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Basic Flashcards

1
Q

C6

A

Chassaignac tubercle

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2
Q

C7

A

Vertebra prominens, level of stellate ganglion

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3
Q

T1-T4

A

Cardioaccelerator fibers

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4
Q

T3

A

Axilla

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5
Q

T4

A

Nipple Line

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6
Q

T7

A

Xiphoid process

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7
Q

T8

A

Inferior border of scapula

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8
Q

T9-L2

A

Origin of artery of Adamkiewicz in 85% of patients

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9
Q

T10

A

Umbilicus

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10
Q

T12-L4

A

Lumbar PLexus

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11
Q

L1

A

Level of celiac plexus

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12
Q

L2

A

Termination of spinal cord (adults)

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13
Q

L3

A

Termination of spinal cord (pediatrics)

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14
Q

L4

A

Iliac crest

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15
Q

L4-S3

A

Sacral plexus

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16
Q

S2

A

PSIS, termination of subarachnoid space (adults)

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17
Q

S3

A

Termination of subarachnoid space (pediatrics)

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18
Q

Absolute pressure

A

Gauge pressure + atmospheric pressure

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19
Q

1 atm =

A

760 mm Hg, 988 cm H2O, 14.7 psi

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20
Q

pipe line pressure vs E cylinder

A

55 vs 45

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21
Q

Full E cylinder of O2

A

660 L (roughly 2000 psi)

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22
Q

Nitrous oxide E cylinder

A

mixture of gas and liquid, Cannot tell amount left based on guage. 20% left when gauge starts to fall. Have to weigh to accurate measurement

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23
Q

Flow of fluid in a tube

A

Flow = velocity X radius^2

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24
Q

Reynolds number (point at which transition from laminar flow to turbulent flow)

A

= (density X velocity X diameter)/ viscosity

laminar < 2000, mixture 4000 < turbulent

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25
Q

Hagen Poiseuille (laminar flow)

A 
Q= Delta P X pie X radius^4/ 8 Viscosity X length  or
Q = Delta P/ R
R= 8 viscosity X Length/ Pie R ^4
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26
Q

Venturi effect

A

When a fluid passes through a tube with constriction the lateral pressure exerted by the fluid drops because of the increase in velocity

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27
Q

Coanda effect

A

Due to high velocity and low pressure and constrictions fluid may adhere to one surface of the constriction causing maldistribution of flow

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28
Q

ultrasound frequency

A

> 20,000Hz

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29
Q

Relationship of US frequency

A

higher the frequency the increased resolution with decreased penetration

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30
Q

Local anesthestic absorption rates

A

intravenous > tracheal > intercostal > caudal > paracervical > epidural > brachial plexus > sciatic/femoral > subcutaneous

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31
Q

Daltons law

A

P total = P1+ P2 +P3 ….

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32
Q

Ideal Gas law

A

PV=nRT

R= gas constant= 0.82 atm /mol K

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33
Q

Charles Law

A

V1/T1=V2/T2

King Charles under constant pressure to rule

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34
Q

Boyles Law

A

P1V1= P2V2

Water Boyles at a constant T

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35
Q

Gay Lussac

A

P1/T1=P2/T2

Gay Volume

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36
Q

alveolar gas equation

A

PaO2= FiO2 X (Patm-P H20) - (PaCo2/RER)
P H20=47
RER= 0.8

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37
Q

Henrys law

A

C=kP

concentration = K(solubility) X partial pressure

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38
Q

Flow rates in vaporizers

A

decreased output at very low and very high
low= no turbulence to pick up gas
high= incomplete mixing

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39
Q

Desflurane vaporizer

A

Desflurane boils are room temperature. Specific vaporizer was developed which is heated to 39 C. Not pressure compensated so at high altitude the partial pressure will decrease. Also if carrier gas is not 100% O2 then at low flows will be less than expected.
Required dial setting = desired % x (760* mm Hg / current atmospheric pressure mm Hg)

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40
Q

Relationship of solubility within a liquid vs gas partial pressures

A

Inversely related

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41
Q

Factors affecting Aveloar concentration(FA)

A

1) delivery into the lungs (alveolar ventilation, inspired concentration FI)
2) uptake of agent by the blood (solubility, cardiac output, Aa anesthetic partial pressure gradient)

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42
Q

Tissue groups (uptake of volatile)

