Anesthesia EFFECTS, COMMONs, Triads, DISSOCIATION CURVES, REFLEXES Flashcards
Carbon dioxide dissociation curve: When blood contains mainly oxygenated hemoglobin , the CO2 dissociation curve shifts to the _______
Right
When does the CO2 dissociation curve shifts to the Right?
When blood contains mainly oxygenated hemoglobin
When blood contains mainly oxygenated hemoglobin and the CO2 dissociation curve shifts to the RIGHT what does that do?
REDUCE the BLOOD CAPACITY to HOLD CO2
When blood contains mostly DEOXYhemoglobin , the CO2 dissociation curve shifts to the _______
LEFT
When does the CO2 dissociation curve shifts to the LEFT?
When blood contains mostly DEOXYhemoglobin
When blood contains mainly DEOXYhemoglobin and the CO2 dissociation curve shifts to the LEFT what does that do?
Increasing the capacity to carry CO2
CO2 dissociation curve mnemonic to remember
Right O2
Left
Explain the HALDANE EFFECT?
Allows the blood to LOAD more CO2 at the tissue level where more deoxyhemoglobin is present
And to UNLOAD CO2 at the lung, where more HgbO2 is present .
This effect permits more CO2 to be carried in the form of bicarbonate ions
Haldane effect
With this effect: The associated of H+ with the amino acids of hemoglobin lowers the affinity of hgb of O2, shifting the HgbO2 dissociation curve to the right at low pH or HIGH CO2
Bohr effect
The Haldane Effect (along with the Bohr Effect) facilitates the
release of O2 at the tissues and the uptake of O2 at the lungs.
The Haldane Effect results from the fact that deoxygenated hemoglobin has a
higher affinity (~3.5 x) for CO2 than does oxyhemoglobin.
HALDANE EFFECT MAINLY states that
Deoxygenated blood can carry increasing amounts of carbon dioxide, WHEREAS oxygenated blood has a reduced carbon dioxide capacity.
The Haldane Effect describes the effect of
oxygen on CO2 transport.
Bohr effect describes the effect of
carbon dioxide on oxygen transport
Central chemoreceptors respond to
H+ in the CSF
Peripheral chemoreceptors respond to
↑ H+, ↑ CO2, and ↓ PaO2
What is the primary stimulus for ventilatory response?
PaCO2
Hamburger shift”
Cl- exchange for HCO3- in RBC’s:
HCO3- out, Cl- in; non-pulmonary
Occulocardiac Reflex: Afferent and Efferent Pathway
Afferent pathway = Trigeminal nerve Efferent pathway = Vagus nerve
Cushing’s triad : What is it and what does it tell you?
HTN
Bradycardia
Irregular respirations
Increased ICP
Triple H Therapy: is used for
For treatment of cerebral vasospasm
What is the triple H therapy ?
Hypervolemia = CVP > 10 mm Hg PCWP = 12-20 Hypertension = SBP 160-200 mmHg Hemodilution = Hct 33%
Obesity Hypoventilation syndrome triad
Obesity
Daytime hypoventilation
Sleep disordered breathing
What does Virchow’s triad tells you?
Risk factors for venous thrombosis
Virchow’s triad (HIS)
Venous stasis
Venous injury (endothelial)
Hypercoagulable State
Hepatopulmonary syndrome Triad (PHW)
PORTAL HTN
Hypoxemia (Arterial deoxygenation)
Widespread pulmonary vasodilation
Cholecystitis triad:
Sudden RUQ tenderness
Fever
Leukocytosis
Clinical significant Hypoglycemia WHIPPLE TRIAD
Hypoglycemia (catecholamine)
Low blood glucose
Relief of symptoms after IV glucose
DKA Triad
Hyperglycemia
Ketonemia
ACIDEMIA
Pheochomocytoma Triad
Paroxysmal diaphoresis
Tachycardia
Hypertension
Hypothermia TRIAD
ACIDOSIS
Hypothermia
COAGULOPATHY
SPINAL shock TRIAD
Hypotension
Bradycardia
Hypothermia
SAMTER syndrome Triad
Nasal polyps
Asthma
Aspirin allergy
FIRE TRIAD
Fuel
Oxidizer
Ignition source
Beck’s triad indicates
Cardiac Tamponate
What is beck’s triad?
