Hall Flashcards
1
Q
Desflurane vapor pressure
A
- so when pressurized to 1500mm Hg there will be 664/1500 or 44% at the vaporizing chamber
2
Q
Check valves
A
permit unidirectional flow of gases. Prevent retrograde flow from machine or transfer of gasses between e-cylinders
3
Q
Driving force of ventilators
A
O2
4
Q
pressure sensor shutoff valve ( fail safe)
A
prevents delivery of hypoxic gas mixture. When falls below 30 osi will discontinue the flow of N2O
5
Q
stage regulators for O2 and N2O
A
first stage reduce pressure to 45 psi
second reduces O2 to 14-16
6
Q
Vapor pressures
A
Sevo 160, Iso 240 Des 669
7
Q
RA in waste gas disposal system
A
due to negative pressure relief valve
8
Q
Splitting ratio
A
Splitting ratio is the ratio of glows between a variable bypass and the vaporizer chamber. Splitting ratio depends on anesthetic agent, temperature, vapor concentration set to be delivered, and SVP
9
Q
Soda lime
A
indicator dye will turn back to white after recharged
- Compound A (sevo), CO (des, iso)
10
Q
Ambsorb
A
indicator dye will NOT turn back white
-no significant compound A or CO
11
Q
high and low frequency filters on ECG
A
low: respiration
high: fasciculations, tremors, electrical equipment
12
Q
N2O as carrier gas
A
when N20 enters the vaporizing champer a portion of N2O dissolves in liquid agent. Thus output is decreased.
13
Q
clear glasses are safe with what laser
A
Co2
14
Q
transcutaneous monitoring of O2 and Co2
A
ptcO2 will be lower, ptcCO2 will be higher
15
Q
gas density vs altitude
A
decrease with increased altitude. There for at high flow (density is more important) due to decreased density there will be higher flows
16
Q
pacemaker code
A
five letters;
1: chamber paced
2: where endogenous current is sensed
3: response to sensing
17
Q
amount of volatile taken up by patient in first minute
A
equals the amount taken up between the squares of any two consecutive number
18
Q
laser that penetrates the most
A
Nd;YAG
19
Q
scavenging system bag distending during inspiration
A
icompetent pressure relief valve in the mechanical ventilator
20
Q
shock to cause v fib
A
through skin higher than 100 mA, through device to heart .1mA
21
Q
line isolation monitor
A
sounds an alarm when grounding occurs
22
Q
BP cuff too narrow or loosely wrapped
A
cause falsely elevated pressure
23
Q
ECG leads for MRI
A
as close as possible and in center of the magnetic field
24
Q
fundamental difference between micro and macroshock
A
location of shock
25
pressure and volume per minute delivered from central hospital O2 supply
50 psi and 50 L/min
26
V5 position
anterior axillary line, 5th intercostal space
27
Soda lime
best at absorptive capacity, but creates compound A, CO, does turn back white
28
compression factor
Compression volume is amount absorbed by breathing circuit. Compression volume/RR = compression per breath. This / peak inflation pressure gives you the compression factor.
29
maximize which lung parameter after surgery
Maximize FRC post op to prevent atelectasis. Increased FRC compared to CC will prevent atelectasis
30
highest chance of MI with surgery (in patient with previous MI)
2-3 days after (reasons unknown)
31
DC cardioversion not helpful
MAT is a non-reentrant ectopic atrial rhythm (often seen in COPD), DC cardioversion is ineffective
32
Rise of PaCO2 in apnea
During apnea the PaCO2 rises 6 mm Hg the first minute and then 3-4 mm Hg each subsequent minute
33
RIFLE criteria
predict mortality from renal failure
34
P50 for normal adult
26 mm Hg
35
Work of breathing
transpulmonary pressure X tidal volume
36
vital capacity
maximum expiration
| -60-70 cc/kg
37
increased RR with carbon monoxide poisoning
Carbon monoxide poisoning increased RR when sufficient lactic acid builds up from decreased O2 delivery
38
P50 for sickle cell
31 mm Hg
39
lung parameters with age
increased: FRC, residual volume, closing volume
decreased: vital capacity, total lung capacity, maximum breathing capacity, FEV1, ventilatory response to hypercarbia/hypoxemia
40
Vd/Vt=
(PaCO2-PeCO2)/ PaCO2
41
least well compensated acid/base disorder
