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Miscellaneous Flashcards

1
Q

What % of surgical patients have recall?

A

12%

*Greatest in trauma

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2
Q

Where do the vertebral arteries arise from?

A

The subclavian arteries

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3
Q

What 3 vessels can be most easily compressed during mediastinoscopy?

A
  1. Innominate (R carotid and R subclavian)
  2. R brachiocephalic
  3. R common carotid
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4
Q

What are the top 3 complications of a mediastinoscopy?

A
  1. Hemorrhage - have blood available
  2. Pneumo (R. side)
  3. Recurrent laryngeal nerve injury (50% of cases are permanent)
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5
Q

What 2 nerves are around the aortic arch and should be considered during a mediastinoscopy?

A

L recurrent laryngeal nerve

Phrenic nerve

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6
Q

What is the proper position of the Aline, BP cuff, and pulse ox for a mediastinoscopy?

A

Aline - R radial artery
BP cuff - L arm
Pulse ox - R finger if no Aline, L finger if Aline

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7
Q

Rheumatoid Arthritis

A 
Symmetric polyarthropathy 
Significant systemic involvement 
Cervical vertebral involvement 
Consider cricoarytenoid involvement - hoarseness or stridor 
PFTs and ABGs - restrictive 
Tx: ASA, corticosteroids
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8
Q

Osteoarthritis

A 
Degenerative 
Articular cartilage 
Lack of inflammatory reaction 
Primarily - middle to lower cervical spine + lower lumbar area 
Tx: ASA, NO corticosteroids
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9
Q

Pheochromocytoma

Tissue and location?

A

Tumor of the adrenal medullary or chromaffin tissue of the paravertebral sympathetic chain
Found in the abdominal cavity (95%)
Originates in the adrenal medulla (90%)

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10
Q

Manifestations of a Pheochromocytoma

A 
Paroxysmal HTN
Sweating 
Tremulousness 
Tachycardia 
Headache
Palpitations 
Orthostatic hypotension
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11
Q

What is the diagnostic triad of a pheochromocytoma?

A
  1. Diaphoresis
  2. Tachycardia
  3. Headaches
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12
Q

What will happen if a pheochromocytoma is left untreated?

A

Patient may die from CHF, MI, or intracerebral hemorrhage

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13
Q

Describe the pre-op prep for a pheochromocytoma.

A

Alpha block - BP control
Phenoxybenzamine
Prazosin

Beta block - HR control

Correct fluid status

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14
Q

Anesthesia Goals for a Pheochromocytoma

A

Continue pre-op therapy
Do NOT stimulate the SNS
Control hemodynamic swings

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15
Q

What is the goal of OLV?

A

Optimize arterial oxygenation

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16
Q

Explain the placement of the Robertshaw tube.

A

Concave cure of tube is anterior
After the tip of the tube passes the cords the tube is turned 90 deg to the LEFT and advanced until RESISTANCE is met
Inflate tracheal cuff
Confirm bilateral and equal breath sounds

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17
Q

ASA Physical Status Classification

Class 2

A 
MILD that only SLIGHTLY limits activity 
Heart disease 
Essential HTN 
DM
Anemia 
Extremes of age
Morbid obesity 
Chronic bronchitis
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18
Q

ASA Physical Status Classification

Class 3

A 
SEVERE that limits activity 
Heart disease 
Hx of prior MI and chest pain 
Poorly controlled HTN 
DM with complications 
Chronic pulmonary disease
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19
Q

ASA Physical Status Classification

Class 4

A

Constant THREAT to life
CHF
Persistant chest pain
Any advanced kidney, liver, or pulmonary disease

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20
Q

ASA Physical Status Classification

Class 5

A

Moribund patient - NOT expected to live 24 hours
PE
Cerebral trauma
Ruptured AAA

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21
Q

ASA Physical Status Classification

Class 6

A

Brain-dead

Organ donation

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22
Q

List examples of when to add “E” to the ASA class.

A

Appendicitis
D&C for bleeding
Non-elective basis

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23
Q

List the one absolute contraindication for performing anesthesia for mediastinoscopy.

A

Previous mediastinoscopy

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24
Q

A patient with a mediastinal mass is induced and intubated and BP falls dramatically. What should you do?

