back is broken down into four 9% quadrants, each leg is 9% front and 9% back. |
|
|
Term
| What is the parkland formula for burns |
|
Definition
| %BSA burned x Kg x 4mL. Give the first half over the next 8 hours then give the remaining half over the next 16 hours. |
|
|
Term
| What is the hematocrit of one unit of pRBC? |
|
Definition
| 70% in the avg 250-350 mL bag |
|
|
Term
| What part of the preservititve causes a drop in calcium |
|
Definition
| the citrate binds to Ca and thereby lowers serum Ca in recepitent |
|
|
Term
| why cannot you not use D5W or other hypotonic solutions with blood products |
|
Definition
| they can cause hemolysis from over saturating rbcs with H20 since they are hypotonic solutions |
|
|
Term
| What blood product cannot go through a fluid warmer or level 1? |
|
Definition
|
|
Term
| One pack of platelets will raise your platelets how much? (this is 50-70mL pack) |
|
Definition
|
|
Term
| What are the chances of contracting HIV from blood donation? How about Hepatitis C? |
|
Definition
HIV: 1 in 2 million
Hep C: 1 in 1.6 million |
|
|
Term
| most common type of blood product that may transmit a virus |
|
Definition
| Platelets due to its storage in dextrose at room temperature. That's why platelets are only kept for less or equal to 5 days. |
|
|
Term
| What are the three types of transfusion reactions |
|
Definition
1. febrile non-hemolytic reaction
2. allergic/anaphylactic reaction
3. Acute hemolytic reaction |
|
|
Term
| what are sx of a acute hemolytic reaction following transfusion |
|
Definition
1. fever
2. chills
3. flank pain
4. hypotension
5. Brown urine! |
|
|
Term
| Treatment for acute hemolytic reaction |
|
Definition
| Big worry is kidney damage. Maintain alkaline urine, give bicarb and diuretics. |
|
|
Term
| Describe TRALI etiology, management and sx. |
|
Definition
| TRALI is most often associated with FFP and platelets more than RBCs, it occurs 4 hours after transfusion. Has a 5-10% mortality. Presents like other etiologies with Sx of dyspnea, hypoxemia, hypotension, fever and pulmonary edema. So need to rule out sepsis, volume overload and cardiogeneic pulmonary edema FIRST. Treat is supportive. Resolves within 48 hours. |
|
|
Term
| Describe the different Mallampati scores |
|
Definition
There are four scores to assess a person's airway difficulty
Class 1: Is a good airway. You can visualize the hard palate, soft palate, uvula, and pillars.
Class II: You can visualize only hard palate, soft palate and part of the uvula
Class III: You can only visulaize the hard palate and soft palate
Class IV: You can only visualize the hard palate. |
|
|
Term
| Name the two cartilages that are above and below the area you would perform an emergency cricothyroidotomy |
|
Definition
| The thyroid cartilage is superior to the cricothyroid ligament while the cricoid cartilage is inferior. |
|
|
Term
| Ramp obese patients may present as a difficult intubation due to their oral, pharyngeal and laryngeal airways being very misalligned. What allignment should you attempt? |
|
Definition
| Line their tragus with their sternum |
|
|
Term
| In your preevaluation and history what things in the patient report would indicate that they are likely hypovolumic? |
|
Definition
1. vomiting
2. diarrhea
3. fever
4. sepsis
5. trauma |
|
|
Term
| During hypovolumia you may see a BUN/Cr ratio of? |
|
Definition
|
|
Term
| Why is UOP decrease during or after surgery not always indicative of hypovolumia? |
|
Definition
| b/c surgery causes stress response. Stress response in body results in increase ADH production. ADH tells kidney's to retain water. Therefore decrease UOP. May not be from hypovolumia. |
|
|
Term
| What tool would be a very good indicator of hemodynamics in patients. (not a swan..) |
|
Definition
|
|
Term
| what are some disadvantages of NS compared to LR |
|
Definition
NS can cause hyperchloremic metabolic acidosis and hyperchloremia can decrease GFR.
