Harmon Hints for the Final Flashcards by Study Study

What are the 5 goals of General Anesthesia?

analgesia
amnesia
immobility
unconsciousness
attenuation of autonomic reflexes to pain

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What are the two main types of amnesia?

retrograde and anterograde.

(retrograde - previously formed memories are lost

anterograde - inability to form new memories)

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What is the Mallampati class if the hard palate is not visible?

Mallampati IV

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What is the Mallampati class if only the hard and soft palates are visible?

Mallampati III

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What is the Mallampati class if you can see the hard palate, the soft palate, the uvula, and the tonsilar pillars?

Mallampati I

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What is the Mallampati class if you can see the hard palate, the soft palate, and part of the uvula?

Mallampati II

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At what spinal process does the adult spinal cord terminate?

L1-L2

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What can provide the best sensitivity and specificity for a patient in regards to their diagnoses?

patient history

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Define sensitivity.

the proportion of actual positives which are correctly identified as such (e.g. the percentage of sick people who are correctly identified as having the condition)

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Define specificity.

the proportion of negatives which are correctly identified (e.g. the percentage of healthy people who are correctly identified as not having the condition)

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Would a patient who previously had endocarditis, but who does not have valve dysfunction, require prophylactic antibiotics?

No.

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How much air is needed to inflate a size 4 LMA?

30mL

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What is the definitive way to guarantee placement of a double ETT?

fiberoptic scope

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One way to assess a decreased volume status.

urine output

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What is the number of mL/kg used to calculate the estimated blood volume of an adult female?

65 mL/kg

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What is the number of mL/kg used to calculate the estimated blood volume of an adult male?

70 mL/kg

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What is the number of mL/kg used to calculate the estimated blood volume of an infant?

80 mL/kg

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What is the number of mL/kg used to calculate the estimated blood volume of a full-term neonate?

80-90 mL/kg

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What is the number of mL/kg used to calculate the estimated blood volume of a premature neonate?

100-120 mL/kg

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How does the 4-2-1 rule work for maintenance fluid calculation?

4 mL for each of the first 10kg
2 mL for each of the next 10kg
1 mL for each of the rest.

(or for adults > 30kg, just add 40 to their weight, and there is the maintenance.

80kg = 120mL/hr maintenance)

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What do you do if you are unable to ventilate and unable to intubate a patient?

create a surgical airway.

especially after 3 intubation attempts

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Most nerve injuries are due to these two things.

pressure ischemia and overstretching

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Which patient position is the worst for V/Q mismatching?

lateral decubitus

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What potassium level would require rapid treatment?

> 5.5

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Would ascites be considered an insensible loss?

No.

A basal skull fracture is contraindicated in what type of intubation?

nasal intubation

Which nerve is responsible for sensation above the vocal cords?

internal branch of the superior laryngeal nerve

Which nerve is responsible for the motor function of the cricothyroid muscle?

external branch of the superior laryngeal nerve

Which nerve is responsible for sensation below the vocal cords and motor function of everything but the cricothyroid muscle?

recurrent laryngeal nerve

When replacing an NPO deficit, how much fluid is given during each of the first three hours?

1/2 of the total deficit during the 1st hour, 1/4 of the total deficit during the 2nd hour, 1/4 of the total deficit during the 3rd hour.

How many mL/kg of fluid is required to replace insensible losses for minimal trauma?

4 mL/kg

How many mL/kg of fluid is required to replace insensible losses for moderate trauma?

6 mL/kg

How many mL/kg of fluid is required to replace insensible losses for extensive trauma?

8 mL/kg

What is the ratio of how much crystalloid fluid you would give for each mL of blood lost?

3:1 (3mL crystalloid for each mL of blood lost)

What is the ratio of how much colloid fluid you would give for each mL of blood lost?

1:1 (1mL colloid for each mL of blood lost)

What is the calculation for allowable blood loss (ABL)?

