misc Flashcards
name 5 risk factors for citrate toxicity
hypothermia liver disease peds population blood transfusion hyperventilation
the first 3 have to do w decreased metabolism
how does hyperventilation cause citrate toxicity
decreases ionized calcium therefore causing hypocalcemia therefore causing citrate toxicity
ingesting water 2 hours preop comapred to 4 hours preop does what to gastric ocntent and pH
drinkning water 2 hours preop will result in smaller gastric volumes and higher pH because tehre is a positive feedback loop that when stomach senses liquid in it it will try to empty faster
what are the least stable factors in FFP
factor 5 and 8
4 signs of citrate toxicity
- hypocalcemia
- hypomag
3, myocardial depression –> hypotension - coagulopathy
right to left shunt is going to effect the rate of induction of a more or less soluble voltaline
it will slow the rate of induction of a less soluble anesthetic because the low blood:gas the dilutional effect of mixing shunt blood will be greater felt with lower soluble gases
which two gases should be measured by weight to see how much is left rather than cylinder pressure
NO, CO2
what is the bainbridge reflex
increases HR by blocking parasympathetic activity when stretch receptors located in the RA sense increased pressure
think they feel more blood aka stretch so increase HR to pump it out
hering bruer reflex
pulmonary stretch receptors prevents inspiration and triggers expiration to prevent overinflation of lungs
what hormones decrease in stress response
GH
T3/T4 think sick euthyroid syndrome
Tsh may increase oor decrease or stay norm
GH increase at first then drop
vasopressin will drop in septic shock
what is the advantage of a bain circuit aka modified mapleson D
what ekg leads in combination or alone are the best for detecting MI
in combination lead II and V4 are ideal
alone V5 is the best
what will trigger the sub ambient pressure alarm on vent
placing suction of NG tube in trachea
benefits of leukoreduction of blood products
- reduced cmv transmission
- decreased febrile non hemolytic rxn
- decreased inflammatory response and inflamatory mediators accumulated during storage
what is the first line of treatment w someone displaying cushings triad after brain injury
intubate
what lab value reflects synthetic function of liver the best
PT
represents extrinisic pathway (factor 7)
changes in what 2 properties will cause a jump to another higher functioning frank starling cure
- ionotropy jump upwards
2. stroke volume (vasodilators will decrease end diastolic pressure ) causing lefwards jump improves cardiac pressures
which peripheral neurotransmitters cause inhibition at spinal cord
GABA
glycine
opioids
what can result in clotting time variability
hypothermia
hemodilution
platlets 30-50k
drugs that affect platelets
how much liters in full n2O tank
1500 L, 750 psig
whats the main reason infants have a higher voaltile anesthetic update compared to adults
increased minute ventilation to FRC ratio
name the three ways nitroprusside toxicity occurs
- cyanide ions bind to cytochrome C oxidase
- formation of cyanomethemeglobin
- thiocynate production which causes CNS effects
whats the pre succ dose of roc you would give?
10% of ED95 dose
when doing caudal epidural in infant what are the layesr your needle croses
skin, subq fat, sacralcoccygeal ligament
what EKG abnormality will be seen in someone with multiple blood transfusions
prolonged QT
2/2 to hypocalcemia
what action requires the highest mac to prevent movement
endotracheal intubation
NOT DL
as the gas flow through a bobbin rotameter increases, what increases as well?
cross-sectional orifice area
how does storage of RBC affect 2,3 BPG
storage causes a decrease of 2,3 BPG
think that the hgb wants to keep the O2 so the curve is shifted to left since tehres no tissue in the RBC
what physiologic state can mimic the effects of mannitol
hyperglycemia
osmotic diueresis
does prealbumin increase or decrease after HD
it increases because its too large to go through the ultrafiltration
which part of the frank starings curve is volume dependent steep or flat
the steep part of the curve
local anesthetic systemic absorption based on site
ICE BaLLS
intercostal > caudal > epidural> brachial plexus > lower limb > subQ
when you have an incompetent inspiratory valve, increasing fresh gas flow does what
minimizes rebreathing
what is kidney stones more common w corticosteroid use
because u have increased urinary calcium
transfusion related immunomodulation has what benefit
renal allograft survival rates
with non invasive blood pressure measurement how is the MAP deteremined
maximum amplitude of oscillations
what advantages do airway exchange cathetars have over gum bougies when performing ETT exchange
allows for jet ventilation and end tital CO2 monitoring
what infection has highest rate of infection within a blood product
CMV
if max amp is low or lys 30 is low what do u need
for max amp u need platlets
for lys 30 u need plasmin (TXA etc.)
