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APEX-Miscellaneous > MISC-misc topics 1-11 > Flashcards

MISC-misc topics 1-11 Flashcards

1
Q

Where is the control center for thermoregulation

A

Hypothalamus

Brainstem

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2
Q

What are 4 thermoregulatory efferent responses for coldness

A
  1. vasoconstriction
  2. piloerection
  3. shivering
  4. nonshivering thermogenesis
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3
Q

What are 2 thermoregulatory efferent responses for heat

A
  1. vasodilation

2. diaphoresis

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4
Q

What are 4 mechanisms of heat transfer

A
  1. radiation
  2. convection
  3. conduction
  4. evaporation
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5
Q

What is the greatest percentage of heat loss in the OR

A

radiation = 60%

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6
Q

How is heat loss from radiation prevented

A

By covering the patient

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7
Q

What is the 2nd greatest form of heat loss in the OR

A

convection (15-30%)

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8
Q

Define heat loss by radiation

A

Heat follows a temperature gradient. If the patient is warmer than the environment, then heat is lost to the environment in the form of infrared radiation

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9
Q

Define heat loss by convection

A

Transfer of heat by the movement of matter (air over the surface of the pt)

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10
Q

How is heat loss from convection minimized

A

prevention of air flow or breezes

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11
Q

Define heat loss by evaporation

A

heat lost by heat of vaporization as a function of the pts exposed surfaces and relative humidity of the environment

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12
Q

Where does heat loss from evaporation occur

A

Skin, respirations, wounds, open abdomen

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13
Q

Define heat loss by conduction

A

Heat is lost by direct contact with cooler surfaces as a function of temperature gradients between the patient and the surface

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14
Q

What are examples of heat loss by conduction

A

contact with the cold OR table, IV fluids, or irrigation fluids

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15
Q 
What percentage of heat is lost to the following methods:
radiation
convection
evaporation
conduction
A 
radiation= 60%
convection= 15-30%
evaporation= 20%
conduction= 5%
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16
Q

What are the 3 phases of heat loss

A

Phase 1=heat redistribution from core to periphery
Phase 2= heat transfer>heat production
Phase3= heat transfer ~ heat production

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17
Q

During what timeframe does most heat transfer occur in the anesthetized pt and how

A

During the first hour via redistribution to periphery

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18
Q

At what point after induction does heat transfer approximate heat production

A

Around 5 hours

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19
Q

3 ways anesthetics impact thermoregulation

A
  1. impairment of thermoregulatory response in the hypothalamus
  2. prevent shivering
  3. causes vasodilation
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20
Q

Describe heat transfer during phase 1

A

Heat isn’t lost, it is transferred from the core to the periphery

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21
Q

Describe heat loss of phase 2

A

Heat is lost to the environment is greater than heat produced

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22
Q

Describe heat loss of phase 3

A

Equilibrium has developed between heat lost to the environment and heat production

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23
Q

What are 5 CV consequences of hypothermia

A
  1. SNS stimulation
  2. shift of oxyhgb dissociation curve to LEFT
  3. vasoconstriction + decreased tissue PO2
  4. Coagulopathy and plt dysfunction
  5. sickling of hgb S
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24
Q

What are 2 pharmacologic consequences of hypothermia

A
  1. slowed drug metabolism

2. increased solubility of volatile agents (henry’s law)

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25
Q

How does hypothermia affect anesthetic duration

A

Prolongs effects of anesthetics

Prolongs emergence

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26
Q

How does vasoconstriction and decreased tissue PO2 impact the hypothermic pt

A

Less O2 available for tissues

Increases surgical site infections

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27
Q

How does SNS stimulation impact the hypothermic pt

A

can lead to myocardial ischemia and dysrhythmias

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28
Q

How does hypothermia impact coagulation

A

Causes plt dysfunction and increases bleeding and blood loss

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29
Q

What are the physiologic effects of shivering

A

O2 consumption increases by 400-500%

Can increase risk of myocardial ischemia or MI

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30
Q

What are 3 pharmacologic modalities to mitigate shivering

A
  1. meperidine
  2. clonidine
  3. dexmedetomidine
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31
Q

