MISC-misc topics 1-11 Flashcards
1
Q
Where is the control center for thermoregulation
A
Hypothalamus
Brainstem
2
Q
What are 4 thermoregulatory efferent responses for coldness
A
- vasoconstriction
- piloerection
- shivering
- nonshivering thermogenesis
3
Q
What are 2 thermoregulatory efferent responses for heat
A
- vasodilation
2. diaphoresis
4
Q
What are 4 mechanisms of heat transfer
A
- radiation
- convection
- conduction
- evaporation
5
Q
What is the greatest percentage of heat loss in the OR
A
radiation = 60%
6
Q
How is heat loss from radiation prevented
A
By covering the patient
7
Q
What is the 2nd greatest form of heat loss in the OR
A
convection (15-30%)
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
9
Q
Define heat loss by convection
A
Transfer of heat by the movement of matter (air over the surface of the pt)
10
Q
How is heat loss from convection minimized
A
prevention of air flow or breezes
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
12
Q
Where does heat loss from evaporation occur
A
Skin, respirations, wounds, open abdomen
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
14
Q
What are examples of heat loss by conduction
A
contact with the cold OR table, IV fluids, or irrigation fluids
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%
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
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
18
Q
At what point after induction does heat transfer approximate heat production
A
Around 5 hours
19
Q
3 ways anesthetics impact thermoregulation
A
- impairment of thermoregulatory response in the hypothalamus
- prevent shivering
- causes vasodilation
20
Q
Describe heat transfer during phase 1
A
Heat isn’t lost, it is transferred from the core to the periphery
21
Q
Describe heat loss of phase 2
A
Heat is lost to the environment is greater than heat produced
22
Q
Describe heat loss of phase 3
A
Equilibrium has developed between heat lost to the environment and heat production
23
Q
What are 5 CV consequences of hypothermia
A
- SNS stimulation
- shift of oxyhgb dissociation curve to LEFT
- vasoconstriction + decreased tissue PO2
- Coagulopathy and plt dysfunction
- sickling of hgb S
24
Q
What are 2 pharmacologic consequences of hypothermia
A
- slowed drug metabolism
2. increased solubility of volatile agents (henry’s law)
25
How does hypothermia affect anesthetic duration
Prolongs effects of anesthetics
| Prolongs emergence
26
How does vasoconstriction and decreased tissue PO2 impact the hypothermic pt
Less O2 available for tissues
| Increases surgical site infections
27
How does SNS stimulation impact the hypothermic pt
can lead to myocardial ischemia and dysrhythmias
28
How does hypothermia impact coagulation
Causes plt dysfunction and increases bleeding and blood loss
29
What are the physiologic effects of shivering
O2 consumption increases by 400-500%
| Can increase risk of myocardial ischemia or MI
30
What are 3 pharmacologic modalities to mitigate shivering
1. meperidine
2. clonidine
3. dexmedetomidine
31
How is oxygen consumption affected by temperature reductions in the absence of shivering
It is reduced by 5-7% for every 1*C reduction
32
What are 7 useful scenarios for induced hypothermia
1. cerebral ischemia
2. cerebral aneurysm clipping
3. TBI
4. CPB
5. Cardiac arrest
6. Aortic x-clamp
7. CEA
33
6 methods of measuring core temperature
1. esophageal
2. nasopharynx
3. rectum
4. bladder
5. PA
6. Tympanic membrane
34
What is the ideal position of esophageal temp probe
distal 1/3rd to 1/4th of esophagus
35
How can esophageal temperature be impacted by improper placement
In stomach = increased temp from liver metabolism
| Proximal esophagus = decreased temp from cool inspiratory gas
36