JVD
Hypotension
Muffled heart sounds
Aortic stenosis Triad
Angina
Syncope
CHF (dyspnea)
Ruptured Abdominal Aortic Aneurysm triad
Severe abdominal pain radiates to back
Pulsatile abdominal mass
Hypotension
Chronic pancreatitis triad
Steatorrhea
Pancreatic calcification
Diabetes mellitus
Myotonic dystrophy triad in males
Frontal baldin
premature ocular cataracts
testicular atrophy
Bezold-Jarish reflex is associated with this triad?
hypotension, bradycardia, and coronary vasodilation
The Bezold-Jarisch reflex results in
unmyelinated vagal afferent stimulation in response to noxious ventricular stimuli (chemical or mechanical),
2 things that are increased with Bezold-Jarisch reflex
increased parasympathetic tone
Increased ANP and BNP
Up to 25% of patients undergoing surgery in the beach chair position under general or regional anesthesia can experience hemodynamically significant hypotensive bradycardic events thought to be caused by
ventricular underfilling and the Bezold–Jarisch reflex.
Bainbridge reflex causes an
increase in heart rate when the right atrium or great veins are stretched by increased vascular volume.
Associated with the Bainbridge reflex are the
Venous baroreceptors–> are located in the right atrium and great veins
When blood pressure increases which receptors are stimulated?
the baroreceptors are stimulated
When baroreceptor are stimulated, what happens to myocardial contractility, venous tone, heart rate, systemic vascular resistance (SVR), and blood pressure?
When stretched, the baroreceptors fire –> inhibit the *sympathetic nervous system outflow resulting in a decrease in myocardial contractility, a decrease in heart rate, a decrease in venous tone, a decrease in SVR, and a decrease in blood pressure. *Parasympathetic outflow is simultaneously increased, which also decreases heart rate.
What nerves carry the afferent and efferent signals o f the Bainbridge reflex?
When the great veins and right atrium are STRETCHED BY INCREASED vascular volume, stretch receptors send AFFERENT signals to the medulla VIA the VAGUS nerve. The medulla then transmits EFFERENT signals via the sympathetic nerves to increase heart rate (by as much as 75%) and myocardial contractility.
What does the Bainbridge reflex help prevent?
prevent damming up of blood in veins, the atria, and the pulmonary circulation.
The Bainbridge reflex, in which stimulation of
right atrial stretch receptors leads to vagal afferent stimulation of the medulla and subsequent inhibition of parasympathetic activity (increasing the heart rate, or, in the case of decrease atrial pressure, lowering heart rate)
What three maneuvers can trigger the
oculocardiac reflex?
1) traction on the extraocular mus-
cles, especially the medial rectus
(2) ocular manipulation
(3) manual pressure on the globe of the eye.
What nerves carry the afferent and effer- ent action potentials in the oculocardiac reflex arc?
The trigeminal nerve (cranial nerve V) carries afferent (sensory) action potentials and the vagus nerve (cranial nerve X) carries efferent (motor) action potentials. This is the five (V) and dime (X) or nickel (V) and dime (X) reflex.
What reflex best explains bradycardia during spinal anesthesia?
The Bainbridge reflex relates to the characteristic but paradoxical slowing of the heart rate seen with spinal anesthesia..
The usual mechanism given for bradycardia with spinal anesthesia is
blockade of the sympathetic efferents from Tl-T4 (cardioaccelerator fibers) with subsequent unopposed parasympathetic stimulation (bradycardia)
However, bradycardia during spinal anesthesia is more clearly related to the development of arterial hypotension than to the height of the block. The primary deficiency in the development of spinal hypotension is a
Decrease in venous return.
The reduced venous pressure is sensed by low pressure venous baroreceptors, resulting in a reflex bradycardia.
A decrease in cardiac filling pressures may also stimulate vagally mediated bradycardia via the.
Bezold– Jarisch reflex.
A decrease in cardiac filling pressure may stimulate what?
A decrease in cardiac filling pressures may also stimulate vagally mediated bradycardia via the Bezold– Jarisch reflex (SLOWS THE HR SO THAT HEART CAN FILL)
An INCREASE in cardiac filling pressure
increase HR to get rid of extra fluid
BAINBRIDGE
RA & great veins → Bainbridge reflex, stretch of Right Atrium
Increases HR with inspiration via vagus nerve.