How is oxygen consumption affected by temperature reductions in the absence of shivering

A

It is reduced by 5-7% for every 1*C reduction

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32
Q

What are 7 useful scenarios for induced hypothermia

A
  1. cerebral ischemia
  2. cerebral aneurysm clipping
  3. TBI
  4. CPB
  5. Cardiac arrest
  6. Aortic x-clamp
  7. CEA
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33
Q

6 methods of measuring core temperature

A
  1. esophageal
  2. nasopharynx
  3. rectum
  4. bladder
  5. PA
  6. Tympanic membrane
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34
Q

What is the ideal position of esophageal temp probe

A

distal 1/3rd to 1/4th of esophagus

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35
Q

How can esophageal temperature be impacted by improper placement

A

In stomach = increased temp from liver metabolism

Proximal esophagus = decreased temp from cool inspiratory gas

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36
Q

Where is the best site for nasopharynx temp monitor

A

sensor contacting posterior nasopharyngeal wall, posterior to soft palate

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37
Q

What is the ideal insertion depth of rectal temp monitor

A 
Adult = 8 cm
Child = 3 cm
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38
Q

What are the drawback of rectal temp probe use

A
  1. risk of bowel perf

2. measurement lags during rapid warming or cooling

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39
Q

How is a rectal temp impacted by the gut

A 
Increased = d/t heat producing bacteria in the gut
Decreased = cooled from LE or insulated by stool
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40
Q

What are the drawbacks of bladder temp

A
  1. risk of UTI

2. measurement lags with rapid warming and cooling

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41
Q

When should bladder temps not be used

A

during GU procedures

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42
Q

How is a bladder temp impacted by UOP

A

decreased if UOP is inadequate

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43
Q

Why is the tympanic membrane considered a core measure of temp

A

It is close to the carotid a. and blood supply to hypothalamus

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44
Q

What is the best noninvasive measure of core temp

A

tympanic membrane

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45
Q

What is the best measure of core temp

A

PA but it is invasive and affected by CBP and thoracotomy

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46
Q

Which temperature monitoring site offers the best combination of accuracy and safety over an extended period of time

A

esophageal

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47
Q

List 5 clinically relevant CV consequences of perioperative hypothermia

A
  1. myocardial ischemia/infarction
  2. Decreased DO2
  3. SSI
  4. increased blood loss from coagulopathy
  5. risk of sickle cell crisis
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48
Q

What is the triad of fire production

A
  1. ignition source
  2. fuel
  3. oxidizer
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49
Q

What are 2 sources for fire ignition in the OR

A
  1. electrosurgical cautery

2. Laser

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50
Q

What are 3 fuel sources for fire in the OR

A
  1. ETT
  2. Drapes
  3. Surgical supplies
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51
Q

What are 2 oxidizer sources in the OR

A
  1. O2

2. N2O

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52
Q

What are 5 steps to take when a fire is present

A
  1. stop ventilation, remove ETT
  2. Stop flow of all gases
  3. Remove flammable material from airway
  4. Pour water or NS into airway
  5. Use CO2 extinguisher is fire not extinguished
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53
Q

What are 4 steps taken after fire is controlled

A
  1. re-establish ventilation by mask
  2. avoid supplemental O2 or N2O
  3. Check ETT for damage and fragments in airway
  4. Perform bronch to inspect airway for injury
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54
Q

What can happen if the reservoir bag is squeezed on extubation during an airway fire

A

It can create a blow torch effect at the distal end of the ETT and push debris into the airway

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55
Q

What does LASER stand for

A 
Light
Amplification by
Stimulated
Emission of
Radiation
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56
Q

What are 3 differences between laser and ordinary light

A

Laser light is:

  1. Monochromatic (single wavelength)
  2. Coherent (oscillates in the same phase)
  3. Collimated (exists in narrow parallel beams)
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57
Q

