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NCE Flashcards

1
Q

↑PVR

A

Hypoxia
Low FiO2 < 30%
Acidosis ↓pH ↑H+
Hypercarbia ↑CO2
PEEP ↑ITP or airway pressures
Mechanical ventilation
Light anesthesia/pain
Surgical stress SNS stimulation
Vasoconstrictors
HPV response to atelectasis
Trendelenburg
Nitrous oxide N2O
Desflurane & Ketamine
Hypothermia

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2
Q

↓PVR

A

Hyperoxia ↑PaO2
↑FiO2 100%
Alkalosis ↑pH ↓H+
Hypocarbia ↓CO2
Hyperventilation
No PEEP ↓ITP
Low airway pressures
Spontaneous ventilation
Deep anesthesia
Vasodilators iNO, NTG, PDEi, PGE1, PGI2, CCBs, ACEi

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3
Q

Pulmonary Vascular Resistance

A

PVR = [(Mean PAP - PAOP) / CO] x 80
Normal 150-250 dynes/sec/cm

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4
Q

Acidosis

A

↑CBF ↑ICP
↑P50 (R shift)
↑SNS tone ↑dysrhythmias risk ↓contractility
↑PVR
Hyperkalemia

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5
Q

Anion Gap

A

= Na+ - (Cl¯ - HCO3¯)

Normal 8-12 mEq/L

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6
Q

When to calculate the anion gap?

A

Metabolic acidosis

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7
Q

Metabolic Acidosis
Normal AG Causes

A

HARDUP
Loss HCO3¯ or ECF dilution
NS hyperchloremia

Hypoaldosteronism
Acetazolamide
Renal tubular necrosis
Diarrhea
Uretosigmoid fistula
Pancreatic fistula

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8
Q

Metabolic Acidosis
Elevated AG Causes

A

MUDPILES
> 12 mEq/L

Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Isoniazid
Lactate ↓DO2, sepsis, cyanide poisoning
Ethanol or ethylene glycol
Salicylates inhibit the Krebs cycle

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9
Q

Alkalosis

A

↓CBF ↓ICP
↓P50 (L shift)
↓coronary blood flow
↑dysrhythmias risk
↓PVR
Hypokalemia
↑ionized Ca2+

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10
Q

Metabolic Alkalosis
Causes

A

Loops diuretics
Vomiting
Antacids
Hyperaldosteronism

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11
Q

Oxyhemoglobin Curve
Left Shift

A

Alkalosis ↑pH ↓H+
Hypocarbia ↓CO2
↓2,3 DPG
Hypothermia
Fetal/Met/CO Hgb
Lungs
HaLdane

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12
Q

Oxyhemoglobin Curve
Right Shift

A

Acidosis ↓pH ↑H+
Hypocarbia ↑CO2
↑2,3 DPG
Hyperthermia
Tissues
Bohr O2 offloading

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13
Q

PAO2

A

Alveolar O2 partial pressure
= FiO2 x (760 - 47 mmHg) - [PaCO2 / RQ]

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14
Q

CO2 Production

A

200 mL/min

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15
Q

O2 Consumption

A

250 mL/min
OR
3.5 mL/kg/min

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16
Q

How does body temperature affect O2 consumption?

A

Direct correlation
↓core body temperature ↓O2 consumption
Every 1°C ↓5-7%

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17
Q

Acute Hypercarbia

A

↑CO2 10 mmHg > 40 ↓pH 0.08

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18
Q

Chronic Hypercarbia

A

↑CO2 10 mmHg > 40 ↓pH 0.03

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19
Q

Hypoxia Causes:

A
  1. Hypoxic mixture
  2. Hypoventilation
  3. Diffusion limitation
  4. V/Q mismatch
  5. Shunt
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20
Q

↓FiO2

A

Normal A-a gradient
+FiO2

Hypoxemic mixture
O2 pipeline failure
High altitude

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21
Q

Hypoventilation

A

Normal A-a gradient
+FiO2

Opioid overdose
Residual anesthetic agent or NMB
Neuromuscular disease
Obesity hypoventilation

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22
Q

V/Q Mismatch

A

Most common hypoxemia cause***
↑A-a gradient
+FiO2

COPD
OLV
Impaired HPV
Embolism - air, gas, amniotic fluid

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23
Q

Diffusion Impairment

A

↑A-a gradient
+ FiO2

Pulmonary fibrosis
Emphysema
Intestitial lung disease

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24
Q

Shunt

A

↑A-a gradient
FiO2 does NOT help

Atelectasis
Pneumonia
Bronchial intubation
Intercardiac shunt
Anatomic shunt

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25
Q

What inhibits HPV?