A

Change positions

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25
Q

What are the hallmark signs for a tension pnemo?

A 
Hypotension
Hypoxemia
Tachycardia
Increased CVP
Increased PIP
Absence of breath sounds on the affected side 
Tracheal shift
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26
Q

What is the treatment for a tension pneumo?

A

Chest decompression via a large bore needle through the chest wall in the 2nd ICS MCL

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27
Q

What accounts for nearly all cases of superior vena cava syndrome?

A

Cancer

Mediastinal tumor that obstructs venous drainage in the upper thorax

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28
Q

What are the 4 absolute indications for OLV?

A
  1. Presence of blood or infectious secretions in one lung
  2. Bronchopulmonary lavage
  3. Unilateral bullae
  4. Bronchopleural fistula
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29
Q

Identify the 2 greatest risk factors predicting morbidity in the patient undergoing a carotid endarterectomy.

A
  1. Cigarette smoking

2. HTN

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30
Q

Why should you avoid dextrose-containing fluids in a patient undergoing a carotid endarterectomy?

A

Moderate hyperglycemia worsens ischemic brain injury

Hyperglycemia is least tolerated with carotid occlusion

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31
Q

What regional block is performed for a CEA?

A

Cervical plexus block

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32
Q

Where should you keep the PaCO2 during a CEA?

A

Normocarbia

Avoid hypocapnia-induced vasoconstriction

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33
Q

What is the most reliable way to assess cerebral perfusion during a CEA?

A

An awake patient

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34
Q

What should you do if your patient develops symptomatic bradycardia with a labile BP during a CEA?

A

Have the surgeon anesthetize the baroreceptors with lidocaine

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35
Q

What is the incidence of post-op HTN following a CEA?

A

10-66%

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36
Q

What are the first and second most common cause of morbidity and mortality associated with a CEA?

A
  1. MI

2. Stroke

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37
Q

What is the leading cause of perioperative mortality at the time of peripheral vascular surgery?

A

Coronary artery disease

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38
Q

What is reactive hyperemia?

A

4-7 fold increase in BF to tissues that had been deprived of flow
Metabolites cause vasodilation when flow is reestablished

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39
Q

When the abdominal aortic cross clamp is removed, would you increase or decrease MV?

A

Increase MV

Hypocarbia - constrict vessels, divert flow to ischemic tissues = inverse/reverse steal, Robin Hood effect

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40
Q

Does renal blood flow increase, decrease, or remain unchanged after infrarenal placement of the cross-clamp?

A

Decrease

To prevent renal failure - keep up with fluids*, mannitol prior to cross-clamping, lasix post cross-clamping

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41
Q

Aneurysm Classification System
DeBakey
Stanford

A

DeBakey
Type I - tear originates in the ascending aorta and the dissection is not confined
Type II - dissection is confined to ascending aorta
Type IIIa - dissection is confined to the descending thoracic aorta
Type IIIb - dissection extends into the abdominal aorta and iliac arteries

Standford
A - ascending aorta is involved
B - ascending aorta is NOT involved

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42
Q

What is the fluid of choice for a bowel obstruction?

A

Fluid supplemented with K

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43
Q

The surgeon is complaining of “active bowel.” What should you do?

A

Give an antimuscarinic - atropine or glyco

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44
Q

What electrolyte disturbances are expected during a Whipple procedure?

A

Hypocalcemia
Hypomagnesemia
Hypokalemia
Hypochloremic metabolic alkalosis

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45
Q

During laparoscopic procedure the patient develops a gas embolus. What position should the patient be placed?

A

L lateral decubitus position

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46
Q

Laparoscopic tubal ligation…
HTN and bradycardia
Hypotension and tachycardia

A

HTN and bradycardia - gas insufflation 20-25 cmH2O increases CVP and CO

Hypotension and tachycardia - gas insufflation 30-40 cmH2O decreases CVP and CO

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47
Q

TURP Syndrome - Acute Hyponatremia S/S

A 
Respiratory distress 
HTN or hypotension 
Widened QRS or increased ST segment 
Dysrhythmias and bradycardia 
Hemolysis 
ARF
Hyponatremia, hypoosmolarity 
Hyperglycinemia
Hyperammonemia 
N/V
Confusion
Seizures
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48
Q

TURP Syndrome Treatment

A 
Give O2
Provide circulatory support 
Notify surgeon
Terminate procedure 
Send labs 
12-lead ECG 
Fluid restriction and Lasix
Hypertonic saline (3%) - rarely necessary
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49
Q

What non-electrolytes are found in irrigating solutions used for TURP?

