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Basic > Hall > Flashcards

Hall Flashcards

1
Q

Desflurane vapor pressure

A
  1. so when pressurized to 1500mm Hg there will be 664/1500 or 44% at the vaporizing chamber
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2
Q

Check valves

A

permit unidirectional flow of gases. Prevent retrograde flow from machine or transfer of gasses between e-cylinders

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3
Q

Driving force of ventilators

A

O2

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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

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5
Q

stage regulators for O2 and N2O

A

first stage reduce pressure to 45 psi

second reduces O2 to 14-16

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6
Q

Vapor pressures

A

Sevo 160, Iso 240 Des 669

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7
Q

RA in waste gas disposal system

A

due to negative pressure relief valve

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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

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9
Q

Soda lime

A

indicator dye will turn back to white after recharged

- Compound A (sevo), CO (des, iso)

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10
Q

Ambsorb

A

indicator dye will NOT turn back white

-no significant compound A or CO

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11
Q

high and low frequency filters on ECG

A

low: respiration
high: fasciculations, tremors, electrical equipment

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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.

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13
Q

clear glasses are safe with what laser

A

Co2

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14
Q

transcutaneous monitoring of O2 and Co2

A

ptcO2 will be lower, ptcCO2 will be higher

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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

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16
Q

pacemaker code

A

five letters;

1: chamber paced
2: where endogenous current is sensed
3: response to sensing

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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

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18
Q

laser that penetrates the most

A

Nd;YAG

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19
Q

scavenging system bag distending during inspiration

A

icompetent pressure relief valve in the mechanical ventilator

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20
Q

shock to cause v fib

A

through skin higher than 100 mA, through device to heart .1mA

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21
Q

line isolation monitor

A

sounds an alarm when grounding occurs

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22
Q

BP cuff too narrow or loosely wrapped

A

cause falsely elevated pressure

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23
Q

ECG leads for MRI

A

as close as possible and in center of the magnetic field

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24
Q

fundamental difference between micro and macroshock

A

location of shock

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25
Q

pressure and volume per minute delivered from central hospital O2 supply

A

50 psi and 50 L/min

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26
Q

V5 position

A

anterior axillary line, 5th intercostal space

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27
Q

Soda lime

A

best at absorptive capacity, but creates compound A, CO, does turn back white

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28
Q

compression factor

A

Compression volume is amount absorbed by breathing circuit. Compression volume/RR = compression per breath. This / peak inflation pressure gives you the compression factor.

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29
Q

maximize which lung parameter after surgery

A

Maximize FRC post op to prevent atelectasis. Increased FRC compared to CC will prevent atelectasis

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30
Q

highest chance of MI with surgery (in patient with previous MI)

A

2-3 days after (reasons unknown)

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31
Q

DC cardioversion not helpful

A

MAT is a non-reentrant ectopic atrial rhythm (often seen in COPD), DC cardioversion is ineffective

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32
Q

Rise of PaCO2 in apnea

A

During apnea the PaCO2 rises 6 mm Hg the first minute and then 3-4 mm Hg each subsequent minute

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33
Q

RIFLE criteria

A

predict mortality from renal failure

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34
Q

P50 for normal adult

A

26 mm Hg

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35
Q

Work of breathing

A

transpulmonary pressure X tidal volume

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36
Q

vital capacity

A

maximum expiration

-60-70 cc/kg

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37
Q

increased RR with carbon monoxide poisoning

A

Carbon monoxide poisoning increased RR when sufficient lactic acid builds up from decreased O2 delivery

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38
Q

P50 for sickle cell

A

31 mm Hg

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39
Q

lung parameters with age

A

increased: FRC, residual volume, closing volume
decreased: vital capacity, total lung capacity, maximum breathing capacity, FEV1, ventilatory response to hypercarbia/hypoxemia

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40
Q

Vd/Vt=

A

(PaCO2-PeCO2)/ PaCO2

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41
Q

least well compensated acid/base disorder

A

metabolic alkalosis due to limited ability to hypoventilate

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42
Q

transpulmonary shunt

A

for every increase of 20 in alveolar-arterial O2 of 20 there is an increase in shunt fraction of 1%

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43
Q

Most important buffer system in the body

A

[HCO3-]

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44
Q

change of K with decrease in pH of 0.1

A

increase of 1 mEq

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45
Q

carboxyhemoglobin half life

A

RA 4-6 hours

100% O2 1 hour

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46
Q

physiologic effects of acidosis

A

CNS depression, increased ICP, cardiovascular system depression, dysrhythmias, vasodilation, hypovolemia, hypovolemia, pulm HTN