A

1) vessel rich: heart, brain, splanchnic, liver; 75% of cardiac output ( near complete saturation in 4-8 minutes)
2) muscle group (and skin): receives 20% cardiac output 2-4 hours for saturation
3) fat group: poorly perfused but great affinity for anesthestics

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43
Q

Fa/Fi ratio graph

A

highest to lowest: nitrous oxide, desflurane, sevoflurane, isoflurane, halothane, methoxyflurane

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44
Q

metabolic derangement with diuretics

A

loop and thiazaide= hyperchloremic hypokalemic metabolic alkalosis
k sparing+ hypochloremic metabolic acidosis

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45
Q

Respiratory alkalosis electrolyte derangement

A

hypocalcemia, hypokalemia, hypophosphtemia

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46
Q

Which abx can potentiate neuromuscular blocking

A

aminoglycosides, polymyxins, tetracyclines, lincomycin, and clindamycin

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47
Q

Para vs sympathetic nervous system for bronchoconstriction

A

parasympathetic

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48
Q

relationship of lung volume and PVR

A

PVR highest at extremes; residual volume and total lung capacity

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49
Q

MELD score

A

serum creatinine, bilirubin, INR, sodium

MELD: “I Crush Several Beers Daily” for INR, creatinine, sodium, bilirubin, dialysis

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50
Q

Child-Pughs

A

“Pour Another Beer At Eleven” for PT, Ascites, Bilirubin, Albumin, Encephalopathy

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51
Q

lab test to monitor enoxaparin

A

Factor Xa activity

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52
Q

signs of PrIS (propofol infusion syndrome)

A

metabolic lactic acidosis, cardiac failure, renal failure, rhabdomyolysis, hyperkalemia, hypertriglyceridemia, hepatomegaly, and pancreatitis.

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53
Q

highest blood product for risk of infection

A

platelets

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54
Q

meperidine can potentiate what?

A

Seratonin syndrome if other drug on board.

Libby Zion

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55
Q

chronic opioid effect on hormones

A

increased prolactin levels, and decreased testosterone, estrogen, cortisol, LH, and FSH

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56
Q

Succinylcholine effect on esophageal sphincters

A

decrease upper and increase lower tone.

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57
Q

FFP dose for warfarin revesal

A

typically 10-15 mL/kg which attains a goal factor activity level of 30-40% in most patients

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58
Q

side effects of glycopyrrolate

A

Glycopyrrolate delays gastric emptying, decreases salivary and gastric secretions, increases heart rate, relaxes bronchial smooth muscle, decreases lower esophageal sphincter tone, and causes urinary retention

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59
Q

myxedema coma

A

Myxedema coma is an extreme form of hypothyroidism that generally occurs in patients with chronic, severe, and/or poorly treated hypothyroidism, or hypothyroidism in the setting of a physiologic stressor (infection, trauma, exposure to cold, MI, etc). Key features of myxedema coma are altered mental status (ranging from confusion to coma), non-pitting edema, and hypothermia. Other symptoms that can be present include constipation, dry skin, bradycardia, and hypotension.

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60
Q

Concentration effect

A

Increasing the Fi of an inhalation anesthetic will more rapidly increase the FA of that agent.
80% NO vs 20%; if 50% is absorbed then 40/60 vs 10/90 is a 6 fold increase not the initial 4 fold. Due to increase concentration from the increased Fi. Additionally the amount absorbed is replaced with a high concentration from the original Fi

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61
Q

Second gas effect

A

Addition of NO will increase the rate at which the volatile FA approaches the Fi.

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62
Q

Nitrous Oxide

A
  • second gas effect
    -0.47 blood partition coefficient= fast on fast off
    sympathomimetic = increased CO and SVR
    -does not inhibit hypoxic pulm vasoconstriction
  • does not cause uterine relaxation or muscle relaxation
    -mild analgesic
    -megaloblastic anemia ( oxidize cobalt atom in VitB12 stopping b12 dependent enzymes)
    -expands gases
    -PONV
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63
Q

Nitrous expansion

A

NO is about 30 times more soluble in blood than nitrogen
- highly blood soluble NO is brought to the space faster than the poorly soluble N2 can be carried away from the space
- volume of expansion depends on time and Fi
Contraindicated: intestinal obstruction, Pneumo, VAE, COPD (bleps), laparoscopy, intraocular air, tympanoplasty/middle ear surgeries, penumocephalus,
Check your ETT cuff

