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Anes Oral Boards > Extra Stuff > Flashcards

Extra Stuff Flashcards

1
Q

Physical Exam Maneuvers:
What are the effects of
1) valsalva?
2) handgrip?
3) Squatting?

A

1) Valsalva reduces preload
2) Handgrip increases after load
3) Squatting increases preload

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2
Q

What are the components of a pre-thoracotomy evaluation? (3)

A

1) Respiratory mechanics: FEV1 and ppoFEV1
2) Cardiopulmonary reserve: VO2 Max, stair climbing, 6-minute walk test
3) Lung Parenchymal function: DLCO, PaO2, PaCO2

*Others: Split lung function studies, spirometry, exercise tolerance test, V/Q scan

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3
Q

Formula to estimate normal arterial PaO2 on room air?

A

Normal arterial PaO2 = 102 - (age/3)

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4
Q

In what ways can PFT’s be helpful, especially for pneumonectomy/lobectomy surgeries? (4)

A

1) Help predict post-op pulm function (ppoFEV1)
2) Identify risk of post-op pulmonary complications
3) Determine severity of COPD, obstructive, or restrictive disease
4) Determine if patient might benefit from bronchodilator therapy

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5
Q

predicted postoperative FEV1 cutoff value to remember?

A

<40% = higher risk of right heart failure, other pulmonary complications

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6
Q

What conditions may produce cyanosis in the first year of life? (Generally, 1 & 5 examples)

A

Generally: Any condition that result sin right to left shunting

1) Tetralogy of Fallot
2) Transposition of the great vessels
3) Truncus arteriosus
4) Tricuspid Atresia
5) Total anomalous pulmonary venous return

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7
Q

Drug dosing in obesity:
Propofol
Etomidate
Ketamine

A

Propofol: Induction = lean body weight, Maintenance = total body weight

Etomidate: Induction = lean body weight

Ketamine: Induction: Lean body weight
maintenance = ideal body weight

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8
Q

Drug Dosing in obesity:
Rocuronium
Vecuronium
Cisattacurium
Succinylcholine

A

Roc, Vec, and Cis: Induction dose = Ideal body weight

Succinylcholine: Induction = Total body weight
Infusion = Total body weight

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9
Q

Drug dosing in obesity:
Sugammadex
Neostigmine

A

Sugammadex: Total body weight or (IBW + 40%)
Neostigmine: Total body weight

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10
Q

Why Utilize a precordial or esophageal stethoscope?

A

May facilitate early detection of some critical events such as:
1) Cardiac arrhythmias
2) Laryngospasm
3) CHanges in CO and BP

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11
Q

Roller Pumps:
1) How is Flow produced?
2) Pros of roller pumps (2)
3) Cons of roller pumps (4)

A

1)partial compression of tubing by two roller heads produces forward flow
2) Pros:
- Not sensitive to preload or afterload,
- can delivery pulsatile flow,
- reliably produces a certain amount of flow based on pump speed
3) Cons:
- Increased shear damage to RBCs,
- potential to delivery entrained air,
- risk of overpressurization (rupture of tubing)
- risk of preload occlusion leading to pressure-induved CAVITATION

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12
Q

Centrifugal pumps:
1) How is flow produced?
2) Pros (3)
3) Cons (3)

A

1) Rotational force generates forward flow
2) Pros:
-less damage to RBCs
- Will stop if air is entrained (will NOT deliver air embolism)
- No risk of over pressurization or cavitation
3) Cons:
- Sensitive to changes in preload or afterload
- Can NOT generate pulsatile flow
- Only able to partially compensate for decreases in forward flow

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13
Q

1) What risks are associated with rapid sequence induction?
2) What strategies can help mitigate these risks?

