24.2 Flashcards
- During paediatric gas induction, the gas flow recommended by SPANZA for least
environmental impact is
● 1L/min
● 2L/min
● 3L/min
● 4L/min
● 5L/min”
3L/min
The Society of Paediatric Anesthesia recommends 0.15/min/kg as the minimum safe and effective FGF during induction i.e . 3L/min for a 20kg child. Many anaesthetists routinely run 6-10L/min regardless of the child’s weight.
https://journalwatch.org.au/reviews/reducing-the-environmental-impact-of-mask
- The Mapleson circuit to best achieve normocarbia with mechanical ventilation is:
“● Mapleson A
● Mapleson B
● Mapleson C
● Mapleson D
● Mapleson E”
Mapleson D
Journal article entitled Mapleson’s Breathing Systems 2013: “For adults, Mapleson A is the circuit of choice for spontaneous respiration where as Mapleson D and its Bains modifications are best available circuits for controlled ventilation. For neonates and paediatric patients Mapleson E and F (Jackson Rees modification) are the best circuits.”
- SQUIRE guidelines
“From the SQUIRE website: SQUIRE stands for Standards for QUality Improvement Reporting Excellence. The SQUIRE guidelines provide a framework for reporting new knowledge about how to improve healthcare. They are intended for reports that describe system level work to improve the quality, safety, and value of healthcare.
PRISMA: Systematic review”
- Box and whisker plot - What does the box mean
Box = interquartile range
The five number summary is the:
minimum,
first quartile,
median,
third quartile and
maximum
- What does a green line on the rigid laryngoscope blade mean
(a) Reusable
(b) Recyclable
(c) Single use - disposable
(d) Immersible
? - single use?
Arndt blocker attachment point for the breathing circuit (just a schematic drawing provided in
the exam)
C
perpendicular port for ventilation, pop top for bronch, oblique port for suction
Vivasight components (arrow to the red bit in the exam)
Red port - flush port for the lens
Airway ports - blue = bronchial lumen, white = tracheal lumen
Monitor connector
Red port - flush for lens
Cuffs - tracheal clear, bronchial blue
What is the half life of semaglutide
3 days
7 days
14 days
7 days
https://pubmed.ncbi.nlm.nih.gov/29915923/
PREVENTT trial showed that in major abdominal surgery, iron infusions:
A Reduced allogenic red cell transfusion
B Reduced mortality
C Reduced readmission rates within 30 days
D Reduced infection rates
C - Reduced readmission rates within 30 days
Compared to UFH, enoxaparin
More selective for factor Xa compared to UFH which binds both Xa and thrombin via ATIII
- Child on 15mcg/kg steroids, duration of treatment to give hydrocortisone peri-operatively
A > 2 weeks
B 1 month
C 2 months
B - 1 month
AOA guidelines
DCD which is the organ which can have the longest ischaemic time
A Lungs
B Kidneys
C Liver
D Pancreas
E Heart
A - Lungs (90mins)
Warm ischaemia time:
Liver and pancreas 30mins
Heart 30mins (from sBP <90mmHg to cold perfusion)
Kidneys 60mins (from sBP <50mmHg)
Lungs 90mins (from sBP <50mmHg)
DCD criteria does not include:
A Immobility
B apnoea
C absent skin perfusion
D absence of circulation (no arterial pulsatility for 2 min)
C - absent skin perfusion
DCD. -absence of circulation 5 mins for withdrawal of cardio resp support
- if ECG present need to observe asystole for 5mins
Unresponsive, apnoea, no pulse/heart sounds
Post herpetic neuralgia, feels like insects crawling across head, what is it?
- Allodynia
- Dysaesthesia
- Formication
- Pruritis
Formication
- although technically dysaesthesia
Congenital long QT, drug should avoid:
A propofol
B thiopentone
C ketamine
Ketamine
Triggers:
- beta-agonists, ketamine
- SNS stimulation
- Other QT prolonging medications: antiemetics, antipsychotics, amiodarone, methadone
- bradycardia, tachycardia, hypertension, hypoxaemia, hypercapnia
- electrolyte disturbance. - low K, Mg, Ca
Treatment for recurrent torsades de pointes?