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64
Q

Intraocular air

A
  • sulfur hexafluoride (SF6) ; expands 2.5 times in eye, stays 10-14 days
  • perfluoropropane (C3F8); expands 4 times stays 60 days
  • should be cleared by ophtho after bubble is gone
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65
Q

Absorbers

A

Allow for a closed system

  • H20 and heat are a byproduct = benefit
  • smaller granules can absorb more but have increased resistance
  • dry granules can cause CO and high temp = fire risk
  • Sevo compound A
  • Amsorb is calcium hydroxide lime which minimized compound A and CO
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66
Q

Fresh gas entry

A

between absorber and inspiratory valve

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67
Q

pressure fail safe

A

detects if O2 pressure falls too low ( usually 30 psi) and alarms

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68
Q

Rotameters/ flometers

A
  • measure flow; glass tube with increasing diameter
  • bobbin or ball rides the gas jet, which stabilizes at correct height due to the annulus (space around the item)
  • bobbins have grooves to rotate
  • tube is calibrated for specific gas
  • viscocity is important in low flow/ density in high
  • affects by temp (minimally) and altitude (higher the altitude the more falsely low the reading will be)
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69
Q

O2 and N2O proportioning devices

A

Connection between the two to prevent hypoxic gas flow.

- 14 tooth gear (N2O) connected to 29 teeth gear (O2) to maintain 25% or higher

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70
Q

Acoustic Impedance

A

product of the density of the medium and the propagation speed of sound through that medium

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71
Q

Chloroprocaines rapid onset time due to

A

concentration

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72
Q

EMLA cream contraindications

A
  • Allergy to amide anesthetics
  • Concomitant class III anti-arrhythmic drugs
  • Congenital or idiopathic methemoglobinemia or G6PD deficiency
  • Infants (< 12 months) receiving treatment with methemoglobin-inducing agents
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73
Q

Hemophilia A vs B vs C

A

Factor VIII, Factor IX, Factor XI

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74
Q

Metaclopramide

A
  • derives its anti-nausea effect from antagonizing dopamine in the chemoreceptor trigger zone in the CNS
  • accelerated gastric emptying, reduced gastric fluid volume, increased tone and amplitude of gastric contractions, and enhanced peristalsis of the duodenum and jejunum.
  • It causes relaxation of the pyloric sphincter, however increases lower esophageal sphincter tone. It has no effect on gastric pH.
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75
Q

Eccrine sweat gland innervation

A

synpathetic preganglion-> nicotonic recepter ->sympathetic post ganglion -> muscarinic

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76
Q

BBB

A
  • small lipophilic molecules diffuse through, <500 Da

- glucose through transporter

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77
Q

Clonidine

A

Clonidine is a selective alpha-2 adrenergic agonist with an affinity ratio of 220:1 for the alpha-2 receptor compared to the alpha-1 receptor

  • rebound HTN in 12-60 hours
  • decreased MAC
  • decrease PONV and shivering post op
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78
Q

Soda Lime

A

-silica added to make granules more hard
-NaOH is what absorbs O2
-

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79
Q

Ambsorb

A
  • less capacity than Soda Lime

- No alkali agents like NaOH and KOH = less risk of compound A or CO

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80
Q

Baralyme

A

withdrawn due to risk of fires

81
Q

Absorbent granules

A

balance of size ( smaller = better absorber but increased resistance)
- Channeling can occur (path of least resistance)

82
Q

absorbed dessication

A
  • gets dried out
  • increase risk of CO and heat production (Des > Enflurane > iso» halthothan =sevo)
  • more likely in absorbers with strong base
  • Monday morning CO poisoning
83
Q

Fire in absorber (risks)

A

Sevo
baralyme
granule dessication

84
Q

Nasal Cannula

A
  • 1-6 L/min (anything above doesnt do anything)
  • FiO2 increased 4% each L
  • FiO2 varies with minute ventilation
  • HFNC: warms and humidifies: can go above 6
85
Q

Face Masks

A
  • flow of at least 5L/min
  • Simple 35-60%
  • non rebreather 60-90%
  • Partial non rebreather 60-80%
86
Q

