Comp 16 Flashcards
What is the density of CSF?
1.003
How much buffer is available in sodium bicarb 8.4%?
50 mEq
What is the best plan for emergence and post op air management for adult who has undergone total laryngectomy?
SV with trach collar, uncuffed laryngectomy tube
FiO2 = 0.21 SaHbo2 = 86% SaHbCO = 0.4% SaMET= 0.2% PaO2 = 72 mmHg PaCO2= 38 mmHg pH = 7.36 Hb= 17.6
What is the acid-base state?
What is the acid-base condition?
Normal
What is the initial dose of intralipid for LA toxicity?
1 mg/kg over 1 min
What is the YAG laser advantage over CO2 laser for airway surgery?
Atttracts dark pigment (Hbg) that helps with controlling the bleeding
What total score for fast-track criteria bypasses the recovery room?
12 or greater
What score obviates (removes) fast tracking?
0 in any category
What are the guidelines for neuraxial anesthesia in patients taking daily aspirin 82mg?
continue
What regional anesthetic technique will most likely produce ipsilateral diaphragmatic paresis or paralysis?
interscalene block
What narcotics are prohibited for administration in PACU to outpatients?
none
What V/Q type of lung unit produces hypoxemia associated with post-op atelectasis?
low V/Q
Which way will the following reaction be driven as blood becomes more acidemic?
R-NH3+ R-HN2 + H+
to the left
What diagnosis should be made for suppurative inflammation of subcutaneous connective tissue in the submental space? Name 2 associated comorbid conditions.
Ludwig’s Angina
Diabetes mellitus
Dental abscess
What is rhabdomyolysis?
The breakdown of muscle tissue that results in muscle fiber contents being released in the bloodstream
What perioperative risks does rhabdomyolysis pose?
acute renal failure because the muscle fiber content is hard on the kidneys
What is the approximate pH of sodium bicarb?
7.8
For the pt who has suffered significant hemorrhage due to blunt trauma, the best method of restoring blood pressure will be with the administration of?
blood
Indocyanine green would be injected after a TAH because:
want to determine patency of ureters to ensure they ligate the ureters
When acidemia occurs, what is the human body’s fundamental response direced towards?
buffering –> respiratory –> renal
A diabetic pt who has not taken insulin for 3 days presents with abdominal pain, vomiting, lethargy, RR 32, PR 134, BP 149.96, T = 38.8. What is the most likely acid base disorder?
Metabolic acidosis
In the first 3 postop days following massive fluid resuscitation with LR what will most likely occur in a pt who has a good surgical oucome?
metabolic alkalosis b/c lactate –> bicarb in liver
What physiologic effect describes deoxygenated Hb having a greater affinity for hydrogen ions than oxygenated Hb?
Bohr
What drug can be injected via IV prior to administration of etomidate to prevent tonic-clonic activity?
magnesium
What occurs with bilateral RLN paralysis? (2)
stridor
aphonia
What occurs with unilateral RLN paralysis?
hoarseness
What is the appropriate treatment for a tension pneumothorax?
large bore needle into 2nd intercostal space in midclavicular line
What are the signs of cardiac tamponade? (5)
tachycardia, low bp dyspnea chest pain pulsus paradoxus increased CVP
What is “Beck’s Triad”?
Signs to directly assess cardiac tamponade:
distended neck veins (look)
hypotension (feel)
muffled heart sounds (hear)
What is the best method to restore BP in a trauma pt who suffered significant hemorrhage?
Type O, Rh negative blood
How do you manage the airway in a pt with a laryngectomy?
anode tube, 2nd black line can be placed at the level of the marker
Is the larynx essential for speech?
no
How would the anesthetic plan for pt with rhabdomyolysis be modified?
avoid renally metabolized drugs
Which of the following is modified RSI appropriate?
closed head injury planned surgery rhabdomyolysis tachypnea unknown gastric contents
unknown gastric contents
How do you manage an open globe injury in a pt with pseudocholinesterase deficiency?
no sux
Roc at 1.2 mg/kg
What is an appropriate rate of infusion for epi?
0.05 mcg/kg/min
If blood is not initially available for a trauma patient with major hemorrhage, what drugs should be administered along with IV fluids to resuscitate the patient?
epi
What test is used to determine fibrinolysis?
d-dimer which is a fibrin degradation product which is a small protein that is present in the blood after a blood clot is degraded by fibrinolysis. It contains 2 cross linked D fragments
Why are D-dimers ordered?
To rule out the presence of a thrombus such as DVT, PE, and strokes
Test is necessary to diagnose conditions that cause hypercoagulability and DIC for example
What is a normal, or negative, D-dimer?
< 500 mg/ml
What does a positive D-dimer indicate?
thrombus
DIC (very elevated D-dimer)
If bound calcium is low, what do we expect ionized calcium to be?
What are normal ionized levels of Ca?
Ionized calcium can be normal even if the bound calcium is low.
