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Misc Topics Flashcards

1
Q

What are the 3 main pharmacological modalities to treat shivering?

A

Meperidine
Clonidine
Precedex

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2
Q

How much is O2 consumption reduced for every 1 degree C reduction in body temp?

A

5-7%

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3
Q

What are considered core temperature measurements?

A

Literally all but skin

Esophagus, nasal, rectum, bladder, pa, and tympanic membrane

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4
Q

Where is the ideal placement of an esophageal stethoscope?

A

Distal 1/3 -1/4 of esophagus

(Or 38-42 cm pst incisors)

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5
Q

What are the 3 ingredients to a fire?

A

> Ignition source (cautery, laser)
Fuel (drapes, surgical supplies, ETT)
Oxidizer (oxygen, nitrous oxide)

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6
Q

What are the steps when a fire is present? IN ORDER

A
  1. Stop ventilation and REMOVE ETT
  2. Stop the flow of all airway gases
  3. Remove other flammable material
  4. Pour water or saline into the airway
  5. If fire isn’t extinguished, use CO2 fire extinguisher

Following fire control:
> reestablish ventilation by mask
> check ETT for damage ~ fragments may remain in airway
> perform bronch to inspect for airway injury

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7
Q

Should you squeeze the reservoir bag as you extubated during an airway fire?

A

NO!! It’s like a blow torch

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8
Q

What is a laser an acronym for?

A

L: light
A: amplification
S: stimulated
E: emission
R: radiation

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9
Q

How does laser light differ from ordinary light?

A

Monochromatic (one wavelength)
Coherent (light oscillates in the same phase)
Collimated (light exists as a narrow parallel beam)

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10
Q

What are some facts about CO2 lasers?

A

Wavelength: 10,600 nm
Type of surgery: oropharyngeal/vocal cord
Structures damaged: cornea
Eye protection: Clear lenses

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11
Q

What are some facts about Nd:YAG lasers?

A

Wavelength: 1064 nm
Type of surgery: tumor debunking/tracheal
Structures damaged: retina
Eye protection: Green goggles

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12
Q

What are some facts about Ruby lasers?

A

Wavelength: 694 nm
Type of surgery: retinal
Structures damaged: retina
Eye protection: Red goggles

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13
Q

What are some traits about Argon lasers?

A

Wavelength: 515
Type of surgery: vascular lesion
Structures damaged: retina
Eye protection: Amber goggles

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14
Q

Are ETT flammable?

A

Yes! Most are flammable

***Laser reflective tape is no longer advised ~ use a laser resistant ETT.

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15
Q

What is the most vulnerable part of the ETT?

A

The cuff!

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16
Q

What is the rule of 9s?

A

Divides the body surface into areas that represent 9% or multiples of 9

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17
Q

In the rule of 9s, what % is the head?

A

10%

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18
Q

In the rule of 9s, what % is the trunk?

A

36%

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19
Q

In the rule of 9s, what % is the arm?

A

9%

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20
Q

In the rule of 9s, what % is the leg?

A

18%

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21
Q

In the rule of 9s, what % is the perineum?

A

1%

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22
Q

What is a 1st degree burn?

A

Epidermis only
> spontaneous healing
> stinging, tender, and sore (sun burn)

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23
Q

What is a second degree burn (superficial)?

A

Dermis (this is specifically superficial ~ upper dermis)
> spontaneous healing
> painful (but not as painful as a deep 2nd degree)

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24
Q

What is a second degree deep burn?

A

Dermis (both upper and lower dermis)
> needs a skin graft to heal
> very painful!!

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25
Q

What is a 3rd degree burn?

A

Epidermis, dermis, and subQ tissue
> full thickness
> will require a skin graft
> complete destruction of dermis and epidermis
> ***no sensation d/t nerve ending damage

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26
Q

What is a 4th degree burn?

A

Epidermis, dermis, subQ, and muscle
> full thickness
> will require skin graft
> extends to muscle and bone
> no sensation d/t nerve ending damage

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27
Q

When are fluid shifts and edema formation the greatest?

A

In the first 12 hours

**they begin to stabilize by 24 hours ~ hence why fluid requirements are greatest in the first 24

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28
Q

What should be avoided in the first 24 hours following a burn?

A

Albumin! (It will get lost in the intravascular space)

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29
Q

What does a rising hemoglobin in the first few days post burn suggest?

