Boardvitals Flashcards
Benzos cause
Hyperpolarization of the cell membrane
Order to act on infant if APGAR score is low
Stimulating
Then ventilation then
Chest compressions then
Epi
Pre excitation of a fib give
Procainamide
AV nodal blockers like calcium channel or beta blockers are bad bc they prolong conduction time in AV node which could lead to Afib
Dilation of pupils from
Fibers that arise from short and long ciliary nerves that originate from superior cervical ganglion
Ziconitide MOA
Site of action includes dorsal horn lamina of spinal cord
Sch 1 drug
Solely abuse potential with no medical use
Sch 2 is cocaine bc it has high abuse potential but has medical usage
Larynx sits at the level of the
C3-C6 vertebrae
How many sacral nerves are there
5
Pin fixation systems like Mayfield clamp can lead to
Pressure ulcers
Pneumoperitoneum can cause an increase in
SVR
Sinus tachycardia is specific sign of
Myocardial contusion
Causes of rhabdomyolysis which can show up a few days post surgery
Prolonged tourniquet time
Postop surgical trauma
Urine will be red to brown
Never place a magnet on a device without
Knowing the effect of the maneuver
Which blood product highest risk for bacterial contamination
Plts
Botulism toxin blocks
Release of AcH
Repetitive muscle exertion may temporarily correct
Lambert Eaton syndrome
Opioid side effect only from parasympathetic system
Constipation
In ARDS want tidal volume with decrease in plateau pressure to a goal of
<30
No significant ketoacidosis is seen with HHS so
PH is normal whereas it is low in DKA
PVC and red rubber tubes are
Flammable
Desflurane inhalation agent of choice for
Chronic liver disease
Chronic liver disease requires more induction meds due to
Higher Vd
Laparoscopic surgery higher drop in
BP then open procedures
Nerve conduction velocity increases with
Application of heat
Don’t do heat therapy as can increase Edema and
Bleeding acutely
Surfactant
Lowers surface tension
Produced by type 2 alveolar cells
Helps prevent alveolar flooding
AS
High LV pressure and low normal LV volume
Hallmark of MS is
Cerebral or spinal plaque which consists of discrete regions of axonal degeneration and myelination
Facet arthropathy as cause of back pain
Do diagnostic medial branch block
Risk factors for PDPH
Female Pregnancy Prior headaches Younger adults Low BMI
Artery of Adamkiewicz dermatome
T8-L1
Does anterior two thirds of spinal cord
Ketoconazole has
Cytochrome P450 inhibitory effects
It inhibits CYP3A4 which metabolizes lidocaine
Enteral nutrition max protein
1.7 g/kg/day on patients on CRRT and 0.8-1 g/kg/d in noncatabolic AKI patients without need for dialysis
Atropine is a
Muscarinic blocker
Can decrease sweating which can present as hyperthermia
Lesser occipital nerve is
Lateral to the greater occipital nerve
Least compensated acidosis or alkalosis in body is
Metabolic alkalosis bc pulmonary system will not hypoventilate higher than PaC02 of 55
Long thoracic nerve from the
Anterior Rami of C5-C7 nerve roots
Acute cocaine use is associated with an increase in
MAC
Cigarette use has no effect on
MAC value
Hydrocortisone has mineralocorticoid activity whereas dexamethasone does not
Causes fluid retention
Gold standard for measuring lung volume
Body plethysmography
Wall stress is proportional to
Pressure and radius and inversely proportional to thickness
Nerve crosses neck of fibula
Common peroneal
Dry cough can start after
Ace inhibitor is started
American College no prophylactic abx for
Diagnostic laparoscopy
Operative lap
IUD insertion
Half life of morphine is
Prolonged in neonates
Immature cytochrome p450
Ectothiophate irreversibly inhibits
Plasma cholinesterase so don’t give succ
Cruzdfelt Jakob disease
Can cause EEG changes
Proximaltourniqyet deflated once we know the
Distal is good
Younger child is at lower risk for
PONV
Intrathecal fentanyl acts at
Substantia gelatinosa
Respiratory alkalosis in
Pregnancy and some compensation with bicarbonate
An u please vent abnormal evoked sensation
Dysthesia
Somatic pain
Pain carried by sensory fibers