A

Volatiles MAC > 1.5
Hypoxia
Alkalosis ↑pH ↓H+ ↓CO2
Hypocarbia/hyperventilation
Vasodilators - PDEi or SNP
Vasoconstrictors
Excessive PEEP ↑VT
Hypervolemia LAP > 25
Hemodilution
Hypothermia

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26
Q

SpO2:PaO2

A

SpO2 80 : PaO2 50 mmHg
70 : 40
60 : 30

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27
Q

Soda Lime Reaction

A

CO2 + H2O → H2CO3 (carbonic acid)
H2CO3 + 2NaOH (sodium hydroxide) → Na2CO3 (sodium carbonate) + H2O + heat
Na2CO3 + Ca(OH)2 → CaCO3 (calcium carbonate) + 2NaOH

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28
Q

Soda Limb
Absorption Capacity

A

26L CO2 per 100g absorbent

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29
Q

How does soda lime neutralize CO2?

A

NaOH = weak base
CO2 = acid

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30
Q

KOH

A

Potassium hydroxide
Dessication → CO & compound A

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31
Q

Amsorb

A

Ca(OH)2
No CO
NO compound A

Expensive $$$
Low absorptive capacity
Only able to absorb 10.6L CO2 per 100g

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32
Q

Baralyme

A

Removed from the market
Sevo + baralyme → increased breathing circuit fire risk

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33
Q

Dead Space

A

Vd 2 mL/kg or 150 mL

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34
Q

1 Atmosphere

A

Patm
760 mmHg
760 Torr
1 bar
100 kPa
1,033 cmH2O

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35
Q

A - a Gradient

A

PAO2 - PaO2
Normal < 15 mmHg

36
Q

What ↑A-a Gradient?

A

Shunt
V/Q mismatch
Diffusion defect
Aging
Vasodilators
R → L shunt

37
Q

Trachea

A

Begins at C5
Ends at T4-5

38
Q

Carina

A

T4-5
Angle of Louis

39
Q

Pneumocytes

A

Type 1 provide gas exchange surface
Type 2 produce surfactant & type 1

40
Q

Tracheobronchial Functional Airway Divisions

A

Conducting zone = trachea, bronchi, & bronchioles 0-4

Transitional zone = respiratory bronchioles 17

Respiratory zone = alveolar ducts & alveolar sacs 20-23

41
Q

Reynolds Number

A

Re = (Density x Velocity x Diameter) / Viscosity

Laminar flow [viscosity] < 2,000
Transitional 2,000-4,000
Turbulent [density] > 4,000

42
Q

Dynamic Compliance

A

Cdyn = VT / (PIP - PEEP)

43
Q

Static Compliance

A

Cstat = VT / (Pplat - PEEP)
Normal 35-100 mL/cmH2O

44
Q

↑PIP + Normal Pplat

A

↑resistance OR ↑inspiratory flow rate

Kinked ETT
Endotracheal tube cuff herniation
Bronchospasm Bronchial secretions
Airway compression
Foreign body aspiration

45
Q

↑PIP & ↑Pplat

A

↓total lung compliance OR ↑VT

Endobronchial intubation
Pulmonary edema
Pleural effusion
Tension pneumo
Atelectasis
Chest wall edema
Abdominal insufflation
Ascites
Tburg
Inadequate muscle relaxation

46
Q

Volatile Anesthetics MOA
Unconsciousness

A

Cerebral cortex
Thalamus
RAS

47
Q

Volatile Anesthetics MOA
Amnesia

A

Amygdala
Hippocampus

48
Q

Volatile Anesthetics MOA
Autonomic Effects

A

Pons
Medulla

49
Q

Volatile Anesthetics MOA
Analgesia

A

Spinothalamic tract

50
Q

Volatile Anesthetics MOA
Immobility

A

Spinal cord ventral horn
Where the upper & lower motor neurons synapse

51
Q

Mapleson A

A

Spontaneous ventilation
> FGF 0 = APL <

52
Q

Mapleson D

A

Controlled ventilation
0 APL = FGF <

53
Q

Mapleson E

A

Ayre T-piece
No reservoir bag or APL
= FGF <

54
Q

Mapleson F

A

Jackson-Rees
No APL
0 = FGF <

55
Q

Opioid MOA

A

Pre-synaptic ↓Ca2+ release
Post-synaptic ↑K+ hyperpolarizes the cell membrane ↓RMP

