Focus - Miscellaneous Flashcards
What is the best way to minimize intraoperative heat loss?
Forced air warmer
What is the number one source of heat loss?
Radiation- 60%
Convection(air) - 20%
Evaporation - 20%
Conduction (contact) - 5%
Hypothermia is defined as a core body temperature less than?
36 C
Which temperature monitoring site offers the best combination of accuracy and safety over an extended period of time?
Esophageal
Distal 1/4
How much does shivering increase oxygen consumption? What drugs are used to treat this?
500%
-Meperidine (Demerol)
- Clonidine
- Precedex
For every 1 degree C reduction, how much is oxygen consumption reduced by?
5%
Does hypothermia increase or decrease blood loss? What about risk for infection?
Increases blood loss (coagulopathy)
Increased risk for surgical site infection
Increased risk for MI
What three things are needed for an airway fire?
Source
Ignition
Oxidizer
First step with an airway fire? Rest of the steps?
- Stop ventilation and remove ETT
- Stop flow of all gases
- Remove flammable material
- Pour water or saline
- Use CO2 fire extinguisher
- Evaluate patient and airway
Do long or short waves penetrate deeper with lasers?
Short waves penetrate deeper and less water
Long waves penetrate shorter and absorb more water
Laser types and goggles needed?
CO2 = oropharyngeal = Clear
Nd:yaG = tumor debulking = GREEN
Ruby = retina = RED
Argon = vascular lesion = AMBER
CO2 damages cornea, the rest damage retina
What does FiO2 need to be under when using a laser? Is nitrous okay to use?
<30%
No - nitrous is flammable
Are laser resistant ETT’s laser proof? Should reflective tape be used?
- they are NOT laser proof
- Do not use laser reflective tape
What is the most vulnerable part of the ETT?
Cuff
Best way to protect yourself against smoke/tissue vaporization?
Smoke evacuator and high efficiency masks
How are lasers different than light?
Monochromatic
Coherent
Collimated
Which burn degrees do not feel pain?
3rd degree
4th degree
Which burn degrees need skin grafts?
2nd degree deep
3rd degree
4th degree
Which burn degrees do not need skin grafts?
1st degree
2nd degree superficial
Where does 2nd degree deep burns start?
Deep dermal
Epidermis to lower dermis
What are the skin layers for burns?
Top
Epidermis
Dermis
Subcutaneous fat
Muscle
How much are each leg for burn percentage?
18%
How much is each arm for burn percentage?
9%
How much is the head for burn percentage?
10%
How much is the torso for burn percentage?
Front - 18%
Back 18%
How do kids differ for burn percentage?
Their heads are double
20% instead of the 10% for adults
What is the best fluid to give in the first 24 hours of a burn? What about the second 24 hours?
Lactated ringers (isotonic) - avoid albumin
D5W maintenance rate
or
Colloid 0.5mL * %TBSA * Kg
What is the calculation? How fast should it be replaced?
4mL * TBSA * Kg
1/2 in the first 8 hours
1/2 in the remaining 16 hours
What is the difference between the Parkland and modified Brooke formula?
Parkland is 4mL and Modified Brooke is 2mL
Urine output for burns - adult? child? electrical?
Adult - 0.5mL/kg/hr
Child - 1mL/kg/hr
Electrical - 1.5mL/kg/hr
What can be produced from extensive muscle damage - especially in electrical burns?
Myoglobinemia - highly toxic and needs to be flushed out
How much more does CO bind to hemoglobin? What color does the blood look?
200 times
Cherry red
What will the SpO2 reading be for carbon monoxide? Treatment?
Falsely high
Treatment is 100% FiO2 or hyperbaric
What is the gold standard for evaluating the extent of an airway injury?
Fiberoptic bronch
First priority in burn patients?
Administer high FiO2
How should a burn airway be established? What should be avoided?
-Establish as early as possible
-Awake fiberoptic is the gold standard
-Avoid trach due to sepsis risk
When is succ safe in burn patients? Why?
Safe in the first 24 hours
**after there is an upregulation in extra junctional receptors which may cause hyperkalemia
Dosing for NMB in burn patients?
Nondepolarizers should be 2-3x the normal dose due to more receptors
Avoid succ after 24 hours
Is ketamine safe in burn patients? Etomidate?
Ketamine is great
Etomidate is NOT because of adrenocortical suppression
What happens when patients become hypermetabolic after a burn?