Where is the best site for nasopharynx temp monitor
sensor contacting posterior nasopharyngeal wall, posterior to soft palate
37
What is the ideal insertion depth of rectal temp monitor
```
Adult = 8 cm
Child = 3 cm
```
38
What are the drawback of rectal temp probe use
1. risk of bowel perf
| 2. measurement lags during rapid warming or cooling
39
How is a rectal temp impacted by the gut
```
Increased = d/t heat producing bacteria in the gut
Decreased = cooled from LE or insulated by stool
```
40
What are the drawbacks of bladder temp
1. risk of UTI
| 2. measurement lags with rapid warming and cooling
41
When should bladder temps not be used
during GU procedures
42
How is a bladder temp impacted by UOP
decreased if UOP is inadequate
43
Why is the tympanic membrane considered a core measure of temp
It is close to the carotid a. and blood supply to hypothalamus
44
What is the best noninvasive measure of core temp
tympanic membrane
45
What is the best measure of core temp
PA but it is invasive and affected by CBP and thoracotomy
46
Which temperature monitoring site offers the best combination of accuracy and safety over an extended period of time
esophageal
47
List 5 clinically relevant CV consequences of perioperative hypothermia
1. myocardial ischemia/infarction
2. Decreased DO2
3. SSI
4. increased blood loss from coagulopathy
5. risk of sickle cell crisis
48
What is the triad of fire production
1. ignition source
2. fuel
3. oxidizer
49
What are 2 sources for fire ignition in the OR
1. electrosurgical cautery
| 2. Laser
50
What are 3 fuel sources for fire in the OR
1. ETT
2. Drapes
3. Surgical supplies
51
What are 2 oxidizer sources in the OR
1. O2
| 2. N2O
52
What are 5 steps to take when a fire is present
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
53
What are 4 steps taken after fire is controlled
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
54
What can happen if the reservoir bag is squeezed on extubation during an airway fire
It can create a blow torch effect at the distal end of the ETT and push debris into the airway
55
What does LASER stand for
```
Light
Amplification by
Stimulated
Emission of
Radiation
```
56
What are 3 differences between laser and ordinary light
Laser light is:
1. Monochromatic (single wavelength)
2. Coherent (oscillates in the same phase)
3. Collimated (exists in narrow parallel beams)
57
How do operative lasers with long wavelengths vs short wavelengths differ
Water absorption:
long=absorbs more H2O
short=absorbs less H2O
Tissue penetration:
long=do not penetrate deep into tissue
short=penetrates deeper into tissue
58
What are 4 types of Or lasers
1. CO2
2. Nd:YAG
3. Ruby
4. Argon
59
```
CO2 laser:
Wavelength=
Surgery type=
Structures damaged=
Eye protection=
```
Wavelength= 10,600 nm
Surgery type= oropharyngeal, VC
Structures damaged= cornea
Eye protection= Clear lenses
60
```
Nd:YAG laser:
Wavelength=
Surgery type=
Structures damaged=
Eye protection=
```
Wavelength= 1,064 nm
Surgery type= tumor debulking, tracheal
Structures damaged= retina
Eye protection= GREEN goggles
61
```
Ruby laser:
Wavelength=
Surgery type=
Structures damaged=
Eye protection=
```
Wavelength= 694 nm
Surgery type= retinal
Structures damaged= retina
Eye protection= RED goggles
62
```
Argon laser:
Wavelength=
Surgery type=
Structures damaged=
Eye protection=
```
Wavelength= 515 nm
Surgery type= vascular lesions
Structures damaged= retina
Eye protection= AMBER goggles
63
What is the ideal FiO2 when laser are in use
<30% FiO2
64
Can N2O be used with laser surgery
No, it supports combustion
65
What is the most vulnerable part of an ETT when lasers are used
the cuff
66
When lasers are used near ETT, should the cuff be filled with air or saline?
