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5th year blocks > Anesthesiology > Flashcards

Anesthesiology Flashcards

1
Q

non-shockable rhythm

A

pulseless electrical activity
asystole

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2
Q

drugs during CPR?

A

Adrenalin every 3-5 min
Amiodorane after 3 shocks

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3
Q

Risk of postoperative delirium

A

Preoperative hypalbuminaemia

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4
Q

goal of anesthesia

A

Analgesia (loss of response to pain)
* Paralysis (skeletal muscle relaxation)
* Hypnosis (loss of consciousness)
* Amnesia (loss of memory)
* Stable vegetative state (decreased reflex activity)

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5
Q

Causes of high aniongap metabolic acidosis

A

accumulation of endogenous and exogenous organic acids

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6
Q

endogenous organic acids?

A

lactic acid
ketoacids
renal insufficiency - uremia
rhabdomyolysis

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7
Q

exogenous organic acids?

A

Ingestion of methanol → ↑ formic acid
Ingestion of ethylene glycol (antifreeze products) → ↑ oxalic acid
Ingestion of propylene glycol → ↑ lactic acid
Salicylate toxicity
Iron overdose
Isoniazid (INH) overdose

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8
Q

cause of metabolic alkalosis?

A

vomiting

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9
Q

what is an anion gap?
formula?

A

Difference between positive and negative ions
Na + K - (Cl+HCO3)

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10
Q

Normal value of aniongap?

A

6-10

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11
Q

Causes of low ion gap metabolic acidosis (rare)

A

Low albumin
Hypophosphatemia
Bromide intoxication
Hypercapnea
Hypermagnesia
Hypercholesterolemia
very high Lithium

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12
Q

what drug can cause euglycemic ketoacidosis?

A

Empagliflozin (same symptoms, but glucose is normal)

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13
Q

why give fluids in ketoacidosis?

A

because high levels of glucose shifts fluid to be excreted through kidneys

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14
Q

when to stop insulin therapy in ketoacidosis?

A

at normal glucose levels (4-10)

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15
Q

When do you also give glucose to a ketoacidosis patient?

A

when glucose is under 15

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16
Q

Why is there metabolic acidosis in kidney failure?

A

loss of bicarbonate and low filtration of acids

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17
Q

clear sign of kidney failure?

A

anuria
oliguria (below 1/2 ml/kg/h)

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18
Q

typical signs of kidney failure?

A

Metabolic acidosis
Hyperkalemia
Pulmonary edema
Increase in BUN
Loss of consciousness
Uremic encephalopathy

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19
Q

5 indications of acute renal dialysis?

A

AEIOU mnemonic
Acidosis
Electrolytes (K> 7mmol/L
Intoxication
Overload
Uremia

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20
Q

Non nephrological indication of hemodialysis?

A

Hypothermia
Intoxication

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21
Q

Diffusion capacity of carbon dioxide (DLCO2) vs Oxygen (DLO2)

A

x20 more then O2
CO2 binds 200-250 timer stronger then O2

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22
Q

when does the oxygen saturation curve shift to the RIGHT?
Why is this important to know?

A

Acidosis
We need to give higher partial pressure of oxygen to reach the same saturation as in a normal condition and fix the acidosis

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23
Q

Name 3 antibiotics for pseudomonas?

A

piperacillin-Tazobactam
Carbapenems
Fluoroquinolones

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24
Q

Children above 1 CPR?