LR has Ca which may promote clotting with pRBC administration. It also has K which is potentially dangerous for Renal pts. |
|
|
Term
| Where is albumin made from? |
|
Definition
| Extracted from blood. Minimal risk for viral infection. It is expensive |
|
|
Term
| What are the two different albumin % and when would you give each one. |
|
Definition
| There is a 5% and 25%. The 25% obviously is more concentrated. Both are for hypovolumic patients that may benefit from oncotic pressure support due to low plasma proteins or risk for overload / poor response to crystalloid. 25% is reserved for pts with CHF, renal disease or who need less volume. |
|
|
Term
| What is the Bohr effect with oxygen and hypoxemia |
|
Definition
| Refers to when there is increase CO2, increase temperature, and acidosis that effects Hb and promotes a right shift in the oxygen dissasosciation curve. (O2 leaves Hb more favorable) |
|
|
Term
| Sux can cause an acute rise in K of? |
|
Definition
|
|
Term
| Acidosis does what to K levels? |
|
Definition
|
|
Term
| Transfusions do what to K levels? |
|
Definition
|
|
Term
| Destruction of blood cells does what to K levels |
|
Definition
| Dead cells release K levels so causes hyperkalemia |
|
|
Term
| What leads would you see T wave changes for hyperkalemia and what level of K would this likely occur |
|
Definition
| With K 5.5-6.5 you would start to see peaked T waves. Peaked T waves are easiest to see in precordial leads. |
|
|
Term
| What are the three classes of hyperkalemia and what waveforms on EKG would you see with them? |
|
Definition
Mild: K=5.5-6.5 Peak T
Moderate: K=6.5-8.0 Peak T, loss P wave
Severe: K>8.0. Sine wave (V-fib emminenet) |
|
|
Term
| Why is calcium given for hyperkalemia |
|
Definition
| to stabilize the myocardial membrane during hyperkalemia so you can buy time until a measure is performed to actually decrease the K levels |
|
|
Term
| How does insulin work to decrease K levels. What type of insulin should you give and how much? How much may this lower K levels? |
|
Definition
| Insulin drives K into the cells. Give 10-15 units of fast acting insulin. Follow with 25grams of dextrose to prevent side effect of hypoglycemia. Should lower K levels by 1.0 mmol |
|
|
Term
| What kind of beta drug do you give to help lower K levels? How does it work? How fast until it starts to work, what kind of results do you get? |
|
Definition
| Give a beta agonist such as albuterol. Will work within 30 minutes to lower K about 1.0 mmol |
|
|
Term
| What kind of things can cause hypokalemia? |
|
Definition
1. hypothermia
2. alkalosis
3. insulin therapy |
|
|
Term
| relationship of K and digoxin? |
|
Definition
| K and digoxin compete for the same binding site on the Na/K ATPase pump. |
|
|
Term
| what is the physiology for how digoxin works? |
|
Definition
| Digoxin binds to Na/K ATPasse pump of cardiac MYOCYTES and inhibits it. By doing so less Na leaves cell. So intracellular levels of Na rise. This indirectly effects the Na/Ca 3:1 Na:Ca exchanger. This exchanger usually brings in 3x Na for every 1x Ca removed from the cell. Now there is more Ca intracellular so now more Ca for more contractility!! |
|
|
Term
| what is the physiology of how digoxin effect HR |
|
Definition
digoxin has an indirect action of lowering HR too by inhibiting the NA/K ATPase in the brain,so this result in increase vagal or parasympathetic activity which in turn facilitates decrease heart rate,improve filling and by gigiving more time,increase cardiac output.
it also stimulate the sympathetic,but any organ with dual innervation,you know that the parasympathetic will always predominate. |
|
|
Term
| Hyokalemia will show what on EKG as it progressively gets worse |
|
Definition
| Flattening of T wave which eventually disappears or inverts. ST depression. And U wave formation. |
|
|
Term
| Acute sudden hypokalemia is usually from? |
|
Definition
| redistribution phenomenon. So determine the cause and treat that. (alkalosis, hypothermia) |
|
|
Term
| What is the physiology of Ca and pH |
|
Definition
Alkalosis promotes Ca binding to Albumin therefore lowering free Ca levels
Acidosis causes Ca to repel from albumin. Thereby raising free Ca levels. |
|
|
Term
| Calcium is completely incompatible with what? Therefore what IV crystalloid do you always have to be careful with? |
|
Definition
| Ca and Bicarb hate each other!!!!!!!!! Avoid LR with Ca. |
|
|
Term
| What happens to Ca with PrBC transfusions..why |
|
Definition
| Ca and the preservatitive citrate in pRBC will bind thereby lower free Ca levels in blood |
|
|
Term
| hypothermia is defined as a core body temperature of |
|
Definition
|
|
Term
| temperature pathway.. describe |
|
Definition
| Cold and hot travel via the spinothalamic pathway. Cold travels via A delta and warm via C fibers |
|