Rationale
Saline
| Helps absorb the thermal energy produced by the laser, making the balloon less likely to ignite
67
What type of ETT is best when CO2 laser is used
LaserFlex tube
68
What type of ETT is best when Nd:YAG laser is used
Lasertubus
69
What are the risks of laser plume
inhalation of contaminated fine particulates that have the possibility for transmission
70
What are protective measures against laser plume inhalation
1. high-efficiency masks
| 2. smoke evacuator
71
What are 5 causes of burns
1. heat
2. electricity
3. chemicals
4. radiation
5. friction
72
Layers involved in 1st degree burn
epidermis only
73
```
Describe the depth of each burn type:
1st degree=
2nd degree=
3rd degree=
4th degree=
```
1st degree= superficial, epidermis
2nd degree= superficial dermis
3rd degree= full-thickness, subcutaneous tissue
4th degree= full-thickness, muscle
74
Which burn types preserve nerve ending and are painful
1st and 2nd degree
75
Which burn types destroy nerve endings causing loss of sensation
3rd and 4th degree
76
What is the healing process for 1st through 4th degree burns
1st = spontaneous
2nd = spontaneous or skin grafting
3rd and 4th = skin grafting
77
Which burn type has destroyed epidermis and dermis
3rd degree
78
Which burn type extends to the muscle and bone
4th degree
79
How much TBSA does the head represent in the pediatric pt <1 year
19%
80
```
What percentage does the following areas represent for the child age 1-4 years
Head=
Arm=
Thorax=
Leg=
```
```
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)
```
81
What is the cause of fluid loss in the burn pt
microvascular permeability increase causing capillary leak
82
What is the result of increased vascular permeability in the burn pt
1. Edema
2. Loss of protein-rich fluid to interstitial space
3. Loss of intravascular volume
4. Hypovolemia
83
When do the greatest fluid shifts occur following burn injury
during the first 12 hours
84
Is albumin beneficial in the first 24 hours following burn injury
No
| It should be avoided d/t loss into interstitial space
85
How can adequate fluid volume resuscitation be assessed
Hgb level
| a rising hgb in the first few days suggests inadequate resuscitation
86
What is the Parkland burn formula
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
87
According to the Parkland burn formula, what fluids should be used during the second 24-hrs after burn injury
D5W at maintenance rate
Colloid at 0.5 mL x %TBSA burn x kg
88
What is the UOP goal for the following groups:
Adult=
Child <30 kg=
High voltage electric=
Adult= >0.5 ml/kg/hr
Child <30 kg= >1 ml/kg/hr
High voltage electric= >1-1.5 ml/kg/hr
89
Why is UOP goal much higher for high voltage electric injury
b/c myoglobin is nephrotoxic
90
What are the following goals for the burn pt:
Base deficit=
PvO2=
Base deficit= <2
| PvO2= 35-40 mmHg
91
What is abdominal compartment syndrome and the risks
Intrabd pressure >20 mmHg PLUS evidence of organ dysfunction
risks = aggressive fluid resiscitation
92
How is intraabdominal pressure measured
via transduction of bladder pressure
93
What are 4 treatments for abdominal compartment syndrome
1. NMB
2. Sedation
3. diuresis
4. abdominal decompression via laparotomy
94
How does carbon monoxide affinity to hgb compare to O2
CO has 200x affinity for hgb than O2
95
How does CO affect the oxyhgb dissociation curve
Shifts LEFT
| Impairs tissue oxygenation d/t decreased O2 offloading
96
How does carbon monoxide reflect on SpO2
It can give a falsely elevated result
| therefore, SpO2 is NOT accurate
97
What is the treatment for CO poisoning
1. 100% FiO2
| 2. hyperbaric O2
98
When should a pt with suspected airway burn be intubated
As early as possible
99
How are extrajunctional receptors affected in the burn pt
They are up-regulated after 24 hrs from injury
100
Can succinylcholine be used in the burn pt
Yes and no
Yes = within the first 24 hours
No = after the first 24 hrs, d/t lethal hyperkalemia
101
How is dosing for non-depolarizing NMB affect in the burn pt
Dose should be increased 2-3 fold d/t INCREASED receptors needing block
102
How is thermoregulation affected in the burn pt
increased heat loss by evaporation instead of convection
103
What are 4 physiologic effects of the burn pts hypermetabolism
1. increased catabolism
2. increased O2 consumption
3. increased HR
4. increased RR
104
What is the initial physiologic response to ECT
Increased PNS activity during tonic phase (15 seconds)