How do operative lasers with long wavelengths vs short wavelengths differ

A

Water absorption:
long=absorbs more H2O
short=absorbs less H2O

Tissue penetration:
long=do not penetrate deep into tissue
short=penetrates deeper into tissue

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58
Q

What are 4 types of Or lasers

A
  1. CO2
  2. Nd:YAG
  3. Ruby
  4. Argon
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59
Q 
CO2 laser:
Wavelength= 
Surgery type= 
Structures damaged= 
Eye protection=
A

Wavelength= 10,600 nm
Surgery type= oropharyngeal, VC
Structures damaged= cornea
Eye protection= Clear lenses

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60
Q 
Nd:YAG laser:
Wavelength= 
Surgery type= 
Structures damaged= 
Eye protection=
A

Wavelength= 1,064 nm
Surgery type= tumor debulking, tracheal
Structures damaged= retina
Eye protection= GREEN goggles

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61
Q 
Ruby laser:
Wavelength= 
Surgery type= 
Structures damaged= 
Eye protection=
A

Wavelength= 694 nm
Surgery type= retinal
Structures damaged= retina
Eye protection= RED goggles

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62
Q 
Argon laser:
Wavelength= 
Surgery type= 
Structures damaged= 
Eye protection=
A

Wavelength= 515 nm
Surgery type= vascular lesions
Structures damaged= retina
Eye protection= AMBER goggles

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63
Q

What is the ideal FiO2 when laser are in use

A

<30% FiO2

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64
Q

Can N2O be used with laser surgery

A

No, it supports combustion

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65
Q

What is the most vulnerable part of an ETT when lasers are used

A

the cuff

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66
Q

When lasers are used near ETT, should the cuff be filled with air or saline?
Rationale

A

Saline

Helps absorb the thermal energy produced by the laser, making the balloon less likely to ignite

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67
Q

What type of ETT is best when CO2 laser is used

A

LaserFlex tube

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68
Q

What type of ETT is best when Nd:YAG laser is used

A

Lasertubus

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69
Q

What are the risks of laser plume

A

inhalation of contaminated fine particulates that have the possibility for transmission

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70
Q

What are protective measures against laser plume inhalation

A
  1. high-efficiency masks

2. smoke evacuator

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71
Q

What are 5 causes of burns

A
  1. heat
  2. electricity
  3. chemicals
  4. radiation
  5. friction
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72
Q

Layers involved in 1st degree burn

A

epidermis only

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73
Q 
Describe the depth of each burn type:
1st degree=
2nd degree=
3rd degree=
4th degree=
A

1st degree= superficial, epidermis
2nd degree= superficial dermis
3rd degree= full-thickness, subcutaneous tissue
4th degree= full-thickness, muscle

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74
Q

Which burn types preserve nerve ending and are painful

A

1st and 2nd degree

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75
Q

Which burn types destroy nerve endings causing loss of sensation

A

3rd and 4th degree

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76
Q

What is the healing process for 1st through 4th degree burns

A

1st = spontaneous
2nd = spontaneous or skin grafting
3rd and 4th = skin grafting

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77
Q

Which burn type has destroyed epidermis and dermis

A

3rd degree

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78
Q

Which burn type extends to the muscle and bone

A

4th degree

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79
Q

How much TBSA does the head represent in the pediatric pt <1 year

A

19%

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80
Q 
What percentage does the following areas represent for the child age 1-4 years
Head=
Arm=
Thorax=
Leg=
A 
Head= 19% (add 1% for each year >1)
Arm= 9.5% per arm
Thorax= 16% per front and back
Leg= 15% per leg (add 1% per year >1)
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81
Q

What is the cause of fluid loss in the burn pt

A

microvascular permeability increase causing capillary leak

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82
Q

What is the result of increased vascular permeability in the burn pt

A
  1. Edema
  2. Loss of protein-rich fluid to interstitial space
  3. Loss of intravascular volume
  4. Hypovolemia
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83
Q