A

Inadequate volume resuscitation

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30
Q

When do you consider transfusion in a post burn?

A

Hct < 20 (healthy)
Hct < 30 (cards history)

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31
Q

What are the two fluid resuscitation formulas for burned patients?

A

Parkland
Brooke

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32
Q

What is the parkland formula for burns?

A

Remember ~ there are more parks than brooks (4 vs 2)

4 mL x %TBSA burn x kg
> 1/2 in first 8 hours
> 1/2 in next 16 hours

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33
Q

What is the Brooke resuscitation formula?

A

2 mL x %TBSA x kg
> 1/2 in first 8 hours
> 1/2 in next 16 hours

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34
Q

During volume resuscitation in a burn patient, what fluid do you give in the first 24? What about second 24?

A

First 24: LR
Second 24: D5W

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35
Q

What is an adequate UOP for burn resuscitation?

A

Adult: > 0.5 mL/kg/hr
Child: > 1 mL/kg/hr
High electrical injury: > 1-1.5 mL/kg/hr (this is because myoglobin is nephrotoxic)

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36
Q

What is an adequate BP following burn resuscitation?

A

Adult: MAP > 60 mmHg
Child: SBP > 60 mmHg
Infant: SBP 70 -90 + (2 x age in years)

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37
Q

What is an adequate HR following burn resuscitation?

A

80-140

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38
Q

What is an adequate base deficit following burn resuscitation?

A

< 2

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39
Q

What is an adequate oxygen delivery index following burn resuscitation?

A

600 mL O2/min/m2

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40
Q

What is an adequate mixed venous following burn resuscitation?

A

35-40 mmHg

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41
Q

What is abdominal compartment syndrome defined as?

A

> 20 mmHg

Happens a lot following aggressive fluid resuscitation

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42
Q

What is CO affinity to hemoglobin?

A

200x that of O2

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43
Q

What blood takes in a cherry appearance?

A

CO poisoning.

Also the pulse oximeter will not be accurate ~ it cannot distinguish b/t

Tx: hyperbaric oxygen

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44
Q

What is the gold standard for diagnosing airway injury?

A

Fiberoptic bronch

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45
Q

What is the safest method to controlling an airway of a burn patient?

A

EARLY awake fiberoptic.

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46
Q

Should a surgical airway be used in a burn patient?

A

Only as LAST resort. They increase the risk of sepsis and late pulmonary complications.

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47
Q

When does up regulation of extrajunctional receptors begin?

A

After 24 hours

(Sux is safe within first 24!)

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48
Q

What is a good choice of anesthesia med for burns? What is a bad one?

A

Good: ketamine
Bad: etomidate (they need their adrenal fx)

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49
Q

What is electroconvulsive therapy?

A

It’s a treatment of medication-resistant depression as well as mania, catatonia, suicidal ideation

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50
Q

What is the initial response in ECT?

A

Increased PNS activity during the tonic phase (last around 15 seconds)

(Bradycardia, decreased BP, increased oral secretions, increased gastric secretions)

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51
Q

What is the secondary response in ECT?

A

Increased SNS activity during the clonic phase (last several minutes)

(Increased HR, ^BP, ^intragastric pressure, ^cerebral blood flow, ^ICP, ^IOP)

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52
Q

What are ABSOLUTE CONTRAINDICATIONS for ECT therapy?

A

Recent MI (<4-6 mos)
Recent intracranial surgery (<3 mos)
Recent stroke (< 3 mos)
Brain tumor
Unstable cervical spine
Pheochromocytoma

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53
Q

What is the min recommended seizure length in ECT?

A

25 second. Efficacy is better the longer it is

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54
Q

What meds increase seizure duration?

A

Etomidate
Ketamine
Alfentanil
Aminophylline
Caffeine

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55
Q

what are some conditions that increase seizure duration?

A

Hyperventilation/hypocapnia

***less free ionize calcium (Ca increase seizure threshold and stabilize Na channels)

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56
Q

What are some conditions that decrease seizure duration?

A

Propofol
Midazolam
Lorazepam
Fent
Lidocaine

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57
Q

What are some conditions that decrease seizure duration?

A

Hypoventilation
Hypercarbia
Hypoxia

(More free ionized Ca to stabilize Na channels and increase seizure threshold)

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58
Q

What med is considered the gold standard for ECT therapy?

A

Methohexital ~ it produces rapid recovery and DOES NOT affect seizure duration

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59
Q

What is the antidote for neuroleptic malignant syndrome?