Venturi Mask

A

mixes room air and O2 to assure FiO2

24-50%

87
Q

Meperidine

A
  • works on kappa (and mu) opioid recepter
  • metabolite normeperidine is a proconvulsant
  • structure is similar to atropine = increased heart rate
88
Q

Uremia

A

causes platelet dysfunction

89
Q

Factors that decrease Ach release

A

1) Antibiotics (clindamycin, polymyxin)
2) Magnesium: antagonizes calcium
3) Hypocalcemia
4) Anticonvulsants
5) Diuretics (furosemide)
6) Eaton-Lambert syndrome: inhibits P-type calcium channels
7) Botulinum toxin: inhibits SNARE proteins

90
Q

Apneic window calculations

A

Oxygen consumption in an adult is 3-4 mL/kg/min and functional residual capacity (FRC) is 30 mL/kg
-Minutes until hypoxemia = [FRC (ml) ÷ O2 consumption (mL/min)] * %O2 in FRC

91
Q

Side effects of zofran

A 
QTc prolongation (20%)	
 Headache (11%)	 
 Transient increases in AST and ALT (5%)
 Constipation (4%)	
 Rash (1%)	
 Flushing / warmth (< 1%)
 Dizziness (< 1%)
92
Q

Radiation exposure

A

I = S / (4 * π * r^2)
or
I ∝ 1 / r^2
Where: I = intensity, S = source strength, r = radius (distance from source)

93
Q

time constant

A
  • time constant (t) is calculated by dividing the volume or capacity of the circuit (Vc) by the fresh gas flow (FGF).
  • 63%, 84%, 95%, and 99% of equilibrium will be reached after 1, 2, 3, and 4 time constants, respectively
94
Q

Flumazenil

A

benzo reversal. Shorter duration of action than all clinically used benzos (will have to redose to prevent recrudescence)

95
Q

Which opioid doesn’t cause sphincter of Oddi spams

A

Butorphanol, unlike most opioids, does not cause biliary spasm as it does not cause sufficient sphincter of Oddi contraction to increase pressure in the common bile duct.

96
Q

Post op delerium treatment secondary to scopolamine

A

Physostigmine: penetrates CNS

97
Q

Modified Cormack lehane

A

Grade 1 Full view of the glottis
Grade 2a Partial view of the glottis
Grade 2b Only the posterior arytenoids and the epiglottis are visible
Grade 3 Only epiglottis is visible
Grade 4 Neither the glottis nor the epiglottis are visible

98
Q

SVR

A

SVR = 80 * (MAP - RAP) / CO

99
Q

Train of 4

A
  • 4 stimuli at 2 Hz .5 seconds apart
  • 75% fade when 80% of receptors blocked
  • No TOF4 = 80% blocked
  • No TOF3 = 85%
  • No TOF2= 90%
  • .9 ratio means adequate reversal
  • can’t detect fade greater than 0.4
100
Q

Sustained tetnus

A

indicates TOF greater than 0.7

101
Q

Double burst

A
  • better tactile feel
  • two burst fired 750 ms apart
  • can detect fade up to 0.6
102
Q

Dynamic PV curve vs static

A

Dynamic is constructed during gas flow while static is not

103
Q

Dynamic effective compliance

A

= (Ppeak-PEEP)/delivered TV

-takes airway and circuit resistance into account

104
Q

Static effective compliance

A

=(Pplateau-PEEP)/delivered TV

-influenced by chest wall and alveolar elastic recoil

105
Q

Elastic pressure

A

P plateau- PEEP

106
Q

Heat loss in OR

A
  • mainly due to redistribution initially then;
    1) radiation
    convection, conduction and evaporation
  • typical loss is 0.5-1.5 C 30 minutes from induction
107
Q

4 core T sites

A
  • pulmonary artery
  • distal esophagus
  • nasopharyngeal
  • tympanic membrane
108
Q

Calculate pulse ox

A

Ratio of red (660 nm) to infrared (940 nm)
- uses pulsatile portions to zero out none flowing times; acts as own zero
Ratio of 1 = 85% (.4 = 100% and 3.4 = 0%)

109
Q

Erroneous pulse ox

A
  • MetHb = absorbed at same rate = ratio of 1 = 85%
  • CoHb = falsely high
  • low readings= hypothermia, vasoconstriction, ambient light, red or dark nail polish, methelyne blue > indocyanine green > indigo carmine, anemia < 10
  • doesn’t effect; flourecien, hyperbilirubinemia, fetal hemoglobin,
110
Q

