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APA 1 Flashcards

1
Q

Tight table strap nerve inj

A

Lateral femoral cutaneous

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2
Q

Stirrups nerve inj

A

Common peroneal

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3
Q

Arm board/shoulder brace nerve inj

A

Brachial plexus

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4
Q

BF cuff/tourniquets/firm surfaces nerve inj

A

Radial nerve

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5
Q

Map dec by____ mmHg for Q ___ inch increase in height

A

2, 1

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6
Q

Mask on face/ revisor bag/ no rebreathing/ Insp unidirectional valve only = ____ system

A

Semi-open

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7
Q

Components of an anesthetic (4)

A

Immobility, amnesia, analgesia, unconsciousness (if general)

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8
Q

O2 flush valve delivers how much?

A

35-75 L/min

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9
Q

V5 placement

A

5th intercostal space, anterior axillary line

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10
Q

PVR equation

A

[(MPAP-PAOP)/CO] X 80

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11
Q

CO eq

A

HR X SV

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12
Q

CI eq

A

CO / BSA

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13
Q

SVR eq

A

[(MAP - CVP) / CO] X 80

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14
Q

SVRI eq

A

[(MAP - CVP)/ CI] X 80

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15
Q

PVRI

A

[(MPAP-PAOP)/CI] X 80

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16
Q

Normal CVP

A

2-6

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17
Q

Normal CO

A

4-8 L/min

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18
Q

Normal CI

A

3 L/min

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19
Q

Causes of dampened A-line tracing

A

Bubble/ Bent extremity/ Thrombus/ Kink/ Long tubing

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20
Q

Top 4 PNI in order

A
  1. Ulnar 2. Brachial plexus 3. Lumbosacral 4. Spinal cord
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21
Q

Top 3 litigation reasons in order

A
  1. Death 2. PNI 3. Brain damage
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22
Q

Most common anesthetic injury

A

Eye or dental

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23
Q

High risk awareness

A

Major trauma (43%) OB (1.5%) Cardiac (.4%) Females, young adult, obese, hx awareness,

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24
Q

Best indicator of awareness

A

ET anesthetic conc. (1/3 MAC amnesia)

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25
Q

Most common cause of post-op vision loss

A

Ischemic optic neuropathy ?

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26
Q

Type 1 allergic rxn

A

IMMEDIATE (atrophy (?), urticaria-angioedema, ANAPHYLAXIS)

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27
Q

Type 2 allergic rxn

A

CYTOTOXIC (transf. Rxn, HIT, autoimmune, hemolytic anemia)

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28
Q

Type 3 allergic rxn

A

IMMUNE COMPLEX (RA and serum sickness)

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29
Q

Type 4 allergic rxn

A

DELAYED, CELL-MEDIATED (Contact dermatitis- latex, poison ivy)

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30
Q

Anaphylaxis vs anaphylactoid

A

Anaphylactoid does NOT depend on IgE antibody

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31
Q

Dantroline dosing and frequency

A

2.5 mg/kg STAT Repeat q5 min to max of 10 mg/kg Continue 1 mg/kg q6 hrs for 24 hrs

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32
Q

3 things for fire

A

Ignition source Oxidizing agent Fuel

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33
Q

Total body water: Man ___ Woman ____ Infant ____

A

55% 45% 80%

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34
Q

Intracellular vol. % body weight Extra cellular vol. % body weight

A

ICV= 40% ECV= 20%

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35
Q

Plasma vol ___% of ECV Interstitial vol ___% of ECV

A

25% 75%

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36
Q

Hypovolemia vs Dehydration

A

Hypovolemia= vol depletion, absolute fluid loss Dehydration= concentration disorder, low H2O compared to Na

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37
Q

Most important osmotically active substance influencing H2O content in brain

A

Na

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38
Q

1 u PRBC raises Hgb ____

A

1 g/dL

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39
Q

1 UNIT plts raises plt count ____

A

5,000-10,000 *often use 6 u/bag *still need type and cross

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40
Q

Estimated blood volume EBV male ___ to ___ mL/kg EBV female ___ to ___ mL/kg EBV obese ___ to ___ mL/kg

A

M: 70-75 ml/kg F: 65-70 ml/ kg O: 55 ml/kg

41
Q

ABL (allowable blood loss) formula

A

(EBV X (starting hct- target hct)) / hct starting

42
Q

Maintenance fluids: Based on weight 1st 10 kg ___ 2nd 10 kg ____ Every kg after 20 ___

A

40 ml/hr 20 ml/hr 1 ml/kg/ hr ————— Add together to get deficit

43
Q

Deficit fluid formula

A

Maintenance X hrs NPO (Replace this much in 1st 3 hrs) (1/2 in 1st hr, 1/4 in 2nd hr, 1/4 in 3rd hr)

44
Q

3rd space loss based on _____

A

Surgery

45
Q

Minimal trauma surgery loss

A

3-4 ml/kg/hr (Knee, shoulder, hernia)

46
Q

Moderate trauma surgery loss

A

5-6 ml/kg/hr

47
Q

Severe trauma surgical loss

A

7-8 ml/kg/hr (Open belly, cardiac, thoracic)

48
Q

A alpha fibers

A

Motor/proprioception (largest)

49
Q

A beta fibers

A

Fine touch/ proprioception (2nd largest)

50
Q

A gamma fibers

A

Motor/ Muscle spindle fibers (3rd largest)

51
Q

A delta fibers

A

Sharp pain, cold, touch (Smallest of As)

52
Q

B fibers

A

Sympathetic stimulation (Preganglionic autonomic)

53
Q

C fibers

A

Temp and dull pain and touch (UNMYLEINATED!)