A

Bromocriptine

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60
Q

What is the antidote for serotonin syndrome?

A

Cyproheptadine

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61
Q

What is the antidote during anticholinergic syndrome?

A

Physostigmine

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62
Q

What is the equation to Intraocular perfusion pressure?

A

Intraocular perfusion pressure = MAP-IOP

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63
Q

What is normal IOP?

A

10-20

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64
Q

Where is the aqueous humor produced?

A

Ciliary process (in the posterior chamber)

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65
Q

Where is the aqueous humor reabsorbed?

A

The canal of Schlemm (in the anterior chamber)

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66
Q

What are some things that decrease IOP?

A

Hypocarbia
Decreased CVP
Decreased MAP
Volatile anesthetics
Nitrous oxide
NMB (non depolarizing)
Propofol
Benzos
Hypothermia

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67
Q

What are some things that increase IOP?

A

Hypercarbia
Hypoxemia
Increased CVP
Increased MAP
DL/intubation
Straining
Sux
Nitrous oxide (if bubble is in place)
Tberg
Prone

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68
Q

Is sux ok to use in an open globe injury?

A

Yes ~ but Roc is probably the more suitable option

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69
Q

What is glaucoma?

A

Chronically elevated IOP that leads to retinal artery compression

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70
Q

What is open angle glaucoma cause from?

A

Sclerosis of the trabecular mesh work

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71
Q

What is close-angle glaucoma caused from?

A

Closure of the anterior chamber; this creates a mechanical outflow obstruction

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72
Q

What is Echothiophate?

A

Cholinesterase inhibitor that promotes aqueous drainage humor via the canal of schlemm

**it can prolong duration of Sux

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73
Q

What are the two biggest anesthetic considerations during strabismus surgery?

A

Increased PONV
Increased risk of activating the Oculocardiac reflex

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74
Q

How long should you discontinue N2O prior to SF6 bubble placement? How long should should you avoid N2O?

A

Discontinue: 15 mins before
Avoid: 7-10 days

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75
Q

How long should you discontinue N2O prior to silicone oil bubble placement? How long should should you avoid N2O?

A

Avoid: 0

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76
Q

How long should you discontinue N2O prior to air bubble placement? How long should should you avoid N2O?

A

Avoid: 5 days

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77
Q

How long should you discontinue N2O prior to perfluoropropane bubble placement? How long should should you avoid N2O?

A

Avoid: 30 days

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78
Q

What type of procedures are best suited for TAP blocks?

A

General, GYN, and urologic that involve the T9-L1 distribution

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79
Q

What are the landmarks to the TAP block?

A

The Triangle of Petit

External oblique muscle
Latissimus dorsi muscle
Iliac crest

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80
Q

What are the two most common complications of a TAP block?

A

Liver hematoma
Peritoneal puncture

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81
Q

What is allodynia?

A

Pain due to a stimulus that does not normally produce pain

**fibromyalgia

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82
Q

What is algogenic?

A

A stimulus that is normally expected to produce pain

**surgical incision

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83
Q

What is analgesia?

A

No pain is senses in response to a stimulus that produces pain

**opioids

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84
Q

What is dysesthesia?

A

Abnormal and unpleasant sense of touch

**burning in DM patients

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85
Q

What is hyperanalgesia?

A

Exaggerated pain response to a pain stimulus

** remifentanil

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86
Q

What is neuralgia?

A

Pain localized to a dermatome
**herpes zoster

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87
Q

What is neuropathy?

A

Impaired nerve function
* silent MI r/t DM

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88
Q

What is paresthesia?

A

Abnormal sensation described as pins and needles

Nerve stimulation during block placement

89
Q

What are the two types of complex regional pain syndrome?

A

Type 1: reflex sympathetic dystrophy
Type 2: causalgia

90
Q

How is complex regional pain syndrome described?

A

Neuropathic pain with autonomic involvement

91
Q

What are the main risk factors to complex regional pain syndrome?

A

Female gender
Previous trauma
Or previous surgery

92
Q

What is the key difference b/t type 1 CRPS and Type 2 CRPS?

A

Type two is ALWAYS preceded by a nerve injury (type 1 is NOT)

93
Q

What is considered a single shot, unilateral epidural block that provides analgesia for breast surgery, thoracomty and rib fractures?

