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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
Q

Top 3 pharmacological agents in bradycardia?

A

Atropin!!! (500 ug IV and max 3mg)
Isoprenaline
Adrenaline
Glycopyrrolate
Dopamin!

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26
Q

US findings heart subxiphoid view?

A

Tamponade - collapsed RV + fluid in pericardium
D sigh if PE

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27
Q

US findings lungs

A

Sliding pleura for PTX
B lines for fluid
A lines is air

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28
Q

US findings IVC

A

Hypovolemia - collapsing IVC

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29
Q

Dose and administration of epinephrin in the ICU?

A

0.5 ml IM in anaphylaxis
0.01-0-03 ug/kg/min IV

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30
Q

5 uses of ETCO2 (end tidal CO2 - capnography)

A
  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
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31
Q

values of ETCO2 capnography

A

Normal 35-45 mmhg
Hyperventilation < 35 mmhg
Hypoventilation > 45 mmhg

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32
Q

3 indications of thrombolysis

A

Early STEMI (< 12 hours) but rare
Early ischemic stroke (< 3 hours)
Massive pulmonary embolism
Acute peripheral arterial occlusion.

33
Q

Top nosocomial bacteria

A

Pseudomonas
MRSA
Klebsiella
Acinetobacter

34
Q

3 symptoms of hyperglycemia

A

Neurogenic/autonomic
- Increased symp activity: tremor, pallor, anxiety, tachycardia, sweating
- Increased parasymp activity: hunger, paresthesia, nausea/ vomiting
Neuroglycopenic
- Agitation, confusion
- Seizure
- coma → death

35
Q

Difference between CRRT (constant renal replacement therapy) and IRRT Intermittent renal replacement therapy

A

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
Q

5 commonly used opioids

A

Morphine
Fentanyl
Sulfentanyl
Remifentanyl
Tramadol

37
Q

3 non invasive airway managments

A

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
Q

symptoms of cardiogenic shock?

A

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
Q

symptoms of hypovolemic shock

A

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
Q

symptoms of obstructive shock

A

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
Q

symptoms of distributive shock

A

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
Q

Lethal triad

A

Coagulopathy
Hypothermia
Metabolic acidosis

43
Q

4 IV anesthesia’s

A

Thiopental
Midazolam
Propofol
Ketamine

44
Q

3 inotropes

A

NE
Epi
Dobutamine
Dopamine

45
Q

SE of local anesthetics

A

Hematoma
Infections
Allergic reaction
Spinal/epidural: headache, bradycardia, hypotension

46
Q

criteria for empty stomach (fasting)

A

clear fluids (water tea) 2h
Breastmilk 4h
Nutritional drinks, food, cow milk 6h

47
Q

first line treatment for TPX

A

FIRST: rest support and treat dyspnea + one of these
PVK needle - mid clavicular line 3rd ICS
Thoracotomy with tube

48
Q

OSMOLALITY formula

A

2 [NA] + [Glu] / 18 + [BUN] / 2.8

49
Q

OSMOLARITY formula

A

2Na + Glu + Urea (mmol/L)

50
Q

Definition of shock

A

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
Q

Shock index = pulse rate/systolic blood pressure

A

pulse rate/systolic blood pressure
Shock index in clinical practice is used to assess hypovolemic shock or the severity of non-hypovolemic shock.

52
Q

Anti-hypertensive drugs + doses

A

ACEIs
- Lisinopril
- Enalapril
- Captopril
ARBs
- Losartan
- Valsartan
Thiazide diuretics
- Chlorthalidone
- Hydrochlorothiazide
Dihydropyridine CCBs
- Amlodipine
- Nifedipine
Nondihydropyridine CCBs
- Diltiazem
- Verapamil

53
Q

How to calculate Pulmonary MAP

A

1/3 SBP + 2/3 DBP

54
Q

Atmospheric pressure im mmhg

A

760 mmHg
10332 mmH2O

55
Q

5 reasons AMI causes Shock

A
  1. Impaired contractility - Hypotension - decreased perfusion - ischemia
  2. Arrhythmias
  3. wall rupture
  4. valvular dysfunction
  5. Tamponade
56
Q

Complications of central venous catheter

A

Complications of indwelling catheters
- Infection
- Thrombosis
Complications of CVC insertion
- Arrhythmia
- Arterial injury
- Venous air embolism
- Pneumothorax
- Hemothorax
- Guidewire embolism
- Incorrect catheter placement

57
Q

Gynecological emergencies in ICU

A

Placental abruption
Miscarriage
ectopic pregnancy
Acute PID
Pelvic endometriosis

58
Q

difference between dehydration and hypovolemia

A

Dehydration is PURE water loss
Hypovolemia is loss of EC fluid volume and can be due to salt and water loss

59
Q

Type 2 respiratory failure

A

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
Q

Threshold pH

A

below 7.2 (catecholamines stop working)

61
Q

Anaphylaxis symptoms in ABCDE order

A

A: Stridor, wheezing
B: Dyspnea
C: Hypotension
D: Dizziness, fainting
E: hives, itching, urticaria, Angioedema, nausea, vomiting

62
Q

Define septic shock

A

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
Q

General symptoms of shock

A

MOF
Urine output < 0,5 ml/kg
Loss of consciousness
confused
Absent bowel sounds

64
Q

3 indications for CVK

A

Fluids
Dialysis
Longer hospital stay
ICU

65
Q

what is the 60-40-20 rule

A

TBW 60% of body weight
IC fluids 40 % of body weight
EC fluids 20 % of body weight

66
Q

2 ways of decreasing ICP

A
  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
Q

opioid antidote?
Benzo antidote?
Depolarizing muscle relaxants?

A

Opioids: Naloxone
BZ: Flumazenile
NDMR: Neostigmine (CE inhibitor)

68
Q

3 ways to measure CO

A
  1. DUS
  2. Puls pressure methods
  3. Impedance cardiography
  4. MRI
  5. Calculate SVxHR
69
Q

Horowitz index

A

used to assess lung function in patients, especially those on ventilation
PaO2/FIO2

70
Q

FIO2?

A

Fraction of oxygen in the inhaled air

71
Q

treatment of tachycardoa

A
  1. treat cause
  2. beta blockers / Ivabradine
  3. Vagal maneuver
  4. Cardioversion
  5. ICD
  6. PM
  7. Ablation
72
Q

ECG hyperkalemia

A

Peaked T waves
flat P waves
short QT
ST depression

73
Q

Hypokalemia ECG?

A

T wave depression
ST depression
U waves

74
Q

hyperkalemia treatment

A
  1. Calcium glyconte IV
  2. Insulin + Glucose
  3. Hemodialysis
  4. B-agonists
    NaHCO3 for acidosis
75
Q

Layers of spinal and epidural anesthesia

A

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
Q

HCO3 indications

A

CPR when acidosis pH < 7.1
Metabolic acidosis
Correcting hyperkalemia

77
Q

HCO3 dosage for DKA

A

50 mmol

78
Q

3 symptomes of GI bleeding

A

Signs of circulatory insufficiency or hypovolemic shock
Hematemesis
Melena
BP drop
Hematochezia

79
Q

Normal EtCO2 levels

A

range from 30s and 40s

5th year blocks (14 decks)

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