Ionized Ca = 1.2 - 1.3 mg/dL
What is leukocytosis and when does it occur most often?
elevated WBC count
most commonly a result of infection –certain parasitic infections
What is a normal WBC level?
4.5 - 11 mm^3
What are normal bicarbonate levels?
22 - 26
How is metabolic alkalosis determined?
bicarb > 26
How is metabolic acidosis determined?
bicarb < 22
At what creatinine level is GFR decreased by half?
2 * normal creatinine levels
What are normal Na levels?
135 - 145
What are normal K levels?
3.5 - 4.5
What are normal Cl levels?
95 - 105
What are normal CO2 levels?
22 - 29
What are normal BUN levels?
7 - 21
What are normal creatinine levels?
0.5 - 1.5
What are normal Hb levels?
12 - 17
What are normal Hct levels?
Hb * 3
What are normal Plt levels?
150 - 400 k
What is GGTP?
glutanyl transpeptidase
It is a test to detect biliary obstrucion, cholangitis, cholecystitis
What does increased ammonia indicate?
end stage liver disease
What does decreased albumin indicate?
liver damage
What does an increased conjugated bilirubin indicate?
bile duct blockage
What factor deficiency leads to a prolonged PT and a normal PTT?
factor 7
What lab will be prolonged with intrinsic factor issues, von Willebrands dz and hemophilia A and B?
PTT
What ACT is acceptable for CPB?
> 400
What is therapeutic INR for warfarin pts?
2.0 - 3.0
What is the equation for calculating pH?
- log [H+]
What does paCO2>45 indicate?
respiratory acidosis
How can you calculate HCO3?
using Henderson Hasselbach equation
pH = pKa + log [HCO3/CO2]
Increased amylase values indicate what?
acute pancreatitis which will be 4 - 5 times greater
What does increased lipase values indicate?
acute pancreatitis which will be 5-6 times greater
What does decreased lipase indicate?
permanent damage to pancreatic cells
What is an example of a disease results in low lipase levels?
cystic fibrosis
How much buffer is available in sodium bicarb 8.4%?
50 meq/ 50 cc –> 1 meq/ml
What is the anion gap equation?
Na + K - Cl - HCO3
What is the normal range for anion gap?
7 - 14 mEq/L
What does an anion gap > 30 indicate?
high anion gap acidosis
How do the kidneys influence metabolic and respiratory disturbances?
control the amount of bicarb resorbed
form new bicarb
eliminate H+
Describe the Bohr effect.
deoxygenated Hb has a greater affinity for H+ than does oxyHb
Describe the Haldane effect.
deoxygenated Hb has a greater affinity for CO2 than does oxyHb
When acidemia occurs, what is the body’s fundamental response directed towards?
maintaining the pH
What are the chronological changes that occur in response to acidemia?
buffering –> ventilation –> renal changes
A diabetic patient who has not taken insulin for 3 days presents with abdominal pain, vomiting, lethargy, RR = 32/min, 148/96 and temp 38.8. What is the most likely acid-base disorder?
metabolic acidosis…which occurs in insulin deficiency
What patients are most suitable for fast track recovery, bypassing phase I? (2)
MAC sedation
extremity regional anesthesia
What does the Aldrete score observe? (5)
Activity Respiration Circulation Consciousness Oxygenation
What are SAFE drugs in the outpatient setting?
Short acting
Fast emerging
During a GA, how should the eyes be protected for a pt who has recently undergone LASIK surgery?
tape them closed
What is the selection criteria for outpatient anesthesia?
ASA I or II of varying age
Arbitrary limits on age, duration of the procedure, use of premeds other than narcotics
What are ASA practice guidelines for children to take breast milk preop?
> 4 hours
What are the guidelines for NPO for light meals?
> 6 hours
What are the levels of differential blockade?
Sympathetic blockade is 2 segments higher than sensory which is 2 segment higher than motor blockade
If warfarin initial dose was given > 24 hours, how should you proceed with neuraxial?
check PT/INR
If warfarin initial dose was given < 24 hours and only 1 dose was given, how should you proceed with neuraxial?
safe to proceed
If pt is taking ASA and/or NSAIDS, how should you proceed with neuraxial?
safe to proceed
If pt is taking minidose subq heparin, how should you proceed with neuraxial?
safe to proceed, blocks should be performed 1 hour or more before heparin administration
What test checks for heparin levels?
PTT/ACT
If pt is taking LMWH, how should you proceed with neuraxial?
Wait to place needle at least 10 hours after last dose
If pt is taking fibrinolytics how should you proceed with neuraxial?
NOT safe to proceed
What nerves are blocked in an ankle block?
DP PT Sural Saphenous Superficial peroneal
What nerve blocks the great toe?
DP
What drugs can reverse a spasm of the sphincter of oddi?
Narcan
Nitroglycerine
Atropine
Glucagon
Name the phases of capnogram.
Phase 0: inspiration
Phase 1: deadspace
Phase 2: deadspace and alveolar gas
Phase 3: alveolar gas
What is the main cause of hypoxemia after repositioning?
Mainstem intubation