A

Paravertebral block

This block targets the ventral ramus of the spinal nerve

94
Q

What is a celiac plexus block useful for?

A

Cancer pain of upper abd organs (distal esophagus, liver, pancreas, small intestine, and parts of the colon.)

95
Q

What is a superior hypo gastric block useful for?

A

Cancer pain of pelvic organs (uterus, ovaries, prostate, and descending colon)

96
Q

What is a sphenopalatine block used for?

A

Relieve postural puncture headache.

97
Q

What is a complication of a retrobulbar block?

A

The optic nerve is PART OF THE CNS. You can cause a subarachnoid block in the optic sheath. If local anesthetic is injected into optic sheath, it can migrate over and affect CN 2 and 3 ~ this results in contralateral Amaurosis (blindness)

***it’s essential to assess contralateral pupil

***in addition, if local anesthetic reaches the brainstem, it can cause apnea

98
Q

What are examples and risks r/t beta-lactam abx?

A

examples: PCN, cephalosporins
Risks: allergic reaction

99
Q

What are examples and risks r/t aminoglycosides?

A

examples: gentamycin, streptomycin
Risks:ototoxicity, nephrotoxicity, skeletal muscle weakness (they may potentiate NMB)

100
Q

What are examples and risks r/t tetracyclines?

A

examples: doxycycline
Risks: hepatotoxicity, nephrotoxicity

101
Q

What are examples and risks r/t fluoroquinolones!

A

examples: ciprofloxacin, Levofloxacin, moxifloxacin
Risks: GI intolerance and tendinitis and tendon rupture

102
Q

What are examples and risks r/t macrolides?

A

examples: erythromycin
Risks: p450 inhibition

103
Q

What are examples and risks r/t clindamycin?

A

Risks: skeletal muscle weakness (caution with NMB) ; allergy

104
Q

What are examples and risks r/t vancomycin?

A

Risks: hypotension with rapid infusion (d/t histamine), red man syndrome, Steven-Johnson syndrome

105
Q

What are examples and risks r/t metronidazole?

A

Risks: peripheral neuropathy and alcohol intolerance

106
Q

If a patient has a PCN allergy, when can they receive a cephalosporin?

A

Was not IgE mediated (anaphylaxis)
Did not produce exfoliative dermatitis (Steven Johnson syndrome)

107
Q

What is the most common SE of antibiotics?

A

Pseudomembranous colitis

108
Q

How do cephalosporin and Vanco act?

A

They disrupt bacterial cell wall synthesis (in a different way)

109
Q

How often should ancef be re-doses?

A

Q 4 hours

110
Q

What antibiotics can impact fetal development?

A

Tetracyclines
Fluoroquinolones
Erythromycin
Chloramphenicol

111
Q

What is the abx of choice for a MRSA infection?

A

Vanco

112
Q

What is the MOST important method of infection prevention?

A

Hand washing

113
Q

What is the MOsT common source of blood stream infection in the hospital?

A

Central line

114
Q

What are the 7 SCIP protocols?

A

> Abx within 60 mins
abx is determined by site of surgery
abx discontinued within 24 hours
BBG < 200 for cardiac surgery
surgical patient get hair removal
colorectal patients are normothermic > 36
post op wound drainage is diagnosed during initial hospitalization

115
Q

What is the most common cause of HIV occupational exposure?

A

Needle stick

Percutaneous injury (needle): 0.3%
Mucous membrane: 0.09%

116
Q

What is a classic example of a prion disease?

A

Creutzfeldt- Jakob disease
(Mad cow disease)

**it can lead to encephalopathy and dementia

117
Q

What are the most common S&S of tuberculosis?

A

Productive cough, hemoptysis, weight loss, fever, night sweats, anorexia and malaise

118
Q

What is the most common test for TB?

A

Mantoux test

119
Q

What is a + Mantoux test?

A

Site of induration > 10mm (> 5 mm in the immunocompromised)

***a positive skin test necessitates a chest X-RAY

120
Q

What is the first-lien agent for TB?

A

Isonaizid (but it causes neuropathy and hepatotoxicity)

Rifampin may also be used (causes thrombocytopenia, leukopenia, anemia, kidney failure; AND sweat, urine, and tears turn orange)

121
Q

What is associated with the highest risk of skin test conversion in the health care professional?

A

number 1: Bronchoscope

Then ETT intubation

122
Q

What WBCs are considered granulocytes?

A

Neutrophils, basophils, and eosinophils

123
Q

What WBCs are considered agranulocytes?

