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1internyearprep > Intern Prep Class - 2/29 > Flashcards

Intern Prep Class - 2/29 Flashcards

1
Q

Mallampati Class I and II

A
  1. complete visualization of soft palate

2. complete visualization of the uvula

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2
Q

Mallampati Class 3 and 4

A
  1. Visualization of base of uvula only

4. soft palate not visible at all

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3
Q

Thyromental distance

A

tip of mentum to thyroid cartilage
should be around 6 inches (3 fingers)
less is not good

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4
Q

RF for difficult ventilation

A 
obesity, snoring
age>55 years, lack of teeth
presence of a beard
mallampati 3 or 4
abnormal mandibular protrusion test
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5
Q

Reasons down syndrome pts are difficult to intubate

A

c1/c2 instability
macroglossia
small mouth opening
short, thick neck

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6
Q

Adequate oxygenation

A

spo2 more than 90

pao2 more than 60

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7
Q

Appropriate oxygenation

A

estimate Pao2 with Fio2 x 5

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8
Q

fio2 from 1L o2

A

2%

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9
Q

A-a gradient

A

difference between calculated alveolar oxygen partial pressure and measured arterial oxygen partial pressure

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10
Q

A-a gradient value based on

A

fio2
Room air ~10mm difference
100% fio2 ~100mmhg

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11
Q

BIPAP, support to

A

both ventilation and oxygenation

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12
Q

BIPAP, ventilation

A

IPAP

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13
Q

BIPAP, oxygenation

A

EPAP (functionally similar to PEEP?)

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14
Q

BIPAP and CPAP contraindications

A

mental status issues

risk of emesis

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15
Q

CPAP, support to

A

oxygenation

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16
Q

condition that may require CPAP only

A

cardiogenic pulmonary edema

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17
Q

Pressure Control - constants and variables

A

constant: Paw, Palv
variable: Vt, peak flow
Flow: decelearting

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18
Q

Volume Control - constants and variable

A

Variable: Paw, Palv
Constant: vt, peak flow
preset flow pattern

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19
Q

peak inspiratory pressure

A

pressure required to deliver the tidal volume

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20
Q

plateau pressure

A

pressure required to distend the lung

compliance

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21
Q

peak inspiratory flow

A

greatest flow used to deliver the tidal volume

resistance and compliance

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22
Q

mean airway pressure

A

time weighted average airway pressure measured during entire cycle

23
Q

PEEP

A

increase mean airway pressure
increase recruitment of collapsed alveoli
prevent de-recruitment of easily collapsible alveoli

24
Q

PEEP and worsening oxygenation

A

over-distended alveoli

25
Q

PEEP and worsening hypoventilation

A

deadspace ventilation is increased

26
Q

PEEP and hypovolemic pt

A

causes hypotension

give fluids or turn off peep

27
Q

Control Mandatory Ventilation

A

OR

machine triggered, no ability to sense pts

28
Q

Assist Control Ventilation

A

constant TV, rate

trigger breaths with machine + pt spontaneous effort (neg pressure)

29
Q

AC Ventilation - issues

A

develop mild resp alkalosis

30
Q

Norepinephrine receptors

A

alpha one

beta one

31
Q

Norepinephrine uses and considerations

A

first line for septic shock (increase SVR)

but can cause cardiac dysrhythmias

32
Q

Phenylephrine Receptors

A

alpha one

33
Q

Epinephrine Receptors

A

B1, B2 low dose

alpha1 high dose

34
Q

Epinephrine Considerations

A

can elevate lactate during initial administration

35
Q

B1 receptor & SVR

A

initially decreases VR

36
Q

Dopamine receptors

A

d1, b1, alpha one

37
Q

Vasopressin works by

A

vasoconstricting, increases SVR

38
Q

caveat for vasopressin

A

decreases UOP at high doses

39
Q

Treatment for local extravasation

A

phentolamine alpha1 blocker, SQ

40
Q

Vasopressor complications

A

dysrhythmias, hyperglycemia from inhibition of insulin secretion, local extravasation

41
Q

Dobutamine receptors

A

B1 and B2

getting vasodilation and afterload reduction

42
Q

Dobutamine major AE

A

hypotension, dysrhytmias

43
Q

Milirinone mechanism

A

PDE III inhibitor

increases CO, contractility, profound vasodilation

44
Q

Milirinone metablized in

A

kidneys

45
Q

Milirinone better suited for…

A

right sided HF from pulm HTN

46
Q

How do we treat flash pulmonary edema?

A

Afterload reduction, hypertensives. Not necessarily diuretics.

47
Q

NIPPV - decreases mortality w/

A

COPD and CHF

48
Q

NIPPV - don’t use w/

A

AMS, emesis

49
Q

What is CPAP to start at?

A
  1. Titrate 2-5 q15min.
    Max is 20. (why?)
50
Q

BIPAP setting to start with

A

10/5

51
Q

Epi pen IM dosing

A

0.3 mg of 1 in 1000

52
Q

Epi IV bolus dose

A

0.1mg (1/10000) over 5-10min

53
Q

Epi IV drip dose

A

1 mg of 1/1000 added to 250ml D5w

1internyearprep (9 decks)

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