A

1) Untitrated administration of an induction drug
- increased risk of exaggerated sympathetic response to laryngoscopy –> HTN
- Increased risk of hypotension
2) To mitigate risk:
- Administer lidocaine, opiates, ketamine during induction to attenuate sympathetic response to DL
- Be prepared to treat any hypotension that develops

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14
Q

What are the negative effects of metabolic alkalosis? (4)

A

1) Leftward shift of hemoglobin dissociation curve (decreased oxygen delivery to peripheral tissues)
2) Reduced ionized calcium
3) Increased risk of seizures
4) Decreased serum potassium (increased risk of arrhythmia)

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15
Q

Reasons to place a pulse ox on a neonate? (4)

A

1) If you anticipate the need for resuscitation
2) If PPV is required
3) If you need to use supplemental O2
4) If cyanosis is persistent after birth

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16
Q

Where to place a pulse ox on a neonate?

A

Right upper extremity (Pre-ductal saturation)

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17
Q

Neonatal resuscitation algorithm steps? (6)

A

6 main steps, continue along algorithm/escalate to next step if you don’t get expected response:

1) Assess neonate
2) Warm, dry, stimulate baby. Clear airway/suction oropharynx if needed
- if HR <100, apnea, gasping, or cyanosis
3) place RUE SpO2, start PPV (start with RA, titrate supplemental O2 as needed), consider EKG
-if HR remains <100, or unable to attain goal SpO2 with PPV
4) Intubate, titrate FiO2 to goal SpO2
-If HR remains <100, or drops <60 at any time
5) Start chest compressions, intubate if not already done, and establish venous access (umbillical vein catheter or IO)
-If HR remains <60
6) IV epi (10mcg/kg) or tracheal epi (100mcg/kg), treat hypovolemia with NS or type O- blood, consider pneumothorax

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18
Q

GSC Score: Motor Response?

A

1 to 6 (think V-6 motor)

6 = obeys commands (“squeeze my hand”)
5 = moves to localize pain
4 = withdraws from pain, but doesn’t localize
3 = Abnormal flexion (decorticate posturing)
2 = Abnormal extension (decerebrate posturing)
1 = No movement

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19
Q

GCS Score: Verbal response

A

1 to 5 (Roman numeral V for “verbal”)

5 = Alert/oriented to time, person, place
4 = confused
3 = inappropriate words
2 = incomprehensible sounds
1 = no response

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20
Q

GCS Score: eye opening?

A

1 to 4

4 = spontaneous eye opening
3 = eyes open to speech/verbal command
2 = eyes open to pain
1 = no response

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21
Q

GCS: Three components?

A
  • Eye opening score, 1 to 4
  • Verbal score, 1to 5
  • Motor score, 1 to 6
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22
Q

Apgar Scoring: Criteria and how scored?

A

Appearance (skin color)
2 = Normal color
1= Blue-ish extremities (acrocyanotic)
0= blue, grey, or pale all over

Pulse (heart rate)
2 = >100
1 = <100
0 = absent

Grimace (reflex irritability
2 = pulls away, sneezes, or coughs with stim
1 = grimace with stim, but doesnt pull away
0 = no response to stim

Activity (Muscle tone)
2 = active, spontaneous movement
1 = arms/legs flex, but little movements
0 = flaccid tone/no movement

Respirations ( resp rate)
2 = normal rate/effort, good cry
1 = slow, irregular breaths, no cry
0 = absent

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23
Q

Indications for arterial line? (5)

A

1) Inability to use a BP cuff
2) Hemodynamic monitoring (tight BP control, anticipate instability or large fluid shifts, titrating vasoactive drugs)
3) Need for repeated/frequent blood sampling
4) Continuous cardiac monitoring (such as for bypass or cardiac surgery)
5) Diagnostic or interventional procedure (endovascular procedure, intra-aortic balloon pump counter-propulsion timing, etc.)

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24
Q

Contraindications for arterial line (5)

A

1) Absence of collateral circulation,
2) infection/burns over the site,
3) aneurysm,
4) AV malformation/fistula
5) Patient refusal

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25
Q

Factors that decrease MAC? (9)

A

1) Acute alcohol use
2) older age (6% decrease per decade over 40)
3) hyponatremia
4) hypothermia
5) anemia (esp. hgb <5)
6) Hypercarbia/acidosis
7) Hypoxia
8) Pregnancy
9) Other drugs/adjuncts (nitrous, opioids, benzos, propofol, alpha-2 agonists, lidocaine)

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26
Q

Does thyroid disease affect MAC?