|
Term
| The central autonomic thermoregulatory center is? (other areas along neuron pathway from skin also regulate to a smaller degree |
|
Definition
| preoptic-anterior hypothalamus |
|
|
Term
| during hypothermia your body self regulates with behavioral repsonses that respond to skin or core temp? |
|
Definition
| Skin! Core temp is what your central control looks at and responds with non-conscious mechanisms |
|
|
Term
| what does general anesthesia and regional anesthesia do to temp regulation |
|
Definition
| They both effect the bodies interthreshold range. General effect the whole body and regional only effects what's below the block. Together they can inhibit thermogregulation range to 4 degrees celsius when normally body only tolerates changes up or down of 0.2 degrees celsius |
|
|
Term
| how does anesthesia contribute to redistribution hypothermia. |
|
Definition
| So normally the body self regulates its interthreshold range to maintain 37 C and be within 0.2 C of that. But anesthesia inhibits the normal mechanisms of thermoregulation. The biggest being vasoconstriction of extremities in colder environments (table/OR suite) Anesthesia does this by vasodilating the vasculator and redistributing blood to areas of more surface area and exposure to cold environment |
|
|
Term
| The tissue metabolic rate decreases ___ % for drop in a degree of celseisu |
|
Definition
| 8% drop in tissue metabolism for every degree C drop. |
|
|
Term
| What kind of oxygen dissoassociation shift is caused by hypothermia? |
|
Definition
| left shift. Meaning more O2 wants to stay on Hb |
|
|
Term
| Why do patients have shivering when they are febrile |
|
Definition
| Fevers reset the thermoregulatory set point fooling the brain into believing the core temp is actually lower than it should be. |
|
|
Term
| Do rates of MI correlate with post op shivering? |
|
Definition
|
|
Term
| Shivering can increase O2 consumption how much? |
|
Definition
| 400-500% increase!!!!!!!!!!!!! |
|
|
Term
| What dose of demerol would you give for post op shivering |
|
Definition
|
|
Term
| what gender is at more risk for PONV |
|
Definition
|
|
Term
| older or younger pts more at risk for PONV |
|
Definition
|
|
Term
| smoker or non-smoker more at risk for PONV |
|
Definition
|
|
Term
| Describe APFEL Score for PONV |
|
Definition
Score can be 0-4. 4 is the worse. If following risk is present than get a point.
1. Female
2. Non-smoker
3. Hx of PONV
4. Post op opioids
Higher the score the more nausea meds you prescribe |
|
|
Term
| What dose of steroids can you give for PONV |
|
Definition
|
|
Term
| anticholinergic side effects from giving scopolamine |
|
Definition
| Mad as a hatter, blind as a bat, dry as a bone, red as a beet. |
|
|
Term
| what is the dose of a scopolamine patch and where is the patch applied |
|
Definition
| applied behind the ear in a hairless area. Dose is 1.5 mg patch that stays on for 72 hours. Takes 2-4 hours to kick in. |
|
|
Term
|
Definition
| 0.625-1.25 IV at end of case. |
|
|
Term
| What two non-drowsy antihistamines can be given for PONV |
|
Definition
1. cimetidine 300mg IV
2. Ranitidine 50mg IV |
|
|
Term
| how does ephedrine work to prevent PONV. What dose would you give |
|
Definition
| Give 50mg IM!! Prevents gut hypoperfusion to gut. Found in double blind study to be as effective as droperidol but without the unwanted sedation side effects. |
|
|
Term
| how does hypervolumia contribute to nausea |
|
Definition
| hypervolumia will cause gut edema. That causes nausea. |
|
|
Term
| What are the ventilator settings you are looking for when you want to extubate |
|
Definition
| RSBI<100. NIF >20cm H20, Volumes 5mL/kg, RR <30. + Cuff leak, Can lift head, +Gag, + cough, follows, Off major pressors, no PNA, not a difficult airway to begin with |
|
|
Term
| Delayed emergency is defined as |
|
Definition
| failure to regain consciousness as expected 20-30 minutes within the end of the case. |
|
|
Term
| If you need to give narcan for an overdose what amount do you give |
|
Definition
| Give 0.04mg in 2 minute increments |
|
|
Term
| If you suspect central cholinergic syndrome what do you give |
|
Definition
| Give physostigmine 1-2mg IV. Give with atropine. |
|
|
Term
|
Definition
| manipulation of airway, not sedated enough patients, suctioning, stage 2 of anesthesia, blood or secretions in airway, Upper resp tract infection. |
|
|
Term
| Treatment/response to laryngospasm |
|
Definition
| emergency. Open airway, deepen anesthesia, CPAP with bag valve mask, Give Sux 10-20mg IV, may need surgical airway, |
|
|
Term
| Anaphylaxis physiology compared to anaphylactoid |
|
Definition
anaphylaxis: IgE mediated Type I hypersensitivty raction. Comes from prior exposure to an antigen. Mast and basophils release histamine as they undergo degranulation
