Anesthesia 2nd year Flashcards
To determine the etiology of hypoxemia, calculate the?
A-a gradient to narrow thedifferential diagnosis
When other causes have been ruled out, persistent and refractory hypotension in trauma or other critically ill patients may be caused by (2)
hypocalcemia
hypomagnesemia
Speed of onset of volatile anesthetics is increased by (4)
Increasing the
- Concentration
- Fresh gas flow
- Alveolar ventilation
- Using non-lipid soluble agents
Termination of effect of intravenous anesthetics is by ________________ , not biotransformation and breakdown.
Redistribution
- Lipid solubility, pKa, and protein binding of the local anesthetics determine their _______, _________, and _____________, respectively
- Potency
- Onset
- Duration
When compressed, some gases condense into a liquid such as (2) and some do not such as (2)
- N2O and CO2
2. O2 and N2
Most commonly used anesthesia circuit?
What are its components (6)?
- Semiclosed circuit using a circle system
- inspiratory limb
- expiratory limb
- unidirectional valves
- CO2 absorber
- Gas reservoir bag
- Pop-off valve on the expiratory limb
Every patient ventilated with an ascending bellows anesthesia ventilator receives approximately ___ cm H2O of positive end-expiratory pressure (PEEP) because of the weight of the bellows.
2.5 to 3 cm H2O
The first step in the care of the hypoxic patient fighting the ventilator is to?
Ventilate the patient manually with 100% oxygen
Risk factors for auto-PEEP include (4)
- High minute ventilation
- Small endotracheal tube
- Chronic obstructive pulmonary disease
- Asthma
Below a hemoglobin saturation of ____, a small decrease in saturation corresponds to a large drop in PaO2.
90%
Except for visualization with bronchoscopy, _____ is the best method of verifying
endotracheal tube location.
CO2 detection
If a patient’s ______ is excellent, even in the presence of ischemic heart disease, the chances are good that the patient will be able to tolerate the stresses of surgery.
Exercise capacity
The necessary criteria for acute lung injury/acute respiratory distress syndrome (ALI/ARDS) include: (5)
(1) Acute onset
(2) PaO2/FiO2 ratio of 300 for ALI
(3) PaO2/FiO2 ratio of 200 for ARDS
(4) Chest radiograph with diffuse infiltrates
(5) Pulmonary capillary wedge pressure of 18 mm Hg
Mechanical ventilation settings for patients with ARDS or ALI include tidal volume of at _____ of ideal body weight while limiting plateau pressures to ______ cm H2O. FiO2 should be adjusted to maintain
oxygen saturations between __________.
6 to 8 ml/kg
<30 cm H20
88% and 92%
Measures to acutely decrease intracranial pressure (ICP) include (4)
- elevation of the head of the bed
- hyperventilation (PaCO2 25 to 30 mm Hg)
- diuresis (mannitol and/or furosemide)
- minimized intravenous fluid
Malignant hyperthermia (MH) is an inherited disorder that presents in the perioperative period after exposure to inhalational agents and/or succinylcholine. The disease may be fatal if the diagnosis is delayed and dantrolene is not administered. The sine qua non of MH is an unexplained rise in \_\_\_\_\_\_\_\_\_\_, with a simultaneous increase in \_\_\_\_\_\_\_\_\_\_\_, in the setting of an unexplained, \_\_\_\_\_\_\_\_\_\_\_.
Rise in end-tidal carbon dioxide
Increase in minute ventilation
Unexplained tachycardia
In patients with ___________ spinal anesthesia should be used with caution and only in situations in which the benefits of spinal anesthesia over general anesthesia are clear.
Multiple sclerosis
The inability to touch the palmar aspects of the index fingers when palms touch (the ____sign) can indicate a difficult oral intubation in patients with diabetes.
Prayer sign
The initial goal of burn resuscitation is to correct ________.
Hypovolemia
Abrupt oxygen desaturation while transporting an intubated pediatric patient is probably the result of ___________?
Main stem intubation
Infants may be difficult to intubate because they have a more anterior larynx, relatively large tongues, and a floppy epiglottis.
The narrowest part of the larynx is below the vocal
cords at the _______
Cricoid cartilage
Best first step in treating a pulmonary hypertensive event?
Hyperventilation with 100% oxygen
If a child with tetralogy of Fallot has a hypercyanotic spell during induction of anesthesia, _____________, can reverse the right-to-left shunt
while pharmacologic treatments are being prepared.
Gentle external compression of the abdominal aorta