Atrial pacing can’t be determined in prescience of
A fib
Umbilical veins brings oxygenated blood from placenta to
Fetus
Has highest oxygen content within fetal circulation
Mallampati 4 only see the
Hard palate
Mallampati type 3 see
Soft and hard palate
Secondary hyperparathyroidism
Low calcium
High PTH
Tramadol is a
Mu opioid receptor agonist
DIC is associate with
Increased PT
SBP mainly due to
Gram negatives
Staph is very unlikely to cause it
Prostate bony metastasis to spine treat with
External beam radiation therapy
Norepinephrine offset due to
Neuronal cell reuptake
TFA and bromide for from hepatic transformation of
Halthone
Recommended ACT level prior to iniation of cardiac bypass is
480
ACT target for peripheral vascular surgery is
Greater then 200
After 500U/kg of heparin and still not high enough ACT give
FFP or antithrombin 3 complex
How many coccygeal spinal nerves
1
Ondansetron has greatest antiemetic effect if given at
End of surgery
Worse rhythm for long term survival
Asystole
Ethacrynic acid is not a
Sulfonamide whereas lasix is
Distal third of humerus fractures affect
Radial nerve
Affects C6-C8 and can cause wrist drop
Resistance is a feature of direct current
Direct
For regional procedures need to have
ECG from beginning to end
Can do BP every 5 minutes
Herpes simplex outbreak requires emergent
C section
Can usually use regional
What is recommended after anesthesia provider comes back after taking LOA from substance abuse
Frequent urine testing
Mainstay for monitoring
If need be, add fentanyl and propofol to drugs to check
Celiac plexus block main side effect
Orthostatic hypotension for 5 days
Increasing pulmonary pressures
As you go lower down lung
CPDA1 contains citrate which is an
Anticoagulant
Has shelf life of 35 days
Risk factors for PONV
Female sex
Non smoker, history of PONV,
Volatilevanesthetic use, nitrous use, prolonged surgery
Toradol half life is
5-6 hours
Ketorolac only 3-5 days max due to decreased total body clearance and renal impairment
Peribulbar block involves
Injection of larger volume of local anesthetic
Lateral aspect of foot is innervated by
Sural nerve
Prolonged C02 pneumoperitoneum can lead to
Significant reduction of portal venous blood flow
Morphine is not metabolized by CYP2D6
Yea
At what level of spinal cord or higher will autonomic hyperreflexia occur
T6
Pathological effects of autonomic hyperreflexia
Hypertension, bradycardia, cutaneous vasoconstriction below site of lesion and cutaneous vasodilation above
Acute PE treatment is
LMWH
PE
Blood clot within pulmonary artery
Initial treatment is with LMWH
Radiation intensity decreases as
Inverse square of distance from radiation source
After transposition of the great arteries, most common cause of cyanotic heart disease in first four hours of life is
Pulmonary atresia
Pulmonary atresia newborns present with a
PDA
WideQRS
Peaked t waves think
Hyperkalemia
Epidural steroids or oral antivirals for
Herpes zoster although none has shown full benefits
Cervical spondylotic myelopathy be careful of
Neck hyper extension
Acromegaly is associated with
OSA
Acromegaly
GH is oversecreted in anterior pituitary
Mixed venous is checked at the
Pulmonary artery
In what zone is perfusion pressure equal to arterial-alveolar pressure
West zone 2
Blood transfusion most highlybtransmissable viral organism
Hepatitis B
Guidelines suggest similar fasting times for
General and regional anestgesia
RDDs should be worn at
Collar level or on lead apron depending on manufacturer
Don’t store RDDs next to x ray equipmrnt
Clonidine is known to cause a
Reflexive bradycardia
Hydralazine only affects
Arterioles and not the veins
TEE absolute contraindication
Zenker diverticulum
So is active bleeding esophageal varices
Intrascalene often misses the
Ulnar nerve
During strabismus surgery surgeon pulls at extraocular muscles causing bradycardia
The ophthalmic branch of the trigeminal nerve enters the
Gasserion ganglion
5 minute APGAR score of
7-10 is reassuring
Hetastarch has direct inhibitory effects on factor
8
4 Ts for HIT
Thrombocytopenia plt decreases of more then 50%