A

NO.
Neither hyperthyroid nor hypothyroid has any effect on MAC

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27
Q

ASA Standard monitors?

A

1) Qualified anesthesia personnel who can interpret and respond appropriately to monitors

2) VOTC
- Ventilation: end tidal CO2 (capnography), Vent with inhalational gas analyzer, tidal volume measurement, disconnect alarm
- Oxygenation: Pulse Ox/SpO2, inspired oxygen analyzer with low level alarm
- Temperature: “Must be monitored with changes in body temp are expected through the duration of the case
- Circulation: Heart rate, BP (minimum q5 mins), continuous EKG

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28
Q

EKG: 3 lead vs. 5 lead?

A
  • 3 lead: RA, LA, LL
    Leads I, II, III (limb leads)
  • 5 lead: RA, LA, RL, LL, V5
    Leads I, II, III, aVR, aVL, aVF, V5
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29
Q

Which EKG lead is best for monitoring heart rhythm?

A

Lead II = has best visibility of P-waves

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30
Q

Which EKG lead is best for monitoring for ischemia?

A

Lead V5 = most sensitive for ischemia (anterior and lateral ischemia)

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31
Q

Estimated blood volume:
Pre-term neonate?

A

100ml/kg

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32
Q

Estimated blood volume:
Term neonate?

A

90 ml/kg

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33
Q

Estimated blood volume:
Infant (3 - 12 months)?

A

80 ml/kg

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34
Q

Estimated blood volume:
Child ( 1 - 12 years)?

A

75 ml/kg

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35
Q

Estimated blood volume:
Adult?

A

70 ml/kg

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36
Q

Estimated blood volume:
Pregnant woman?

A

90 ml/kg

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37
Q

Treatment of airway fire (4)?
Treatment after airway fire is extinguished (3)?

A

1) Alert surgical team (if not aware)
2) Stop ventilation/stop oxygen flow
3) Remove ETT
4) Flood field with saline to extinguish any residual fire

1) Ventilate with 100% O2
2) Reintubate
3) Perform bronch to rule out foreign bodies, assess airway damage/edema
*Need to keep intubated for minimum of 24 hours to monitor delayed airway edema

38
Q

Anesthetic considerations for Down’s Syndrome (7)?

A

1) Atlantoaxial instability
2) Macroglossia
3) OSA
4) Subglottic stenosis
5) Congenital heart defects (endocardial cushion defects, ASD, VSD, PDA, Tetralogy, pulm HTN, Eisenmenger syndrome)
6) Extremes of cardiac chronotropy
7) Intestinal malformations (increased risk of aspiration)

39
Q

Complications associated with surgery in the preterm neonate? (5)

A

1) Hypothermia/temperature regulation
2) retinopathy of prematurity
3) intraventricular hemorrhage
4) Post-op apnea
5) Hypoglycemia / glucose hemostasis

*Glucosuria is NOT uncommon in preterm babies <34 weeks gestation, does NOT necessarily indicate true hyperglycemia

40
Q

Risk Factors for retinopathy of prematurity? (7)

A

1) prematurity (esp. <32 weeks)
2) Low birth weight (esp <1500g)
3) cyanotic congenital heart disease
4) mechanical ventilation/hyperoxia
5) Resp. disress
6) hypoxia
7) acidosis

41
Q

Goal SpO2 and PaO2 for prevention of retinopathy of prematurity?