A

Monocytes and lymphocytes

124
Q

What is the most abundant WBC?

A

Neutrophil ~ immune defense

60% of all WBCs

125
Q

What are Basophils?

A

Essential to allergic reactions
Release histamine, cytokines, and prostaglandins

126
Q

What are eosinophils?

A

Defend against parasites

127
Q

What are monocytes?

A

Fight bacterial, viral, and fungal infections

Release cytokines

Present piece of pathogens to T-lymphocytes

128
Q

What are lymphocytes?

A

B-humoral immunity (produce antibodies)

T- cell mediated immunity (do NOT produce antibodies)

Natural killer cells: limit the spread of tumor and microbial cells

Function is reduced by opioids

129
Q

What is a classic example of a type 1 hypersensitivity?

A

Anaphylaxis

130
Q

What is a classic example of a type 2 hypersensitivity?

A

ABO incompatibility

131
Q

What is a classic example of a type 3 hypersensitivity?

A

Serum sickness after a snake bite

132
Q

What is a classic example of a type 4 hypersensitivity?

A

Graft vs host

133
Q

What is the main different b/t anaphylaxis and anaphylactiod?

A

Anaphylaxis requires previous sensitization or cross-sensitivity

134
Q

What does the H1 receptor do?

A

Vasodilation
Increased vascular permeability
Smooth muscle contraction (not vascular)

135
Q

What does the H 2 receptor do?

A

Increase gastric secretion
Cardiac stimulation (tachycardia)

136
Q

What do leukotrienes and prostaglandins do?

A

Bronchoconstriction and vasodilation

137
Q

What is a type 1 sensitivity?

A

Antigen + antibody interaction in a patient with a previous sensitization

IgE mediated

**anaphylaxis

138
Q

What is the best lab to determine if an allergic response has occurred?

A

Tryptase ~ released from mast cells

139
Q

What is a type 2 sensitivity?

A

IgG and IgM antibodies bind to cell surfaces or extracellular regions

Activates a complement cascade

**HIT, ABO incompatibility

140
Q

What is a type 3 hypersensitivity?

A

An immune complex is formed and deposited into the patient’s tissue

Activates the complement cascade

**snake bite

141
Q

What is a type 4 hypersensitivity?

A

Allergic reaction is delayed at lease 12 hours

**contact dermatitis, graft vs host, tissue rejection

142
Q

What is the treatment for intraoperative anaphylaxis?

A

> Discontinue agent
increase FiO2 and provide airway support
epi
iv hydration 10-20 mL/kg
H1 receptor antagonist (benadry)
H2 receptor antagonist (ranitidine)
hydrocortisone
albuterol
vaso

143
Q

In what three ways does epi treat anaphylaxis?

A

Prevents degranulation
Provides CV support
And dilates the airway

144
Q

What are the MOST common cause of allergic reactions?!

A

Neuromuscular blocks

(Sux is the worst)

145
Q

What are the 3 most common culprits for an intraoperative allergic reaction?

A

NMB (most)
Latex
Abx

146
Q

What is doxorubin’s main side effect?

A

Cardiac toxicity

“The D kind of looks allied a heart”

147
Q

What is bleomycin’s main side effect?

A

Pulmonary toxicity

***Bleo and Blebs!! Also it’s affects right where the boobs are!

148
Q

What is Cisplatin’s main side effect?

A

Renal toxicity

(Remember the chemo man ~ ears and beans) ~ both are shaped like a C!

149
Q

What is Methotrexate’s main side effect?

A

Bone marrow suppression

(That’s why we use it in Lupus and RA)

150
Q

What is Vincristine and Vinblastine’s main side effects? Chemo man!

A

Peripheral neuropathy (the limbs look like vs)

151
Q

What are some traits about gastrin?

A

Site of production: G cells in stomach
Stimulus: food in the stomach
Function: ^ gastric acid/Pepsinogen secretion

152
Q

What are some traits about secretin?

A

Site of production: S cells ~ small intestine
Stimulus: acid in duodenum
Function: increase pancreatic bicarb; decrease gastric

153
Q

What are some traits about cholecystokinin?

A

Site of production: I cells ~small intestine
Stimulus: food in duodenum
Function: gallbladder contraction, ^ pancreatic enzyme release, decrease gastric emptying

154
Q

What are some traits about gastric inhibitory peptide?