Timing, thrombosis and other causes of thrombocytopenia
The PF4/Heparin ELISA test sensitivity of nearly 100%
Oral morphine to tramadol conversion is
10 to 1
Ginkgo destroys platelets
Ginger increases intraop bleeding as well
Sensory innervation to oropharynx is done by CN
9
To do cricothyrotomy palpate
Thyroid and cricoid cartiledge and go in between
Don’t do cricothyrodtomy on patients less then
6
Hypocalcemia can lead to
Laryngospasm
TRALI presents as
Acute hypoxia and noncardiac pulmonary edema occurring within 6 hours of blood product transfusion
Awareness monitors are unreliable in patients at
Extremes of age(neonates, infants, or very elderly)
Procainamide can
Slow conduction across accessory pathway and potentially treat A fib
Most common complication of tourniquet use is
Nerve injury
Max dose of lido with Epi is
7 mg/kg
Without Epi is 4-5 mg/kg
Safe dose of bupivicaine or ropi is 3mg/kg
Pneumoperitoneum from C02 can lead to peritoneal stretching which stimulates the vagus nerve leading to
Bradycardia
Don’t give anticholinergic like glyco or atropine with pt with glaucoma
Isoprenaline a beta agonist can be used to increase HR
Amiodarone 300mg is
Second line for V fib if epinephrine is ineffective
Procainamide
Class 1a sodium channel blocker
Used for SVT
Can be associated with drug induced lupus
Drug induced SLE
Antihistone antibody
Amiodarone prolongs repolarization ad used for atrial and ventricular arrhythmias
Ocular changes and changes in skin tone have been described from amiodarone
Veno veno bypass for liver transplantation
Minimizes hypotension
Augments preload during vena cava clamping
Splanchic blood flow best preserved using
Norepinephrine
Vasopressin caution because of its adverse effects on
Gut perfusion
Most common cause of preventable birth defects in US
Alcohol
Drug use particularly with cocaine, heroin increases
Risk of stroke
IV heroin is associated with strokes due to septic emboli from endocarditis
Hydroflouric acid
Can lead to torsades de pointe
IV vitamin K works faster to lower INR than
Oral vitamin K
A practitioner wearing leader protective gear should stand on side
Containing X-ray intensifier when obtaining lateral views
Cervical spine X-ray not needed for
Cervical spine X-ray
Cardiac risk index
Include hx of stroke
Premature infant with retinopathy of immaturity
Anestgesia with mid of anesthetic and analgesic medications at lower doses
Paradoxical adduction of vocal cords on inspiration
Reassurance and breathing techniques
Roc is metabolized by liver
CYP450 75% and 10% by kidneys
Precedex leads to
Suppression of the release of norepinephrine from the presynaptic receptors at the alpha adrenergic synapse
Placing chest tube on right side with falling hgb is a sign of
Injury to the liver
Intercostal injury is
Fast bleeding and drop in hgb or it tamponades itself fast
NYHA classification deals with
Cardiac failure
Cardiac cath does not require
Endocarditis prophylaxis
Rebreathing can be due to
Faulty expiratory valves
Postconceotual age<60 weeks
No ambulatory surgery
Also ASA3 or 4
Decrease distance of patient from image intensifier to lower
Radiation exposure
There is a physiologic tachycardia of
Pregnancy
If asthmatic becomes hypotensive suddenly think air trapping or auto peep
First step is to disconnect from ventilator to let trapped air escape
Patients become real hypotensuve when they require
Sedation
Morphine has
Delayed onset so not good for active labor
Post herpetic neuralgia
Atrophy of the dorsal horn and necrosis of the dorsal root ganglion
Post herpetic neuralgia first line
TCA
Usually in opthalmic portion of dorsal root ganglion
ESWLithotripsy is contraindicated in patients with
Bleeding disorder
Pregnancy is absolute contraindication to
EWSL
EWSL is in warm water and leads to
Vasodilation and increase in cardiac output
P450 CYP2D6
Breakdown codeine and oxycodone
Pure sensory strokes
Due to thalamus
Can cause contra lateral loss of sensation on one side of body if thalamus messed up
Decreased IOP from
Opioids