metabolic alkalosis due to limited ability to hypoventilate
42
transpulmonary shunt
for every increase of 20 in alveolar-arterial O2 of 20 there is an increase in shunt fraction of 1%
43
Most important buffer system in the body
[HCO3-]
44
change of K with decrease in pH of 0.1
increase of 1 mEq
45
carboxyhemoglobin half life
RA 4-6 hours
| 100% O2 1 hour
46
physiologic effects of acidosis
CNS depression, increased ICP, cardiovascular system depression, dysrhythmias, vasodilation, hypovolemia, hypovolemia, pulm HTN
47
Best pressor in the setting of acidosis
vasopressin
48
sedative that most resembles normal sleep
precedex
49
water soluble then lipid soluble in body
versed
50
epinephrene max dose (LA)
Epinephrine max doses depend on volatile being used. Halothane has max dose of 2 mcg/kg while iso, des and sevo have max dose of 5 mcg/kg
51
risk with propranolol
blunted response to hypolygemice
bronchoconstriction
rebound tachy s/p cessation
NO RISK for orthostatic HTN
52
Methylnaltrexone
opioid receptor antagonist that does not cross into CNS. Will act peripherally to treat opioid induced constipation
53
protease enzyme inhibitors
(HIV antrivirals) inhibit CY3A4 and can prolong versed
54
1 twitch in TOF correlates to what decrease in single twitch
>85%
| 2= 70-85%
55
histamine relase (NDMB)
Atracurium
| Mainly the benzylisoquinolinium will have slight histamine release at high doses –urium
56
calcium and NDMB
antagonizes (by lowering Mg)
57
abx and muscle blocking
Erythromycin will not prolong muscle blockade. Aminoglycosides and lincosamides will
58
side effect of flumazenil
nausea and emesis
59
potassium and paralytics
hypokalemia caused hyperpolarization of cell membranes. This causes resistance to depolarizing blockers and sensitivity to NDMBs
60
percent of receptors blocked for 5 second head lift
50 or lower
61
odonsetron is metablized by
CYP 1A2, 2D6, 3A4
| 2D6 ultrarapid metabolizers will have decreased effect
62
predominant mechanism for sux induced tachycardia in adults
stimulation of nicotinic receptors at autonomic ganglia
63
emergence delirium most common with
sevo
| not ketamine
64
muscle relaxant that inhibits the reuptake of norepinephrine by adrenergic nerves
pancuronium
65
naloxone doesnt reverse respiratory depression of which drug
buprenorphrine
66
side effects of H2 blockers
Cimetidine and other H2 receptor blockers, can cause bradycardia, AMS, delayed awakening and impairs the metabolism of drugs such as lidocaine, propranolol and diazepam
67
Sarin gas treatment
Atropine
| pralidoxime
68
NMS treatment
bromocriptine, amantadine and dantrolene
69
C5 isoenzyme varient
increased plasma pseudocholinesterase
| decrease duration of Sux
70
affect of TCA on anesthesia
increase MAC, exaggerate response of ephedrine
71
Mac is highest in neonates (0-6 months) for which volatile
Sevo
72
volatile that increased CO
N2O
73
volatile that does not decrease CO at less than 1 MAC in healthy individuals
iso
| -iso des and sevo maintain CO at 1 mac
74
volatiles that Va matters most
highly soluble
75
Verapamil and MAC
decreases
76
if CO and VA are both doubled how does it affect FA/Fi
somewhat increased
77
histologic evidence of megoloblastic changes with N20
bone marrow
78
volatile containing a preservating
halothane (thymol)
79
volatiles that are absorbed in plastic
iso and halothane
80
degree of metabolism for volatiles
Sevo 2-5%
| iso and Des 0.2%
81
brain time constant for volatile
estimated by doubling the brain/blood gas coefficient
82
random volatile facts
sevo decreased HR at 1 mac,
halothane does not effect HR or SVR
Iso increased CO
83
Factor VIII calculations for hemophilia A
- one unit of factor VIII is equal to 1 ml of 100% normal plasma
- calculate patients blood volume
- then calculate plasma volume (1-hct)
- then multiple the plasma volume by the % increase to figure out how many ml needed
84
how long can blood be stored? Criteria
70% of transfused erythrocytes must remain in circulation for 24 hours
85
reduced the possibility of transmission of CMV
reduction of leukocytes
86
Reduced chance of Graft V Host
irradiation
87