A
  1. 5 breaths
  2. compression rate 100-120
  3. comp/vent 15/2 if professional and 30/2 if amateur
  4. Defib: 2-4 J/kg
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25
Top 3 pharmacological agents in bradycardia?
Atropin!!! (500 ug IV and max 3mg) Isoprenaline Adrenaline Glycopyrrolate Dopamin!
26
US findings heart subxiphoid view?
Tamponade - collapsed RV + fluid in pericardium D sigh if PE
27
US findings lungs
Sliding pleura for PTX B lines for fluid A lines is air
28
US findings IVC
Hypovolemia - collapsing IVC
29
Dose and administration of epinephrin in the ICU?
0.5 ml IM in anaphylaxis 0.01-0-03 ug/kg/min IV
30
5 uses of ETCO2 (end tidal CO2 - capnography)
1. If high quality compressions are being delivered 2. Right position of advanced airway allowing accurate ETCO2 measurements 3. Prognosis: ETCO2 persistently below 10mmHg after 20 minute of resuscitation is a poor prognostic sign. 4. ROSC
31
values of ETCO2 capnography
Normal 35-45 mmhg Hyperventilation < 35 mmhg Hypoventilation > 45 mmhg
32
3 indications of thrombolysis
Early STEMI (< 12 hours) but rare Early ischemic stroke (< 3 hours) Massive pulmonary embolism Acute peripheral arterial occlusion.
33
Top nosocomial bacteria
Pseudomonas MRSA Klebsiella Acinetobacter
34
3 symptoms of hyperglycemia
Neurogenic/autonomic - Increased symp activity: tremor, pallor, anxiety, tachycardia, sweating - Increased parasymp activity: hunger, paresthesia, nausea/ vomiting Neuroglycopenic - Agitation, confusion - Seizure - coma → death
35
Difference between CRRT (constant renal replacement therapy) and IRRT Intermittent renal replacement therapy
CRRT: done over 24h, slow type of dialysis (better hemo stability and improves survival and rena recovery) IRRT: less then 24h 2-7 times/week
36
5 commonly used opioids
Morphine Fentanyl Sulfentanyl Remifentanyl Tramadol
37
3 non invasive airway managments
Head chin til Eschmark CPAP (mild air P to keep breathing airways open while you sleep) BiPAP (different air pressure levels for inhalation and exhalation) Bag-valv-mask
38
symptoms of cardiogenic shock?
Rapid breathing Severe shortness of breath Sudden, rapid heartbeat (tachycardia) Loss of consciousness Weak pulse Low blood pressure (hypotension) Sweating Pale skin Cold hands or feet Less than normal urination or none at all
39
symptoms of hypovolemic shock
Anxiety or agitation Cool, clammy skin Confusion Decreased or no urine output Generalized weakness Pale skin color (pallor) Rapid breathing Sweating, moist skin Unconsciousness (lack of responsiveness)
40
symptoms of obstructive shock
Unusually fast breathing. Hypotension (low blood pressure). Tachycardia (fast heart rate). Altered consciousness. Very little pee output. Cool, clammy skin. Subcutaneous emphysema (air under your skin). Chest or abdominal pain.
41
symptoms of distributive shock
Skin rash. Fast heart rate and breathing. Low blood pressure. Warm arms and legs. Skin that starts out warm and then turns cold and clammy. Fever. Chills. Pain in your belly. Confusion. Cough. Shortness of breath. Nausea. Throwing up. Pain when trying to pee.
42
Lethal triad
Coagulopathy Hypothermia Metabolic acidosis
43
4 IV anesthesia's
Thiopental Midazolam Propofol Ketamine
44
3 inotropes
NE Epi Dobutamine Dopamine
45
SE of local anesthetics
Hematoma Infections Allergic reaction Spinal/epidural: headache, bradycardia, hypotension
46
criteria for empty stomach (fasting)
clear fluids (water tea) 2h Breastmilk 4h Nutritional drinks, food, cow milk 6h
47
first line treatment for TPX
FIRST: rest support and treat dyspnea + one of these PVK needle - mid clavicular line 3rd ICS Thoracotomy with tube
48
OSMOLALITY formula
2 [NA] + [Glu] / 18 + [BUN] / 2.8
49
OSMOLARITY formula
2Na + Glu + Urea (mmol/L)
50
Definition of shock
Shock: a life-threatening disorder of the circulatory system that results in inadequate organ perfusion and tissue hypoxia, leading to metabolic disturbances and, ultimately, irreversible organ damage
51
Shock index = pulse rate/systolic blood pressure