NMB not to use with renal failure

A

pancuronium

111
Q

Respiratory failure 2/2 to hypermagnesium

A

15-20 mg/dL

112
Q

Blood Gas value calculated

A

bicarb

113
Q

Blood gas

A

pH: 7.35-7.45
Partial pressure of oxygen (PaO2): 75 to 100 mmHg
Partial pressure of carbon dioxide (PaCO2): 35-45 mmHg
Bicarbonate (HCO3): 22-26 mEq/L
Oxygen saturation (O2 Sat): 94-100%

114
Q

pH stat

A

During pH-stat acid-base management, the patient’s pH is maintained at a constant level by managing pH at the patient’s temperature. pH-stat pH management is temperature-corrected. Compared to alpha-stat, pH stat (which aims for a pCO2 of 40 and pH of 7.40 at the patient’s actual temperature) leads to higher pCO2 (respiratory acidosis), and increased cerebral blood flow. Often CO2 is deliberately added to maintain a pCO2 of 40 mm Hg during hypothermia.

115
Q

Alpha stat

A

During alpha-stat acid-base management, the ionization state of histidine is maintained by managing a standardized pH (measured at 37C). Alpha-stat pH management is not temperature-corrected – as the patient’s temperature falls, the partial pressure of CO2 decreases (and solubility increases), thus a hypothermic patient with a pH of 7.40 and a pCO2 of 40 (measured at 37C) will, in reality, have a lower pCO2 (because partial pressure of CO2 is lower), and this will manifest as a relative respiratory alkalosis coupled with decreased cerebral blood flow. During alpha-stat management you have no idea what the patient’s pCO2 is, your goal is to maintain a constant dissociation state of histidine.

116
Q

change in temp vs pH

A

every 1 degree celcius drop the pH will increase by 0.015

117
Q

Polarographic O2 analyzer (clark electrode)

A

gold or platinum cathode with silver anode

-needs small voltage applied to two electrodes

118
Q

Galvanic O2 analyzer

A

lead anode and gold cathode bathed in KCl

-expose to RA when not in use

119
Q

Paramagnetic O2 analyzer

A

plots O2 concentrations continuously

120
Q

O2, CO2 and pH measurement

A

pO2 is measured via the Clark electrode (as per above)
pCO2 is measured via the Severinghouse electrode
pH is measured via the Sanz electrode

121
Q

Raman scattering

A
  • intense beam of laser light into gas sample
  • this cause unstable vibrational and rational energy states which causes photons to change and emerge at various wavelengths
  • light is collected through monochromator and the Rayleigh scattering is filtered out and the rest is dispersed on a detector.
122
Q

Piezoelectric gas analysis

A
  • uses oscillating quartz crystals, one of which is covered in a lipid
  • volatile anesthetics dissolve in the lipid layer and change frequency of oscillations
123
Q

Damage to the preoptic anterior hypothalamus

A

can impair thermoregulation and temperature homeostasis

124
Q

pre renal oliguria

A

A urine-to-plasma osmolar ratio (UOSM : POSM) >1.5

125
Q

epidural with morphine

A

increased risk of nausea and vomitting compared to more lipophilic opioids (fentanyl)

126
Q

endobronchial intubation vs speed of induction

A

One-lung ventilation (OLV) creates a right to left pulmonary shunt, which has the greatest effect on the less soluble inhalational anesthetics, such as desflurane

127
Q

highest infection rate with blood transfusions

A

CMV

128
Q

amnesia with versed

A

anterograde

129
Q

Aspirin MOA

A
  • Aspirin inhibits the enzyme cyclooxygenase (COX). COX mediates the biotransformation of arachidonic acid into three eicosanoid compounds: prostaglandin, prostacyclin, and thromboxane.
  • Aspirin inhibits platelet aggregation by blocking thromboxane
130
Q

Transducer

A

any device that converts energy from one for to another

131
Q

Wheatstone bridge

A

several strain gauges (electrical resistance of a wire increased as it extends)
-movement of the diaphragm stretches or compresses several wires and alters the resistance

132
Q

Resonance vs Dampening

A

Resonance is amplification of the signal
-dampening is a decrease of signal amplitude (2 way stop cocks, clots, arterial vasospasm, large catheter size, narrow long of compliant tubing)