Increased catabolism
Increased oxygen consumption
Increased HR
Increased RR
Abdominal compartment syndrome is defined as a intraabdominal pressure greater than?
> 20mmHg
What is the first phase of ECT treatment?
Increased PNS tone (tonic phase)
Increased secretions
Decreased BP and HR
What is the second phase of ECT treatment?
Increased SNS tone (clonic phase)
Increased HR and BP
Increased intragastric, intraocular, and intracranial pressure
What drug is the gold standard of ECT treatment? Does it affect seizure duration?
Methohexital - does not affect the seizure duration
Precedex and clonidine also do not affect duration
How does lithium affect NMB?
Prolongs succ and NonD NMB
How does hypocapnia and hypercapnia affect seizure duration?
Hypocapnia - increases duration
Hypercarbia - decreases duration
How does alfentanil and propofol combined affect seizure duration?
Increases seizure activity
Treatment for MH?
Dantrolene 2.5mg/kg
Supportive care
Treatment for serotonin syndrome?
Cyproheptadine
Chlorpromazine
Supportive care
Treatment for anticholinergic syndrome?
Physostigmine
Supportive care
Treatment for neuroleptic malignant syndrome?
Bromocriptine
Dantrolene
Supportive care
Can give succ
What is neuroleptic malignant syndrome associated with?
Psych meds
Which two medications can lead to anticholinergic poisoning?
Atropine
Scopolamine
Three features of anticholinergic poisoning?
Red, dry, hot skin
Delirium
Mydriasis
What is the MOA of neuroleptic malignant syndrome?
Dopamine depletion of the basal ganglia and hypothalamus
What causes open angle glaucoma vs closed angle glaucoma?
Closed - closure of the anterior chamber which causes a mechanical outflow obstruction
Open- sclerosis of the trabecular meshwork which impairs drainage
Which levels do TAP blockers cover?
T7-L1
Landmarks for a TAP block?
Pain chart
What is a thoracic Paravertebral block?
-Paravertebral space that targets the ventral ramus
-Single shot, need at each level
-Breast surgery, thoracotomy, rib fracture
What is a Celiac plexus block?
- Good for cancer pain in the upper abdominal organs
-Complications, AAA dissection, back pain, orthostatic hypotension,
What is a superior hypogastric plexus block?
-Cancer pain in the pelvic organs (hypo)
-Uterus, ovaries, prostate
- Complications, retrograde migration of the injectate
What is a sphenopalatine block good for?
Postdural puncture headache
What is the only cranial nerve apart of the CNS?
Optic nerve
CN II
Big concerns with a retrobulbar block?
The local migrates to other cranial nerves or the brainstem
-Supportive care till it subsides (15 minutes usually)
During a retrobulbar block you notice the opposite pupil dilates, what happened?
Development of post retrobulbar block apnea syndrome
Supportive care till local is cleared
What is the most common side effect of prophylactic antibiotics?
Pseudomembranous colitis
Allergic reactions are most commonly caused by which type of antibiotics?
Beta-Lactam
How long should vanco be given over?
1 hour
When can someone with a penicillin allergy receive a cephalosporin?
was NOT IgE mediated (anaphylaxis, bronchospasm, urticaria)
Did not produce exfoliative dermatitis (stevens-Johnson syndrome)
How often should ancef be redosed?
Every 4 hours
Antibiotic of choice for MRSA?
Vanco
Do antibiotics cross the placenta?
Yes - should be avoided
How long does alcohol need to dry?
2 minutes
Skin prep of choice for a central line?
Chlorhexidine
What is the most common source of bloodstream infections in hospitalized patients?
Central venous catheter infection
When should a preop antibiotic be administered before surgery? What about vanco?
Within 60 minutes before incision
Vanco - within 120 minutes
When are prophylactic antibiotics D/C after surgery? What about cardiac surgery?
D/C’d within 24 hours after surgery
Cardiac - within 48 hours
Cardiac surgery patients must have a blood glucose less than ?
<200
What must a colorectal patient’s temperature be?
Must be >36 C (normothermic) upon arrival to PACU
What type of needle is the most common cause of occupational exposure to HIV?
Hollow bore
STATEMENT - must provide proper hair removal around incision
What is the #1 best way to prevent a nosocomial infection?
Handwashing
Creutzfeldt-Jakob disease is an example of which type of infection? Additional considerations?
