misc. Flashcards
why does primary adrenal insufficiency cause metabolic acidosis
aldosterone usually causes acid secretion in kidneys which theres not neough aldoeterone so then u have aciosis (hydrogen channel or some nonsense)
how does heliox (helium + oxygen) help thoe w stridor
heliu has lower density, therefor decreasing reynolds number, therefore allowing for more laminar flow rather than turbulent flow
reynolds number is directly proportional to velocity, density, diameter
what can cause overdampening of a line
air bubbles
additioanl stop cocks
increased compliance in circuit thing blood clot causes dampening whic is why u flush it
what electrolyte abnormalities are seen with respiratory alk
hypocalcemia (ca binds to the proteins that release H+)
hypokalemia (think K/H exchanger )
hypophosphate
what decreases the chance of non hemolytic transfusion reaction
leukoreduction
blood pressure management for AVM malformation?
want permission hypotension so the embolization agent doesnt spread further than the AVM
what is the haladane effect
oxygen binding to hgb and displacing co2 causing downward shift in hemogolobin o2 curve
the opposite of this is the bohr effect where co2 displaces oxxygen on hgb
what ion has the highest concentration intracellularly
K+
neuromonitoring evoked potentials from most to lease sensitive to MAC gas
visual
motor
somatosensory
auditory
think first gas makes u blind
last gas will effect the hearing
what lab test monitors low molecular weight heparin (enoxparin)
factor Xa activity
what congenital heart condition will have ST segment elevations in v1-v3
brugada syndrome
asian people
avoid sodium channel blocking agents
how to determine between cerebral salt wasting and SIADH
cerebral salt wasting patient will be hypovolemic
in SIADH THEY WILL BE hypervolemic or euvolemic
think the fluid follows the salt out the body and they are hella dehydrated
is ECT parasympathetic or symmpathetic response
ECT is briefly parasympathetic then sympathetic prolonged response so you iwill see transient bradycardia at first
where is the most common location for cardiac myxoma
left atrium
function of preoptic anterior hypothalmus
thermoregulation
**medial tubercle hypothalamus secretes vasopressin and oxytococin to posterior pituitary
issue with transplanted lungs to consider during next surgery
its denervated so
impaired ciliary function, cough reflex and lymphatic drainage
when is vasospasms after SAH most likely to occur
between 2-14 days
rebleeding likely in first 24 hours
when is retrograde cardioplegia preferred
- diffuse CAD
- aortic insufficiency
- manipulation of aorta
what is the sensory innervation of the anterior abdominal wall
anterior and lateral branche of the cutaneous branches of the lower thoracic spinal nerve
how long should u wait to remove neuroaxial cath after DVT ppx low dose has been given
wait 12 hours
type 1 pnuemocytes
where gas exchange occurs
made out of sqaumous cells
type 2 pneumocytes
where surfactant is produced
cuboidal cells
factors that increase Fa:Fi ratio
increase minute ventilation
decreased cardiac output
low blood: gas solubility
low alveolar partial pressure
factors that increase Fa:Fi rati
increase minute ventilation
decreased cardiac output
low blood: gas solubility
low alveolar partial pressure
do the true vocal chords abduct or adduct on inspiration
they abduct
think that they stay open to allow air to flow
cricothyroid muscle is the only laryngeal muscle not innervated by the recurrent laryngeael nerve
its innervated by the external branch of the superior laryngeal nerve
factors that increase citrate toxicity
blood products liver disease peds populatiojn hyperventilated hypothermic
think breathing in citrate when hyperventilationg and not using it all cause its a cold body so then u have incrasing citrate
when is pulmonary vascular resistance at its highest
at the extreme of lung volumes
its the lowest at
FRC
recommended max NO concentration
25 parts per million
how quickly can u see PT/INR change when hepatic dysfunction occurs
24 hours
how quickly can u see PT/INR change when hepatic dysfunction occurs
24 hours
what two disease are related to elevated DLCO
asthma
obesity
what two disease are related to elevated DLCO
asthma
obesity
biggest concern for airway management in achondroplasia patients
atlantoaxial instability
what substance of ett are more likely to cause fires
all nom metal ett are at higher risk of causing fires
what enzyme in the electron transport chain does cyanide toxicity inhibit
cytochrome C oxidase
think cyanIDE makes cytohrome C DIE
the orientation of the double lumen tube is where the bronchial cuff is going give example
aka when its a left sided double lumen tube the bronchial cuff will go to the left of the carina
what extra subunit to immature extrajunctional Ach receptors have that mature ones dont
gamma (y) subunit. mature receptor will have epsilon subunit
both have 2 alpa 1, 1 beta 1, and one delta (?) present in fetus but also sepsis, burns immboliation etc.