A

SpO2 = 87 - 94%
PaO2 = 50 - 80 mmHg

42
Q

ASA minimum standards for non-OR anesthetizing locations? (8 + 2 if using inhaled anesthetics)

A

1) 2 sources of oxygen (main and backup)
2) Suction
3) Airway equipment (minimum PPV, bag/valve mask)
4) Adequate drugs/ supplies
5) ASA standard monitors
6) Emergency meds/crash cart
7) Staff trained to assist in CPR/emergencies
8) Battery powered flashlight as backup light source

if using inhaled anesthetics:
9) Anesthesia Machine
10) Scavenging system for waste anesthetic gasses

43
Q

Alternative to heparin ggt in the setting of HIT? (3 classes, 5 drugs)

A

Direct thrombin Inhibitors:
1) Argatroban ( IV infusion, titrated to PTT or assay. OK in renal insufficiency, hepatic clearance)
2) Bivalirudin (IV infusion, titrated to PTT or assay, rapid proteolytic cleavage in plasma, OK in hepatic or renal failure)

Indirect Xa inhibitors:
3) Fondiparinux (indirectly, irreversibly binds to factor Xa, once-daily dosing, subQ injection, no reversal, long half life)

Direct factor Xa inhibitors
4) Apixaban
5) Riveroxaban
(both are selective, direct inhibitors, long half life, no monitoring, oral meds)

44
Q

Describe blood flow to spinal cord?

A

Posterior Spinal Cord: Posterior 1/3 of cord, sensory function
- Supplied by 2 posterior spinal arteries

Anterior Spinal Cord: Anterior 2/3 of cord, Motor function
- Single anterior spinal artery (from basilar and vertebral arteries)
- Contributions from 6-8 transverse radicular arteries (arising from aorta)
- Most important radicular artery is Artery of Adamkiewicz, which helps supply lower 2/3rds of anterior cord, originates variably from T5-L5 (T9-T12 in 60%)

45
Q

Venous Air embolism: Signs and symptoms? (4)

A

1) Hypotension
2) decreased ETCO2
3) precordial dopplar –> Roaring sound
4) Characteristic “Millwheel murmur” (beast heard with esophageal stethoscope

46
Q

Venous Air Embolism: Treatment (7)

A

1) Alert surgeon, surgeon flood the field with saline
2) Discontinue nitrous if using
3) Ventilate with 100% FiO2
4) Aspirate entrapped air with central line (if no central line consider placing one)
5) Cardiovascular support (fluids, pressors, chest compressions)
6) Place patient in HEAD DOWN, RIGHT SIDE UP position
7) Be prepared to treat reflex bronchospasm

*Of questionable benefit:
- PEEP
- Compress jugulars

47
Q

Physiology of Pituitary Gland:
Which hormones are release by anterior pituitary?
Which Hormones released by posterior pituitary

A

Anterior Pituitary: Synthesis, storage and secretion of 6 trophic hormones:
1) ACTH
2) HGH
3) TSH
4) FSH
5) LH
6) Prolactin

Posterior Pituitary: Stores and secretes two hormones that are originally made in the hypothalamus, transported to the posterior pituitary:
1) AHD (Vasopressin)
2) Oxytocin

48
Q

Factors affecting rate of inhalational induction? (3 +2)

A

1) Alveolar ventilation: as alveolar minute ventilation increases, rate of induction increases
2) Gradient partial pressure of inhalational agent: higher/larger gradient partial pressure = higher concentration of gas with each inhalation = more rapid induction
3) Blood:gas coefficient (Inverse relationship: lower blood:gas coefficient = less gas dissolved in blood = less gradient between inspired and alveolar concentrations = faster induction

4) Right to left shunt slows inhalational induction (can speed IV induction)
**Left to right shunt has minimal effects

5) Increased cardiac output slows induction

49
Q

Factors that increase MAC (7)

A

1) Chronic alcohol use
2) Infancy (MAC peaks at age 6 months, then decreases)
3) Hypernatremia
4) Hyperthermia
5) Acute Amphetamine use
6) Acute Cocaine use
7) Ephedrine use

**DO NOT affect MAC:
- Sex
- Hypo- or hyper- thyroidism

50
Q

Parkland Formula?

A

Guideline for fluid resuscitation in burn patients:

Fluid replacement = (4ml/Kg) x (% BSA burned)

This is fluid replacement for first 24 hours, half in first 8 hour, half in remaining 16 hours

51
Q

What is the difference between alpha-stat and pH-stat strategies?