Hering-Breuer reflex:
Vagus nerve, prevents over-stretching
The primary components of this DESCENDING pain inhibition system, but certainly not all-inclusive, is the “triad” of the
- Periaqueductal gray (PAG)
- Rostral ventral medulla (RVM)
- Dorsolateral pontine tegmentum (DLPT).
One of the principal goals during early management of the hemorrhaging trauma victim is to avoid the development of the so-called vicious cycle or lethal triad, consisting of –>
Hypothermia
Acidosis
Dilutional coagulopathy
Signs of cyanide toxicity include the triad of
Elevated mixed venous O2 (SVO2)
Increasing requirements for SNP (tachyphylaxis)
metabolic acidosis.
Preeclampsia is diagnosed by the triad of
HEP
hypertension, edema, and proteinuria.
Occurs in 15-30% of patients and can be treated by volume, atropine, and ephedrine. what reflex?
Bezold -Jarish REFLEX
Treatment for Bainbridge reflex
None (per APEX)
How do you treat Symptoms of Bezold Jarish refelx
Restore preload (IVF, raise legs above heads, EPI) Increase HR, atropine, ephedrine
Full heart –> Increase HR
BainBridge
Empty heart –> Decrease HR
Bezold-jarisch
Autotransfusion during childbirth is an example of what reflex
Bainbridge
Sensors of Bezold Jarisch located in
RV
Mechanoreceptors (VR)
Chemoreceptors (Ischemia)
1st -3rd treatment step of oculocardiac receptor
Surgeon removes stimulus
100 oxygen , proper ventilation, deepen anesthetic
Anticholinergics
Inhalation on intrathoracic pressure/ venous return / HR
Decrease intrathoracic pressure
Increase venous return
Increase heart rate
Exhalation on intrathoracic presssure/venous return/ HR
Increase intrathoracic pressure
decrease venous return
decrease heart rate.
In a patient with a history of a spinal cord lesion higher than T7, ___________ and ________is concerning for autonomic hyperreflexia.
marked hypertension and bradycardia
AUTONOMIC DYSREFLEXIA explain
Normally, descending inhibitory impulses travel down the spinal cord to block reflex arcs to cutaneous, visceral, or proprioceptive stimuli. This arc is disrupted in spinal cord injury and can lead to autonomic instability, most notably severe hypertension followed by a sustained vagal response including bradycardia, vasodilation, and cutaneous flushing.
AUTONOMIC DYSREFLEXIA Treatment
Treatment is supportive, including stopping the inciting stimulus (ask surgeons to pause) and lowering the blood pressure to normal levels via vasodilators and assuring adequate levels of anesthesia.
Proposed mechanism of bradycardia when doing ISB block?
Bezold-Jarisch reflex.
What is the most common cause of AKI ?
Prolonged renal hypoperfusion
What is the leading cause of transfusion-related fatalities and the most common cause of major morbidity and death after transfusion?
TRALI (transfusion-related acute lung injury)
The most common cause of cholestasis is
Obstruction of the biliary tract outside of the liver
Most common cause of Peptic Ulcer disease is
Ingestion of NSAIDS
Major and most common cause of pancreatic insufficiency
Chronic pancreatitis
Most common cause of Methemoglobin in clinical practice is
Medications ( Benzocaine and procaine LAs; dapsone ABT; Nitroglycerin and nitric oxide)
Most common cause of drug hypersensitivity reactions during anesthesia
Antibiotics
Still the most common cause of adult valvular disease
RHD (rheumatic heart disease)
Most common cause of Hypercalcemia and 2nd most common cause
Primary hyperparathyroidism
Malignancy
FDA has identified the most common cause of Transfusion related deaths as
TRALI followed by hemolytic transfusion reactions.
What is the most common cause of Central Retinal Artery OcclusioN (CRAO)?
Head positioning that result in external pressure on the eye.
What is the most common cause of Post operative vision loss associated with prone spine surgery in adult patients?
ISCHEMIC OPTIC NEUROPATHY
Most common cause of UNANTICIPATED difficulty with the airway>
Lingual tonsil hyperplasia
Most common cause of acute pericarditis is
Viral infection
Chronic constrictive pericarditis CURRENTLY (not in the past)
Idiopathic, post cardiac surgery, neoplasia, uremia
What is the most common cause of Aortic stenosis
CONGENITAL DEFECT resulting in a BICUSPID AORTIC VALVE and as a SEQUELAE of Rheumatic valvular heart disease
Most common dysrhythmias associated with MVP
PVCs.