56
Q

Mu 1

A

Supraspinal & spinal analgesia
Bradycardia
Euphoria
Low abuse potential
Miosis
Hypothermia
Urinary retention

57
Q

Mu 2

A

Spinal analgesia
Bradycardia
Respiratory depression
Constipation
Physical dependence

58
Q

Delta

A

Enkephalins
Supraspinal & spinal analgesia
Respiratory depression, physical dependence, urinary retention, & pruritis

59
Q

Kappa

A

Dynorphins
Supraspinal & spinal analgesia
Miosis, diuresis, & hypoventilation
Agonist-antagonist MOA
Anti-shivering
Sedation, dysphoria, delirium, & hallucinations

60
Q

AGM O2

A
  1. O2 pressure failure alarm
  2. O2 pressure failure device (failsafe)
  3. O2 flowmeter
  4. O2 flush valve
  5. Ventilator drive gas
61
Q

EKG Normal Axis

A

-30° → +90°
Lead I +
aVF +

62
Q

Poiseuille

A

= (π∙r^4∙∆P) / 8ηl

63
Q

Stenosis
Anesthesia Management

A

Full, slow, & constricted
Maintain or ↑afterload

64
Q

Aortic Stenosis

A

Normal aortic valve orifice 2.5-3.5 cm^2

SEVERE < 0.8 cm^2

65
Q

Mitral Stenosis

A

Normal mitral valve orifice 4-6 cm^2

SEVERE < 1 cm^2

66
Q

Insufficiency/Regurgitation
Anesthesia Management

A

Full, fast, & forward
AVOID bradycardia

67
Q

Pulsus Parvus

A

Aortic stenosis → narrow PP & small amplitude

68
Q

Pulsus Tradus

A

Aortic stenosis → slower systolic upstroke & delayed peak

69
Q

Bisferiens Pulse

A

Aortic regurgitation → biphasic systolic peaks
Sharp upstroke & low DBP
Wide pulse pressure

70
Q

Pulsus Alternans

A

Severe LV failure
Alternate ↑↓A-line waveform

71
Q

Pulsus Paradoxus

A

Cardiac tamponade ↓SBP > 10 mmHg w/ inspiration

72
Q

Thoracoaortic Aneurysm Classifications

A

Crawford
Most common classification system*

73
Q

Crawford Type

A
  1. All or most descending thoracic aorta + only upper abdominal aorta
  2. All or most descending + most abdominal
  3. Only lower descending + most abdominal
  4. No descending + most abdominal
74
Q

Aortic Dissection Classification

A

Stanford & DeBakey

75
Q

Stanford

A

Type A - Ascending
Type B - Does not involve the ascending aorta

76
Q

DeBakey

A
  1. Tear in ascending aorta + dissection along entire aorta B
  2. Tear in ascending aorta + dissection only in ascending aorta A
  3. Tear in proximal descending aorta D
    a. Dissection limited to thoracic aorta
    b. Dissection along thoracic & abdominal aorta
77
Q

Antiarrhythmics 1a

A

Na+ channel blockers (phase 0)
Disopyramide
Norpace
Quinidine
Procainamide

78
Q

Antiarrhythmics 1b

A

Na+ channel blockers (phase 0)
Lidocaine
Phenytoin
Mexiletine

79
Q

Antiarrhythmics 1c

A

Na+ channel blockers (phase 0)
Flecainide
Propafenone
Moricizine

80
Q

Antiarrhythmics 2

A

β blockers -olol
SA node phase 4

81
Q

Antiarrhythmics 3

A

K+ ion channel blockers (phase 3)
Amiodarone
Sotalol
Ibutilide
DofetilideA

82
Q

Antiarrhythmics 4

A

Ca2+ channel blockers (phase 2)
Verapamil
Nifedipine
Diltiazem
Nicardipine

83
Q

Antiarrhythmics 5

A

OTHER
Adenosine
Atropine
Magnesium
Digoxin

84
Q

Microshock

A

20-100 μA → V fib

85
Q

MACROshock

A

1 mA = perception threshold
5 = max harmless current
10-20 = “let go” current
50 = pain or possible mechanical injury
100-300 mA → V fib

86
Q

Line Isolation Monitor

A

Alarms when > 5 mA detected
1st fault
OR grounded

87
Q

What is the maximum current leakage allowed in the OR?

APEX (18 decks)

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