Nagelhout videos: NMB's Flashcards
Pt can start breathing when _____% of their nicotinic cholinergic receptors are still blocked
80%
-only need 20% return of function to breathe
Smooth muscle isn’t affected by NMB… what kind of things are smooth muscle
- Bronchi
- Uterus
- Bowel
T/F- GI sphincters are affected by NMB
True but the smooth muscle itself is not
if smooth muscle in the abdomen aren’t affected by NMB, why do we need to give relaxant to belly cases?
Think of it as a tube and toothpaste ; the way we keep the toothpaste from squeezing out of the tube, is by relaxing the tube (all the abdominal muscles surrounding the guts)
which way is the electric current flowing between the red and black leads on twitch monitor
electricity flows from positive to negative
What muscles are the easiest muscles to paralyze?
the eyelid muscles
Hardest muscle in the body to paralyze?
Diaphragm- makes sense, you need to breathe to live
Why shouldn’t you put the electrodes for TOF like around the eye like you sometimes might do lol
bc you can directly stimulate the muscle even if its 100% paralyzed- youre sending the electricity directly into the muscle- the muscle is going to contract;
& paralytics don’t paralyze the muscle, they paralyze nerve-to-muscle transmission
Why would you give SUX for an RSI? And don’t say bc it’s fast onset of action, what’s the real deal
Bc propofol makes people lose their airway reflexes, and during that time they are vulnerable to aspiration; the ability to give sux lessens the time they are a-reflexic and vulnerable to aspirating bc you can get the tube in quicker to secure the airway; whereas with roc/vec you would have to wait a much longer time for it to work
want prop to tube time to be as short as possible
What is a modified RSI
instead of not ventilating at all while waiting for relaxant to work, you gently ventilate
Recovery time with neostigmine based on
1 twitch:
2-3 twitches:
4 twitches:
1 = up to 30 minues
2-3 twitches = 4-15 mins
4 twitches = 5-10 mins
How is TOF ratio measured?
Comparing the first twitch to the 4th twitch
What percent is blocked with each line
4 twitches = 70% blocked
3 twitches = 75% blocked
2 twitches = 80% blocked
1 twitch = 90% blocked
0 twitch = 100% blocked
4 twitches without fade = ___% blocked, ___% recovered, TOFR:
4 twitches with fade = ____% blocked, ___% recovered, TOFR:
- no fade = <70% blocked, >30% recovered; TOF > 0.9 or 90%
- fade = 70-75% blocked, 25-30% recovered; TOF < 0.9 or 90%
someone asks you what the TOF ratio is on someone with 2 twitches
n/a - it’s a TOfour , need 4 twitches to get a TOF ratio
Single twitch = ____hz
TOF twitchs = _____hz
DBS = _____hz
Tetany = _______hz
single = 1 hz
TOF = 2 hz
DBS = 50hz
Tetanus = 50-100hz
DBS is 2 twitches at ___ hz with what time lapse in between
50hz, 3/4 of a second
Explain why post-tetanic potentiation is a shitty way to claim someone has twitches
okay so you give a tetanus over 5 seconds
- this mobilizes acetylcholine down the presynaptic nerve and floods the synapse but pt is 100% blocked and you don’t see any reaction from that ACH right away
- After you flood the synapse with ACH and do a TOF, there hasn’t’ been enough time that lapsed for AchE to metabolize it, so it can breifly overpower the blocked receptors
- However, that NMB is going to hop right back onto that receptor as ACH becomes more and more metabolzied by AchE.
- So you’re only kidding yourself if you think the patient is any bit kind of recovered
T/F- dibucaine SHOULD inhibit psedudocholinesterase
True
T/F- dibucaine should NOT inhibit pseudocholinesterase
false - it should
if it doesn’t inhbit PchE, the patient is atypical
T/F- the dibucaine number reflects the amount of pseudocholinesterase that was inhibited in the test tube
true- if it’s 80, means 80% was inhibited and 80% is normal
1 culprit of MH
Sux
2 drugs that increase IOP
Sux and Ketamine
What percentage of burn injury shouldn’t you give sux to after 24 hrs?
>35% burned