Adrenal androgen production is controlled by
ACTH
And can lead to hirsutism when in excess
Turbulent flow is proportional to square of
Pressure
What heart sound is not heard in patients with a fib
S4
Due to atrial kick against stiffened ventricle
Pa02=
Fi02 x patm- pC02/.8
Cardioversion is electric shock synchronized to the
R wave
Annual limit of radiation to providers should be
5 REM
Sickle cell trait is a relative contraindication to
Tourniquet usage
Nitrous oxide use
Increases uptake of volatile anesthetics and makes inhalational induction faster
First stage of labor pain can be treated by
Bilateral para cervical block
Primarily responsible for hepatic buffer response
Adenosine
Pregnant patients should not be offered
Food as can lead to aspiration
Can have modest fluids up to 2 hours before induction of anesthesia
Gas embolus
Place on 100% Fi02
Deflate abdomen
Move to left lateral and hyperventilate
PCI better than fibrinolytics if can get to facility within
90 min
Load at outside facility with plavix 600mg once
SVR
MAP-CVP x 80/CO
3rd letter is
Response to sensing
Rate modulation should be turned off before
Proceeding to operating room by reprogramming pacemaker
If more cold reaches probe of pulmonary catheter then
Cardiac output will be underestimated
Hocm
Decreased contractility and HR is better with increased preload and Afterload
Work of ventricle is
Product of volume times pressure and therefore area inside a standard pressure volume loop
Valsalva or increased pressure on vena cava leads to
Decreased venous return
Inspiration augments
Venous return due to negative pressure generated in thoracic cavity
Early prosthetic valve endocarditis is caused by
S aureus
Digoxin increases myocardial contractility
Inhibition of sodium potassium ATP
Heparin must bind antithrombin to have
Anticoagulant effect
Reduced heart rate variability in
Transplanted heart
Major intracellular receptor of nitric oxide is
CGMP
Can get central venous sample from
PAC to measure mixed venous and can’t do with TEE
V5 lead should be placed at
Anterior axillary line fifth intercostal space
Don’t want MR patient to get
Bradycardia
Blood flow is inverse to
Length of vessel
Blood flow is directly proportional to
Radius to the fourth power
NYHA3
Marked limitation of physical activity and comfortable at rest
To get shoulder if no intrascalene wanted target
Axillary nerve block and suprascapular
Periop hypothermia in shivering patients requiring neuraxial anesthesia due to
Core to periphery heat redistribution
Each degree in temp down decreases metabolic rate by
6-8%
Spinal associated HTN in pregnant females
Phenylephrine
Bubble of SF6 lasts about
3 weeks in the eye
IV induction faster when patient has
Right to left shunt
Mid humerus fracture think
Radial nerve
Increased alVEDP is seen with
Aortic stenosis
Niacin need to check
Plasma Uric acid levels
Post pyloric stenosis surgery pts at risk for
Respiratory depression
Increase in mixed venous is seen with
Hypothermia
Serum thyroid levels do not increase in
Stress situation
Cortisol, glucagon, Epi, ADH do
Sotalol leads to
QT prolong
Retrobulbar block affects CN
2 3 5 and 6
Triceps reflex is
C7-C8
Parathyroid hormone leads to
Bone demineralization
PTH increases serum calcium and decreases phosphate
At most sites
Increase in GFR increases
Excretion of mannitol
Gabapentin leads to
Memory impairment and tremors
Pregabalin leads to
Peripheral edema
Carbamazepine
Ataxia, sedation, nausea, liver damage, skin rash
Lidocaine with Epi max dosage
7 mg/kg
Opioid induced constipation is via the
Peripheral nervous system alone
If patient with v fib are amenable to surgical or catheter ablation procedures
Should not undergo AICD placement
Botulism toxin
Prevents release of Ach from presynaptic nerve terminal
Upper again contrast study is good standard for diagnosing
Volvulus
Patients with deenervated hearts are super sensitive to the affects of
Adenosine
Infants
Large tounge
Anterior larynx
Narrowest part of infant airway is at
Cricoid cartiledge
Iv anesthetics termination of effect is through
Redistribution
