Hutt Extras Flashcards
How is lactate cleared
70% liver - check for dysfunction
20% kidneys
Peads Sux IM dose?
Iv
2mg/kg
4mg/kg IV
Dexamathasone dose
0.15mg/kg
Why no sux in burns patients if burn several days old? Mechanism
Hyperkalaemia
Upregulation of acetylcholine receptors subsequent to a burn resulting in life-threatening hyperkalemia after using succinylcholine.
In healthy patients, succinylcholine use is associated with only 0.5 mEq/L, but in the burn patient, this response is exaggerated
Addition of adrenaline to local? What conc do you get
0.1ml of 1mg/ml (1 in 1000)
In 20mls local
[100mcg in 20ml
= 5 mcg per ml]
Peads maintenance fluids
maintenance fluid requirements are calculated using the 4,2,1 rule
4ml/kg/hr for the first 10kg,
2ml/kg/hr for the second 10kg
1ml/kg/hr after that, with a maximum of 100ml/hr maintenance).
Peads bolus fluids
10mls / kg and can repeat
Difficult bag mask acronym
MOANS
M Mask seal. Facial features such as beards, saliva or blood, anatomical disruptions such
as facial fractures or retrognathia
O Obesity. BMI >26kg.m-2, Parturient or at-term mothers
A Age >55 years
N No teeth, edentulous
S Snoring or stiff. OSA, bronchospasm. Neck radiation changes
Gliclazide od with persistent hypoglycaemia what else can you use bar sugar
Octreotide - inhibits insulin secretion from pancreas
Hydrocortisone
House fire with upper airway burns and raised lactate / carboxyhaem.
What are you worried they inhaled?
Rx?
Cyanide poisoning
5g Hydroxocobalamin
Rx hypermg
Calcium gluconate 30mls
Drug rx of exacerbation of chronic heart failure ?
Mechanism?
Why?
Levosimenden
Sensitised Ca channels
Prolonged action - up to 4 weeks
Why does hypoCl lead to on blood gas? Ie what will you find on ABG
Increases absorption and decreases secretion of bicarbonate
Metabolic alkalosis
Raised hco3
Raised base excess
ACEi angiodema refractory to steroids, antihistamines and adrenaline. What else can you give to help prevent requirement of intubation?
What is the key drug called? Mechanism
FFP
Tranexamic acid
Icatibant
inhibits bradykinin from binding the B2 receptor
Autonomic dysreflexia essentially is? Usual trigger?
1st line rx?
Imbalance between sympathetic / parasympathetic nervous system due to a spinal cord lesion - usually T6 or higher
Tend to get HTN + brady
Bladder Eg catheter / UTI
Bowel eg constipation
10 mg Nifedipine
or GTN spray 1-2 sprays repeat every 20-30 min
What is often first sign of malignant hyperthermia in Anaesthetics? Which drugs and pathophysiology including receptor?
Rx?
Rise in etco2 - hypermetabolic
[Muscle rigidity, tachy….]
Volatile gases, suxamethonium
Ryanodine receptors->
Ca channels open -> ca influx into muscles which contract
Dantrolene
Cooling
Hyperventilate (etco2 30)
Rx arrhythmia
Charcoal filters in vent tubing to suck up volities
Why alfentanyl such fast onset
It is a base so at physiologic pH becomes unionised quickly so can cross blood brain barrier
What causes sux apnea ? Incidence? Rx?
Inherited plasma cholinesterase deficiency
3% have heterozygous- Paralysis lasts about 10 mins
[Usually not noticed]
1:3000 homozygous -> may last up to 3 days as relies on renal clearance
Keep sedated and ventilated
Monitor with nerve stimulator
IV salbutamol dosing if brinchospasm in anesthetics
500mcg diluted to 10mls
Give 1ml (50mcg) as repeatable bolus
Remi conc
2mg in 50 mls
COPD with only moderate impairment of FEV1 and FVC. What is the other thing you must look at to explain why they are so bad from a resp point of view
DLCO
diffusing capacity of the lungs for carbon monoxide
[Anything under 50% is bad]
Score system for liver failure
CLIF-C ACLF (acute on chronic liver failure)
Rivaroxaban reversal
Prothrombinex
Approx 3000u
How to calculate base excess
Base-excess = [Na − Cl − 35] + [1 − lactate]
+ [0.25 × (42 − albumin)]+ other ions.
(Stewart acid base approach)
Base excess from Na and Cl
= measured Na − measured Cl − 35.