105
What is the secondary response to ECT
Increased SNS activity during clonic phase (lasts several minutes)
106
What is ECT
Seizures from electroconvulsion causing profound physiologic changes for the treatment of med-resistant depression, mania, catatonia, suicidal ideation, and some scizophrenias
107
What are the 2 responses of ECT therapy
tonic phase
| clonic phase
108
What are 2 CV effects seen during the tonic phase of ECT
1. decreased HR
| 2. decreased BP
109
What are 2 GI effects seen during the tonic phase of ECT
1. increased oral secretions
| 2. increased gastric secretions
110
What are 2 CV effects seen during the clonic phase of ECT
1. increased HR
| 2. increased BP
111
What is a GI effect seen during the clonic phase of ECT
increased intragastric pressure
112
What are 3 CNS effects seen during the clonic phase
1. increased CBF
2. increased ICP
3. increased IOP
113
What are the most common causes of death r/t ECT
1. MI
| 2. cardiac dysrhythmias
114
What are 6 absolute contraindications for ECT
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
What are 6 relative contraindications for ECT
1. pregnancy
2. PM/ICD
3. CHF
4. glaucoma
5. retinal detachment
6. severe pulmonary dz
116
What is the minimum recommended seizure duration for ECT and why
25 seconds
| ECT efficacy is dependent on seizure duration (longer is better)
117
What medications should be avoided with ECT to aid in seizure proliferation
1. propofol
2. midazolam
3. lorazepam
4. fentanyl
5. lidocaine
118
What 5 medications can increase seizure duration and are appropriate for use with ECT
1. etomidate
2. ketamine
3. alfentanil w/ propofol
4. aminophylline
5. caffeine
119
What are 2 physiologic states that increase seizure duration with ECT
1. hyperventilation
| 2. hypocapnia
120
What are 3 physiologic states the decrease seizure duration with ECT
1. hypoventilation
2. hypercarbia
3. hypoxia
121
What medication is the gold standard for use in ECT
methohexital
| quick recovery and no effect on seizure duration
122
What are 3 risks of etomidate use during ECT
1. causes myoclonus
2. increases risk of PNV
3. more HTN after ECT
123
What are the benefits and drawbacks of propofol use with ECT
1. reduces seizure duration (not ideal)
| 2. blunts hemodynamic response (good for CV pts)
124
Why should ketamine be avoided with ECT
it increases the SNS response (bad for CV pts), and prolongs recovery
125
What medication is used to mitigate tonic phase effects with ECT
Glycopyrrolate
- antisialagogue
- reduce risk of bradycardia
126
What technique can the anesthetist use following induction to improve response to ECT
hyperventilate pt, decreasing CO2
127
How does lithium affect succinylcholine and nondepolarizers
PROLONGS duration of both
128
In which pts should indirect acting sympathomimetics be used d/t risk of HTN crisis
Pts taking MAOis
129
Other than MH, what are 5 drug-induced hyperthermic syndromes
1. Sympathomimetic syndrome
2. tricyclic antidepressant OD
3. Serotonin syndrome
4. anticholinergic syndrome
5. neuroleptic malignant syndrome
130
What 2 drug-induced hyperthermic syndromes present in less than 6 hours of exposure from the cause
1. sympathomimetic syndrome
| 2. tricyclic antideperessand OD
131
What 2 drug-induced hyperthermic syndromes present in less than 12 hours of exposure from the cause
serotonin syndrome
| anticholinergic syndrome
132
What drug-induced hyperthermic syndrome can present 24--72 hours after exposure to the casue
neuroleptic malignant syndrome
133
What is the cause for sympathomimetic syndrome
amphetamine or cocaine use
134
What is the cause for tricyclic antidepressant OD
```
TC antidepressants:
amitriptyline
nortriptyline
clomipramine
imipramine
```
135
What are the causes of serotonin syndrome
exposure to serotoninergic drugs:
- SSRIs (sertraline, citalopram, fluoxetine, St. John's wart)
- SNRIs (venlafaxine, duloxetine)
- MAOis (phenelzine, selegiline, tranylcypromine)
- Ecstasy
136
What 3 drugs can increase the risk of serotonin syndrome when taking a serotoninergic drug
1. methylene blue
2. meperidine
3. fentanyl
137
What are the causes of anticholinergic syndrome
Too much centrally-acting anticholinergic
- atropine
- scopolamine
138
What herbal supplement can induce serotonin syndrome
St John's war
139
what are the causes of neuroleptic malignant syndrome
dopamine depletion in the basal ganglia and hypothalamus d/t dopamine antagonists