Most common cause of sudden death in pediatric young adult populations>
Hypertrophic Cardiomyopathy.
What is the most common cause of peripheral vascular occlusive disease?
Atherosclerosis
What is the most common cause of aneurysmal vascular occlusive disease?
Atherosclerosis
Most common causes of COPD
Chronic Bronchitis
EMPHYSEMA
Most common cause of Pulmonary edema due to upper airway obstruction?
Laryngospasm after extubation OR GA.
What is the most common cause of POSTOP. respiratory dysfunction after or under General anesthesia?
Atelectasis
In nonsurgical setting, most common cause of death with chronic renal failure is
Ischemic heart disease.
What is the most common cause of death associated with Acromegaly?
Cardiac and respiratory complications
The most common cause of Cushing syndrome today is the
Administration of glucocorticoids
Outside of Glucorticoids, the most common cause of Cushing syndrome is
Cushing’s disease.
Primary Adrenocortical insufficiency aka
Addison’s disease
What is the most common cause of acute Stent thrombosis?
Premature discontinuation of dual anti platelet therapy.
AKI is the most common after 5 days of burn injury and the most common cause is
Sepsis.
The most common cause of Thyrotoxicosis
Hyperthyroidism
The most common cause of HYPERTHYROIDISM
Grave’s disease (Multinodular diffuse goiter)
The most common cause of postoperative mortality after bariatric surgery is
Thromboembolism
The most common signs and symptoms of a leak and %
Tacychardia 72%
Fever 63%
Abdominal pain 54%
The most common causes of Anesthesia related maternal mortality in obstetrics include
High cephalic spread of neuraxial block.
The most common cause of arrest in non cardiac procedures is
Hyperkalemia
The most common cause of AIRWAY obstruction in the immediate postoperative phase is the
loss of pharyngal muscle tone in a sedated/obtunded patient.
The most common causes of hypoxemia in the PACU include (6)
Atelectasis (can lead to increase in R-to-L shunt) Pulmonary edema Pulmonary embolism Aspiration Bronchospasm Hypoventilation
The most common causes of delayed awakening
Prolonged action of anesthetic drugs
Common causes of delayed awakening other than anesthetic drugs.
Metabolic causes
Neurologic injury.
Most common causes of pediatric anesthesia adverse events for both therapeutic or diagnostic procedures TOP 3 only
Drugs errors
Nitrous oxide in combination with other sedative
Inability to rescue the patient from an adverse anesthetic event.
Most common cause of Postoperative arterial hypoxemia
Atelectasis.
The most common cause of significant anesthetic related morbidity and mortality in Laboring women is
Unrecognized intrathecal injection of local anesthetics.
The most common cause of upper GI obstruction in the newborn?
Pyloric Stenosis.
Most common cause of death or CNS injury during MAC cases
Excessive sedation leading to respiratory compromise
Most common cause of hyperphosphatemia is
Renal failure.
The most common causes fo the anaphylaxis, IgE mediated events
NMBAs (58%), latex, ABT
The leading injuries in anesthesia-related malpractice claims
Death
Nerve damage,
Permanent brain damage
Airway injury
Most common cause of serious bronchiolitis and lower respiratory tract disease in infants and young children>
Human RSV
Most common cause of ARDS
SEPSIS
Most common cause of acute increase in dead space in the acute setting?
Decreased CO
Most common cause of Intraoperative death?
Uncontrollable bleeding (80%) f/b brain herniation and air embolism.
Most common cause of early trauma mortality
CNS injury and hemorrhage.
The most common causes of acute transplanted lung failure
Acute graft rejection
Most common cause of 30-day mortality following liver transplantation ?
Cardiovascular disease.
The most common cause of AKI
Acute Tubular necrosis (ATN)
Most common cause of metabolic alkalosis is
GI loss due to vomiting or NG suctioning.
The most common causes of stridor in infants
Laryngomalacia
Most common cause of elevated liver enzyme in adults
Nonalcoholic fatty liver disease (NAFLD)
Most common cause of acute liver disease
Drug toxicity AND Infection
What is the hallmark of MI and ventricular aneurysm?