133
Q

pressure vs height

A

7.4 mm Hg for every 10 cm

134
Q

dexmedetomidine

A

Alpha 2 adrenergic agonist

  • reduce incidence of perioperative myocardial ischemia
  • provides sedation, anxiolysis, hypnosis, analgesia, and sympatholysis. Dexmedetomidine decreases heart rate (HR) and systemic vascular resistance (SVR) and indirectly decreases cardiac output (CO), systemic blood pressure (SBP), and myocardial contractility.
  • minimal respiratory depression
135
Q

precedex vs clonidine alpha ratio

A

dexmedetomidine (α2:α1 = 1600:1) than clonidine (α2:α1 = 200:1)

136
Q

PaCO2 vs CBF

A

CBF changes 1-2 mL/100 g/min per every 1 mmHg change in PaCO2

137
Q

Power

A

1- type 2 error

Type II or β error = incorrectly accepting Ho (false negative)

138
Q

Increase MAC

A

Hyperthermia, hypernatremia, chronic ethanol abuse, and increased central neurotransmitter levels (e.g. MAOIs, amphetamine, cocaine, ephedrine, and levodopa use)
-gingers

139
Q

abx ppx for dental

A
  • prosthetic cardiac valves
  • history of infective endocarditis
  • unrepaired cyanotic congenital heart disease (CHD),
  • completely repaired congenital heart defect during the first 6 months after the procedure,
  • repaired CHD with residual defects at or adjacent to the site of prosthetic material,
  • cardiac transplantation recipients with cardiac valvular disease
140
Q

single best choice for hepatic protein synthesis function

A

coag factors

141
Q

cushing triad

A

HTN, bradycardia, respiratory changes

142
Q

Perioperative blood salvage

A
  • contraindicated if pus, feces, amniotic fluid contamination or certain types of malignant cell exposure
  • complication is incomplete blood filtration
  • coagulopathy can occur because only RBC are transfused back (platelets and clotting factor is removed)
143
Q

1L of room temp crystalloid decreases temp by

A

.25 C

144
Q

Standard error of mean

A

SEM = σ/√n

145
Q

Depth of MAC

A

Minimal: Normal response to verbal stimulation
Mod: Purposeful response to verbal or tactile stimulation Deep: Purposeful response after repeated or painful stimulation
GA: Unarousable with painful stimulus

146
Q

adverse outcome related to anesthesia equipment

A

misuse of equipment

147
Q

Addition of bicard to LA

A
  • can cause precipitation with bupic and ropiv
148
Q

MOA of LA

A

act on the cytoplasmic side of voltage-gated sodium channels in nerves. Therefore, the local anesthetic must pass through the cellular membrane to reach its target. To travel through the nerve membrane the local anesthetic needs to be in the unionized form. When the pH of a solution is less than the pKa the molecule will be ionized. When the pH of a solution is equal to the pKa, 50% of the molecules will be ionized and 50% will be unionized.

149
Q

extrapyramidal symptoms in PACU

A
  • most likely from antidopimenergic drugs for PONV - droperidol, metaclopramide, prochlorperazine
  • treat with anticholinergics (benztropine) or diphenhydramine
150
Q

Hoffman elimination

A
  • atracurium

- pH- and temperature-dependent reaction that proceeds more readily when pH and temperature are increased

151
Q

thiopental termination

A
  • bolus from redistribution

- infusion ; become dependent on hepatic metabolism (side chain oxidation)

152
Q

work up for non cardiac surgery ( concern fro major adverse cardiac event MACE)

A

if > 4 mets and asymptomatic then no additional workup is needed

153
Q

nail polish pulse ox

A

Blue, green, and to a lesser extent, black nail polish cause falsely low oxygen saturations to be displayed by standard two-wave pulse oximeters by interfering with the differential absorption of 660 and 940 nm light
- red nail polish does not interfere as much

154
Q

hypercalcemia vs paralytics

A

-antaganize the effects of NDMB; need a higher dose

155
Q

repeat dose of sux

A

-After a second dose of succinylcholine the patient is likely to develop bradycardia Bradycardia often occurs in children after they receive succinylcholine because of the activation of muscarinic receptors at the sinoatrial node, along with a high baseline vagal tone