A

Site of production: K cells ~ small intestine
Stimulus: food in duodenum
Function: increased insulin release; decreased gastric acid secretion and reduced gastric motility

155
Q

What are some traits about somatostatin?

A

Site of production: D cell in the pancreas
Stimulus: food in gut/Gastrin/CCK
Function: decrease all GI function
(Off switch!)

156
Q

What is increased in a patient with Zollinger-Ellison syndrome?

A

Gastrin

157
Q

What is used for treatment of carcinoid tumors?

A

Somatostatin

158
Q

What are some things that Decrease lower sphincter tone?

A

Anticholinergics
Cricoid pressure
Pregnancy

159
Q

What are some things that increase lower sphincter tone?

A

Reglan!

160
Q

Where does the vomiting center reside?

A

Nucleus tractus solitarius (medulla)

161
Q

What 3 areas does sensory input to the vomiting center come from?

A

Chemoreceptor trigger zone
GI tract
Vestibular apparatus

162
Q

What are some traits about 5-HT3 antagonists?

A

Receptor target: 5-HT3
Ligand: serotonin
Example: ondansetron
Dose: 4-8 mg

163
Q

What are some traits about Neurokinin-1 antagonists?

A

Receptor target: NK-1
Ligand: substance P
Example: aprepitant
Dose: 40

164
Q

What are some traits about dopamine antagonists?

A

Receptor target: D2
Ligand: dopamine
Example: droperidol (0.625 mg), Haloperidol (0.5 mg) , metoclopramide (10 mg)

165
Q

What are some traits about antihistamines

A

Receptor target: H1 and M1
Ligand: histamine and acetylcholine
Example: Benadryl (25) and promethazine (12.5 mg)

166
Q

What are some traits about anticholinergics?

A

Receptor target: M1
Ligand: acetylcholine
Example: scopolamine
Dose: 1.5 mg

167
Q

What are some traits about steroids?

A

Receptor target: intracellular receptors
Ligand: steroid
Example: decadron
Dose: 4-10 mg

168
Q

What patient risk factors increase the risk of PONV?

A

Female
Non-smoker
Young
History of motion sickness
History of PONV

169
Q

What are surgery risk factors to PONV?

A

Long surgery
GYN
Laparoscopic
breast
plastics
peds

170
Q

What are some anesthetic risk factors to PONV?

A

Anesthetic gas
Nitrous oxide > 50%
Opioids
Etomidate
Neostigmine

171
Q

What is the most common SE of Zofran?

A

HA and diarrhea

172
Q

Which antiemetics prolong the QT?

A

5-HT3 and butyrophenones

173
Q

Which drugs are contraindicated in a patient with Parkinson’s?

A

Dopamine antagonists/ butyrophenones

174
Q

What should patients undergoing ear surgery receive as an antiemetic?

A

Agents that target the vestibular system (scopolamine and Benadryl)

175
Q

When is scopolamine best applied?

A

> 4 hours before anesthesia

176
Q

What is the non pharmacological method of reducing PONV?

A

The P6 acupressure point

177
Q

What are the complications (symptoms) r/t bone cement implantation syndrome?

A

Bradycardia
Dysrhythmias
Hypotension
Pulmonary HTN
Hypoxia
Cardiac arrest

178
Q

Which surgery has the highest risk of bone centenary implantation syndrome?

A

Hip arthroplasty

179
Q

What are the first signs of bone cement implantation syndrome in an AWAKE patient? What about in the asleep patient?

A

Awake: Dyspnea and altered mental state

Asleep: decreased EtCO2

180
Q

What is the triad of Fat embolism syndrome?

A

Resp insufficiency (hypoxemia, ARDs)
Neurological involvement (confusion/coma)
Petechial rash

181
Q

What procedure is associated with the highest risk of bone cement implantation syndrome?

A

Hip arthroplasty

182
Q

What is the max inflation time?

A

2 hours

183
Q

What is the tourniquet inflation pressure for the upper extremity?

A

70-90 mmHg above the SNP

184
Q

What is the inflation pressure in the lower extremity?

A

2x the SBP

185
Q

What is the inflation pressure in a bier block?

A

250 mmHg or 100 mmHg over the SBP

186
Q

What is the inflation pressure in the lower extremity?

A

350-400 mmHg

187
Q

What does releasing the tourniquet produce?

A

Increased EtCO2
Decreased core body temp
Decreased BP
Decreased SvO2
Metabolic acidosis

188
Q

When does tourniquet pain begin?