Dyskinesia (paradoxical movement)
What is the hallmark of Asthma? (clinically)
Inflammation of the airways
In acute parenchymal injury offers the most rapid and reliable hallmark of liver dysfunction ?
Prothrombin time
Hallmark signs of upper airway obstruction in the unanesthesized patient include
Hoarse or muffled voice
Difficult swallowing secretions
stridor and dyspnea.
Hallmark of OSA is
habitual snoring
Fragmented sleep –> Day time somnolence
Hallmark of COPD (symptoms)
Chronic productive cough
progressive exercise limitation
Hallmark of COPD (signs)
Reduction of FEV1
What is the hallmark of Asthma? (symptoms)
Recurrent wheezing
Dyspnea
cough
Traditional hallmark of early pulmonary edema
Detection of basilar crackles on auscultation
The hallmark sign of aspiration pneumonitis (and is frequently the first sign of aspiration) is
Arterial hypoxemia
Hallmark finding of ARDS
NONCARDIOGENIC pulmonary edema
Hallmark of Flail chest is
Paradoxical movement of the chest wall.
Hallmark sign of tension pneumothroax
Hypotension hypoxemia Absent breath sounds on AFFECTED SIDE Tachycardia Increased CVP Increased airway pressure
Hallmark clinical signs related to TURP (3)
Water intoxicatoion
fluid overload
Hyponatremia
Clinical hallmark of Myasthenia Gravis?
Generalized muscle weakness that IMPROVES WITH REST
Inability to sustain or repeat muscular contractions.
Hallmkar of DI is the
Excretion of abnormally large volume of dilute urine (polyuria)
Hallmark of initial therapy for burn?
Fluid resuscitation
Airway management
Minimum UO for burn patients
0.5 - 1 ml/kg/hr
American Burn consensus formula for fluid resuscitation?
2-4 ml x kg body weight x % of TBSA burned
Hallmark of burn shock is
Reduction in CO
May develop within 5 years of post lung transplantation
Bronchiolitis obliterans syndrome (BOS)
Bronchiolitis obliterans syndrome (BOS) hallmark is
Development of airway obstruction with a reduction of FEV1 that does not respond to bronchodilation
Hallmark of both primary and secondary immunodeficiency
Increased susceptibility to infection
Hallmark of quality anesthetic care
Evidence-based practice (EBP)
During cryoablation, _____% of the CO is lost when the pulmonary artery is occluded
25%
Coanda Effect explains the
tendency of fluid flow to follow a curved surface upon emerging from a constriction
With the coanda effect If a constriction occurs at a bifurcation due to
due to increase in velocity and reduction of pressure, hence the fluid/air tends to stick to the side of the branch causing maldistribution.
Application of Coanda Effect in anesthesia
- Mucus plug at the branching of tracheo-bronchial tree may cause maldistribution of respiratory gases.
- Unequal flow may result because of atherosclerotic plaques in the vascular tree
Bernoulli’s principle describes what?
Described the effect of fluid flow through a tube containing a constriction
Bernoulli’s principle states that as flow pass through a ________, the velocity of flow ________and there is a corresponding _______in pressure
narrowing in a tube; decreases; decrease
Jet ventilation is based on which effect
Venturi effect
2 key players in the mechanism of anesthesia
neurotransmitter-gated ion channels
K+ Channels
What is the approximate blood loss per minute during the resection phase of a transurethral prostate resection?
2-4 mL
The average amount of fluid absorbed during a TURP is about
20 mL/min of resection time.
The most commonly used endogenous marker of renal reserve or GFR is
Creatinine clearance
For trigeminal neuralgia (tic douloureux). What is the MOST appropriate first-line pharmacologic treatment?
Carbamazepine
What is the most common cause of death in the period following resection of a pheochromocytoma??
Hypotension
How much of the cardiac output does the kidney receive?
15-25%
The liver gets its blood supply from the portal vein and the hepatic artery which together receives what % of cardiac output?
20-25%
% of CO to the brain is
20%
The most common cause (organism) of epiglottis infection
haemophilus influenza
The 4Ds of epiglottis are
Drooling
Dysphonia
Dysphagia
Dyspnea
What is the most common serious complication associated with opioid intrathecal and epidural administration?