A

Different strategies for managing CO2 in the hypothermic patient (bypass, etc.)

  • Alpha-stat: Does NOT add CO2 to the circuit/patient. Allows pH and PCO2 to change with hypothermia (PCO2 decreases, pH increases, blood flow to brain decreases).
    *Maintains electrochemical neutrality
  • pH-stat adds CO2 to the oxygenator/circuit, with goal to maintain PaCO2 at 40 mmHg and pH at 7.40. (This maintains blood flow to brain)
52
Q

Alpha-stat vs. pH-stat:
Which strategy is better in adults?
Why?

A

Alpha-stat is recommended for adults undergoing MODERATE hypothermia –> leads to improved neurologic outcomes.
- Primary mechanism of brain injury in adults is embolic events, so improved cerebral blood flow a/w pH-stat may be more harmful for adults.

*For adults undergoing DEEP hypothermia, best strategy is unknown

53
Q

Alpha-stat vs. pH-stat:
Which strategy is better in pediatrics?
Why?

A

pH stat is preferred in children.
It provides superior brain protection
- Primary mechanism of neurologic injury in peds is thought to be related to ischemia, so increased cerebral blood flow a/w pH strategy helps to reduce risk of ischemia.

54
Q

What are the different types of protamine reactions? (3)

A

I. Hypotension (decreased SVR) related to rapid administration/histamine release?
II. Anaphylactic /anaphylactoid reactions
III. Pulmonary vasoconstriction (often catastrophic leading to acute right heart failure/cardiogenic shock/collapse)

55
Q

PONV Risk factors:
Patient-specific risk factors? (5)

A
  1. Female gender
  2. younger age (have seen <40 as a cutoff)
  3. non-smoker
  4. anxiety
  5. hx of PONV or motion sickness
56
Q

PONV Risk factors:
Anesthetic-specific risk factors (4)

A
  1. use of volatile agents
  2. use of nitrous oxide (>30 mins)
  3. use of neostigmine
  4. use of intra- or post-op opioids
57
Q

PONV Risk factors:
Surgical risk factors (2 + 7)

A

1) Length of surgery
2) Type of surgery

Higher risk surgeries:
1. laparoscopy
2. Laparotomy
3. ENT
4. neurosurgery
5. strabismus surgery
6. breast surgery
7. plastic surgery

58
Q

Drug dosing in obesity:

Midazolam
Fentanyl / Sufentanil
Remifentanil

A

Midazolam
Bolus = TBW
Infusion = TBW

Fentanyl / Sufentanil (opposite of most drugs)
Loading dose = TBW
Maintenance = IBW

Remifentanil
Induction/bolus = IBW
Maintenance = IBW

59
Q

Obstructive sleep apnea definition/criteria? (4)

A

1) Complete cessation of airflow for >10 seconds
2) Occurs 5 or more times per hour
3) Occurs despite continued respiratory effort against a closed glottis
4) a/w >4% decrease in SpO2

60
Q

Obstructive Sleep Hypopnea definition/criteria? (3)

A
  1. 50% reduction in airflow lasting >10 seconds
  2. Occurs 15+ times per hour of sleep
  3. A/w >4% decrease in SpO2
61
Q

Obesity hypoventilation syndrome definition/criteria (5)

A

Obesity hypoventilation syndrome (OHS) is defined by:
1. Obesity (BMI >30)
2. daytime arterial hypercapnea (PaCO2 >45)
3. Nocturnal hypoxia
4. Polycythemia
5. Absence of known cause of hypoventilation (pulm disease, etc.)

62
Q

Pickwickian syndrome definition/criteria? (2)

A
  • Severe form of OHS in which chronic hypoventilation leads to:
    1. Pulm HTN
    2. RV failure
63
Q

10 generic causes of hypertension?