156
Q

Functional Residual Capacity (FRC)

A
  • increases with height and age
  • decreased with obesity, short, female,
  • decreased PANGOS: Pregnancy, Ascites, Neonatal, General anesthesia, Obesity, Supine position.
157
Q

Termination of action potential

A

Termination of the action potential occurs primarily via two mechanisms. First, the voltage-gated sodium channels terminate their positive feedback by self-inactivation within milliseconds of opening. Inactivated sodium channels do not allow further sodium ion influx despite a still depolarized membrane. Second, both voltage-gated and voltage-independent potassium channels open in response to depolarization and allow potassium efflux out the cell. Combined, these effects result in neuron membrane repolarization back towards the resting potential. During this time, the sodium channels transition from an inactivated state (unable to potentiate an action potential) to a closed state (ready to open upon threshold stimulation). However, the potassium channels are slower to close than the sodium channels and overshoot the repolarization, causing a brief period of hyperpolarization. The cell membrane returns to its resting potential due to numerous other ion channels/pumps, namely the sodium-potassium-ATPase

158
Q

Ventilation and K

A

Hypoventilation causes hyperkalemia

159
Q

Increases EtCO2

A 
Malignant hyperthermia  
Hyperthermia 	   
Hyperthyroidism	    
Hypoventilation	
Rebreathing 	
Sepsis	
Shivering
160
Q

Decreases EtCO2

A 
Disconnect from or loose sampling line
Malpositioned endotracheal tube
Hyperventilation
Hypoperfusion (hypotension, cardiac arrest)
Hypothermia
Hypothyroidism
Pulmonary embolism
161
Q

Fluid in body

A 
Total body water = 60% body weight
Intracellular = 40% body weight
Extra cellular = 20% body weight
 - Interstitial fluid volume 75-80% of extracellular
 - PLamsa 20-25% of extracellular
162
Q

largest concentration for flouride ions upon metabolism

A

methoxyflurane (off market)
methoxyflurane > sevoflurane > enflurane > isoflurane > desflurane
- flouride induced nephrotoxicity

163
Q

Efficacy vs potency

A

Efficacy is the maximum effect of a drug. It does not depend on dose. Potency is the relative dose required to achieve a given effect and is related to receptor affinity.

164
Q

BEta blocks vs asthmsa

A

Beta blockers can potentiat bronchospasm in pt with asthma

165
Q

EKG leads that are sensative

A

2: arrythmia
V5: ischemia

166
Q

OR fire

A

1) oxidizer: O2, N2O
2) Ingition source: cautery, lazers, argon beams, fiber optic cables, defibrillators
3) fuel source: drapes, laps, etoh swabs, caps gowns, tubes

167
Q

Line Isolation Monitor

A
  • ungrounded
  • protects from electrocution by power isolation and continuous monitoring of the isolated power sytem
  • alarm at 2-5 mA (does not protect against microshock)
168
Q

Air exchange in OR

A

2 ppm for halogenated gas

or 0.5 halogenated gas with 25 ppm N20

169
Q

Sucessfull defibrilation

A

when ventricular fibrilation has terminated for at least 5 seconds. Even if postshock rhythm is nonperfusing or hemodynamically unstable

170
Q

unshockable rhythms

A

PEA, asystole

171
Q

monophasic charge vs biphasic

A

360 vs 120 for biphasic retiliniar, 150-200 for biphasic truncated exponential (200 if unknown)

172
Q

Ohms Law

A

Voltage =Current X Resistance

V= I X R

173
Q

Maximum allowable blood loss

A 
ABL= [EBV x (Hi-Hf)]/Hi
EBV =Premature Neonates 95 mL/kg
Full Term Neonates 85 mL/kg
Infants 80 mL/kg
Adult Men 75 mL/kg
Adult Women 65 mL/kg
174
Q

Variables

A

catagorical: values that functions as labels rather than as numbers
Continuous: numeric values where the relative magnitude is significant

175
Q

Incidence

A

incidence= number of new cases/ population at risk

176
Q

Prevalence

A

prevalence= number of cases at a given time/population at risk at a given time

177
Q

Cohort

A
  • prospective
  • identifies patients based on the presence or absence of risk factors and follows them through time
  • expensive, time consuming, need many patients
  • less susceptible to bias= true incidence
178
Q