When do the greatest fluid shifts occur following burn injury

A

during the first 12 hours

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84
Q

Is albumin beneficial in the first 24 hours following burn injury

A

No

It should be avoided d/t loss into interstitial space

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85
Q

How can adequate fluid volume resuscitation be assessed

A

Hgb level

a rising hgb in the first few days suggests inadequate resuscitation

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86
Q

What is the Parkland burn formula

A

1st 24-hours LR:
4 mL x %TBSA burned x Kg
-1/2 in first 8 hrs
-1/2 in next 16 hrs

Second 24-hrs colloid:
0.5 mL x %TBSA burned x kg

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87
Q

According to the Parkland burn formula, what fluids should be used during the second 24-hrs after burn injury

A

D5W at maintenance rate

Colloid at 0.5 mL x %TBSA burn x kg

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88
Q

What is the UOP goal for the following groups:
Adult=
Child <30 kg=
High voltage electric=

A

Adult= >0.5 ml/kg/hr
Child <30 kg= >1 ml/kg/hr
High voltage electric= >1-1.5 ml/kg/hr

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89
Q

Why is UOP goal much higher for high voltage electric injury

A

b/c myoglobin is nephrotoxic

90
Q

What are the following goals for the burn pt:
Base deficit=
PvO2=

A

Base deficit= <2

PvO2= 35-40 mmHg

91
Q

What is abdominal compartment syndrome and the risks

A

Intrabd pressure >20 mmHg PLUS evidence of organ dysfunction

risks = aggressive fluid resiscitation

92
Q

How is intraabdominal pressure measured

A

via transduction of bladder pressure

93
Q

What are 4 treatments for abdominal compartment syndrome

A
  1. NMB
  2. Sedation
  3. diuresis
  4. abdominal decompression via laparotomy
94
Q

How does carbon monoxide affinity to hgb compare to O2

A

CO has 200x affinity for hgb than O2

95
Q

How does CO affect the oxyhgb dissociation curve

A

Shifts LEFT

Impairs tissue oxygenation d/t decreased O2 offloading

96
Q

How does carbon monoxide reflect on SpO2

A

It can give a falsely elevated result

therefore, SpO2 is NOT accurate

97
Q

What is the treatment for CO poisoning

A
  1. 100% FiO2

2. hyperbaric O2

98
Q

When should a pt with suspected airway burn be intubated

A

As early as possible

99
Q

How are extrajunctional receptors affected in the burn pt

A

They are up-regulated after 24 hrs from injury

100
Q

Can succinylcholine be used in the burn pt

A

Yes and no
Yes = within the first 24 hours
No = after the first 24 hrs, d/t lethal hyperkalemia

101
Q

How is dosing for non-depolarizing NMB affect in the burn pt

A

Dose should be increased 2-3 fold d/t INCREASED receptors needing block

102
Q

How is thermoregulation affected in the burn pt

A

increased heat loss by evaporation instead of convection

103
Q

What are 4 physiologic effects of the burn pts hypermetabolism

A
  1. increased catabolism
  2. increased O2 consumption
  3. increased HR
  4. increased RR
104
Q

What is the initial physiologic response to ECT

A

Increased PNS activity during tonic phase (15 seconds)

105
Q

What is the secondary response to ECT

A

Increased SNS activity during clonic phase (lasts several minutes)

106
Q

What is ECT

A

Seizures from electroconvulsion causing profound physiologic changes for the treatment of med-resistant depression, mania, catatonia, suicidal ideation, and some scizophrenias

107
Q

What are the 2 responses of ECT therapy

A

tonic phase

clonic phase

108
Q

What are 2 CV effects seen during the tonic phase of ECT

A
  1. decreased HR

2. decreased BP

109
Q

What are 2 GI effects seen during the tonic phase of ECT

A
  1. increased oral secretions

2. increased gastric secretions

110
Q

What are 2 CV effects seen during the clonic phase of ECT

A
  1. increased HR

2. increased BP

111
Q

What is a GI effect seen during the clonic phase of ECT

A

increased intragastric pressure

112
Q

What are 3 CNS effects seen during the clonic phase

A
  1. increased CBF
  2. increased ICP
  3. increased IOP
113
Q

What are the most common causes of death r/t ECT

A
  1. MI

2. cardiac dysrhythmias

114
Q

What are 6 absolute contraindications for ECT

A
  1. recent MI <6 mo
  2. Recent intracranial sx <3 mo
  3. Recent stroke <3 mo
  4. brain tumor
  5. unstable C-spine
  6. pheochromocytoma
115
Q