A
  1. CKD
  2. renovascular disease
  3. Chronic steroids
  4. OSA
  5. Obesity/metabolic syndrome
  6. thyroid or parathyroid dz
  7. pheochromocytoma
  8. coarctation of aorta
  9. alcohol abuse
  10. drugs (cocaine, amphetamines, supplements, OCPs)
64
Q

Examples of end-organ damage from HTN? (9)

A
  1. LVH
  2. angina
  3. myocardial ischemia/infarction
  4. CHF
  5. CAD
  6. Stroke/TIA
  7. CKD
  8. Retinopathy
  9. Peripheral arterial disease
65
Q

When to suspect amniotic fluid embolism? (timing)

A

Usually occurs shortly after delivery of baby, but can occur during labor (anytime placenta separates from uterus)

66
Q

What are the symptoms of amniotic fluid embolism? early (6) and second (3) phases?

A

Early:
1. dyspnea
2. pulm HTN (from pulm vasospasm)
3. hypotension (from right heart failure)
4. hypoxia
5. seizure/loss of consciousness
6. cardiac arrest

Second phase:
1. LV failure
2. Pulm edema
3. Coagulopathy –> DIC

67
Q

Anesthetic goals for patients with Mitral regurgitation? (5)

A
  1. maintain preload and forward systemic flow
  2. judiciously reduce afterload (to encourage forward flow)
  3. Maintain HR in the high-normal range (80-100BPM) - decreases time for regurg to occur
  4. Minimize drug-induced myocardial depression
  5. Avoid increases in PVR
68
Q

Anesthetic goals for patients with mitral regurgitation due to mitral valve prolapse (MVP)? (5)

A

General: avoid reducing preload, avoid LV emptying, which can worsen prolapse and MR

  1. Avoid sympathetic activation (catecholamines increase HR and contractility)
  2. Maintain SVR
  3. Maintain Preload
  4. Avoid increased myocardial contractility (which causes more LV emptying)
  5. Avoid tachycardia (need more time for adequate LV filling)
69
Q

Omphalocele vs. Gastroschisis:

How are they similar? (3)

A
  • Both congenital disorders
  • Both more likely in Males
  • Characterized by abdominal wall defects that allow for EXTERNAL HERNIATION OF ABDOMINAL CONTENTS
70
Q

Omphalocele vs. Gastroschisis:

How are they Different? (4)

A
  1. Omphalocele occurs at base of umbilicus, gastroschisis usually occurs LATERAL to the umbilicus
  2. Omphalocele has membranous covering around abdominal contents, gastroschisis has no membranous covering, so contents are exposed to environment and have increase risk of infection and loss of fluid
  3. Omphalocele usually involved functioning bowels, gastroscisis usually involves inflammed, non-functional bowel
  4. Omphalocele is associated with congenital anomalies (esp. cardiac, diaphragmatic hernia, trisomy 21, etc.), gastroscisis is less likely to be associated with congenital anomalies.
71
Q

Characteristics of Beckwith-Wiedemann Syndrome? (8)

A
  1. macroglossia (large tongue –> difficult airway)
  2. macrosomia
  3. hemihyperplasia (asymetric overgrowth)
  4. midline abdominal wall defects (umbillical hernia, omphalocele)
  5. ear creases/ ear pits
  6. Neonatal hypoglycemia (hyperinsulinism)
  7. polycythemia / hyperviscosity
  8. embryonal tumors in childhood (Whilm’s tumor, hepatobastoma, neuroblastoma, rhabdomyosarcoma)
72
Q

What is the “carcinoid triad”? Two other common symptoms?

A
  1. diarrhea
  2. flushing
  3. cardiac involvement (typically right sided: triscuspid regurgitation/stenosis or pulm stenosis/regurg)
    *Other common symptoms:
    - bronchoconstriction, hypo- or hyper-tension
73
Q

What hormones are released by carcinoid tumors? (3)

A

histamine
kallikrein (precursor of bradykinin)
serotonin

74
Q

Properties of Volatile anesthetics: Sevoflurane
Vapor Pressure?
Blood Gas Partition Coefficient?
MAC (~40 yrs old)?

A

Sevoflurane
Vapor Pressure = 160 mmHg
Blood Gas Partition Coefficient = 0.69
MAC (~40 yrs old) = 1.8

75
Q

Properties of Volatile anesthetics: Isoflurane
Vapor Pressure?
Blood Gas Partition Coefficient?
MAC (~40 yrs old)?