Anaphylactoid: direct activation of mast cells and basophils by non-IgE mechanisms or direct activation of complement system. Can occur on first exposure. |
|
|
Term
| What muscle relaxants have the highest incidence of anaphylaxis...Roc, CIs, VEC, Sux |
|
Definition
|
|
Term
| narcotics cause hypotension by |
|
Definition
| suppressing sympathetic response |
|
|
Term
| versed or opioids worse on BP |
|
Definition
|
|
Term
| Anaphylaxis suspected..what dose of epi do you give |
|
Definition
| 5-10mcg IV boluses for HYPOTENSION |
|
|
Term
| IF no IV what dose of EPI can you give IM |
|
Definition
|
|
Term
| local anesthetics work by? |
|
Definition
| binding INTRAcellularly to Fast NA channels. Prevents influx but does nothing to resting membrane potential |
|
|
Term
| What are the three major chemical moieties of local anesthetics |
|
Definition
1. Have a lipophillic aromoatic benzene ring
2. Have either an ester or amide linkage
3. Have a hydrophilic tertiary amine. |
|
|
Term
| local anesthetic potency is derived from |
|
Definition
|
|
Term
| duration of action for locals is derived from? |
|
Definition
|
|
Term
| Speed of onset is related to what for locals |
|
Definition
| pKa (degree of ionization) Less ionzied version in blood means more likely it will be soluble and cross cell membrane then it beocmes ionized and binds to NA channel FROM WITHIN and blocks it. |
|
|
Term
| what is the difference in metabolism for amides and esters |
|
Definition
| Amides are metabolized in the liver and esters are metabolized by plasma cholinesterases |
|
|
Term
| Which local may cause an allergic type reaction and why |
|
Definition
| Esters may have a PABA metabolite which can induce allergic reactions |
|
|
Term
| What are some signs of CNS toxicity from Locals |
|
Definition
| lightheadedness, tinnitus, tongue numbness, CNS depression, seizure then coma. |
|
|
Term
| Which is more likely CNS or cardio toxicity. |
|
Definition
| CArdio is not common! so CNS will come first. |
|
|
Term
| Treatment for LA toxicity |
|
Definition
| Intralipid therapy 20% give 1.5mL/kg over 1 minute. Then follow up with infusion of 0.25mL/kg. Total dose 12mL/kg. Pt may need cardio bypass if bad Cardio toxicity too. |
|
|
Term
| What sx may be seen on induction that precedes 15-30% of MH emergencies? |
|
Definition
|
|
Term
| What are the triggers for MH |
|
Definition
| all inhalation agents except for Nitrooxide. Sux also big trigger. |
|
|
Term
|
Definition
1. increase CO2 production (most sensitive!!)
2. masseter muscle rigidity: muscle on check infront of ear.
3. Tachycardia
4. Increase O2 consumptions
5. increase body heat.
6. increase K from damage
7. increase myoglobin and CK
* TEMP is late sign of MH. |
|
|
Term
| Differential diganosis of neuro malignant syndrome as compared to MH. What would casue NMS |
|
Definition
| parkinson patients on antidopaminergicdrugs or those who may be going through withdrawal from them |
|
|
Term
| How would you rule out thryoid storm as not being culprit for suspected MH |
|
Definition
| Thryoid storm should not present with hyperkalemia or acidosis |
|
|
Term
| How would you rule out pheochromocytoma from MH |
|
Definition
| Pheochromocytoma and MH would have increase SNS but Pheo would have normal EtCO2 and temp!!!!!! |
|
|
Term
| SErotonin syndrome and MH how do you know whats what |
|
Definition
| Serotonin syndrome is associated with demerol, or SSRI or MAOIs and combinations in between |
|
|
Term
|
Definition
| Dantrolene 2.5mg/kg. Draw up 20mg in 60mL sterile water and push. Needs 24 hour intense monitoring for potential reoccurence |
|
|
Term
| Why is it important to place a foley if you give dantrolen |
|
Definition
| because dantrolen contains mannitol which is a potent diuretic. |
|
|
Term
|
Definition
| it is a autosomal dominant so all closely related family should be considered susceptible in absence to testing. |
|
|
Term
| The two biggest side effects of gentamycin are |
|
Definition
1. ototoxicity
2. nephrotoxicity |
|
|
Term
| clindamycin's big side effeect is |
|
Definition
|
|
Term
| What two abx can potentiate neuromuscular blockers |
|
Definition
1. clindamycin
2. gentamycin |
|
|
Term
| what abx is ideal for craniotomies since it has good CSF penetration |
|
Definition
| 3rd generation cephalosporins such as ceftriaxone |
|
|
Term
| Which type of anaphyl... reaction will decrease in nature based on dose amount of precipitating agent... is it anaphylaxis or anaphylactoid |
|
Definition
| anaphylactoid will be less if dose given is less. since it has nothing to do with IgE. IT is a direct stimulator to complement system. If no drug then no reaction. Unlike phylaxis wher eonce you trigger IgE you're screwed. |
|
|
Term
| what antagonizes the effect of magnesium? |
|
Definition
| calcium. More calcium means less mag. |
|
|