{substance P}

54
Q

Blockade sequence

A

1st B

2nd A & C

55
Q

Blockade sequence pneumonic

A

ATP, TP, MVP Autonomic, touch, pain Temp, pressure Motor, vibration, proprioception

56
Q

Adding epi to LA

A

Vasoconstriction Prolonged duration Increased intensity Decreased systemic tox Decreased surgical bleeding Assists with test dose

57
Q

Adding sodium bicarbonate to LA

A

Increases pH & :. Non-ionization inc. Speeds onset Decreases injection burn

58
Q

Adding opiate to LA

A

Increases strength and duration Mostly for neuraxial blocks

59
Q

GCS Categories

A

Eye (max 4 points) Verbal (max 5 points) Motor (max 6 points) 15 perfect 3 worst

60
Q

Systolic murmur

A

Mitral regurgitation Or Aortic stenosis

61
Q

Diastolic murmur

A

Atrial regurgitation Or Mitral stenosis

62
Q

S3 sound

A

Early diastole Sudden deceleration of blood flow from LA to LV [overly compliant LV] (Indicates systolic CHF in elderly/ normal in young people or athletes or pregnant)

63
Q

S4 sound

A

Just before S1 Blood forced from LA into NONCOMPLIANT LV (Diastolic HF or active ischemia, can be sign of LV hypertrophy)

64
Q

Gauge range and length for spinal needles

A

22-29 g 3.5-5 inches *mostly use 25-27 g and 3.5 inch

65
Q

Pencil point needle advantages

A

Non-cutting tip Less PDPH Drags less contaminants into subdues tissue Pierce dura with clearly perceptible “POP”

66
Q
A

Pencil point - Whitacre

67
Q
A

Pencil point - gertie marx

68
Q
A

Quincke (in spinals) or quincke-babcock has a “cutting bevel tip” - hold the bevel direction parallel to the longitudinal dural tissue fibers to minimize the risk of PDPH

bevel can cut- so direct which way it goes

69
Q
A

Touhy needle (turns for catheter)

[for Epidurals]

(like 17 g)

70
Q

Differential Blockade order

A

top: autonomic

2-3 lower: sensory

2-3 lower: motor

71
Q
A
72
Q

Spinal complications

A

Failure of block- may try again or another method of anesthesia/

Post – dural puncture headache POSITIONAL when sitting up/

High spinal/

Nausea – COMMON r/t hypotension and decreased perfusion, block symp outflow to GI but not parasymp outflow to GI/

Urinary retention /

Hypoventilation/

Backache/

Hematoma/

Orthostatic hypotension

73
Q

Hematoma Recognition/Treatment

A

New onset weakness to lower limbs and sensory deficit, OR spinal never wears off (should wear off 1-4 hrs), OR get feeling again then starts to get numb

New onset back pain

New onset bowel or bladder dysfunction

Must diagnose and surgically decompress hematoma within 8 hours for best outcome

Can cause paraplegia

Consult neuro and send for MRI

74
Q

how long to NSAIDS stop before neuraxial

A

no contraindication

75
Q

how long to stop asprin before neuraxial

A

no contraindication

76
Q

how long to stop Clopidogrel (Plavis) before neuraxial

A

7 days pre-op

77
Q

how long to stop heparin before neuraxial

A

place a needle or catheter 1 hour prior to administration of heparin. Catheters should be pulled when heparin activity is at a minimal level (10-12 hrs). (An hour before the next dose) Monitor aPTT

78
Q

how long to stop Coumadin before neuraxial

A

monitor anticoagulation with Pt and INR

79
Q

how long to stop ticlopidine before neuraxial

A

14 days pre-op

80
Q

how long to stop Abciximab before neuraxial

A

7 days pre-op

81
Q

how long to stop Eptifibatide before neuraxial

A

4-8 hrs pre-op

82
Q

how long to stop tirofiban before neuraxial

A

14 days pre-op

83
Q

how to treat post-dural puncture headache

A

analgesics, bed rest, oral hydration, or oral caffeine 1st

then blood patch

84
Q
A
85
Q

short acting L.A.s

A

lido and procaine

86
Q

longer lasting L.A.s

A

bupivacaine and tetracaine

87
Q

structures exterior to interior to pass needle through for subarachnoid block

A
  1. skin
  2. subcutaneous
  3. supraspinous ligament
  4. interspinous ligament
  5. ligamentum flavum
  6. dura mater
  7. arachnoid mater
  8. subarachnoid space
88
Q

if doing an epidural stop needle after what structure?

A

ligamentum flavum

89
Q

PCWP should be take when?

A

end of expiration

90
Q

CVP a wave

A

RA contraction

91
Q

CVP c wave

A

Ventricular contraction

92
Q

CVP x wave

A

atrial relaxatiom

93
Q

CVP v wave

A

RA filling

94
Q

CVP y wave

A

tricuspid valve opening

95
Q
A
96
Q

what happens if insp. valve of AGM sticks open?

A

exp. volume goes out isp. limb

therefore increased EtCO2

97
Q

what happens if exp. valve of AGM sticks open?

A

breath will take path of least resistance and skip going to patient- right out exp. limb

98
Q

L.A. caridotoxicity order (most to least)

A

1. Bupivicaine/Ropivacaine, Cocaine/Tetracaine

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