what labs do u get periodically for someone using dantrolene
LFTs
how does hyperbaric oxygen increase oxygen delivery
it increases the amount of disolved oxygen in the blood
why is the simaultaneous release of lidocaine and liposomal bupivicaine contraindicated
can result in rapid release of bupi and then toxicity–
wait at least 20 min between them
exxcercise challenege test criteria for bronchoconstriction
10% decrease in fev1 after 406 minutes of 80% exxertion will indicate exercise induced bronchoconstriction
difference between anterior ischemic optic neuropathy and posterior ishchenmic optic neuropathy
AION will have optic disc edema and pallor, PION will not have any PE findings (things its posterior so its hidden) and is more related to spine surgery
criteria to get supplmental oxygen for COPD
spo2 < 88% on RA
OR
pao2 < 55
carotid body vs. carotid sinus
carotid body have chemo receptors that response to changees in O2, H+ co2 in blood
carotid SINUS Has baroreceptors that will decrease SVR ifs systemic pressure increases
think the BODY undergoe CHEMO aka carotid BODY has CHEMOreceptors
what two disease states have no pure shunting
COPD and asthma will have no shunt
whihc i think is perfusion no ventilation bc dead space is ventilation but no perfusion
the dichrotic notch on a line waveform represents what
aortic valve closure
risk factors for peri operative vaso occlusive events
- older age
- recent hospitaliation
- infection
- hx of pulm disease
best IVF for traumatic brain injury
normal saline
patients with what syndrome are at a higher risk of jaundice after RBC infusion
gilberts syndrome
have less of the enzyme that conjugates bilirubin
when you say ascending or descending bellow vent it refers to what phase
its describing the expiratory phase
so ascending bellow means ascending during expiratory phase
art line transducer height and how it affects BP reading
20 cm of hight will change the reading by 15
raising the transducer 20 cm will decrease the blood pressure by 15
lowering tranducer will increase BP reading by 15
an autoimmune condition that causes muscle cramping, bag of worms under skin excessive sweating muscle hypertrophy treated by phenytoin and carbamazipine
acquited neuromyonia
antibodies against volated gated Ca channel
are sympathetic preganglionic fibers long or short
they are short coming from the CNS think fight or flight response is QUICK aka SHORT signal
compartment pressure over what number for emergent fasciotomy
40 mm hg
think when u hit ur 40s ur muscles breakdown
what is the bainbridge reflex
aka atrial stretch reflex its when HR increases as preload increases
vagus mediated increase in HR by decreases parasympathetic input
brain bridge BOOST aka ur HR gets a BOOST (increases) with a BOOST of preload
what is max cuff pressure in ett vs lma
in ett its 30 mm h20
lma its 60 mmh20 (44 mm hg)
tight junctions vs gap junctions
tight junctions are to form barriers that regulate water and solute movement
gap junctions are for cardiac myocytes for quick propogation
think small GAPS for quick communication
G for GOOD rate of communication
obviously for barrier it would be tight
what patient factor most closely relates to the block height of isobaric spinal
patients weight is closely related to amount of CSF
height of block and amount of CSF are inversely related
most common indication for retrograde cardioplasia
retrograde: aortic insufficiency
most common indication for retrograde cardioplasia
retrograde: aortic insufficiency
list the sensitive from least to most sensitive of the modalities in which you can identify venous air embolism
EKG, end tidal CO2, pulmonary artery cath, precordial doppler TEE
explain how thermodilution cardiac output measurements are interpereted
so the measure youre getting is reflective measure of cardiac output
basically u inject a cold solution into the RA (Ti) and then you also measure the ;pulm artery blood temp (Tb) the longer it takes for Tb to come back to normal the slower the cardiac output
what will a pregnant ladies blood gas look like
hyper ventilation because progesterone stimualtes ventilation so ph will be slightly alk, pco2 on the lower side, a little higher pao2, and bicarb will be mildly decreases bc ur mildly compensated
how does partial pressure affect temperature
partial pressure is directly proportional to temp so as temp decreases the pa02 goes down, paco2 down down, and therefore pH will increase since paco2 is going down
what are the 5 criteria categories in the aldrete scoring system to by pass phase 1 PACU
movement/activity breathing O2 sat circulation consciousness
what acid base derrangement would hypoalbumin cause
metabolic alkalosis because albumin is a (weak) acid
the difference between complex regiona pain syndrome 1 and 2?
they differ by the cause
CRPS 1 is a trivial injury
CRPS 2 is caused by traumatic injury
elemental vs polymeric feeds
elemental diets are more expensive and can cause increased mortality and hospital length of stay
what measurement in non invasive blodo pressure monitoring is the least reliable
systolic
what two volumes equal closing capacity
residual volume plus closing volume
forced exhalaiton results in apex emptying and closure of the bases
two signs that your injection is intraneural when doing a block
high opening injection pressure
electrical stimulation with a motor response < 0.2 mA
neonates are more sensitive to what opioid
codeine because decreased cyp2d6 avbility in the first 2 weeks to change into morphine
at what level does autonomic dysreflexia occur
T7 or above
how is the intensity of light detected by infrared spectophotometer in gas machine related to paco2
intensity of light is inversely proportional to paco2
o2 cannot be analyzesd in this manner
what things would trigger the subambient pressure alarm on vent
aka when pressure falls below atmospheric pressure
- NGT suctionin in trachea
- pt inhaling against increases resistence in circuit
- pt inhaling against collpased resovoir bag
- blocked inspiratory limb during exalation
- malfunctioning closed scavenging system
what are the sxs of propofol infusion syndrom
metabolic acidosis cardiac issues hyerpkalemia renal failure pancreatitis hepatomegly high triglyceride rhabdo
