Anestesi Flashcards
Why is there metabolic acidosis in renal failure?
loss of bicarbonate, low filtration of acids (ex. Uric acids)
How can we see that a patient has a renal failure?
We check the urine output - if lower than 1⁄2 ml/kg/h there is a kidney failure, as the GFR takes too long (it takes 24-48 hours to drop)
AKI - Typical symptoms:
Metabolic Acidosis, hyperkalemia
Pulmonary edema
Increase in BUN
Loss of consciousness
Uremic encephalopathy
Four indications for acute renal dialysis:
Theres actually 5 and you can use the AEIOU mnemonic:
A: Acidosis,
E: electrolytes (K>7mmol/L),
I: intoxication
O: overload (fluid)
U: Uremia
Hyperkalemia
Uremic encephalopathy or cardiomyopathy
Persistent metabolic acidosis Fluid overload
Non nephrological indications for hemodialysis:
Intoxication
Hypothermia (ex. If there is a resuscitation in a very hypothermic patient, we use extracorporeal heating and we are giving dialysis for heating the blood!)
What kind of renal failure do you know and how would you treat them?
Prerenal ARF
Intrarenal
Postrenal
Oxygenisation and peripheral tissues (examiners like to ask about it): Know the Hemoglobin Curve.
The Hemoglobin curve can shift to the right or to the left:
if it shifts to the right (in acidosis) we need a higher partial pressure to reach the same saturation as normally. Why is this? -> In acidosis the Hemoglobin “drops” the oxygen away -> so if the patient with acidosis is in shock we need to correct the ph in order to correct the peripheral oxygenation of the tissues.
How can we know a patient has a respiratory failure and how do we examine him?
Symptoms: hypo/hyperventilation, decreased breathing sounds, cyanosis, accessory muscles are involved, decreased respiratory rate, fatigue, gasping, unconsciousness, blood pressure (at beginning increased, after the fatigue decreased), brady- or tachycardia
Examination: ABCDE
Name 3 antibiotics for pseudomonas coverage (just the classes)
- Piperacilin-Tazobactam(antipseudo penicillin),
- Carbapenems
- Fluroquinolones.
Child CPR/ALS different from adults?
15:2 ratio. From Amboss:
·
Children older than 1 year
5 initial rescue breaths → CPR
Compression rate: 100-120/min
Compression-to-ventilation ratio:
- Medical professionals: 15:2
- Lay rescuers: 30:2
Further management should follow the guidelines for adults.
Defibrillation: monophasic and biphasic waveforms: 2–4 J/kg of body weight
Symptomatic treatment of bradycardia, top 3 pharmacological agents.
- Atropin(he asked dose, 500mcg IV each time for max 3mg),
- isoprenaline,
- adrenaline,
- glycopyrrolate,
- dopamin.
Ultrasound during CPR, you can investigate:
Hypovolemia (collapsing IVC), Tamponade (Collapsed RV + fluid filled pericardium), PE (Enlarged RV and RA), PTX (Lack of lung sliding and B-lines)
How many joules for infants/children with the defib?
4 J/KG
Dose of Epinephrine and how do you give a patient in ICU?
Infusion, he was happy with 0.01-0.03 mcg/KG/min.
Top nosocomial bacterias?
Pseudomonas, MRSA, Klebsiella, Acinetobacter
Top nosocomial bacterias?
Pseudomonas, MRSA, Klebsiella, Acinetobacter
3 symptoms of hypoglycemia:
CNS(agitation, coordination, sleepiness) pale, sweating, tachycardia
3 symptoms of hypoglycemia:
CNS(agitation, coordination, sleepiness) pale, sweating, tachycardia
Basic difference between CRRT and IRRT? What do you use when?
CRRT= Continuous Renal Replacement Therapy, done over 24 hours, and is a slow type of dialysis
IRRT= Intermittent Renal Replacement Therapy: performed for less than 24 hours in each 24 hour period, two to seven times per week
CRRT has better haemodynamic stability (BP control) and improved survival and greater likelihood of renal recovery.
Name 5 opioids commonly used?
Morphine, Fentanyl, Sufentanyl, Remifentanil, tramadol