Respiratory depression
All local anesthetics cause vasodilation except for (ROLICO)
cocaine, lidocaine, and ropivacaine.
LA with low potency and short duration is
Procaine
Elevated carbon dioxide levels can increase the potential for toxicity for
all local anesthetics, including tetracaine.
Duration of which local anesthetic is prolonged the most by the addition of the epinephrine?
Lidocaine
Prevent the euphoric effect of opioids?
Naltrexone
Butorphanol is different from nalbuphine in that it is a kappa receptor agonist and a weak mu receptor antagonist, but it has ______analgesic qualities, and _______sedative effects
greater analgesic qualities
greater sedative effects
Opioids and the CO2 responsiveness curve
They shift the curve to the right, which represents a decrease in responsiveness to CO2
What is the main determinant of the rate at which an amide local anesthetic is metabolized?
Hepatic clearance
The Cockcroft and Gault equation can be used to estimate based upon__________ (select three) SAW
creatinine clearance
Serum Creatinine
Age
Weight (SAW)
Creatinine Clearance formula
(140-age) x weight / Serum Cr x 72
Most drug metabolism is performed by microsomal enzymes in the smooth endoplasmic reticulum of the
liver cells
Most potent endogenous glucocorticoid produced by the adrenal cortex is
cortisol.
Hepatic clearance is the product of the 2 things :
Hepatic blood flow
Hepatic extraction ratio of the drug.
The percent of a drug that the liver can clear as it passes through it is referred to as the
hepatic extraction ratio
The primary etiologic factor in the development of retinopathy of prematurity (ROP) is the
gestational age.
Factors such as (3) are also associated with an increased risk of developing ROP.
hyperoxia, hypocarbia, and acidemia
What layer of skin is the rate-limiting layer for the absorption of eutectic mixture of local anesthetic (EMLA) cream?
stratum corneum
The only process that does not involve the cytochrome P450 pathway is
hydrolysis
The most frequent cause of hospitalization in patients older than 65 is
heart failure.
Glucagon increases the blood glucose concentration by
Stimulating glycogenolysis in the liver
The primary inhibitory neurotransmitter in the “brain
GABA
The primary inhibitory neurotransmitter in the :”spinal cord
Glycine
Which anesthetic agent is most associated with a transient increase in liver enzyme levels?
Desflurane
Changes in alveolar ventilation affect which agent more? a soluble agent or a non-soluble agent?
a soluble agent more than a poorly-soluble agent.
Spontaneous ventilation will ______ the uptake of inhalation anesthetics by ________ alveolar ventilation.
decrease, decreasing
Which volatile agent increases cerebrospinal fluid absorption?
Isoflurane
Chemotherapy drugs that can produce renal and hepatic dysfunction.
Methotrexate
Peripheral neuropathies are most common in patients treated with
Methotrexate
Doxarubicin (Adriamycin) can result in
cardiomyopathy and congestive heart failure.
Alkylating agent that can produce pulmonary toxicity and pulmonary fibrosis.
Cyclophosphamide is an
Alkylating agent that can produce pulmonary toxicity and pulmonary fibrosis.
Cyclophosphamide
The alveolar-arterial difference for oxygen increases from approximately ______-at age 20 and to ___mmHg at age 70
8 mm Hg at age 20 to approximately 20 mm Hg at age 70.
What are the most common arterial blood gas findings in the presence of asthma?
Hypocarbia
Respiratory Alkalosis
What is the most common life-threatening manifestation of ventilator-induced barotrauma?
Tension Pneumothorax
3 that suggests tension pneumothorax
Hypotension
Worsening hypoxemia
Increased airway pressure
The most common cause of cardigenic shock is
acute myocardial infarction involving 40% or more of the Left ventricular mass.
What is the Most common etiology of hyper dynamic distributive shock ?
Sepsis
Obstruction to cardiac outflow is most commonly encountered in patients with a
Pulmonary embolism
What is the most common preventable cause of hospital death?
PE
What is the most common in distributive shock?
Loss of vascular tone leading to cardiovascular collapse
The most common cause of relative adrenal insufficiency ?
Septic shock
What is an indication for steroid replacement
Septic shock refractory to volume resuscitation and vasopressor therapy
What are the first line drugs to treat non-neuropathic pain in critically ill patients?