Prion Disease
Caused by contaminated animal protein, contaminated eye implants. cadaver pituitary hormones
Standard precautions
What procedure is the highest risk for acquiring TB?
- Bronchoscopy
- ETT placement
What is the first line treatment for TB?
Isoniazid
Which two WBC causes anaphylaxis?
Mast cells
Basophils
What is the most abundant white blood cell? What do they do?
Neutrophils
Immune defense against bacterial and fungal infections
What are basophils?
Essential component of allergic reactions
Release histamine, leukotrienes, and prostaglandins
What do Eosinophils do?
Fight against parasites
eewwww
What are monocytes?
Fight against bacterial, viral, and fungal
Release cytokines
What are lymphocytes?
B - humoral (produce antibodies)
T - cell mediated immunity (does not produce antibodies)
Natural killer - limit the spread of tumor
What type of drug reduces lymphocyte function?
Opioids (increases cancer recurrence)
Does anaphylaxis or anaphylactoid reactions require prior exposure?
- anaphylaxis - prior sensitization required
- anaphylactoid - no prior exposure needed
Presentation of anaphylaxis?
What is a type 1 hypersensitivity reaction? Ex:
Immediate hypersensitivityAnaphylaxis or extrinsic asthma
IgE reaction
Need to have prior exposure
What is a type 2 hypersensitivity reaction? Ex:
Antibody mediated
IgG and IgM
Ex: ABO-incompatibility, HIT
What is a type 3 hypersensitivity reaction? Ex:
Immune complex mediated
Something is created and deposited into the body
Ex: snake venom
What is a type 4 hypersensitivity reaction? Ex:
Delayed
Allergic reaction is delayed
Ex: Graft vs Host, Contact dermatitis, tissue rejection
Treatment for anaphylaxis?
- D/C offending agent
- 100% FiO2
- Epi
- IV fluids
- H1 antagonist
- H2 antagonist
- Hydrocortisone
- Albuterol
- Vaso
Chemo man
What is Gastrin? What produces it?
increases stomach acid and stimulates chief cells to secrete pepsinogen
Produced by G cells in the stomach
What is Secretin? What produces it?
Tells the pancreas to secrete Bicarb and the liver to secrete bile
Produced by S cells in the small intestine
What is Cholecystokinin? What produces it?
Tells the pancreas to release digestive enzymes and the gall bladder to contract
Produced by I cells in the small intestine
What is Gastric inhibitory peptide? What produces it?
Slows gastric emptying and stimulates the pancreas to release insulin
Produced by K cells in the small intestine
What is Somatostatin? What produces it?
Universal off switch
Produced by D cells in the stomach, small intestine, and pancreatic islet
What causes gallbladder pain after a fatty meal?
Increased CCK
What is the treatment for carcinoid tumors?
Somatostatin
What is Zollinger-Ellison syndrome?
Gastrin secreting tumor that leads to an ulcer from increased acid
What increases gastric barrier pressure?
Reglan (increases LES tone)
What decreases gastric barrier pressure?
Pregnancy
Anticholinergics
Cricoid pressure
Why does droperidol have a black box warning?
QT prolongation
Which Accupressure point is associated with reducing PONV?
P6 - below the wrist
How does ephedrine and midazolam reduce PONV?
Midazolam - decreases DA in the CTZ
Ephedrine IM - maintains BP and cerebral perfusion
Which cranial nerve is linked to the vestibular apparatus?
CN8
Vestibulocochlear
Which receptors are a part of the vestibular apparatus?
H1
M1
Which receptors are a part of the GI tract?
5-HT3
NK-1
Which receptors are a part of the CTZ?
5HT3
NK1
DA2
Noxious chemicals
When should zofran be given?
30 minutes before emergence?
Best antiemetics for a patient undergoing a mastoidectomy?
Anticholinergics
What drug class is Promethazine?
Antihistamine
What is a major concern when using bone cement?
Micro emboli that can travel to the lungs
What is BCIS?
Bone Cement Implantation syndrome
(Highest during Hip surgery)
Bradycardia
Dysrhythmias
Hypotension
Pulm HTN
Hypoxia
What is the greatest risk for a fat embolism during orthopedic surgery?
Any long bones
First 72 hours
Does tourniquet pain respond to narcotics?
No
What does body temperature do after releasing the tourniquet?
Decreases
Best way to treat tourniquet pain with a neuraxial block?
Convert to a general
30mg of Toradol is equal to how much morphine?
30mg Toradol = 10mg morphine