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47
Q

Best pressor in the setting of acidosis

A

vasopressin

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48
Q

sedative that most resembles normal sleep

A

precedex

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49
Q

water soluble then lipid soluble in body

A

versed

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50
Q

epinephrene max dose (LA)

A

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

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51
Q

risk with propranolol

A

blunted response to hypolygemice
bronchoconstriction
rebound tachy s/p cessation
NO RISK for orthostatic HTN

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52
Q

Methylnaltrexone

A

opioid receptor antagonist that does not cross into CNS. Will act peripherally to treat opioid induced constipation

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53
Q

protease enzyme inhibitors

A

(HIV antrivirals) inhibit CY3A4 and can prolong versed

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54
Q

1 twitch in TOF correlates to what decrease in single twitch

A

> 85%

2= 70-85%

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55
Q

histamine relase (NDMB)

A

Atracurium

Mainly the benzylisoquinolinium will have slight histamine release at high doses –urium

56
Q

calcium and NDMB

A

antagonizes (by lowering Mg)

57
Q

abx and muscle blocking

A

Erythromycin will not prolong muscle blockade. Aminoglycosides and lincosamides will

58
Q

side effect of flumazenil

A

nausea and emesis

59
Q

potassium and paralytics

A

hypokalemia caused hyperpolarization of cell membranes. This causes resistance to depolarizing blockers and sensitivity to NDMBs

60
Q

percent of receptors blocked for 5 second head lift

A

50 or lower

61
Q

odonsetron is metablized by

A

CYP 1A2, 2D6, 3A4

2D6 ultrarapid metabolizers will have decreased effect

62
Q

predominant mechanism for sux induced tachycardia in adults

A

stimulation of nicotinic receptors at autonomic ganglia

63
Q

emergence delirium most common with

A

sevo

not ketamine

64
Q

muscle relaxant that inhibits the reuptake of norepinephrine by adrenergic nerves

A

pancuronium

65
Q

naloxone doesnt reverse respiratory depression of which drug

A

buprenorphrine

66
Q

side effects of H2 blockers

A

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
Q

Sarin gas treatment

A

Atropine

pralidoxime

68
Q

NMS treatment

A

bromocriptine, amantadine and dantrolene

69
Q

C5 isoenzyme varient

A

increased plasma pseudocholinesterase

decrease duration of Sux

70
Q

affect of TCA on anesthesia

A

increase MAC, exaggerate response of ephedrine

71
Q

Mac is highest in neonates (0-6 months) for which volatile

A

Sevo

72
Q

volatile that increased CO

A

N2O

73
Q

volatile that does not decrease CO at less than 1 MAC in healthy individuals

A

iso

-iso des and sevo maintain CO at 1 mac

74
Q

volatiles that Va matters most

A

highly soluble

75
Q

Verapamil and MAC

A

decreases

76
Q

if CO and VA are both doubled how does it affect FA/Fi

A

somewhat increased

77
Q

histologic evidence of megoloblastic changes with N20

A

bone marrow

78
Q

volatile containing a preservating

A

halothane (thymol)

79
Q

volatiles that are absorbed in plastic

A

iso and halothane

80
Q

degree of metabolism for volatiles

A

Sevo 2-5%

iso and Des 0.2%

81
Q

brain time constant for volatile

A

estimated by doubling the brain/blood gas coefficient

82
Q

random volatile facts

A

sevo decreased HR at 1 mac,
halothane does not effect HR or SVR
Iso increased CO

83
Q

Factor VIII calculations for hemophilia A

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
Q

how long can blood be stored? Criteria

A

70% of transfused erythrocytes must remain in circulation for 24 hours

85
Q

reduced the possibility of transmission of CMV

A

reduction of leukocytes

86
Q

Reduced chance of Graft V Host

A

irradiation

87
Q

trachial capillary pressure

A

25-35 mm Hg

88
Q

most frequent cause of hypoxemia in PACU

A

v/q mismatch (atelectasis)

89
Q

airways symptoms due to hypocalcemia s/p accidental removal during thyroidectomy

A

24-72 hours

90
Q

guidlines for discharge from ambulatory center

A
  • PADS

- walk w/o dizziness, controlled pain, absence of nausea/emesis, minimal surgical bleeding