trachial capillary pressure
25-35 mm Hg
88
most frequent cause of hypoxemia in PACU
v/q mismatch (atelectasis)
89
airways symptoms due to hypocalcemia s/p accidental removal during thyroidectomy
24-72 hours
90
guidlines for discharge from ambulatory center
- PADS
| - walk w/o dizziness, controlled pain, absence of nausea/emesis, minimal surgical bleeding
91
calculate mEq Na needed to fix hyponatremia
TBW = .6 X kg
| multiple TBW by amount needed
92
Huntingtons CHores and Sux
HC has decreased levels of pseudocolinesterase which would cause prolongation of sux
93
paO2 and temp
measured PaO2 should decrease about 6%; for every degree celsius cooler than 27
94
most common reason for admission in outpatient
PONV
95
CO and obesity
CO increases by about 100 ml/min for each kilogram of weight gained
96
treatment of hypotension in a patient anesthetized for resection of metastatic carcinoid
octreotide
97
insulin metabolism
both hepatic and renal
| pt with renal dysfunction are more greatly impacted than hepatic dysfunction
98
anaphylactic diagnosis based off of measuring
tryptase
99
Strongest predictor of PONV
Female gender
100
reversal in preggos
atropine and scopalomine easily cross the placenta
-glyco does not
- neostigmine poorly passes but can cause bradycardia
use neo and atropine for preggos (vs neo and glyco)
101
ketorolac side effects (NSAIDS)
inhibit platelet aggregation, gastric ulceration, renal dysfunction, may impair bone healing
102
Syndrome X
insulin resistance that leads to elevated levels of insulin and the metabolic changes that occur with elevated insulin.
-hypoglycemia does not occur
103
IV morphine to oral
1:3
104
risk of quenching magnet in MRI
cold
105
small pox
7-14 days incubation
- malaise HA and fever
- then eruption of lesions all at the same stage
- can receive vaccine within 4 days of exposure with good benefits
106
Anthrax
gram positive bacillus
- widened mediastinum
- 60 days of cipro
107
Plague
gram negative coccobacillys
| tx with streptomycin, gentomicin, tetracycline
108
Ebola
fever, myalgias, headaches, thrombocytopenia, hemorrhagic complications
109
glottis of a new born correlates with what
C3
110
presenting signs of high spinal in infants
decrease in O2 sats
111
retinopathy of prematurity
negligible after 44 week PMA
112
volume to infuse of blood
= EBV ( goal- now /hct of product)
113
leak test in cuffed for kids
15-25 cm H20
114
tube insertion in kids
Age in years/2 + 12
115
1500 rule
divide 1500 by daily insulin requirement
| - this gives you the change with 1 unit insulin
116
Joules for shocking kids
2-4 J/kg initially, then 4 J/kg
117
PVR reaches adult levels
1-2 months
118
EMLA
2.5% lido 2.5% prilocaine
119
newborn tube size
2.5 for premature
3.0 for newborn
7-10 cm from gums
120
GFR in new borns
birth: 15-30%
5-10 days: 50%
6 months: 75%
1 year 100%
121
Uterine atony drug contraindications
```
ergot alkaloids (ergonovine, methylergonovine): HTN. asthmatics, CAD
protaglandins (carboprost, hemabate): asthmatics
```
122
P50 for fetal Hgb
18
123
CO returns to normal after birth
2 weeks
124
hemodynamic changes in pregnacy
increase: LVED, stroke volume, EF, HR and CO
decrease: SVR
no change: CVP, PCWP, PADP, LVESV
125
smoking and preeclampsia
decreased prevalence of preeclampsia in smokers
126
aortocaval compression begins at what week gestation
18-20 weeks
127
Cerebral salt wasting syndome
- hyponatremia
- intravascular volume contraction
- high urine sodium
128
cerebral blood flow
45-55 ml/100g
15% CO
cerebral ischemia at 20 ml/100g
15 ml/100g EEG becomes isoelectric
129
CMRO2
3.5 ml of O2/100g
130
post op urinary retinition
male gender, >50 yrs, joint replacement surgery, spinal anesthetic
131
MET calculations
amount of energy expended during 1 minute rest
| -3.5 ml of O2 per kilogram
132
drugs in ETT
ALONE: Atropine, Lidocaine, O2, Naloxone, Epinephrine
133
Normal resting myocardial O2 consumption
8 ml/100g/min
134
resting coronary blood flow
75 ml/100 g/min
135
anaphylaxis to protamine
NPH or PZI insulin, vasectomy, seafood allergy
136
protamine for reversal
1 mg for every 100 U heparin
