Boot Camp Week 3 Flashcards
What are risk factors for an epidural abscess?
Diabetes
ETOH
Cancer
Immunosuppression
Active infection elsewhere
IVDU
Describe the tonic phase of ECT
15 seconds of increased parasympathetic activity
Describe the clonic phase of ECT
Several minutes of increased SNS activity
What respiratory pattern is ideal for ECT?
Hyperventilation leads to a more prolonged/better seizure
What are RELATIVE contraindications to ECT?
Pregnancy
Pacemaker
CHF
Glaucoma
What is the MOA of intralipid?
creates an expanded lipid phase, which drives toxic drugs from the tissue to the plasma and therefore toward metabolism
What are BG goals in CT surgery patients?
less than 180 during CPB
Less than 150 in ICU
What is the FIRST thing you should do when a surgeon gets ready to enter the trachea?
Remind them to switch to scalpel instead of cautery
What are the most sensitive leads during CARDIAC surgery?
Lead II
V5 (because V4 usually is moved for surgical purposes)
What is the most serious complication of DBS placement?
Intracerebral hemorrhage
What does most blood loss occur in spinal surgery?
During Decortication
What should be avoided during OLV in COPD patients?
No PEEP! in everybody else, PEEP is helpful
CRAO is caused by:
ION is caused by:
CRAO: external compression of the globe
ION: loss of watershed perfusion
What are risk factors for ION?
Male Sex
obesity
Long procedure
Wilson Frame
What are risk factors for CRAO?
Horseshoe headrest
When do serum levels from tumescent lidocaine peak?
12-14 hours
When is the patient with CAD at HIGHEST risk for MI?
It’s usually within 48 hours
What are the indications for Cryo?
Fibrinogen Deficiency
vWD
Hemophilia
Which phase of ECT is associated with skeletal muscle rigidity?
Tonic
Clonic is convulsions
List each heat loss mechanism in order of importance
Radiation
Convection
Evaporation
Conduction
What is the effect of hypocapnea on coronary arteries?
Vasoconstriction
What four conditions increases the risk of HOCM exacerbation?
Decreased Preload
Decreased Afterload
Increased HR
Increased Contractility
What is lusitropy?
Relaxation
What is dromotropy?
Conduction
What are the four categories of antiarrhythmic drugs?
The RCA gives rise to which arteries?
Posterior
Right Marginal
The LCA gives rise to which arteries?
Cflx
Ant. Interventricular
Which drugs undergo plasma hydrolysis?
Anything metabolized by pseudocholinesterase or nonspecific esterases
List all of the drugs that antagonize NMDA
Nitrous
Xenon
Ketamine
Dextromethorphan
Methadone
Magnesium
FiO2 and Nasal Cannula
What is the acceptable level of halogenated agents alone and with nitrous?
Alone 2ppm
With Nitrous 0.5ppm
What is the most common valve disease in ankylosing spondylitis?
Aortic Regurg
Which pain med is contraindicated in thyroid storm
Aspirin. It can dislodge T4 from albumin
Compared to the general population, geriatric patients have a _______ IV induction and a ______ inhalation induction
Slower IV
Faster Inhalation
In terms of body composition, geriatrics have increased ______ and decreased _______
Increased fat
decreased lean body mass
In geriatric patients the Vd for hydrophilic drugs is _______
smaller
Less muscle mass causes:
Decreased BMR
Decreased TB water
Decreased blood volume
Decreased plasma volume
In geriatric patients the Vd for lipophilic drugs is _____
Larger
May prolong elimination
How are drug plasma concentrations altered in the elderly?
Albumin is lower, so acidic drugs will have a higher free fraction
Alpha 1 is higher, so basic drugs will have a lower free fraction
Which lung parameters increase in the elderly?
MV
Lung Compliance
RV
FRC
Closing Capacity
Which lung parameters decrease in the elderly?
Lung elasticity
Chest wall compliance
VC
IRV
ERV
FVC & FEV1
At what age does closing capacity occur during tidal breathing while standing?
65
At what age does closing capacity occur during tidal breathing while supine?
45
Which cardiac parameters are decreased in the elderly?
CO
HR
SV
Diastolic Function
How do geriatrics respond to neuraxial anesthetics?
Smaller epidural and spinal spaces, requiring dose reduction
How is GFR impacted by age?
Approximately 125ml/min in the adult male
Reduces by 1 ml/min/year after age 40
How is hepatocellular function impacted by age
It isn’t. Hepatic function remains intact, but blood flow to the liver decreases
What are the indications for FFP?
Coagulopathy
Warfarin Reversal
Antithrombin Deficiency
Mass Transfusion
DIC
Hereditary Angioedema