What are 6 relative contraindications for ECT

A
  1. pregnancy
  2. PM/ICD
  3. CHF
  4. glaucoma
  5. retinal detachment
  6. severe pulmonary dz
116
Q

What is the minimum recommended seizure duration for ECT and why

A

25 seconds

ECT efficacy is dependent on seizure duration (longer is better)

117
Q

What medications should be avoided with ECT to aid in seizure proliferation

A
  1. propofol
  2. midazolam
  3. lorazepam
  4. fentanyl
  5. lidocaine
118
Q

What 5 medications can increase seizure duration and are appropriate for use with ECT

A
  1. etomidate
  2. ketamine
  3. alfentanil w/ propofol
  4. aminophylline
  5. caffeine
119
Q

What are 2 physiologic states that increase seizure duration with ECT

A
  1. hyperventilation

2. hypocapnia

120
Q

What are 3 physiologic states the decrease seizure duration with ECT

A
  1. hypoventilation
  2. hypercarbia
  3. hypoxia
121
Q

What medication is the gold standard for use in ECT

A

methohexital

quick recovery and no effect on seizure duration

122
Q

What are 3 risks of etomidate use during ECT

A
  1. causes myoclonus
  2. increases risk of PNV
  3. more HTN after ECT
123
Q

What are the benefits and drawbacks of propofol use with ECT

A
  1. reduces seizure duration (not ideal)

2. blunts hemodynamic response (good for CV pts)

124
Q

Why should ketamine be avoided with ECT

A

it increases the SNS response (bad for CV pts), and prolongs recovery

125
Q

What medication is used to mitigate tonic phase effects with ECT

A

Glycopyrrolate

  • antisialagogue
  • reduce risk of bradycardia
126
Q

What technique can the anesthetist use following induction to improve response to ECT

A

hyperventilate pt, decreasing CO2

127
Q

How does lithium affect succinylcholine and nondepolarizers

A

PROLONGS duration of both

128
Q

In which pts should indirect acting sympathomimetics be used d/t risk of HTN crisis

A

Pts taking MAOis

129
Q

Other than MH, what are 5 drug-induced hyperthermic syndromes

A
  1. Sympathomimetic syndrome
  2. tricyclic antidepressant OD
  3. Serotonin syndrome
  4. anticholinergic syndrome
  5. neuroleptic malignant syndrome
130
Q

What 2 drug-induced hyperthermic syndromes present in less than 6 hours of exposure from the cause

A
  1. sympathomimetic syndrome

2. tricyclic antideperessand OD

131
Q

What 2 drug-induced hyperthermic syndromes present in less than 12 hours of exposure from the cause

A

serotonin syndrome

anticholinergic syndrome

132
Q

What drug-induced hyperthermic syndrome can present 24–72 hours after exposure to the casue

A

neuroleptic malignant syndrome

133
Q

What is the cause for sympathomimetic syndrome

A

amphetamine or cocaine use

134
Q

What is the cause for tricyclic antidepressant OD

A 
TC antidepressants:
amitriptyline 
nortriptyline
clomipramine
imipramine
135
Q

What are the causes of serotonin syndrome

A

exposure to serotoninergic drugs:

  • SSRIs (sertraline, citalopram, fluoxetine, St. John’s wart)
  • SNRIs (venlafaxine, duloxetine)
  • MAOis (phenelzine, selegiline, tranylcypromine)
  • Ecstasy
136
Q

What 3 drugs can increase the risk of serotonin syndrome when taking a serotoninergic drug