A
  1. 5% glycine OR

2. 7% sorbitol and 0.54% mannitol

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50
Q

What are SE of TURP when glycine is used?

A

Hyperglycinemia…transient blindness, ammonia toxicity, N/V, headache, ECG changes

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51
Q

What causes coagulopathies during TURP?

A

Dilutional thrombocytopenia

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52
Q

The patient undergoing a TURP with a spinal block experiences shoulder pain. What are 2 possible causes?

A
  1. Perforated bladder - irrigating fluid is entering the peritoneal cavity and irritating the diaphragm
  2. MI - common cause of death in these patients
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53
Q

What level of regional anesthesia is needed for TURP?

A

T10

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54
Q

Sudden N/V and abdominal pain in the awake patient undergoing surgical resection of the prostate gland is most likely due to…

A

Urinary bladder perforation

Incidence 1%

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55
Q

What happens if you rapidly treat hyponatremia?

A

Central pontine myelinolysis

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56
Q

Name 3 anesthetic concerns for strabismus surgery.

A
  1. Oculocardiac reflex
  2. PONV (50-80%)
  3. MH - thought to reflect an underlyting myopathy
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57
Q

What nerves carry afferent and efferent action potentials for the oculocardiac reflex?

A

Afferent - Trigeminal CN 5

Efferent - Vagus CN 10

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58
Q

Which muscle when pulled during strabismus surgery would most likely trigger the oculocardiac reflex?

A

Medial rectus

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59
Q

What are 3 ECG manifestations of the oculocardiac reflex?

A
  1. Bradycardia
  2. Junctional rhythm
  3. PVCs
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60
Q

Are antimuscarinics effective in suppressing the oculocardiac reflex? Retrobulbar block?

A

NO and NO

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61
Q

List the 3 desired effects of a retrobulbar block.

A
  1. Akinesia
  2. Anesthesia
  3. Abolishment of oculocardiac reflex
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62
Q

What is the mechanism by which a patient can receive a total spinal after retrobulbar block?

A

Perforation of the meningeal sheaths that surround the optic nerve
*Suspect if patient has difficult swallowing and becomes apneic

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63
Q

What is the most frequent complication of a retrobulbar block?

A

Hemorrhage

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64
Q

What IOP is considered normal? Abnormal?

A

Normal IOP: 10-22
Abnormal IOP: >25
*Determined by the rate of aqueous humor formation and the rate of outflow

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65
Q

List 3 parameters that determine the rate of aqueous humor formation.

A
  1. CVP - direct *(most profound effect)
  2. BP - direct
  3. PaCO2 - direct
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66
Q

What is sulfur hexafluoride?

A

Inert gas that is less soluble in blood than nitrogen and much less soluble than nitrous oxide
Injected into the posterior chamber of the eye during vitreous surgery
Bubble size doubles from nitrogen moving into bubble
Flattens a detached retina and allows correct healing
*Fick’s law of diffusion
*AVOID nitrous oxide for 10 DAYS after

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67
Q

What do you need to avoid in the intoxicated patient with an open-globe injury?

A

Gagging, coughing, straining
Avoid Sux if possible (increases IOP 6-8 mmHg within 1-4 min)
RSI w/o Sux would be the best

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68
Q

Respiratory obstruction after thyroid surgery is most likely due to what?

A

Tracheomalacia

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69
Q

What does PTU and iodine do prior to thyroid surgery?

A

PTU - inhibits thyroid hormone synthesis, reduces gland vascularity
Iodine - reduce gland vascularity

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70
Q

What is your most important concern for the patient undergoing thyroidectomy?

A

Maintain body temp

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71
Q

What intubation technique is contraindicated in a patient with a LeFort III fracture?