Case control

A
  • retrospective

- compares the proportions of patients with various exposures in a group pf patients with a disease to a group without

179
Q

2 X 2 stats box

A

Diesase on top, Test on Left
A B
C D

180
Q

Relative risk

A

measure of the association between exposure and outcome in a cohort study
= {A/(A+B)} / {C/(C+D)}

181
Q

odds ratio

A

=AD/BC

182
Q

Sensitive

A

-ability of test to give a positive result when the patient actually has the disease
= A / (A+C)

183
Q

Specificity

A

ability to give a negative finding when the patient does not have the disease
= D / (D+B)

184
Q

Errors

A

type 1 = False positive, rejecting the null hypothesis when it is true
type 2= False negative, accepting the null when it is false

185
Q

Chi squared

A
  • categorical variables

- compares distribution of test results with normal distribution to evaluate independence

186
Q

T-test

A
  • continuous variables
  • compares the means of two populations
  • useful with small samples
187
Q

ANOVA

A
  • continuous variables

- compares the means of multiple groups

188
Q

Glucagon

A
  • causes glucose to mobilize to blood stream
  • increase gluconeogensesis, glyucogenolysis, and fatty acid break down
  • Glucagon activates adenylyl cyclase to increase cyclic AMP levels, leading to a positive inotropic and chronotropic cardiac response.
  • single-chain peptide hormone, synthesized and secreted by the alpha cells of the pancreas
  • Glucagon activates G-protein coupled receptors, which stimulates adenylyl cyclase production leading to increased cAMP
189
Q

predictor of difficult intubation

A

1) Relatively long incisors
2) Prominent “overbite”
3) Patient cannot bring mandibular incisors anterior to maxillary incisors
4) Less than 3 cm interincisor distance
5) Uvula is not visible when tongue is protruded with patient in sitting position
6) Highly arched or very narrow palate
7) Mandibular space that is stiff, indurated or occupied by a mass
8) Less than three ordinary finger breadth thyromental distance
9) Short neck length
10) Thick neck circumference
11) Decreased extension or flexion of the neck

190
Q

Fresh frozen plasma indication

A

Correction of excessive microvascular bleeding (PT >1.5 times normal, PTT >2 times normal, or INR >2)
Correction of coagulation factor deficiencies if the patient has been transfused with more than one blood volume (approximately 70 ml/kg)
Urgent reversal of warfarin therapy (prothrombin complex concentrate is another option)
Correction of coagulation factor deficiencies for which there are no specific replacements
Heparin resistance (antithrombin III deficiency) in a patient requiring heparin

191
Q

fospropol

A
  • propofol pro drug
  • paresthesia > 50%
  • burning, tingling, and/or stinging sensations and usually occur in the perianal or genital regions
192
Q

Volatile concentration equations

A
  • Saturated vapor pressure/ total pressure (usually atmospheric) = agent vapor volume / carrier gas volume + agent vapor volume
  • Va= SVP X Vc / Ptotal - SVP
  • % volatile = Va / FGF +Va X 100
193
Q

Single lung transplant and COPD

A

double peaked appearance on capnography

194
Q

Cyclopentolate

A

topical anticholinergic drug used to induce mydriasis (i.e. mydriatic drug) for ocular procedures. Systemic absorption can occur and lead to central nervous system signs and symptoms of anticholinergic toxicity.

195
Q

Increase power

A

Power= ability to detect a difference

1) Increase alpha: the smaller the alpha, the greater the chance of a false-negative conclusion (risky, as this increases type I error).
2) Decrease population variability (difficult to control).
3) Increase the sample size.
4) Make the difference between the conditions greater (most important factor in decreasing a type II error but difficult to control/manipulate)

196
Q

Zero order medications

A

any drug can reach this when they overwhelm max amount of enzymes

  • set amount is eliminated per unit of time
  • not dependent on liver blood flow
  • THE PAW: theophylline, heparin, ethanol, phenytoin, aspirin, warfarin.
197
Q

natural licorice

A

hyperaldosterone-like effects including: hypokalemia, hypertension, hypernatremia, fluid overload, and metabolic alkalosis.

198
Q

thyroid hormone binding ratio

A

increased in hyperthyroidism, decreased in hypo

199
Q

Meyer Overton rule

A

direct correlation between olive oil solubility and anesthetic gas potency

Basic (6 decks)

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