A

45-60 mins after inflation

**Usually do to tissue ischemia
**also this type of pain is unresponsive to opioids

189
Q

What is Samter’s triad?

A

Combo of asthma, nasal polyps, and allergic rhinitis

**these patients can develop life threatening bronchospasm following asa admin

190
Q

Why have most COX 2 inhibitors been removed off the market?

A

Cardiovascular side effects

191
Q

What is ephedra?

A

Diet aid/ athletic enhancer
> can cause serotonin syndrome with MAOs
> catecholamine depletion

192
Q

What is garlic?

A

Anti platelets, hypertension, and HLD
> increased bleeding risk
> decreased serum glucose

193
Q

What is ginger?

A

Nausea
> increased bleeding risk

194
Q

What is ginkgo Biloba?

A

Anti-aging, and poor circulation
> increased bleeding risk

195
Q

What is ginseng?

A

Antioxidant
> increased bleeding risk
> enhances SNS effects if sympathomimetics
> may cause hypoglycemia

196
Q

What is Kava-Kava?

A

Anxiety
> decreased MAC (^ GABA)
> may prolong duration if anesthetic agents

197
Q

What is licorice?

A

Gastric and duodenal ulcers
> mimics aldosterone
> Na and H2O retention ~ decreased K
> Conn’s syndrome

198
Q

What is saw palmetto?

A

BPH
> increased bleeding risk

199
Q

What is St. John’s wort?

A

Depression
> induction of CYP 3A4
> decreased serum of warfarin/ dig
> may prolong duration of anesthetic agents
> can cause serotonin syndrome with MAOIs

200
Q

What is Valerian?

A

Anxiety med
> decreases MAC
> may prolong anesthetic agents
> abrupt discontinue can cause withdrawal

201
Q

Why are the 4 G’s that affect bleeding?

A

Garlic
Ginkgo
ginseng
Ginger

202
Q

What is the number 1 cause of anesthetic mortality?

A

Human error

203
Q

What is the rate of death in an ASA 1?

A

.04 deaths per 10,000

204
Q

What is the rate of death in an ASA 2?

A

0.5 deaths per 10,000

205
Q

What is the rate of death in an ASA 3?

A

2.7 deaths per 10,000

206
Q

What is the rate of death for an ASA 4?

A

5.5 deaths per 10,000

207
Q

What is the most common cause of injury that results in a closed claim?

A

Regional anesthesia

208
Q

What are the most common causes of injury that result in a closed claim? In order

A

Regional > resp events > cardiac events > equipment failure

209
Q

What MUST be performed before every patient?

A

> good suction
function of monitors and alarms
check vaporizers ~ filled with caps tight
check carbon absorbent
perform a high pressure leak test
assess unilateraldirectional valves
document you completed procedures

210
Q

How often must the ventilator be calibrated?

A

Once a day

211
Q

What are the 4 zones of the MRI suite?

A

> Zone 1: public access and requires no supervision (hallway outside MRI suite)
zone 2: public access + min supervision (entrance to MRI suite)
zone 3: limited access and strict supervision (MRI control room)
zone 4: very limited access + very strict supervision (MRI scanner room)

212
Q

What must a patient not have prior to going to the MRI?

A

pacemaker/ICD
Aneurysm clip
Metal implant
Implantable pump
Shrapnel

213
Q

What 5 areas does the modified Alfred’s score address?

A

Activity
Respiration
Circulation
Consciousness
Oxygen saturation

214
Q

What adhere score suggests readiness for discharge from PACU?

A

9

215
Q

What is the aldrete score for activity?

A

2: moves all extremities voluntarily
1: moves 2 extremities voluntarily or on command
0: cannot move extremities or head

216
Q

What is the aldrete score for resp?

A

2: breathes normally and can cough
1: dyspneic or shallow
0: apneic

217
Q

What is the aldrete score for a circulation?

A

2: BP within 20 mmHg of preanesthetic value (min SBP of 90)
1: BP within 20-50 of preanesthetic value
0: BP > 50 mmHg of preanesthetic value

218
Q

What is the aldrete score for consciousness?

A

2: fully awake
1: arousable
0: unresponsive to voice

219
Q

What is the aldrete score for oxygen saturation?

A

2: > 92% on RA
1: > 90%, but need O2
0: < 90 with O2

Apex (47 decks)

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