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Board Exam > Misc. Topics > Flashcards

Misc. Topics Flashcards

1
Q

Best method of preventing heat loss in OR

A

Forced air warming

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2
Q

Modes of heat loss in OR

A

Radiation > Convection > Evaporation > Conduction

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3
Q

Body’s temp control is regulated by

A

Brainstem

Hypothalamus (pre-optic area)

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4
Q

Radiation

A 
#1 source of heat loss (60%)
Protect by covering the skin
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5
Q

Convection

A

20-30% of heat loss

Happens from movement of air over the patient (wind chill)

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6
Q

Evaporation

A

20% of heat loss

Happens from respiration, wounds, and exposure of internal organs

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7
Q

Conduction

A

Only 5% of heat loss

Ex- OR table, IV fluids, and irrigation fluids

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8
Q

Phase I of intra-op heat transfer

A

D/t redistribution of fluids from the central to peripheral compartments
Anesthetic agents cause vasodilation and prevent shivering
Placing warm blankets on the patient BEFORE inducing GA can minimize the peripheral temperature gradient

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9
Q

Phase II of intra-op heat transfer

A

Heat loss to the environment EXCEEDS heat production

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10
Q

Phase III of intra-op heat transfer

A

Heat loss to the environment equals heat production (equilibrium)

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11
Q

CV and pharmacologic consequences of hypothermia

A

CV

  • SNS stimulation
  • Vasoconstriction + decreased tissue PO2
  • Shits O2-Hgb curve to the left
  • Coagulopathy and plt dysfunction
  • Sickling of HgbS

Pharm:

  • Slowed drug metabolism
  • Increased solubility of VAs (prolonged emergence)
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12
Q

Shivering and O2 Consumption

A

Increases O2 consumption by 400-500%!!

- Risk of MI!

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13
Q

Drugs that can be used to treat shivering

A

Meperidine
Clonidine
Precedex

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14
Q

Steps if Airway Fire

A

Remove the ETT and stop flow of all gases
Remove anything else combustable from the airway
Pour cold saline into the airway
If fire still isn’t extinguished, use CO2 extinguisher

After fire under control:

1) Go back to ventilating the patient (avoid nitrous and high O2)
2) Check ETT for damage (any fragments missing?)
3) Perform bronchoscopy to look for airway injury or ETT fragments

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15
Q

This med is the gold standard induction med for ECT

A

Methohexital

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16
Q

3 Drug Induced Hyperthermic Syndromes

A

1) Neuroleptic Malignant Syndrome
2) Serotonin Syndrome
3) Anticholinergic Poisoning

17
Q

Cause of neuroleptic malignant syndrome

A

DA depletion in the basal ganglia and hypothalamus!

From:

  • Reglan
  • Haldol, etc
18
Q

S/S of neuroleptic malignant syndrome

A

1) SEVERE muscle rigidity, muscle necrosis, and rhabdomyolysis, and myoglobinuria.
2) ANS instability

19
Q

Treatment of neuroleptic malignant syndrome

A

DANTROLENE!
Bromocriptine
Supportive care
ECT

20
Q

Cause of Serotonin Syndrome

A

Excess 5HT in the CNS and PNS

Often due to interaction of:
1) SSRI + meperidine or fentanyl

2) MAOI + meperidine or ephedrine

21
Q

S/S of serotonin syndrome

A
  • Akathisia (innter restlessness)
  • Agitation –> coma
  • Muscle rigidity, tremor, and clonus
  • Mydriasis
22
Q

Treatment of serotonin syndrome

A

Cyproheptadine

23
Q

Cause of anticholinergic poisoning

A

Result of excessive Ach blockade in the CNS and PNS

  • Atropine and scopolamine
24
Q

S/S of anticholinergic poisoning

A
  • Delirium
  • Mydriasis
  • Red, hot, dry skin
25
Q

Treatment for anticholinergic poisoning

A

Physostigmine

26
Q

Why is ketamine avoided in eye surgery?

A

It can cause rotary nystagmus and blepharospasm (tight closure of eyelids)

Effect on IOP may or may not exist

27
Q

Effect of sux on IOP

A

Can increase IOP by 5-15mmHg for 10 minutes. This is not reliably blocked by defasciculating dose!

28
Q

3 key considerations for strabismus surgery

A

1) Risk of MH
2) Risk of PONV
3) Risk of OCR

29
Q

Afferent and efferent pathways of the OCR

A 
Afferent = CN V (Trigeminal)
Efferent =  CN X (Vagus)
30
Q

Eye gas bubbles and nitrous

A

SF6 = No nitrous for 7-10 days

C3F8 = No nitrous for at least a month

31
Q

TAP blocks are good for surgeries in this distribution

A

T9-L1

32
Q

What is a TAP block?

A

Transverse Abdominal Plane block

  • Unilateral block that targets the anterior and lateral abdominal wall.
  • Midline incisions and laparoscopic procedures require bilateral blocks
33
Q

LA is deposited between these two landmarks for a TAP block

A

Deposited into the fascial plane between the internal oblique and transverse abdominis muscles of the stomach

34
Q

Complications of TAP block

A

Peritoneal puncture

Liver hematoma

Board Exam (21 decks)

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