General

Question 1

Fluid Status Determination

Answer 1

Mucus membrane
Cap refill
Urine output
EBL

Question 2

Hypothermia Concerns

Answer 2

Coagulopathy, cardiac dysrhythmias, impaired renal fun, poor wound healing

CMRO2 is reduced 7% per degree Celsius below 36C

Question 3

Fat Embolism Syndrome Diagnosis

Answer 3

Gurd and Wilson Criteria (1 major + 4 minor)

Major
     Rash: petechial
     Hypoxemia (PaO2 <60 on FiO2 ,0.4)
     CNS depression
     Pulmonary edema
Minor
     Tachycardia (>110)
     Pyrexia
     Fat - retina, blood, urine, or sputum
     Anemia
     Thrombocytopenia
     Increased ESR
     Jaundice

Question 4

Fat Embolism Syndrome Treatment

Answer 4

Supportive
Ventilation - mechanical with 100% O2,
Hypotension - treat, correct hypovolemia, replace blood and platelets as needed
Monitor for deterioration

Question 5

Methemoglobinemia Treatment

Answer 5

Mild = identify and avoid oxidizing agents
Clinically significant = remove offending agent, 100% O2, Methylene Blue (in G6PD deficiency may induce hemolysis therefore consider exchange transfusion)

Question 6

G6PD Deficiency

Answer 6

Enzymatic disorder that inhibits regeneration glutathione in RBCs = more susceptible to oxidative damage

Anesthetic Mgmt

1. Consider disease history
2. Check Hct and reticulocyte count
3. Avoid drugs precipitate hemolysis
4. Avoid hypothermia, acidosis, hypoxia, hyperglycemia, infection

Question 7

G6PD Deficiency: Drugs to Avoid

Answer 7

Antibiotics - nitrofurantoin, chloramphenicol, co-trimoxazole
LA - benzocaine, lidocaine, prilocaine, articaine
High dose ASA, methyldopa, hydralazine, procainamide, quinidine, sodium nitroprusside, silver nitrate

Question 8

G6PD Deficiency: Hemolytic Anemia

Answer 8

1. Evaluate signs (pallor, SOB, fatigue, substernal pain)
2. Order labs - CBC, reticulocyte count, peripheral blood smear, LFTs, UA
3. Eliminate precipitating factors (hypothermia, acidosis, hypoxia, hyperglycemia, infix, chemicals, drugs)
4. Fluids and mannitol
5. Consider transfusion

*Occurs 2-5 days following exposure, self-limiting

Question 9

Needle Stick

Answer 9

1. Wash with soap and water
2. Report employee health
3. Post-exposure prophylaxis and avoid activities risk transmission

HIV transmission rate = 0.3%