pulse rate/systolic blood pressure Shock index in clinical practice is used to assess hypovolemic shock or the severity of non-hypovolemic shock.
52
Anti-hypertensive drugs + doses
ACEIs - Lisinopril - Enalapril - Captopril ARBs - Losartan - Valsartan Thiazide diuretics - Chlorthalidone - Hydrochlorothiazide Dihydropyridine CCBs - Amlodipine - Nifedipine Nondihydropyridine CCBs - Diltiazem - Verapamil
53
How to calculate Pulmonary MAP
1/3 SBP + 2/3 DBP
54
Atmospheric pressure im mmhg
760 mmHg 10332 mmH2O
55
5 reasons AMI causes Shock
1. Impaired contractility - Hypotension - decreased perfusion - ischemia 2. Arrhythmias 3. wall rupture 4. valvular dysfunction 5. Tamponade
56
Complications of central venous catheter
Complications of indwelling catheters - Infection - Thrombosis Complications of CVC insertion - Arrhythmia - Arterial injury - Venous air embolism - Pneumothorax - Hemothorax - Guidewire embolism - Incorrect catheter placement
57
Gynecological emergencies in ICU
Placental abruption Miscarriage ectopic pregnancy Acute PID Pelvic endometriosis
58
difference between dehydration and hypovolemia
Dehydration is PURE water loss Hypovolemia is loss of EC fluid volume and can be due to salt and water loss
59
Type 2 respiratory failure
Type 2 respiratory failure occurs when the respiratory system is unable to adequately remove carbon dioxide from the body, leading to hypercapnia. PaCO2 > 50 | PaO2 < 60 | pH < 7.3
60
Threshold pH
below 7.2 (catecholamines stop working)
61
Anaphylaxis symptoms in ABCDE order
A: Stridor, wheezing B: Dyspnea C: Hypotension D: Dizziness, fainting E: hives, itching, urticaria, Angioedema, nausea, vomiting
62
Define septic shock
A type of distributive shock caused by excessive inflammatory response to disseminated infection, which leads to extravasation from the vascular space and loss of intravascular volume Sepsis and both of the following, despite adequate fluid therapy: Vasopressors required to maintain an MAP ≥ 65 mm Hg Serum lactate > 2 mEq/L (> 18 mg/dL)
63
General symptoms of shock
MOF Urine output < 0,5 ml/kg Loss of consciousness confused Absent bowel sounds
64
3 indications for CVK
Fluids Dialysis Longer hospital stay ICU
65
what is the 60-40-20 rule
TBW 60% of body weight IC fluids 40 % of body weight EC fluids 20 % of body weight
66
2 ways of decreasing ICP
1. Sedation, drainage of CSF, and osmotherapy with mannitol or hypertonic saline. 2. For intracranial hypertension refractory to initial medical management, barbiturate coma, hypothermia, or decompressive craniectomy should be considered 3. head elevation can be tried
67
opioid antidote? Benzo antidote? Depolarizing muscle relaxants?
Opioids: Naloxone BZ: Flumazenile NDMR: Neostigmine (CE inhibitor)
68
3 ways to measure CO
1. DUS 2. Puls pressure methods 3. Impedance cardiography 4. MRI 5. Calculate SVxHR
69
Horowitz index
used to assess lung function in patients, especially those on ventilation PaO2/FIO2
70
FIO2?
Fraction of oxygen in the inhaled air
71
treatment of tachycardoa
1. treat cause 2. beta blockers / Ivabradine 3. Vagal maneuver 4. Cardioversion 5. ICD 6. PM 7. Ablation
72
ECG hyperkalemia
Peaked T waves flat P waves short QT ST depression
73
Hypokalemia ECG?
T wave depression ST depression U waves
74
hyperkalemia treatment
1. Calcium glyconte IV 2. Insulin + Glucose 3. Hemodialysis 4. B-agonists NaHCO3 for acidosis
75
Layers of spinal and epidural anesthesia
Skin Subcutaneous tissue Supraspinous ligament Interspinous ligament Ligamentum flavum Epidural space containing the internal vertebral venous Plexus Dura Arachnoid And finally the subarachnoid space.
76
HCO3 indications
CPR when acidosis pH < 7.1 Metabolic acidosis Correcting hyperkalemia
77
HCO3 dosage for DKA
50 mmol
78
3 symptomes of GI bleeding
Signs of circulatory insufficiency or hypovolemic shock Hematemesis Melena BP drop Hematochezia
79
Normal EtCO2 levels
range from 30s and 40s

5th year blocks (14 decks)

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