ACE Review - region Flashcards
Dural sac of peds ends where
S3
First sign of intrathecal block in peds caudal block
Apnea…then hypoxia
What is used to treat local anes toxicity
20% lipid emulsion
How admin intralipid
1ml/kg bolus. 0.25cc/kg/min infusion 10 mins.
What is rheobase
Min current needed to stimulate a nerve
What is chronaxie
When a current is twice the rheobase, it is the min duration of a current to cause nerve stimulation
Why do you get motor twitches with nerve stim before feeling pain or paresthesia
The motor nerve fibers Alpha have lower rheobase than A-delta or c-fibers of pain and parenthesis.
When using a nerve stim, what is accomodation.
It is the inactivation of sodium channels of nerve fibers due to subthreshold current. This causes inaccurate placement of the needle for pnb.
How do we prevent accomodation.
Square wave electric signals in nerve stimulators.
The needle of PNB is a cathode…why
Less current is required to get nerve stimulation.
What is the relationship of current and distance of nerve stim needle.
Inversely proportional. 1/distance squared.
what is moderate sedation
responds purposefully to verbal or tactile stimuli, spontaneous vent
deep sedation?
responds purposefully to painful stimuli,spontaneous airway may or may not be adequate
general anesthesia
does not purposefully respond to painful stimuli, ventilation is inadequate
light sedation
requires only verbal stimuli for purposeful movement
what is the benefit of thoracic epidural analgesia compared to systemic opiods
decrease pulmonary complications and gi ileus
what kind of trauma patients benefit from thoracic epidurals
patients with multiple rib fractures have a decrease in mortality
when getting a spinal, which patients are prone to asystole
pt with Bezold-Jarisch reflex
what is bezold-jarisch reflex
pt who has increased vagal tone…leading to bradycard, decrease svr…leading to hypotension
what does a spinal do to people with bezold jarish reflex
it exacerbates the vagal tone leading to brady or asystole
during delivery, during autotransfusion…does the heart rate increase or decrease
it increases
why is the increase in hr so different than normal physiology in pregnancy associated autotransfusion
usually, when pt recieves a preload, they get a decrease in heart rate
why does autotransfusion cause increase in heart rate
it is the bainbridge reflex
what is the moa of bainbridge reflex
the increase in cvp to the right atrium activiates stretch receptors in the atrium…afferent fibers fibers through the vagus goes to the spinal medulla and efferent fibers increases hr