Anesthesia

Question 1

fluid therapy in hypovolemic shock

Answer 1

20 cc/kg Bolus
or
2 Liter NS / RL

can be repeated

Question 2

blood transfusion is initiated

Answer 2

after 2nd bolus

Question 3

serum lactate of …… indicates severe hypoxia and poor prognosis

Answer 3

> 4 mmol/L

Question 4

M/C type of shock in adults

Answer 4

Distributive (septic)

↓
VD → ↓ SVR → > 65 % of blood pools in venous system

Question 5

M/C cause of anaphylactoid shock

Answer 5

X-Ray contrast media

1st exposure

Question 6

Anaphylactoid shock is mediated by

Answer 6

Basophils and Mast cells

Question 7

regarding anaphylactic/anaphylactoid

Answer 7

• may manifest after 12h of initial event
• Thromboembolic events are seen as often as arrhythmias and ventricular dysfunction

Question 8

how differentiate clinically between neurogenic shock and other types of shock

Answer 8

Bradycardia (others is tachy)

SAP < 100mmHg
HR < 60/min

Question 9

hypoperfusion + normal intravascular volume

Answer 9

Cardiogenic shock

diagnosed by echo

Question 10

regarding caval compression syndrome

Answer 10

changing the position of the patient may be enough ( left lateral position)

Question 11

how to differentiate between Cardiogenic and hypovolemic shock

Answer 11

assessment of intravascular volume

Question 12

early indicator of shock

Answer 12

lactic acidosis

Question 13

first sign of decompensated shock

Answer 13

brief, self limiting episodes of hypotension

Question 14

M/C type of shock in pediatrics

Answer 14

hypovolemic

Question 15

shock index

Answer 15

> 0.9

shock index = HR/SBP , Normal = 0.5 ~ 0.7

Question 16

regarding NIRS

Answer 16

• early warning of shock progression during acute hemorrhage
• monitor microvasculature status in septic shock
• less useful during prolonged shock state

Question 17

subcostal view in GDE

Answer 17

Assessment of IVC (cyclic variation with respiration on cases of hypovolemia)

Question 18

in hypothermia, when does shivering decrease

Answer 18

32 ~ 30c

Question 19

regarding subacute hypothermia

Answer 19

• Develops over hours/ days
• Accompanied by hypovolemia
• Treatment requires fluids + re warming

Question 20

in heat exhaustion, all vitals are affected except

Answer 20

blood pressure

• skin is normal ro cool

Question 21

regarding superficial frostbite

Answer 21

skin feels warm

Question 22

to differentiate between heat exhaustion and heat stroke

Answer 22

• Intact mental function
• Core temperature < 39

Question 23

treatment of heat exhaustion

Answer 23

• Adults → 200 ml increments
• peds → 20 ml/kg , repeated to max. 60 ml/kg

Question 24

effect of salt water drowning

Answer 24

hypovolemia & hemoconcentration

freshwater is the opposite effect

Question 25

goal of heat stroke treatment is to

Answer 25

decrease temperature to < 39 c within 30 minutes

Question 26

factors affecting survival of drowning

Answer 26

1. Types of water: 2. Cleanliness of the water. 3. Length of time submerged 4. Age and health of victim 5. Temperature of water (cold water = under 68 degrees.)

Question 27

criteria of major burn

Answer 27

1- Affect more than **15%-20%** burns in an adult and more than **10%** burns in a child. 2- Third degree burn. 3- Burns of special regions: face, hands, feet, perineum . 4- Circumferential burns. 5- Inhalation injury. 6- burn + major trauma

Question 28

time of appearance of inhalational injury

Answer 28

2 ~ 48 hours after the burn

Question 29

Management of combustion compound intoxication

Answer 29

empiric 100% high flow O2 for **4 ~ 6 hours via non-breathing mask** ## Footnote pulse oximetry cannot be relied on as it doesn't distinguish between OxyHb and CarboxyHb

Question 30

fluid equation in burn

Answer 30

2ml Rl x BW (kg) x %TBSA ## Footnote 1/2 fluids given in first 8 hours other 1/2 in the subsequent 16h

Question 31

choice of IV fluids depends on

Answer 31

the cause of deficit

Question 32

regarding colloids

Answer 32

* hydroxyethyl starch increases risk of renal injury * albumin has been associated with poorer outcomes in patients with traumatic brain injury * dextrans and hydroxyethyl starch may adversely affect coagulation when > 1.5 L is given

Question 33

main CCC of normal saline

Answer 33

hyperchloremic metabolic acidosis

Question 34

regarding fluids resucitation

Answer 34

amount of IV fluids is more important than the type

Question 35

Ringer lactate vs Normal saline

Answer 35

* RL is closer to physiological pH * RL is not ideal for transfusion patients * RL should not be used where plasma osmolality is important – ie acute brain injury. * Neither is superior to the other

Question 36

contraindications of ringer's lactate

Answer 36

* Liver failure (Impaired lactate metabolism) ⚠️ * Severe hyperkalemia (Contains potassium) 🚫 * Neurological conditions

Question 37

contraindications of normal saline

Answer 37

- Metabolic acidosis (Can worsen acidosis) ❌ - Hypernatremia & CHF (Can contribute to sodium overload)

Question 38

IV fluids in trauma

Answer 38

give 1 liter of IV fluid, and if no normalization of BP, give blood products.

Question 39

best indicator of end-organ perfuison

Answer 39

urine output of > 0.5 to 1 mL/kg/hour

Question 40

US use in volume depletion

Answer 40

respiratory collapse of the inferior vena cava greater than 50%

Question 41

Normal CVP values

Answer 41

2 to 7 mm Hg (3 to 9 cm water) ## Footnote When the CVP is within the normal range, volume depletion cannot be excluded measure response to 100 ~ 200 ml bolus

Question 42

End goals of fluid resucitation

Answer 42

* MAP ≥ 65 mmHg * HR < 100/min * Urine output Adults ≥ 0.5 ml/kg/h (Pediatrics ≥ 1 ml/kg/h) * ScvO 2 ≥ 70% * Serum lactate ≤ 2 mmol/l

Question 43

Isotonic solutions provide better intravascular filling, with 25% to 30% of crystalloid infusion remaining in the circulation for

Answer 43

1 ~ 2 hours