A - Flecainide
B- Lignocaine
C -Procainamide
D - Amiodarone
E - Sotalol
Lignocaine
TdP is polymorphic VT with long QT
First line treatment is Magnesium then treat the long QT
Amiodarone and procainamide will lengthen QT
https://www.emdocs.net/ecg-pointers-recurrent-and-refractory-torsades-de-pointes/
What level tryptase acceptable to diagnose anaphylaxis?
A- (1.2 of normal) + 2 /ml
B- (1.8 of normal) + 2
C- Normal + 2
D- 10/ml
E- 15/ml
A - 1.2 x normal + 2
UTD: The minimal elevation of the acute total tryptase level that is considered to be clinically significant was suggested to be ≥(2 + 1.2 x baseline tryptase levels) in units of ng/mL or mcg/liter
Treatment for refractory anaphylaxis?
A Glucagon IV 10 min
B Glucagon IV 5
C Glucagon IM 5 min
D Glucagon IM 10 min
Glucagon IV q 5mins (1-2mg)
other refractory treatment:
Norad infusion 3-40mcg/min
vasopressin bolus 1-2 units then 2U/hr
+/- metaraminol or phenylephrine
bronchospasm
salbutamol MDI 12 puffs (1200mcg) - IV bolus 100-200mcg +/- infusion 5-25mcg/min
Mg 2g over 20mins
+/ volatiles or ketamine
- Fem-fem VA ECMO, where is BG best representative of coronary PaO2?
- right radial
- Either radial
- Left radial
- Pre oxygenator
- Post oxygenator
Right radial
https://pmc.ncbi.nlm.nih.gov/articles/PMC8292640/
- Post op cognitive decline has an onset within:
- immediate post
- Within one day, lasting one week
- From ?3wk
- ?10 days post op for a year
- From 1 month to 1 year
From 7 days post op til 1 year post
Blue Book article 2019
Pre-eclamspia at 30 weeks with IUGR
A- low CO, low SVR
B- Low CO, high svr
C- High CO, low svr
D- High CO, high svr
B - Low CO, high SVR
https://www.ahajournals.org/doi/epub/10.1161/HYPERTENSIONAHA.118.11092
Women who subsequently developed preeclampsia/fetal growth restriction had lower preconception cardiac output (4.9 versus 5.8 L/min; P=0.002) and cardiac index (2.9 versus 3.3 L/min per meter2; P=0.031) while mean arterial pressure (87.1 versus 82.3 mm Hg; P=0.05) and total peripheral resistance (1396.4 versus 1156.1 dynes sec cm−5; P<0.001) were higher.
https://www.ajog.org/article/S0002-9378(20)31283-7/fulltext
Burns - expected physiological change in first 24 hours
A- High cardiac index
B- Increased PVR
C- Decreased SVR
D- High stroke volume
Increased PVR
- initially loss of intravascular volume + low CO and catecholamine surge -> vasoconstriction
https://journals.sagepub.com/doi/10.1177/0310057X20914908?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
Which increases the risk of blood product related graft vs host disease
- genetic variability between donor and recipient
- irradiated
- leukodepleted
- Immunodeficiency
- transfusion of non-cellular product
Immunodeficiency
The three primary risk factors for developing TA-GVHD are:
https://www.lifeblood.com.au/health-professionals/clinical-practice/adverse-events/TA-GVHD
Factors increasing risk:
- degree of immunodeficiency of the recipient.
- number of viable T lymphocytes transfused (affected by the age of the blood transfused, degree of leucodepletion and irradiation status), and
- genetic diversity between donor and recipient. Greatest risks are donations from blood relatives and with HLA-matched blood products (because in GVHD, the body cannot recognise the foreign T cells and allows them to engraft)
When reconstituted, fibrinogen concentrate should be transfused within:
- 30min
- 4h
- 6h
- 8h
6 hours
“RIASTAP product info:
If it is not administered immediately, it must be stored below 25oC and used within 6 hours of
reconstitution. The reconstituted solution should not be stored in the refrigerator”