A

Nasotracheal intubation

*Place patient in lateral position and pull mandible or maxilla forward to secure the airway

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72
Q

How long does it take for the tract from stoma to trachea to establish?

A

5 days

*Do NOT change or remove a trach tube w/in 5 days

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73
Q

During radical neck dissection, the QT interval may become prolonged. Explain.

A

Trauma to the R stellate ganglion and cervical autonomic NS

Lowers the threshold to V.Fib

74
Q

What is the best way to prevent hypotension during radical neck dissection?

A

Block the carotid sinus nerve with lidocaine

75
Q

What is the major anesthetic consideration for the patient undergoing surgery for breast augmentation?

A

Avoid MR so that nerve function can be assessed

76
Q

Which causes greater stimulation, surgical incision or intubation?

A

Intubation!

25% will exhibit severe HTN

77
Q

How many total seizure seconds of ECT are generally needed to see a good therapeutic effect?

A

400-700 seconds

30-60 sec each session

78
Q

List 6 absolute contraindications to ECT.

A
  1. Pheo
  2. MI < 6 weeks ago
  3. CVA < 3 mo ago
  4. Intracranial surgery < 3 mo ago
  5. Intracranial mass lesion
  6. Unstable cervical spine

Relative: CHF, PM, major bone fracture, pregnancy

79
Q

What are the autonomic s/s of ECT?

A

Immediate parasympathetic NS stimulation followed by late SNS stimulation

80
Q

Can ECT cause memory loss?

A

YES, retrograde memory loss lasting 2-3 weeks

81
Q

What is the chief cause of blood loss during spinal instrumentation and fusion procedures?

A

Bone decortication/bone manipulation

82
Q

What are the strongest predictors of an increased risk for perioperative MI and increased risk of post-op death?

A

Ischemic heart disease (prior MI or angina)

CHF

83
Q

List 4 most common causes of hypertension.

A
  1. Pain
  2. Hypercapnia
  3. Hypoxia
  4. Fluid overload
84
Q

Define hypertensive crisis.

A

DBP > 130 mmHg

85
Q

Your patient is hypotensive. What ventilation changes can you make to help?

A

Decrease PEEP
Switch to CPAP
Do NOT increase the I:E ratio (this creates auto-PEEP)

86
Q

List causes of unilateral decrease in breath sounds during GA.

A
  1. Migration of ETT into one of two main bronchi
  2. Pneumo
  3. Mucous plug
  4. Atelectasis
87
Q

Ischemia of the tracheal mucosa is likely to occur when the pressure in the cuff of the ETT exceeds what level?

A

32 mmHg

*This is capillary hydrostatic pressure

88
Q

What is the most frequent cause of upper airway obstruction in the unconscious patient?

A

Tongue and other soft tissue structures falling back against the posterior pharyngeal wall

89
Q

What is the leading cause of death in patients undergoing total joint replacement?

90
Q

Fat Embolism Syndrome has been associated with what?

A 
Acute pancreatitis 
Cardiopulmonary bypass 
Parental infusion of lipids 
Liposuction 
*Syndrome usually occurs 12-72 hours after insult
91
Q

What triad of s/s should arouse suspicion of fat embolus syndrome?

A
  1. Hypoxemia
  2. Mental confusion
  3. Petechiae
92
Q

What agent may be administered prophylactically for patients at risk for fat embolism syndrome?

A

Corticosteroids

Limit endothelial damage

93
Q

What ECG change is seen in the hyperparathyroid patient?

A

Shortened QT interval

Hypercalcemia can also cause bradycardia

94
Q

When do s/s of hypocalcemia after thyroidectomy develop?

A

24-72 hrs post-op

May manifest 1-2 hrs after surgery

95
Q

What are 2 causes of stridor following thyroidectomy?

A
  1. Hypocalcemia

2. Bilateral damage to recurrent laryngeal nerves

96
Q

What is the most common nerve injury associated with thyroid surgery?

A

Unilateral recurrent laryngeal nerve damage

Hoarseness

97
Q

What is the first suggestion that surgically induced hypoparthyroidism and hypocalcemia is present?

A

Inspiratory stridor progressing to laryngospasm

98
Q

With stress, which 6 endocrine organs respond?

