Hutt Extras

Question 1

How is lactate cleared

Answer 1

70% liver - check for dysfunction
20% kidneys

Question 2

Peads Sux IM dose?
Iv

Answer 2

2mg/kg
4mg/kg IV

Question 3

Dexamathasone dose

Answer 3

0.15mg/kg

Question 4

Why no sux in burns patients if burn several days old? Mechanism

Answer 4

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

Question 5

Addition of adrenaline to local? What conc do you get

Answer 5

0.1ml of 1mg/ml (1 in 1000)
In 20mls local

[100mcg in 20ml
= 5 mcg per ml]

Question 6

Peads maintenance fluids

Answer 6

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).

Question 7

Peads bolus fluids

Answer 7

10mls / kg and can repeat

Question 8

Difficult bag mask acronym

Answer 8

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

Question 9

Gliclazide od with persistent hypoglycaemia what else can you use bar sugar

Answer 9

Octreotide - inhibits insulin secretion from pancreas

Hydrocortisone

Question 10

House fire with upper airway burns and raised lactate / carboxyhaem.
What are you worried they inhaled?
Rx?

Answer 10

Cyanide poisoning
5g Hydroxocobalamin

Question 11

Rx hypermg

Answer 11

Calcium gluconate 30mls

Question 12

Drug rx of exacerbation of chronic heart failure ?
Mechanism?
Why?

Answer 12

Levosimenden
Sensitised Ca channels
Prolonged action - up to 4 weeks

Question 13

Why does hypoCl lead to on blood gas? Ie what will you find on ABG

Answer 13

Increases absorption and decreases secretion of bicarbonate

Metabolic alkalosis
Raised hco3
Raised base excess

Question 14

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

Answer 14

FFP
Tranexamic acid

Icatibant
inhibits bradykinin from binding the B2 receptor

Question 15

Autonomic dysreflexia essentially is? Usual trigger?
1st line rx?

Answer 15

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

Question 17

What is often first sign of malignant hyperthermia in Anaesthetics? Which drugs and pathophysiology including receptor?
Rx?

Answer 17

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

Question 18

Why alfentanyl such fast onset

Answer 18

It is a base so at physiologic pH becomes unionised quickly so can cross blood brain barrier

Question 19

What causes sux apnea ? Incidence? Rx?

Answer 19

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

Question 20

IV salbutamol dosing if brinchospasm in anesthetics

Answer 20

500mcg diluted to 10mls

Give 1ml (50mcg) as repeatable bolus

Question 21

Remi conc

Answer 21

2mg in 50 mls

Question 22

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

Answer 22

DLCO
diffusing capacity of the lungs for carbon monoxide

[Anything under 50% is bad]

Question 23

Score system for liver failure

Answer 23

CLIF-C ACLF (acute on chronic liver failure)

Question 24

Rivaroxaban reversal

Answer 24

Prothrombinex
Approx 3000u

Question 25

How to calculate base excess

Answer 25

Base-excess = [Na − Cl − 35] + [1 − lactate]
+ [0.25 × (42 − albumin)]+ other ions.

(Stewart acid base approach)

Question 26

Base excess from Na and Cl

Answer 26

= measured Na − measured Cl − 35.