- metoclopramide
- haloperidol
- chlorpromazine
- risperidone
Withdrawal from dopamine agonists
140
What are 5 key features of sympathomimetic syndrome
1. agitation
2. hallucination
3. arrhythmias
4. myocardial ischemia
5. NO muscle rigidity!
141
What are 3 treatments for sympathomimetic syndrome
1. vasodilators
2. labetalol
3. supportive care
142
What are 4 key features of tricyclic antidepressant OD
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
What are 3 treatments for tricyclic antidepressant OD
1. Magnesium
2. serum alkalization
3. supportive care
144
What are 6 key features of serotonin syndrome
1. akathisia
2. mydriasis
3. tremor
4. AMS
5. YES muscle rigidity
145
What are 2 treatments for serotonin syndrome
1. cyproheptadine (5-HT2A antagonist)
| 2. Supportive care
146
What are 4 key features of anticholinergic syndrome
1. red, hot, dry skin
2. Mydriasis
3. Delirium
4. NO muscle rigidity
147
What is the treatment for anticholinergic syndrome
physostigmine
148
What are 8 key features of neuroleptic malignant syndrome
1. bradykinesia
2. decreased LOC/coma
3. rhabdomyolysis
4. myoglobinuria
5. acidosis
6. ANS instability
7. normal pupils
8. YES muscle rigidity
149
What are 4 treatments of neuroleptic malignant syndrome
1. bromocriptine
2. dantrolene
3. supportive care
4. ECT
150
Is succinylcholine safe to use in a pt with neuroleptic malignant syndrome
yes
151
Which drug-induced hyperthermic disorders include muscle rigidity
MH
Serotonin syndrome
Neuroleptic malignant syndrome
152
Which drug-induced hyperthermic disorders do not include muscle rigidity
1. sympathomimetic syndrome
2. tricyclic antidepressant OD
3. anticholinergic syndrome
153
How is intraocular perfusion pressure measured
MAP - IOP =IPP
154
What 3 factors determine IOP
1. choroidal blood volume
2. aqueous fluid volume
3. extraocular muscle tone
155
What is normal IOP
10-20 mmHg
156
How is aqueous humor produced
By the ciliary process in the posterior chamber
157
how is aqueous humor reabsorbed
by the canal of Schlemm in the anterior chamber
158
What eye structures are in the anterior chamber
1. iris
2. cornea
3. canal of Schlemm
159
What eye structures are in the posterior chamber
1. Ciliary muscle
2. Ciliary process
3. Lens
160
What 10 anesthetic interventions decrease IOP
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
What 11 anesthetic interventions increase IOP
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
How can ketamine affect the eye
It can cause rotary nystagmus and blepharospasm
163
How does succinylcholine affect IOP in the pt w/ an open globe injury
Can increase IOP by 5-15 mmHg up to 10 min
164
What paralytic should be used in the pt undergoing emergent surgery for an open globe on a full stomach
succinylcholine is ok to use
165
What is glaucoma
chronically elevated IOP leading to retinal artery compression
166
What is the difference between open- and closed-angle glaucoma
open = caused by sclerosis of trabecular meshwork, impairing aqueous humor drainage
closed = caused by closure of anterior chamber, creating mechanical outflow obstruction
167
How is IOP reduced in pts with glaucoma
by using drugs that reduce aqueous humor production or facilitates drainage
168
What are drugs that decrease aqueous humor production
1. acetazolamide inhibits carbonic anhydrase
| 2. timolol
169
What are drugs that facilitate aqueous humor drainage
1. echothiophate irreversible cholinesterase inhibitor
170
What glaucoma drug can prolong duration of succinylcholine
echothiophate b/c it's an irreversible cholinesterase inhibitor
171
What are pts undergoing strabismus surgery at increased risk
PONV
| Activation of oculocardiac reflex
172
```
Avoidance of N2O with ocular air bubbles:
SF6=
Silicone oil=
Air=
Perfluoropropane (C3F8)=
```
SF6= 7-10 days
Silicone oil= 0 days
Air= 5 days
Perfluoropropane (C3F8)= 30 days
173
What does a TAP block target
the nerves of the anterior and lateral abdominal wall
174
What types of procedures is the TAP block best indicated for
Abdominal procedures that involve the T9 to L1 distribution
175
What is the order of tissues traversed when performing a TAP block
1. SQ tissue
2. External oblique muscle
3. Internal oblique muscle
4. Transverse abdominis muscle
5. Peritoneum (NOT traversed but seen on US)
176
Where does innervation of the anterolateral abdominal wall arise
anterior rami of T7-L1
177
Which plane is LA injected with a TAP block
just below the fascial plane between *internal oblique muscle* and *transverse abdominis muscle*
178
What are the 3 landmarks for TAP block
| Name for this triangle?
