Anesthesiology, resp care

Question 1

what should you do if bleeding from tracheostomy site? (tracheoinnominate fistula)

Answer 1

• inflate tracheostomy balloon for compression
• reintubate patient using endotracheal tube
• removal of tracheostomy and finger compress innominate artery

Question 2

what should you do if bleeding stopped from trach site or to confirm its a tracheoinnominate fistula

Answer 2

immediate fiberoptic exploration in OR- broncoscopic eval

Question 3

extubate if patient has been weaned to what cm H2O PEEP

Answer 3

<5 cm

Question 4

what should tidal volume be before extubating

Answer 4

<10 L/min

Question 5

what should resp rate be before extubating

Answer 5

under 20 breaths/min

Question 6

what rapid shallow breathing index be before extubating

Answer 6

between 60-105

Question 7

which anesthesia gas can lead to ddistention of air filled spaces during prolonged anesthesia (should be avoided for intestinal obstruction)

Answer 7

nitrous oxide , less dense than air

Question 8

ARDS diagnosis criteria

Answer 8

• CXR: bilaterial pulm infiltrates
• PaO2/FiO2 ratio <200
• pulm wedge pressure <18 mm Hg

Question 9

best management for someone with emphysema with resp acidosis and low O2

Answer 9

intubate them

Question 10

dopamine effects on coronary blood flow

Answer 10

dilates at all doses

Question 11

dopamine effects on blood flow at low vs medium vs high doses

Answer 11

low (1-5): dopaminergic rec- vasodilates renal and mesenteric arteries

medium (2-10): B1- increase CO and BP

high (>10): alpha- peripheral vasoconstriction, shifting flow away from extremities to organs, decrease kidney funct.

Question 12

if someone gets a transfusion and then has resp distress, what should you think?

Answer 12

TRALI- transfusion related acute lung injury

stop transfusion and ventilate

Question 13

drug of choice for cardiogenic shock

Answer 13

dobutamine (pos inotropy and peripheral vasodilation)

Question 14

treatment of post operative cholecystitis

Answer 14

percutaneous drainage of gallbladder

Question 15

how does PEEP increase oxygenation

Answer 15

by increasing FRC- keep alveoli open at end of expiration-

shifts lung water from alveolar to interstitial space so more surface area for gas exchange

Question 16

potential side effects from PEEP

Answer 16

alveolar overdistention—> barotraumas
decreased VR and CO
increased dead space ventilation–> increase minute ventilation requirements

Question 17

beck triad

Answer 17

systemic hypotension
jugular venous distention
distant heart sounds

cardiac tamponade

Question 18

cardiac tamonade on echo and swan-ganz

Answer 18

echo: pericardial fluid and RA collapse
swan: equal pressure across 4 chambers

Question 19

pulsus paradoxus

Answer 19

occurs in cardiac tamponade

decrease in systolic BP by >10 mm Hg at end of inspiratory phase

Question 20

major predictors of having a cardiac event during surgery

Answer 20

unstable angina
recent MI
decompensated HF
significant arrhythmias
severe valvular disease

Question 21

what should be administered locally for removing a nail from a finger

Answer 21

digital block with 1% lidocaine (no epi!)

Question 22

what are benefits of adding epinephrine to lidocaine?

Answer 22

doubles duration and increases maximal safe total dose by 1/3 by decreasing rate of absorption into blood stream

Question 23

what areas can epinephrine not be added to for local anesthesia?

Answer 23

tissues supplied by end arteries (finger, toe, penis, ear, nose)

Question 24

initial management of someone who is hypotensive and bradycardic from blunt trauma causing spinal cord injury (neurogenic shock)

Answer 24

1) fluid bolus

2) vasoconstrictors- dopamine, phenylephrine

Question 25

initial management of air embolism in central venous catheter placement

Answer 25

place patient in left lateral decubitis trendelenburg

Question 26

serious management of air embolism in central venous catheter placement

Answer 26

thoracotomy

Question 27

management of suspected hemothroax

Answer 27

chest tube

Question 28

family history of prolonged paralysis during general anesthsia. think…

Answer 28

pseudocholinesterase deficiency

avoid succinylcholine and mivacurium!

Question 29

what provides a rough estimate of protein nutritional adequacy

Answer 29

serum albumin level

Question 30

what is ideal respiratory quotient (RQ)

Answer 30

0.75-0.85

Question 31

RQ < 0.7 and <1 indicates what?

Answer 31

<0.7: lipid diet

> 1: carb diet , which can impair weaning off ventilator

Question 32

what should you give preoperatively to patients with vWD?

Answer 32

cryoprecipitate

Question 33

extracorpeal membrane oxygenation (ECMO) service is good for irreversible or reversible pulmonary disease?

Answer 33

reversible

Question 34

what is indicated if a patient aspirates particulate matter?

Answer 34

bronchoscopy

Question 35

do you give prophylactic antibiotics for a patient who aspirates particulate matter?

Answer 35

no, only if they develop pneumonia

Question 36

what is diagnostic test for ventilator associated pneumonia

Answer 36

> 10,000 colonies on bronchoalveolar lavage

Question 37

what should you do to treat malignant hyperthermia besides dantrolene?

Answer 37

promptly conclude the procedure and anesthetics

hyperventilate with 100% 02 (because of O2 consump)

alkanize urine to protect kidneys from myoglobin

Question 38

what is a known complication of angiography that would lead to renal failure? and what are the abnl labs?

Answer 38

cholesterol atheroembolism- in renal artery

*eosinophilia, microscopic hematuria, proteinuria, ESR

Question 39

treatment for PE

Answer 39

heparin infusion (same as DVT!)

Question 40

vasopressors of choice for severe sepsis or septic shock

Answer 40

NE and DA