CA2-ITE Flashcards
Acupuncture can be reversed by _______
Naloxone (who knew?)
What are three ventilatory goals in Congenital Diaphragmatic Hernia?
- SpO2 90-95%
- Permissive hypercapnea (up to 65 mmHg)
- Low volumes with PIP < 25 cm H20
“Gentle ventilation”
Which position change causes the largest decrease in FRC?
60 degrees upright to supine. Or supine to Trendelenburg greater than -30 degrees.
Name two difference between BLS and PALS
- In an unwitnessed collapse on an adult one can leave to activate emergency response, in a child 2 mins CPR should be inititated
- With two providers a ration of 15:2 is used in children
What three physiologic conditions are associated with persistent fetal circulation?
- Acidosis
- Hypothermia
- Hypoxemia
Why is pregnancy a hyper coagulable state?
Increase in factors with decrease in factor S and resistance to factor C
Inhaled agents and EEG. What’s the relationship?
Inhaled agents can cause burst suppression at > 2 MAC doses
What is Propofol’s effect on ICP?
Decreases by decreasing CMO2
What is the drug of choice for any (of the three) Protamine reactions?
Epinephrine
Early decelerations:
Late decelerations:
Variable decelerations:
Early: Head compression
Late: Fetal hypoxia
Variable: Cord compression
What is concern for Midazolam infusion in patient with renal failure?
Accumulation of metabolite
What reflects the least amount of Beam rays during US?
Blood (liquid)
What is different about coronary perfusion between left and right coronaries?
Right is also perfused during systole
Define context-senstiive half-time
Time required for drug concentration to decrease by one half
CSF lavage is a reasonable treatment option for what?
High spinal in setting of inadvertent intrathecal catheter placement
Large quantities of blood product can lead to what acid base status? 2/2 what?
Metabolic alkalosis 2/2 Sodium Citrate
What two opioids have the lowest risk of Opioid Induced Neurotoxicity?
Fentanyl and Methadone
What is the Bohr Effect?
The shift in the oxygen dissociation curve caused by changes in pH, temperature, environment
What is the Haldane effect?
Describes hemoglobin’s increased affinity for CO2 when deoxygenated
What is the Heparin dose and goal ACT for SPB?
300-400 units/kg
About 480 seconds
What lab test best measures actual Heparin concentration for CPB?
HiTT (High Dose Thrombin Time)
What is the initial compensatory mechanism to maintain O2 delivery in the setting of anemia?
Rightward shift in the oxygen-hemoglobin dissociation curve
Patient with recent history of postpartum hemorrhage now with inability to breastfeed. Likely (board answer) diagnosis?
Postpartum pituitary necrosis
What is most common cause of death in women with preeclampsia?
Stroke
What finding can differentiate TRALI from other types of transfusion reactions?
Leukopenia
Which nerve block carries the highest risk of pneumothorax?
Supraclavicular
Key features of trisomy 21
Single palmar crease Upslanting palpebral fissures Endocardial cushion defects Atlantoaxial instability OSA
Key Features Trisomy 18
VSD
Rocker Bottom feet
Clenched hand with overriding digits
-Edwards syndrome
Key features trisomy 13
Holoprocencephaly
Cleft lip
Absent ribs
Polydactyly
_Patau syndrome
Key features trisomy 8
Long face
Wide nose
Thick lower lip
Cleft palate
What is the most common congenital heart defect recognized at birth?
VSD
Separation anxiety begins at what age?
6-8 months
Anesthesia specifics for CP:
- Roc dosing
- Succs
- MAC
- Coagulation
- Roc requirements are normal to increased
- Succs in not contraindicated
- MAC is decreased
- Coagulation factors abnormal
Open ureteral reimplantation, postop analgesia, what is mechanism of postop pain and preferred analgesia postop?
Bladder spasm
Caudal catheter
In kids what are 4 independent risk factors for PONV?
- Age > 3
- History is fam or patient
- Surgery > 30 min
- Strabismus surgery
What is preferred initial agent in treatment of cardiogenic shock?
Dobutamine
Brainstem ischemia is best monitored with what?
Brainstem auditory evoked potentials
What is the effect of isoflurane on the baroreceptor reflex?
Blunts the response
Why should hyperventilation be avoided in pregnancy?
Hypocarbia increases uterine vascular tone and decreases uterine perfussion
Radiation is related to distance how?
Inversely proportional to the square of the radius
What can decreased preload do to heart rate via what reflex?
“reverse” Bainbridge reflex. Reduced myocardial stretching results in decreased firing of SA node and bradycardia
Primary hyperparathyroidism does what to acid/base?
Non-ion gap metabolic acidosis
Wait how long after heparin for palacement of epidural?
4-6 hours
In decompensated heart failure what is the effect of diuretic?
Movement downward along the same frank-starling curve. This decreased the filling pressure and stretch on the myocardium
What are EKG findings of hypokalemia?
St-segment and T-wave depression
Dermatomes of lower extremity:
L1: L2: L3: L4: L5:
L1: Inguinal ligament L2: Lateral thigh L3: Medial (lower) thigh L4: Medial lower leg and medial first toe L5: Lower Lateral and lateral second toe
Describe the schematic of renin/angiotensin
Decrease in renal perfusion->renin secreted-> converts angiotensin (from liver) to angiotensin 1-> ACE (from lungs) converts to Angiotensin II -> Angiotensin II :
- Increases sympathetic anctivity
- Stimulates release of aldosterone
- Arteriole vasoconstriction
- Secretion of ADH which reabsorbs H20
Aldosterone: re-absorption of sodium, chloride, and H20. Potassium excreted
What is the equation for respiratory system compliance?
1/CRS= 1/CL + 1/CCW
CL= Compliance of lung CW= Compliance of Chest Wall
Typical intracardiac pressures:
RA, RV, LA, LV
RA: 1-10
RV: 15-30/0-8
LA: 8-10
LV: 140/4-12
Transtracheal injection with anesthetize what nerve?
Recurrent laryngeal
What fracture is associated with radial nerve palsy?
Humerus shaft
In ESRD other than hyperkalemia what other electrolyte abnormality is common?
Hypocalcemia
According to AHA what is definition of hypertension and hypotension?
Hypertension = 130/80
Hypotension is 90 mmHg or MAP 65
What is current preoperative recommendations regarding Metformin?
Continue untill Day of Surgery
In antiphospholipid syndrome what is elevated? What is not elevated?
PTT is elevated
PT is not elevated
What is minimum amount of wait time after MI in the case of no intervention?
60 days
Patient with symptomatic idiopathic intracranial hypertension presents in labor. What is best anesthetic?
Intrathecal catheter. This was medication can be administered with quick relief of pain (ICP increases with pain) and ability to remove CSF.
An epidural can increase the pressure and lead to ocular nerve injury
A simple facemask with flows of 5-10 L/min O2 delivers approximately what FiO2?
35-50%
An increase in albumin and phosphates will cause what acid/base abnormality? Why?
Metabolic acidosis. Albumin and phosphates are weak acids
Chronic phenytoin and gabapentin do what to NDNMB?
Resistance to blockade
What is dosing for intralipid in the setting of LAST?
20% lipid emulsion with bolus of 1.5ml/kg or 2-3 mins followed by infusion at .25 ml/kg/min
Which Mapleson circuit is most efficient user of fresh gas flow during spontaneous ventilation?
Mapleson A