1. external oblique muscle
2. latissimus dorsi muscle
3. iliac crest
aka triangle of Petit
179
What LA volume is injected per side of a TAP block
15 - 20 mL per side
180
What are 2 complications of TAP block
1. peritoneum puncture
| 2. liver hematoma
181
Define and give example of allodynia
definition = pain d/t stimulus that does not normally produce pain
example= fibromyalgia
182
define and give example of algogenic
definition = a stimulus that is normally expected to produce pain
example = surgical incision
183
define and give example of analgesia
definition = no pain is sensed in response to a stimulus that produces pain
example = opioid analgesics relieve kidney stone pain
184
define and give example of dysesthesia
definition = abnormal and unpleasant sense of touch
example = burning sensation from neuropathy
185
define and give example of hyperalgesia
definition = exaggerated pain response to a painful stimulus
example = remifentanil
186
define and give example of neuralgia
definition = pain localized to dermatome
example = herpes zoster
187
define and give example of neuropathy
definition = impaired nerve function
example = silent MI from diabetic neuropathy
188
define and give example of paresthesia
definition = abnormal sensation described as pins and needles
example = nerve stimulation during RA
189
What 3 non-opioid drug classes are used to modulate pain in the spinal cord
1. tricyclic antidepressants (amitriptyline, nortriptyline)
2. SRIs and NRIs (venlafaxine, duloxetine)
3. SSRIs (citalopram, fluoxetine)
190
What characterizes complex regional pain syndrome
neuropathic pain with autonomic involvement
191
What are 3 risk factors for complex regional pain syndrome
1. female gender
2. previous trauma
3. previous surgery
192
What are 7 treatments for complex regional pain syndrome
1. ketamine infusion
2. memantine (NMDA antagonist)
3. gabapentin
4. regional sympathetic block
5. physical therapy
6. steroids
7. amitriptyline
193
What is the difference between type 1 and type 2 complex regional pain syndrome
type 1 = reflex sympathetic dystrophy with no previous nerve injury
Type 2 = causalgia, with previous nerve injury
194
What is a thoracic paravertebral block
LA injected into the paravertebral space targeting the ventral ramus of spinal nerves as they exit the vertebral foramen
195
What are indications for a thoracic paravertebral block
1. breast surgery
2. thoracotomy
3. rib fractures
196
Indication for celiac plexus block
cancer pain of the upper abdominal organs
197
What are complications of a celiac plexus block
1. orthostatic HoTN
2. retroperitoneal hematoma
3. hematuria
4. diarrhea
5. AAA dissection
6. back pain
198
Indications for superior hypogastric plexus block
Management of cancer pain of the pelvic organs
199
What are complications of superior hypogastric plexus block
retrograde migration of injectate
200
Which antibiotics are beta-lactams
PCN
Cephalosporins
Ampicillin
201
Which antibiotics are aminoglycosides
gentamycin
| streptomycin
202
What are 3 risks of aminoglycoside use
| abx examples
ototoxicity
nephrotoxicity
skeletal muscle weakness
ex: gentamycin, streptomycin
203
Which antibiotics are tetracyclines
doxycycline
204
What are 2 risks of tetracycline use
abx example
1. hepatotoxicity
2. nephrotoxicity
ex: doxycycline
205
Which antibiotics are fluoroquinolones
1. ciprofloxacin
2. levofloxacin
3. moxifloxacin
206
What are 2 risks of fluoroquinolones
abx examples
1. GI intolerance
2. tendonitis and tendon rupture
ex: cipro, levaquin
207
Which antibiotics are macrolides
Erythromycin
208
What is a risk associated with macrolides
abx example
P450 INHIBITION (prolong drug effect)
ex: erythromycin
209
what are risks associated with clindamycin
skeletal muscle weakness
210
What are 3 risks associated with vancomycin
1. HoTN w/ rapid infusion
2. red man syndrome
3. stevens-johnson syndrome
211
What are 2 risks associated with metronidazole
1. peripheral neuropathy
| 2. alcohol intolerance
212
What is the rate of cross-reactivity of PCN and cephalosporin reaction
<1%
213
When can a pt with a PCN allergy receive a cephalosporin
1. If the reaction was NOT IgE mediated (anaphylaxis, bronchospasm, urticaria)
2. the reaction did NOT produce exfoliative dermatitis
214
What are the best alternative abx for a pt with pcn allergy
1. clindamycin
| 2. vancomycin
215
What is the MOA of cephalosporins
They disrupt bacterial cell wall synthesis (peptidoglycan)
216
How often is cefazolin redosed during surgery
q4 hrs
217
What is the MOA of vancomycin
disruption of bacterial cell wall synthesis
218
Why can vancomycin cause hotn
d/t histamine release
219
How is the histamine response of vancomycin reduced
diphenhydramine 1 mg/kg
| cimetidine 4 mg/kg
220
Which 4 antibiotics are contraindicated in pregnancy and why
1. chloramphenicol
2. erythromycin
3. fluoroquinolones
4. tetracyclines
they cross the placenta and impact fetal development