Definitive treatment for preeclampsia is
Give birth
Keep patients on beta blocker and clonidine on
Day of surgery
Don’t start beta blocker
Universal donor blood
O negative blood
AB positive plasma
Pregnant women
Decreased FRC
Parasympathetic NS
GI tract
SA node
Uterus
Norepinephrine
Sympathetic postganglionic
Alpha2
Inhibits norepinephrine release
Synethetic chatecholamines
Dobutamine
Isoproterenol
Methylation by PMNT converts norepinephrine to
Epinephrine
Reduces death after MI
Atenolol
Beta 2 antagonism
Dobutamine or isoproterenol can fix
Glycopyrolate doesn’t cross
BBB
No more then
20 meQ of K
PR and QRS prolonged with
Hyperkalemia
Hyperkalemia above 6 have to treat before doing
Elective procedure
IO line
Proximal humerus
Proximal tibia
Distal tibia
Sternum
Platelets greater risk for
Bacterial contamination
TRALI
Non cardiogenic pulmonary edema
Blood transfused with CDPA-1 survives
24 hours and AS-1 42 hours
TRALI
Pulmonary arterial occlusion pressure<18
Bilateral infiltrates on chest radiograph
No diuresis or steroids
Trali
D antigen
Rh positive
Crossmatch it mixing blood with
Donor blood to see in vitro compatability and detects more unique antibodies
Banked blood complications
Hyperkalemia
Hypocalcemia
Acidosis
Impaired oxygen delivery due to reduced 2-3 dpg
Transmucosal at base of tonsillar pillars gets
CN9
Laryngeal strider is a common cause of edema
Post Extubation
When minute ventilation greater than fresh gas flow you
Rebreath gas
No choloroprocaine intrathecal leads to
Adhesive arachoiditis
Oculocardiac reflex is CN
5 and 10
PH stat
Adds C02 when hypothermic during CB bypass
PH stat more likely
Emboli bc co2 added leads to cerebral vasodilation
Ischemic changes in AVM parietal lobe monitor with
Ssep and meps
Succ dosing
Based on TBW
Peribulbar is safer than retrobulbar bc far from
Vital structures
RA is not associated with
Bronchospasm
Do not reduce HR in
Cardiac tamponade
Coronary perfusion pressure
Aortic diastolic pressure - LV diastolic pressure
Carotid sinuses are
Baroceptors
Chemoceptors carotid bodies
First things after smoking cessation
Carboxyhemoglobin lower and shift of O2 dissociation curve to right!
Acidosis right shift due to
Bohr effects
ECT leads to increase in
ICP or CBF
Ecstasy leads to cardiovascular collapse
Collapse
Glitazones can lead to
CHF
IGF1 for
Acromegaly
No effect on inotropy or stroke volume
Diuretic
Milrinone with
Inotropy and vasodilation
Volatile anesthetics decrease
IOP
Hypoalbumin increases
Free fraction of benzodiazepines so lower dose required
NO inactivated by
Hgb
Don’t let venous reservoir of CPB machine go empty can lead to
Air embolus
Hypothermia leads to
Potentiate neuromuscular blockade
Can use RA as place to take
Venous blood from CPB machine
SSEP from dorsal column to
Post central gyrus
Decreases amplitude increases latency of ssep
Volatile anesthetics
Opioids don’t effect
SSEP
SSEP amplitude down 50% is not good or latency by 10%
Hypothermia increases
Latency of sseps
ETc02 more effective at finding venous air embolus then
ECG
SVR increase with
Abdominal insufflation and cardiac output and venous return down
FRC and vital capacity decreased as well
R on T if intrinsic above pacemaker and in
Asynchronous mode
FFP reduces
Dilutional coagulopathy
High Leak pressure replace with
Smaller tube
Left hepatevtomy is better than
Right and easier to do
Helium is
Brown and carbon dioxide is gray
FRC
Amount left after normal expiration
DLCOdecreased
Restrictive lung disease
Cricoid lowers
Les tone
Increased DLCO
CHF exercise increased blood volume increased co
6 hours for subq heparin
12 for
Sub q lovenox
Subglottoc secretion drainage tube and head up to prevent
Ventilator associated pneumonia
Bronchial hyperactivity after virus can last
6 weeks after URI
Normal osmolality
290
Lactated ringers into bicarbonate leading to
Metabolic alkalosis
For burn
Crystalloid
4 x kg body weight x % burn
Give half in first 8 hours
No tourniquet if
Sickle cell, peripheral vascular disease
Physostigmine for
Central nervous system problem due to scop
Crosses bbb