A
  1. Hypothalamus
  2. Anterior pituitary
  3. Posterior pituitary
  4. Adrenal cortex
  5. Adrenal medulla
  6. Pancreas
99
Q

What fluid should be selected in the trauma patient?

A

NS or LR

AVOID dextrose-containing fluids

100
Q

What is “walk & drop” associated with?

A

Loss of consciousness - awakened - then loss of consciousness
Epidural hematoma - skull fracture

101
Q

Evidence of a basal skull fracture is a contraindication to…

A

Nasal intubation

Evidence includes: CSF rhinorrhea, otorrhea, LeFort III, blood behind ear drug

102
Q

What agents should be avoided in the patient with a head injury?

A

Ketamine
Sux
N2O

103
Q

What type of blood should be used in the trauma patient who has not been typed and crossmatched?

A

Type O Neg

104
Q

How does fluid shift in the 1st 24 hours (early) in the burn patient?

A

Increased microvascular/capillary permeability
Shift of fluid from the intravascular space to the interstitial fluid compartment
*Fluid and protein shifts are greatest during the first 6-8 hours

105
Q

What happens to RBCs and Hct early in the burn patient?

A

RBC are destroyed

Hct increases d/t rapid loss of plasma volume

106
Q

When does capillary integrity return and colloids remain in the intravascular compartment in the burn patient?

A

24-48 hours after a burn

*After the first 48 hours, fluid shifts from the interstitial compartment back to the intravascular compartment

107
Q

What is the IV fluid of choice for burn patients?

A

Crystalloid, LR

Colloid

108
Q

Careful monitoring of what may guide fluid management following thermal injury?

109
Q

By what route is most heat lost in the burn patient?

A

Evaporation

110
Q

Describe the pharmacokinetic and pharmacodynamic changes seen in the burn patient.

A

Changes in Vd
Changes in extracellular volume - decreased plasma concentration
Changes in protein binding - decreased albumin, increased alpha 1- acid glycoprotein

111
Q

The administration of Sux to a patient with a new burn injury, paraplegia, or upper motor neuron injury should be avoided for what period of time?

A

B/t the first 24 hours and 24 months after injury

112
Q

Why are patients with 3rd deg burns resistant to the actions of non-depolarizing agents?

A

of cholinergic nicotinic receptors has greater increased

113
Q

Rule of Nines

A 
Head - 9%
UE - 9% each 
Anterior trunk - 18% 
Posterior trunk - 18%
LE - 18% each 
Perineum - 1%
114
Q

Hemoglobin saturation by carbon monoxide of more than ___% is toxic.

115
Q

Which 2 organs are most commonly transplanted?

A
  1. Kidney
  2. Liver
    * 70% of all transplanted organs
116
Q

What is the most predominant cause of death in patient with ESRD? What is the leading cause of death after renal transplantation?

A

Cardiovascular disease

117
Q

List the 3 states of liver transplantation.

A
  1. Preanheaptic (dissection)
  2. Anhepatic
  3. Reperfusion (neohepatic)
118
Q

What are the 2 most common indications for pacemakers?

A
  1. SSS

2. CHB

119
Q

What are the 3 letter identification cods for pacemaker classification?

A
  1. Paced
  2. Sensed
  3. Response to sensing
120
Q

What is VOO pacing?

A

Fixed rate asynchronous pacing

121
Q

What should be done first if the patient’s pacemaker fails intra-op?

A

Increase the inspired O2 to 100%

122
Q

What antidysrhythmics can cause pacemaker failure?

A

Verapamil or a beta blocker can decrease the excitability of the cardiac cell so the cardiac cell does not respond to the pacemaker

123
Q

What electrolyte and acid-base abnormalities can cause decrease cardiac excitability and prevent ventricular capture of the pacemaker’s impulse?

A

Hypokalemia
Hypercalcemia
Respiratory alkalosis

124
Q

Are standard polyvinyl chloride (PVC) ETTs flammable?

A

Yes

Red rubber tubes wrapped in reflective metallic tape, silicone tube - other options

125
Q

Name 2 concerns for laser surgery in the airway.

A
  1. Airway fire

2. Retinal damage

126
Q

Identify 2 types of acquired immunity.