if any other thing is abnormal on TEG u need fibrinogen or FFP
how would u manage extravasation of vasopressor
elevate limb
irrigate w saline. warm compress
stellate ganglion block in upper extremity
phentolamine
when isolation monitor alarms what should be the first step
unplug the most recent device plugged in
relative ontraindications for closed circuit/low flow anesthesia
sevo
acute alcohol
ketoacidsos
malnutrition
how is intensity of light detected by infrared related to co2 partial pressure
inversely related
what vesssel supplies the AV node
blood flow comes from the RCA in 90% and left circumflex in 10%
what prevents microshocks vs macroshocks
micro shocks prevented by eqipment ground wire
macro shocks prevented by ground fault interpreter
what products are contained in cryo
fibrinogen fibronectin vWF factor XIII factor VIII
what is the different exam findings for anterior ischemic optic neuropathy vs posterior
anterior will have optic disc edema or palor wheras posterior has no exam findings
think posterior is hidden so no findings
acoustic impedence of US is based on what two characteristics
density
propogation speed of sound
describe what a CVP tracing will look like if patient has a fib vs. AV dissociation vs tricuspid regurg
a fib A wave is missing
AV dissociation no C wave because youre contracting against closed tricuspid valve
in regurg youll have tall C wave and V wave
how does chornic opioid therapy affect hormones
increased prolactin
decreased cortisol, FSH, LH, testosterone estrogen
should you increase or decrease intubating doses of NMBA in cirrhosis/ CHF / renal failure patients
increase dose because volume of distribution is increased since lower plasma concentration
if u can smell sevo through n95 mask what does that mean
that the safe environmental limit has been exceeded
under HIPPA do u need to get permission from patient to give information about workmans compensation
no
what is the second messenger for NMDA
calcium
think mag analgesic effect happens bc its an NMDA antagonist
glutamate or glycine must be bound to receptor
what is the components of modified aldreate criteria
activity breathing circulation consciousness pulse ox
if patient goes into cardiac arrest because of LAST syndrome how do u adjust ur epi dosem
epi should be <1 mg every 3-5 minutes instead of 1 mg ever 3-5 min
how does clonidine comprare w morphine when given through epidural
clonidine has a longer duration of action (could be up to 1 month)
clondine + morphine together provide synergistic analgesic effect
how can propofol infusion syndrome present
pancreatitis
hepatomegly
rhabdo
renal failure
hyper K
lactic acidosis
cardiac failure
high tryglyceride
what size ETT can fit through LMA size 3,4,5,6
3/4 6.0 ett
5/6 7.0ett
what does ths celiax plexus innervate start and end of GI tract
start : distal third esophagus to distal descending colon
GFR changes around pregnancy
3 months into pregnancy GFR increses to 50%
goes back to normal 3 months post partum
GFR 3 letters think 3 is key
name two nerves that can be acceidentally blocked w deep cervical plexus block (c2-4)
superior laryngeal
phrenic
superficial cervical block can accidentally block the accessory nerve
is glutamine and calcitonin related peptide excitatory or inhbitory
excitatory
think glue two things together its a ppositive so exiting
calcitonin is like calcium ice cream which is hella exciting
is glycine inhibitory or excitatory
GLy think LYING inhibits happiness and therefore its inhibitory
TURP syndrome w distilled water
hypotonic solution causes volume issues, also can cause RBC lysis and impair surgical visualization
TURP syndrome w NS or balanced salt
significant current dispersion
TURP syndrome w glycine
transient blindness
TURP syndrome w mannitol/soribital
cause cause hyperglycemia, wildly used.
what happens to intrinsic heart rate after heart transplant
the intrinsic heart rate is higher (think newer heart) due ot parasymmatetic denervation. also less variability in HR. HR originates from donor atria
hiv exposure ppx
two drugs if known hiv status needle stick
3 drug ppx if severe exposure to known hiv
two opioid meds whos metabolites are problematic in kidney failure patients
hydromorphine–> hydromorphone -3-glucoronide (cognitive dysfunction and myoclonus)
meperidine –> normeperidine (seizures agitation myoclonus)
what issue is going to occur with cogenital diaphragmatic hernia
pulm hypoplasia
allow permissive hypercapnia up to 65 so you can do low lung tidal volumes
how does Nitrous affect CBF, ICP, CMRO
increases it all CMRO CBF and ICP
increases CMRO and CBF whereas iso and sevo uncouple them and decrease CMRO
TEG interpretation, what to do in :
prolonged R time
decreased K or alpha angle
decreased MA
give FFP, clotting factors
given fibrinogen think if the ALPHA girlie just keeps saying “K” shes prob fibbing
give platelets
targets of deep brain stim for parkings
internal globis pallidus
subthalmic nucleus
first sign of diabetic autnomic neuropathy
tachycardia resting around 100
presenting sign of subcutaneous emphysema after abdominal insufflation
very high hypercarbia
for billing one anesthesia unit is how many minutes
15 min
does sympathetic or parasympathetic tone increase in elderly
sympathetic
stimulation of which nerve causes reflex bronchoconstricution
vagus nerve,
think cold air or histamine will cause the senory affeerent and M2 M3 receptors stimualted by vagus nerve will cause constriction
how do volatile anesthetics help w ischemic preconditioning
when cells see ischmie there is activation of kATP channels that cause cellular changes that make them more protected from ischemia– volatile anesthetics also trigger this pathway
what organ metabolizes precedex
liver
does etomidate increase or decreased hepatic blood flow
decreases
physiology anemia happens in new borns at how many weeks and wahts the hgb
happens at 8-12 weeks and drops to 10-12
which material of ETT is nonflammable
metal stainless steel
