Muscoskeletal 2 Flashcards
Does MG get better or worse throughout the day?
Worse
Earliest sign of MG?
Ptosis
also
Bulbar muscle weakness
Treatment for MG?
Oral pyridostigmine
Steroids
Thymectomy
Plasmapheresis
MG vs EL ; adequate response to AchE inhibitors
MG has good response
EL has a poor response
Which disease attacks the myelin sheath ? Treatment?
Guillain Barre
IV Igg and plasmapheresis
Avoid succ
Steroids are not useful
What disease does interferon help treat?
What disease should ephedrine be avoided?
Gullian-Barre
What is the treatment for hypo/hyper periodic paralysis?
Acetazolamide
What should be avoided in periodic paralysis?
Hypothermia at all costs
What channel is affected with hypokalemic PP? Hyper?
Hypo - Calcium
Hyper - Sodium
How is hyper PP diagnosed? hypo?
Hypo - symptoms get worse after glucose
Hyper- symptoms get worse after giving K
Three diseases linked to MH?
Multiminicore
Central core
King Denborough
Steps for MH?
T tubule depolarized - Ca enters through dihydropyridine
Activates RyR1
RYR1 can’t be turned off
SERCA2 pump activates
Consume all ATP, O2 depletes, massive rise in CO2
Sarcolemma breaks down and allows K and myoglobin into the systemic circulation
Consequences of increased Ca
Rigidity
Depletion of ATP
Increased O2 consumption
Increased CO2
Mixed respiratory and lactic acidosis
Sarcolemma breaks down
First S+S of MH?
Masseter spasms
Increased Co2
Tachycardia
Warm soda lime
Tachypnea
Second S+S of MH
Cyanosis
Patient warm
Late S+S of MH
Muscle rigidity
Cola-colored urine
Coagulopathy
Hyperthermia
S+S of all three stages of MH?
Irregular heart
Gold standard of MH testing?
Caffeine-halothane contracture (muscle biopsy)
What drug is contradicted in the treatment of MH?
CCBs
What is Dantrolene a combination of ? How must it be reconstituted?
20mg Dantrolene
3g mannitol
Must be with preservative water NOT 0.9% NS
Dose of dantrolene? How long?
2.5mg/kg repeat every 5-10min
Can continue in ICU 1mg/kg
Steps for treating MH?
D/C agent
Call for help
Hyperventilate 100% 10L
Charcoal filter
Dantrolene
Cool patient
Sodium bicarb (treat acidosis)
Treat hyperkalemia
Class 1 antiarrhythmics (Lidocaine)
Maintain urine
Correct coag’s
How often should charcoal filter be changed?
Every hour
Considerations of Duchenne’s
Kyphoscoliosis -restrictive
Respiratiory muscle weakness
Degeneration of cardiac muscle
Increased R wave in lead I
Deep Q waves in limb leads
Increased risk of pulmonary aspiration
What should be avoided in Duchenne’s
Succ and volatile anesthetics
Normal PFT in scoliosis? Abnormal PFT?
Normal FEV1/FVC ratio
Abnormal FEV1 and FRC
Most common airway complication of RA?
Atlantoaxial subluxation and separation of the atlanto-odotoid articulation
Considerations for RA?
Anemia
Aortic regurgitation
Pulmonary effusion
Restrictive disease
NSAIDS
Hyperglycemia
Treatment for lupus?
Steroids
NSAID
Immunosuppressants
Antimalarials
Considerations for lupus?
Increase risk for airway swelling
**aPTT is prolonged but at risk for clotting
Increased duration of succ from cyclophosphamide
Considerations for Marfan?
at risk for AAA, spontaneous pneumo, pregnancy increases risk
Considerations for Ehlers Danlos
Spontaneous bleeding
avoid regional, IM, line placement
Considerations for osteogenesis imperfecta
Blue sclera - increased risk for fracture
Connective tissue disorder
Increased serum thyroxine
Increased fractures -even from BP cuff
Arterial hypoxemia
Paget’s disease considerations
Pain and fractures are most common
Caused by excessive parathyroid hormone
Cause thick and weak bones
No vascular involvement
What is scleroderma?
Causes fibrosis of skin and organs