A
  1. Humoral (B lymphocyte)

2. Cell-mediated (T lymphocyte)

127
Q

Which lymphocytes are the source of Ig?

A

Mature B lymphocyte plasma cells

Ig account for approx. 20% of total serum proteins

128
Q

Anaphylactic Reaction

aka Type I hypersensitivity reaction

A

Antigen-antibody (IgE) reaction
IgE attach to mast cells, if re-exposed mast cells release their contents

1st signs - vasodilation, hypotension, tachycardia
Then - itching, bronchospasm, circulatory collapse

129
Q

Anaphylactic vs. Anaphylactoid Reaction

A

Anaphylactoid - does NOT involve IgE
Clinically indistinguishable
Equally life-threatening

130
Q

What are the 2 cells that provide endogenous histamine and heparin?

A
  1. Mast cells

2. Basophils

131
Q

List the top 5 causative agents involved in anaphylactic reactions during anesthesia.

A
  1. Neuromusclar blocking agents (60%) - *Sux
  2. Latex (17%)
  3. Antibiotics (15%)
  4. Colloids (4%)
  5. Hypnotics (3-4%) - *Propofol, thiopental, versed
132
Q

Heat loss from the body is mostly due to…

A

Radiation (40%)
Convection (30%)
Evaporation (major route in burn pt)
Conduction

133
Q

For each 1 deg C decrease in temp, metabolism decreases by what %?

134
Q

Where are the centers for regulating temperature found?

A

Hypothalamus

135
Q

Hypothermia is associated with the following…

A 
Brady, PVCs, VFib
Increased SVR
Decreased CO
Increased blood viscosity
L. shift in the oxyhgb curve
Impaired coagulation 
Thrombocytopenia 
Decreased elimination of drugs 
Shivering increases O2 demand by 400%
136
Q

What endocrine disorder is associated with small cell lung carcinoma?

A

SIADH

Lambert-Eaton Syndrome

137
Q

When is Ketorolac contraindicated?

A 
PUD or GI bleed
Cerebral vascular bleed
Risk for bleeding 
Renal failure or risk for renal failure 
Labor and delivery 
Receiving ASA or NSAIDS 
Allergy to ASA or NSAIDS
138
Q

List 5 CV effects of histamine.

A
  1. Relaxes smooth muscle - decrease BP
  2. Increase capillary permeability - edema
  3. Positive inotropic effect
  4. Positive chronotropic effect
  5. Stimulate adrenal medulla to release NE and Epi
139
Q

Highly sensitive diagnostic test…

A

SnNout

Disease can be ruled OUT if patient is NEG by the test

140
Q

Highly specific diagnostic test…

A

SpPin

Disease can be ruled IN if patient is POS by the test

141
Q

What is the Bronsted-Lowry theory?

A

Acid is a proton donor

Base is a proton acceptor

142
Q

What is the name for 2 optical isomers mixed together in a solution?

A

Racemic solution

143
Q

For monitored anesthesia care, is a continuous infusion or intermittent bolus dosing superior?

A

Continuous infusions

144
Q

After conscious sedation, how long before full/complete recovery of psychomotor/cognitive function?

145
Q

What local anesthetics can be used for sensory analgesia with little motor blockade?

A

0.125- 0.5% bupivacaine
0.2% ropivacaine
1% lidocaine
1% mepivacaine

146
Q

TENS is used for nociceptive or neuropathic pain?

A

Neuropathic

147
Q

When is controlled/deliberate hypotension indicated?
What is the most reliable agent to elicit deliberate hypotension?
What are the acceptable ranges for SBP and MAP in a normotensive patient?

A

Major orthopedic procedures
Radical cancer operations
Head and neck surgery
Procedures on the cranium and middle ear

Sodium nitroprusside - rapid and consistent

SBP 80-90, MAP 50-65

148
Q

In the conscious or lightly anesthetized patient who is hypoxic, are respirations increased or decreased?

A

Increase both frequency and TV

149
Q

List the 3 most common causes of delayed awakening in the PACU.

A
  1. Prolonged action of anesthetic drugs
  2. Metabolic causes - hypo/hyperglycemia, disturbances in Na, K, and Ca levels
  3. Neurologic injury
150
Q

What is the most common cause of hypoxemia following general anesthesia?