IV opioids
For management of neuropathic pain what 2 medications?
Gabapentin
Carbamezipine
What should be considered for postoperative analgesia in patients undoing AAA surgery or management of RIB FRACTURES?
Thoracic Epidural anesthesia/analgesia
When is nonopioid analgesia indicated?
Should only be considered only to decrease the dose of opioids used and decrease the opioid related side effects
What is the most common side effect of nitrate treatment
Headache.
Most common side effect of Beta-blocker therapy
Fatigue and insomnia
What are contraindications to beta blockers? (less obvious listed first)
**Sick Sinus Syndrome
**Uncontrolled CHF
Severe reactive airway disease
2nd- 3rd degree AVB
Severe Bradycardia
What are Relative contraindications to beta blockers?
DM , may mask s/s of hypoglycemia
Pt post cardiac transplantation most common of cause of early death?
Opportunistic infection as a result of immunosuppressive therapy
2 factors are associated with the development of AS–>
First –> process of aging –> Calcification and degeneration of aortic leaflets
Second –> Bicuspid aortic valve.
What is the most common form of valvular heart disease?
MVP
What is the most common metabolic disorder seen in newborns and young infants?
Hypoglycemia
Dysfunction of the serratus anterior muscle and winging of the scapula are consistent with injury to the
long thoracic nerve.
What is considered the gold standard in evaluating cardiac function and volume status?
Esophageal doppler monitoring
According to ASTM standards, what is the minimum FiO2 a self-inflating manual resuscitator should be able to deliver when connected to an oxygen source?
40%
what 2 parts of the nephron participate in aldosterone-mediated sodium reabsorption?
The late, distal convoluted tubule and the cortical portion of the collecting tubule
When the amount of sodium chloride passing by the macula densa drops (such as a drop in blood pressure), the macula densa cells produce two major effects:
- They decrease the resistance to blood flow in the afferent arterioles
- They stimulate the JG cells to release renin.
What is the role of the macula dense? where does it do the job?
The macula densa cells sense the amount of sodium chloride in the DISTAL TUBULE (DenseD)
Renin release results in the constriction of the _______ arterioles which helps do what? The feedback mechanism can maintain constant GFR between pressures of _____and ______
efferent arterioles which helps increase glomerular filtration. This feedback mechanism can maintain a relatively constant glomerular filtration rate between pressures of 50 and 180 mmHg
Correct sequence of vessels as they enter and pass through the renal circulation?
Lobar artery, Interlobar artery (LI-Lobar Alobu_
Arcuate artery, interlobular artery
What is the most serious complication associated with the withdrawal of barbiturates?
Grand mal seizures
The normal response to the increased venous return in the Trendelenburg position is ______and ________-why?
vasodilation and a decrease in the heart rate due to baroreceptor reflex stimulation.
Hyperthyroidism on Hemoglobin and platelet?
Anemia AND thrombocytopenia
Characteristics of G-protein receptors include
Modulation of ligand channels
Activation of adenylyl cyclase
Act. PHOSPHOLIPASE C. (MAPI)
Inhibition of adenylyl cyclase
The principal indication for CARDIAC TRANSPLANTATION in adults and children is
Dilated cardiomyopathy
What are the two major capillary systems in the renal circulation?
The glomerular and peritubular capillary systems
Depolarizing agents work at the end plate and desensitize the channel to which they bind. At what type of receptor does this occur? On what type of voltage-gated channel does this take place?
Nicotinic, potassium voltage-gated channel
The most common reason for reintervention following an endovascular aneurysm repair.
Endoleak
Which calcium channel blocker produces the greatest amount of coronary artery dilation?
Nicardipine
The most sensitive factor of the effect of obesity on pulmonary function is the.
Expiratory reserve volume
Those diuretics produce mild hyperchloremic metabolic acidosis.
Carbonic anhydrase (Acetazolamide)
What are the first substances that begin to accumulate in the plasma as renal failure progresses? (select two)
Urea
Creatinine
The half-life of morphine is prolonged in neonates (6 to 9 hours). The elimination half-life decreases to adult values by what age?
4-6 months. The clearance and elimination of morphine is age-dependent. The clearance of morphine is reduced during the neonatal period and increases with increasing age but there is significant inter-individual variability. Most studies suggest total body morphine clearance is 80% that of adult values by 6 months of age.