A
  1. methylene blue
  2. meperidine
  3. fentanyl
137
Q

What are the causes of anticholinergic syndrome

A

Too much centrally-acting anticholinergic

  • atropine
  • scopolamine
138
Q

What herbal supplement can induce serotonin syndrome

A

St John’s war

139
Q

what are the causes of neuroleptic malignant syndrome

A

dopamine depletion in the basal ganglia and hypothalamus d/t dopamine antagonists

  • metoclopramide
  • haloperidol
  • chlorpromazine
  • risperidone

Withdrawal from dopamine agonists

140
Q

What are 5 key features of sympathomimetic syndrome

A
  1. agitation
  2. hallucination
  3. arrhythmias
  4. myocardial ischemia
  5. NO muscle rigidity!
141
Q

What are 3 treatments for sympathomimetic syndrome

A
  1. vasodilators
  2. labetalol
  3. supportive care
142
Q

What are 4 key features of tricyclic antidepressant OD

A
  1. HoTN (from alpha receptor block)
  2. Decreased LOC/coma (histamine and muscarinic block)
  3. Polymorphic VT (cardiac K+ and Na+ channel block)
  4. NO muscle rigidity!
143
Q

What are 3 treatments for tricyclic antidepressant OD

A
  1. Magnesium
  2. serum alkalization
  3. supportive care
144
Q

What are 6 key features of serotonin syndrome

A
  1. akathisia
  2. mydriasis
  3. tremor
  4. AMS
  5. YES muscle rigidity
145
Q

What are 2 treatments for serotonin syndrome

A
  1. cyproheptadine (5-HT2A antagonist)

2. Supportive care

146
Q

What are 4 key features of anticholinergic syndrome

A
  1. red, hot, dry skin
  2. Mydriasis
  3. Delirium
  4. NO muscle rigidity
147
Q

What is the treatment for anticholinergic syndrome

A

physostigmine

148
Q

What are 8 key features of neuroleptic malignant syndrome

A
  1. bradykinesia
  2. decreased LOC/coma
  3. rhabdomyolysis
  4. myoglobinuria
  5. acidosis
  6. ANS instability
  7. normal pupils
  8. YES muscle rigidity
149
Q

What are 4 treatments of neuroleptic malignant syndrome

A
  1. bromocriptine
  2. dantrolene
  3. supportive care
  4. ECT
150
Q

Is succinylcholine safe to use in a pt with neuroleptic malignant syndrome

A

yes

151
Q

Which drug-induced hyperthermic disorders include muscle rigidity

A

MH
Serotonin syndrome
Neuroleptic malignant syndrome

152
Q

Which drug-induced hyperthermic disorders do not include muscle rigidity

A
  1. sympathomimetic syndrome
  2. tricyclic antidepressant OD
  3. anticholinergic syndrome
153
Q

How is intraocular perfusion pressure measured

A

MAP - IOP =IPP

154
Q

What 3 factors determine IOP

A
  1. choroidal blood volume
  2. aqueous fluid volume
  3. extraocular muscle tone
155
Q

What is normal IOP

A

10-20 mmHg

156
Q

How is aqueous humor produced

A

By the ciliary process in the posterior chamber

157
Q

how is aqueous humor reabsorbed

A

by the canal of Schlemm in the anterior chamber

158
Q

What eye structures are in the anterior chamber

A
  1. iris
  2. cornea
  3. canal of Schlemm
159
Q

What eye structures are in the posterior chamber

A
  1. Ciliary muscle
  2. Ciliary process
  3. Lens
160
Q

What 10 anesthetic interventions decrease IOP

A
  1. hypocarbia
  2. decreased CVP
  3. dec MAP
  4. volatile anesthetics
  5. N2O
  6. Nondepolarizing NMB
  7. propofol
  8. BZDs
  9. Hypothermia
  10. opioids
161
Q

What 11 anesthetic interventions increase IOP

A
  1. hypercarbia
  2. hypoxemia
  3. INC CVP
  4. INC MAP
  5. laryngoscopy/ETT
  6. straining/coughing
  7. succinylcholine
  8. N2O w/ SF6 bubble
  9. T-burg
  10. prone
  11. external facemask compression
162
Q