A

Increased intrapulmonary shunting from a decreased FRC relative to closing capacity

151
Q

What is the most common anesthetic complication requiring hospital admission after out-patient surgery?

152
Q

What are the 2 most common reasons for delayed discharge?

A
  1. Excessive post-op pain

2. PONV

153
Q

What is the best indicator of fluid status in the patient who has been NPO for 24 hours?

A

Urine output

154
Q

A thyromental distance

155
Q

Allen’s Test

What does a positive Allen’s test indicate?

A

Adequate collateral flow from the ulnar artery

  • Negative Allen’s test is a relative contraindication to Aline
  • This test has not been shown to be of any value
156
Q

Possible Risk for Latex Allergy

A

Children with spina bifida
Food allergies - avocados, bananas, chestnuts, stone fruits
Frequent exposure to latex

157
Q

Patient has an allergy to soy and soy products. What is your concern?

A

Possible propofol allergy

158
Q

As a rule of thumb, most herbal medications should be d/cd for a min of…
What is the exception?

A

2 weeks prior to surgery

Ephedra - 24-36 hrs prior

159
Q

What is the most critical factor for determining heat loss during surgery?
Most adult patients remain normothermic when OR temp is above what value?

A

OR temp

23 deg C (Infants 26 deg C)

160
Q

What are the concentrations of Na, Cl, K, Ca, and lactate in LR?

A 
Na - 130 
Cl - 109
K - 4
Ca - 3
Lactate - 28
161
Q

Hetastarch
Duration of action?
Max dose?

A

24-36 hrs

20 mL/kg/day

*May increase serum amylase levels

162
Q

What fluid is used to correct free water deficit in normovolemic or hypovolemic hypernatremia?

163
Q

What is the most frequent infection associated with blood transfusion?

A

Viral hepatitis - Hep B or C*

*Cryo is most likely to transmit hepatitis b/c it is pooled

164
Q

What is the most common virus transmitted with blood transfusions?

A

Cytomegalovirus

165
Q

Banked blood is devoid of what 4 things?

A
  1. Plts
  2. Factor 5
  3. Factor 8
  4. 2,3-DPG
166
Q

Banked blood accumulates what 4 things?

A
  1. CO2
  2. Lactate
  3. K
  4. Hgb
167
Q

It is always mandatory to administer blood through a filter of what size?

A

170 micron filter

168
Q

What signals a febrile reaction during a blood transfusion?

A

An increase in temp > 1 deg C

169
Q

What is the most common adverse reaction to blood transfusion?

A

Febrile reaction

170
Q

What can happen after vast quantities of stored blood are rapidly infused? What electrolyte imbalance?

A

Citrate toxicity
Hypocalcemia - > 500 mL/min, > 20 units/hr
Metabolic alkalosis - metabolism of citrate to bicarbonate

171
Q

What is the first sign of hemolytic reaction in the anesthetized patient?

A

Appearance of free hgb in the urine

Hematuria

172
Q

What are the classic signs of hemolytic reaction in an awake patient?

A

Chills
Fever
Chest and flank pain
Nausea

173
Q

What is the legal term for administration of an anesthetic to an unwilling patient?

A 
Battery 
Intentional tort (civil wrong)
174
Q

Define libel and slander.

A

Libel - defamation by written means

Slander - defamation by verbal means

175
Q

What is the term used for the hospital being responsible for the CRNA?

A

Respondeat superior

176
Q

Define negligence.

A

Failure to use reasonable care

177
Q

What is the most common cause of malpractice claims against anesthesiologists?

A

Tooth damage

178
Q

Under which class of laws does the CRNA practice?

A

Common law

Civil law

179
Q

Define res ipsa loquitur.

A

“The thing speaks for itself”

180
Q

If a patient awakens with peripheral nerve injury in a body region unrelated to surgery, what legal doctrine applies?

A

Res ipsa loquitur

181
Q

The most frequent lawsuit involves what perioperative incident?

A

Inadequate ventilation/oxygenation

182
Q

Define proximate cause.

A

Cause that was foreseeable before the event took place

The BIG Test (21 decks)

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