91
Q

calculate mEq Na needed to fix hyponatremia

A

TBW = .6 X kg

multiple TBW by amount needed

92
Q

Huntingtons CHores and Sux

A

HC has decreased levels of pseudocolinesterase which would cause prolongation of sux

93
Q

paO2 and temp

A

measured PaO2 should decrease about 6%; for every degree celsius cooler than 27

94
Q

most common reason for admission in outpatient

A

PONV

95
Q

CO and obesity

A

CO increases by about 100 ml/min for each kilogram of weight gained

96
Q

treatment of hypotension in a patient anesthetized for resection of metastatic carcinoid

A

octreotide

97
Q

insulin metabolism

A

both hepatic and renal

pt with renal dysfunction are more greatly impacted than hepatic dysfunction

98
Q

anaphylactic diagnosis based off of measuring

A

tryptase

99
Q

Strongest predictor of PONV

A

Female gender

100
Q

reversal in preggos

A

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
Q

ketorolac side effects (NSAIDS)

A

inhibit platelet aggregation, gastric ulceration, renal dysfunction, may impair bone healing

102
Q

Syndrome X

A

insulin resistance that leads to elevated levels of insulin and the metabolic changes that occur with elevated insulin.
-hypoglycemia does not occur

103
Q

IV morphine to oral

A

1:3

104
Q

risk of quenching magnet in MRI

A

cold

105
Q

small pox

A

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
Q

Anthrax

A

gram positive bacillus

  • widened mediastinum
  • 60 days of cipro
107
Q

Plague

A

gram negative coccobacillys

tx with streptomycin, gentomicin, tetracycline

108
Q

Ebola

A

fever, myalgias, headaches, thrombocytopenia, hemorrhagic complications

109
Q

glottis of a new born correlates with what

A

C3

110
Q

presenting signs of high spinal in infants

A

decrease in O2 sats

111
Q

retinopathy of prematurity

A

negligible after 44 week PMA

112
Q

volume to infuse of blood

A

= EBV ( goal- now /hct of product)

113
Q

leak test in cuffed for kids

A

15-25 cm H20

114
Q

tube insertion in kids

A

Age in years/2 + 12

115
Q

1500 rule

A

divide 1500 by daily insulin requirement

- this gives you the change with 1 unit insulin

116
Q

Joules for shocking kids

A

2-4 J/kg initially, then 4 J/kg

117
Q

PVR reaches adult levels

A

1-2 months

118
Q

EMLA

A

2.5% lido 2.5% prilocaine

119
Q

newborn tube size

A

2.5 for premature
3.0 for newborn
7-10 cm from gums

120
Q

GFR in new borns

A

birth: 15-30%
5-10 days: 50%
6 months: 75%
1 year 100%

121
Q

Uterine atony drug contraindications

A 
ergot alkaloids (ergonovine, methylergonovine): HTN. asthmatics, CAD
protaglandins (carboprost, hemabate): asthmatics
122
Q

P50 for fetal Hgb

A

18

123
Q

CO returns to normal after birth

A

2 weeks

124
Q

hemodynamic changes in pregnacy

A

increase: LVED, stroke volume, EF, HR and CO
decrease: SVR
no change: CVP, PCWP, PADP, LVESV

125
Q

smoking and preeclampsia

A

decreased prevalence of preeclampsia in smokers

126
Q

aortocaval compression begins at what week gestation

A

18-20 weeks

127
Q

Cerebral salt wasting syndome

A
  • hyponatremia
  • intravascular volume contraction
  • high urine sodium
128
Q

cerebral blood flow

A

45-55 ml/100g
15% CO
cerebral ischemia at 20 ml/100g
15 ml/100g EEG becomes isoelectric

129
Q

CMRO2

A

3.5 ml of O2/100g

130
Q

post op urinary retinition

A

male gender, >50 yrs, joint replacement surgery, spinal anesthetic

131
Q

MET calculations

A

amount of energy expended during 1 minute rest

-3.5 ml of O2 per kilogram

132
Q

drugs in ETT

A

ALONE: Atropine, Lidocaine, O2, Naloxone, Epinephrine

133
Q

Normal resting myocardial O2 consumption

A

8 ml/100g/min

134
Q

resting coronary blood flow

A

75 ml/100 g/min

135
Q

anaphylaxis to protamine

A

NPH or PZI insulin, vasectomy, seafood allergy

136
Q

protamine for reversal

A

1 mg for every 100 U heparin

Basic (6 decks)

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