A

Isoflurane
Vapor Pressure = 240 mmHg
Blood Gas Partition Coefficient =1.46
MAC (~40 yrs old) = 1.17

76
Q

Properties of Volatile anesthetics: Desflurane
Vapor Pressure?
Blood Gas Partition Coefficient?
MAC (~40 yrs old)?

A

Desflurane:
Vapor Pressure = 680 mmHg
Blood Gas Partition Coefficient = 0.42
MAC (~40 yrs old) = 6.6

77
Q

Grading Aortic Stenosis (Mild, Moderate, Severe:
Peak Velocity (m/s)

A

Mild = 2 - 3 m/s
Moderate = 3-4 m/s
Severe: >4 m/s

78
Q

Grading Aortic Stenosis (Mild, Moderate, Severe:
Mean gradient (mmHg)

A

Mild = <20 mmHg
Moderate = 20 - 40 mmHg
Severe = >40 mmHg

79
Q

Grading Aortic Stenosis (Mild, Moderate, Severe:
Valve area (cm^2)

A

Mild = >1.5 cm^2
Moderate = 1 - 1.5 cm^2
Severe = <1 cm^2

80
Q

Grading Aortic Stenosis (Mild, Moderate, Severe:
Indexed Valve area (cm^2/m^2)

A

Mild = >0.85 cm^2/m^2
Moderate = 0.60 - 0.85 cm^2/m^2
Severe = <0.60 cm^2/m^2

81
Q

What diseases have a link to MH? (5)

A
  1. hypokalemic periodic paralysis
  2. hyperkalemic periodic paralysis
  3. Central core disease
  4. King Denborough Syndrome
  5. Multiminicore disease
82
Q

Options for actively cooling a patient? (5)

A
  1. Cold IV fluids
  2. Ice packs to major arteries (groin, axilla, around head/neck)
  3. Gastric, bladder, rectal, or wound lavage with iced saline
  4. Cold peritoneal dialysis
  5. cardiopulmonary bypass
83
Q
A
84
Q

Grading Pulm HTN:
PA Systolic pressure cutoffs?

A

Mild PH = 35 - 50 (Grade 1)
Moderate = 50 -70 (Grade 2)
Severe = >70 (Grade 3)

85
Q

Grading Pulm HTN:
Mean PA Pressure cutoffs?

A

Mild PH = >30 (Grade 1)
Moderate = >40 (Grade 2)
Severe = >50 (Grade 3)

86
Q

Submandibular abscess airway management:
Best option when there are signs and symptoms of airway compromise?

A

Awake Trach or awake fiberoptic

87
Q

Submandibular abscess airway management:
When no signs of airway compromise?

A

Careful laryngoscopy with a spontaneously breathing induction can be attempted with difficult airway equipment available/surgeon for trach

88
Q

Submandibular abscess airway management:
When trismus is present?

A

May be necessary to do awake nasal fiberoptic

89
Q

Aspiration:
1) what is it? What is it initially characterized by? (3)
2) what is the earliest physiological change from aspiration?
3) what are other changes that can develop? (4)
4) how long should you monitor someone with aspiration?

A

1) a chemical pneumonitis characterized by hypoxemia, bronchospasm, and atelectasis
2) earliest change is intrapulmonary shunting
3) other changes include pulm edema, pulm hypertension, and hypercapnea and hypoxia.
4) monitor for 24-48 hours

90
Q

Treatment steps for aspiration? (9)

A
  1. Head down position
  2. Add air to cuff if ETT or trached
  3. Suction
  4. Ventilate with 100% O2 as needed
  5. bronch to remove particulate material/collect sample of tracheal aspirate for cultures
  6. Apply PEEP (after suctioning so you don’t force aspirate further down lungs)
  7. Insert OG/NG to suction stomach
  8. Order baseline CXR and ABG
  9. Monitor for 24-48 hours for development of symptoms
  • NO evidence for prophylactic antibiotics or steroids

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