How can ketamine affect the eye

A

It can cause rotary nystagmus and blepharospasm

163
Q

How does succinylcholine affect IOP in the pt w/ an open globe injury

A

Can increase IOP by 5-15 mmHg up to 10 min

164
Q

What paralytic should be used in the pt undergoing emergent surgery for an open globe on a full stomach

A

succinylcholine is ok to use

165
Q

What is glaucoma

A

chronically elevated IOP leading to retinal artery compression

166
Q

What is the difference between open- and closed-angle glaucoma

A

open = caused by sclerosis of trabecular meshwork, impairing aqueous humor drainage

closed = caused by closure of anterior chamber, creating mechanical outflow obstruction

167
Q

How is IOP reduced in pts with glaucoma

A

by using drugs that reduce aqueous humor production or facilitates drainage

168
Q

What are drugs that decrease aqueous humor production

A
  1. acetazolamide inhibits carbonic anhydrase

2. timolol

169
Q

What are drugs that facilitate aqueous humor drainage

A
  1. echothiophate irreversible cholinesterase inhibitor
170
Q

What glaucoma drug can prolong duration of succinylcholine

A

echothiophate b/c it’s an irreversible cholinesterase inhibitor

171
Q

What are pts undergoing strabismus surgery at increased risk

A

PONV

Activation of oculocardiac reflex

172
Q 
Avoidance of N2O with ocular air bubbles:
SF6=
Silicone oil=
Air=
Perfluoropropane (C3F8)=
A

SF6= 7-10 days
Silicone oil= 0 days
Air= 5 days
Perfluoropropane (C3F8)= 30 days

173
Q

What does a TAP block target

A

the nerves of the anterior and lateral abdominal wall

174
Q

What types of procedures is the TAP block best indicated for

A

Abdominal procedures that involve the T9 to L1 distribution

175
Q

What is the order of tissues traversed when performing a TAP block

A
  1. SQ tissue
  2. External oblique muscle
  3. Internal oblique muscle
  4. Transverse abdominis muscle
  5. Peritoneum (NOT traversed but seen on US)
176
Q

Where does innervation of the anterolateral abdominal wall arise

A

anterior rami of T7-L1

177
Q

Which plane is LA injected with a TAP block

A

just below the fascial plane between internal oblique muscle and transverse abdominis muscle

178
Q

What are the 3 landmarks for TAP block

Name for this triangle?

A
  1. external oblique muscle
  2. latissimus dorsi muscle
  3. iliac crest

aka triangle of Petit

179
Q

What LA volume is injected per side of a TAP block

A

15 - 20 mL per side

180
Q

What are 2 complications of TAP block

A
  1. peritoneum puncture

2. liver hematoma

181
Q

Define and give example of allodynia

A

definition = pain d/t stimulus that does not normally produce pain

example= fibromyalgia

182
Q

define and give example of algogenic

A

definition = a stimulus that is normally expected to produce pain

example = surgical incision

183
Q

define and give example of analgesia

A

definition = no pain is sensed in response to a stimulus that produces pain

example = opioid analgesics relieve kidney stone pain

184
Q

define and give example of dysesthesia

A

definition = abnormal and unpleasant sense of touch

example = burning sensation from neuropathy

185
Q

define and give example of hyperalgesia

A

definition = exaggerated pain response to a painful stimulus

example = remifentanil

186
Q

define and give example of neuralgia

A

definition = pain localized to dermatome

example = herpes zoster

187
Q

define and give example of neuropathy

A

definition = impaired nerve function

example = silent MI from diabetic neuropathy

188
Q

define and give example of paresthesia

A

definition = abnormal sensation described as pins and needles

example = nerve stimulation during RA

189
Q

What 3 non-opioid drug classes are used to modulate pain in the spinal cord

A
  1. tricyclic antidepressants (amitriptyline, nortriptyline)
  2. SRIs and NRIs (venlafaxine, duloxetine)
  3. SSRIs (citalopram, fluoxetine)
190
Q