EBV x (starting Hct - target Hct) ABL = ------------------------------------ starting Hct (ABL = (70mL/kg x 70kg) x (45% - 30%) / 45% = (4900 x 15) / 45 = 1633mL

A 10mL/kg transfusion of PRBCs will increase Hgb by ____ and the Hct by ____.

Hgb by 3g/dL Hct by 10%

Which nerve is most commonly injured due to positioning errors?

ulnar nerve

Which nerve is most commonly injured while patients are in the supine position?

ulnar nerve

Which two nerves are most commonly injured while patients are in the lithotomy position?

sciatic nerve and common peroneal nerve

What causes the majority of postop vision loss following prone spinal procedures?

ischemic optic neuropathy

At what platelet count would you usually consider giving a platelet transfusion?

< 50,000

One unit of platelets will increase the platelet count by how much?

5,000 - 10,000

At what platelet count does spontaneous bleeding usually occur?

~20,000

Platelets can be given specifically to treat what?

thrombocytopenia

Fresh frozen plasma contains all coagulation factors, except what?

platelets

How high would the PT/PTT need to be in order to require fresh frozen plasma?

> 1.5 times normal

Fresh frozen plasma can be used as the urgent reversal of what medication?

coumadin

Cryoprecipitate is used to treat what disease?

hemophilia A

Cryoprecipitate contains more _______ than fresh frozen plasma.

fibrinogen

One unit of whole blood will increase your hematocrit by how much?

3-4%

One unit of PRBC will increase your hematocrit by how much?

2-3%

What is the shortcut ratio for normal hemoglobin and hematocrit?

1:3 (Hgb:Hct) or Hgb x 3 = Hct (+/-3)

What is the hematocrit of one unit of PRBC?

~70%

What are the 3 ways to lose red blood cells?

decreased production increased destruction bleeding

What is the normal range for white blood cells?

4,000 - 7,000

Most common type of anemia found in the hospital?

iatrogenic anemia

Delayed hemolytic transfusion reactions can occur up to ____ days after a transfusion.

Based on what we were told in class, what is probably the first sign/symptom of a hemolytic reaction?

free hemoglobin in blood and urine

Transfusion related acute lung injury (TRALI) mimics what respiratory condition?

ARDS

Bilateral pulmonary edema seen with transfusion related acute lung injury (TRALI) can occur within how many hours of transfusion?

4 hours

If the PTT is elevated and the PT is normal, would this be an intrinsic, extrinsic, or overall clotting problem?

intrinsic clotting problem

If the PTT is normal and the PT is elevated, would this be an intrinsic, extrinsic, or overall clotting problem?

extrinsic clotting problem

If the PTT is elevated and the PT is elevated, would this be an intrinsic, extrinsic, or overall clotting problem?

overall clotting problem

Where is Factor VIII produced?

in the endothelium

Venous air embolisms are a concern when the patient is in what position for surgery?

sitting position | per Dr. Hogan, you can hear venous air emboli with the precordial stethoscope

Name the 3 single and 3 paired cartilages that make up the larynx.

Singles: Paired: cricoid arytenoids thyroid corniculates epiglottis cuneiforms

What Cormack and Lehane grade would be given if most of the glottis is visible?

Grade 1

What Cormack and Lehane grade would be given if only the posterior portion of the glottis is visible?

Grade 2

What Cormack and Lehane grade would be given if the epiglottis, but no part of the glottis, can be seen?

Grade 3

What Cormack and Lehane grade would be given if no airway structures can be visualized?

Grade 4

Bilateral injury of the superior laryngeal nerve causes what?

hoarseness, tiring of voice

Unilateral injury to the recurrent laryngeal nerve causes what?

hoarseness

Acute, bilateral injury to the recurrent laryngeal nerve causes what?

stridor, respiratory distress

Chronic, bilateral injury to the recurrent laryngeal nerve causes what?

aphonia

ASA classification of a healthy person that is a smoker? (per Ms. Harmon)

ASA II

ASA classification of someone with OSA? (per Ms. Harmon)

ASA III

ASA classification of someone who had an MI in the past? (per Ms. Harmon)

ASA III