What characterizes complex regional pain syndrome

A

neuropathic pain with autonomic involvement

191
Q

What are 3 risk factors for complex regional pain syndrome

A
  1. female gender
  2. previous trauma
  3. previous surgery
192
Q

What are 7 treatments for complex regional pain syndrome

A
  1. ketamine infusion
  2. memantine (NMDA antagonist)
  3. gabapentin
  4. regional sympathetic block
  5. physical therapy
  6. steroids
  7. amitriptyline
193
Q

What is the difference between type 1 and type 2 complex regional pain syndrome

A

type 1 = reflex sympathetic dystrophy with no previous nerve injury

Type 2 = causalgia, with previous nerve injury

194
Q

What is a thoracic paravertebral block

A

LA injected into the paravertebral space targeting the ventral ramus of spinal nerves as they exit the vertebral foramen

195
Q

What are indications for a thoracic paravertebral block

A
  1. breast surgery
  2. thoracotomy
  3. rib fractures
196
Q

Indication for celiac plexus block

A

cancer pain of the upper abdominal organs

197
Q

What are complications of a celiac plexus block

A
  1. orthostatic HoTN
  2. retroperitoneal hematoma
  3. hematuria
  4. diarrhea
  5. AAA dissection
  6. back pain
198
Q

Indications for superior hypogastric plexus block

A

Management of cancer pain of the pelvic organs

199
Q

What are complications of superior hypogastric plexus block

A

retrograde migration of injectate

200
Q

Which antibiotics are beta-lactams

A

PCN
Cephalosporins
Ampicillin

201
Q

Which antibiotics are aminoglycosides

A

gentamycin

streptomycin

202
Q

What are 3 risks of aminoglycoside use

abx examples

A

ototoxicity
nephrotoxicity
skeletal muscle weakness

ex: gentamycin, streptomycin

203
Q

Which antibiotics are tetracyclines

A

doxycycline

204
Q

What are 2 risks of tetracycline use

abx example

A
  1. hepatotoxicity
  2. nephrotoxicity

ex: doxycycline

205
Q

Which antibiotics are fluoroquinolones

A
  1. ciprofloxacin
  2. levofloxacin
  3. moxifloxacin
206
Q

What are 2 risks of fluoroquinolones

abx examples

A
  1. GI intolerance
  2. tendonitis and tendon rupture

ex: cipro, levaquin

207
Q

Which antibiotics are macrolides

A

Erythromycin

208
Q

What is a risk associated with macrolides

abx example

A

P450 INHIBITION (prolong drug effect)

ex: erythromycin

209
Q

what are risks associated with clindamycin

A

skeletal muscle weakness

210
Q

What are 3 risks associated with vancomycin

A
  1. HoTN w/ rapid infusion
  2. red man syndrome
  3. stevens-johnson syndrome
211
Q

What are 2 risks associated with metronidazole

A
  1. peripheral neuropathy

2. alcohol intolerance

212
Q

What is the rate of cross-reactivity of PCN and cephalosporin reaction

A

<1%

213
Q

When can a pt with a PCN allergy receive a cephalosporin

A
  1. If the reaction was NOT IgE mediated (anaphylaxis, bronchospasm, urticaria)
  2. the reaction did NOT produce exfoliative dermatitis
214
Q

What are the best alternative abx for a pt with pcn allergy

A
  1. clindamycin

2. vancomycin

215
Q

What is the MOA of cephalosporins

A

They disrupt bacterial cell wall synthesis (peptidoglycan)

216
Q

How often is cefazolin redosed during surgery

A

q4 hrs

217
Q

What is the MOA of vancomycin

A

disruption of bacterial cell wall synthesis

218
Q

Why can vancomycin cause hotn

A

d/t histamine release

219
Q

How is the histamine response of vancomycin reduced

A

diphenhydramine 1 mg/kg

cimetidine 4 mg/kg

220
Q

Which 4 antibiotics are contraindicated in pregnancy and why

A
  1. chloramphenicol
  2. erythromycin
  3. fluoroquinolones
  4. tetracyclines

they cross the placenta and impact fetal development

APEX-Miscellaneous (6 decks)

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