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Non Chem Flashcards

1
Q

How does hypothermia effect SNS?

A

Stimulates it (risk for MI and dysrhythmias)

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2
Q

How does hypothermia effect OxyHgb Curve ?

A

Shifts it to the left (decreased O2 delivery to cells)

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3
Q

How does hypothermia effect vasoconstriction and tissue oxygenation?

A

Causes vasoconstriction and decreases PO2 (surgical site infection)

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4
Q

How does hypothermia effect coagulation and plt?

A

Causes coagulopathy and Plt dysfunction (Increased blood loss)

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5
Q

How does hypothermia effect Hgb S?

A

Causes sickling (risk for sickle cell crisis)

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6
Q

How does hypothermia effect drug metabolism?

A

Slows it down (prolongs effects)

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7
Q

How does hypothermia effect solubility of volatile agents?

A

increases (prolongs emergence)

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8
Q

How much does shivering increase O2 consumption?

A

500% (increased risk for MI or infarction)

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9
Q

What drugs can be used for shivering?

A

Meperidine (kappa)

Clonidine (alpha-2)

Precedex (alpha-2)

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10
Q

Is hypothermia good?

A

It can be. Decreasing O2 consumption by 5% for every 1 degree of C reduction)

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11
Q

Where should an esophageal temp probe be placed?

A

Distal 1/3 or 40cm past incisors

If it’s too distal then increased temp from stomach

If it’s too proximal then decreased temp for cool inspiratory gas

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12
Q

What is probably the best location to measure temperature? Second best ?

A

Pulmonary artery

Tympanic membrane due to close to carotid artery supply

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13
Q

The skin is usually how many degrees less than core temp?

A

2-4 degrees C

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14
Q

If the skin temperature rises after a regional block, what does this mean? Good or bad?

A

This means the block is working and is good. Due to increased rise in peripheral blood flow

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15
Q

What three things are required for an airway fire to occur?

A

Fuel
Oxidizer
Ignition source

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16
Q

Examples of a fuel source for an airway fire?

A

Anything that burns

ET tube
Drapes
Surgical supplies

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17
Q

Examples of an oxidizer source for an airway fire?

A

O2
Nitrous

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18
Q

Examples of a ignition source for an airway fire?

A

Cautery
Laser

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19
Q

What is the first step with an airway fire?

A

Stop ventilation and remove ETT

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20
Q

What is the second step with an airway fire?

A

Stop flow of all gasses

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21
Q

What are the steps in an airway fire?

A
  1. Stop ventilation and remove ETT
  2. Stop flow of all gases
  3. Remove all flammable materials
  4. Pour water or saline on fire
  5. Use CO2 fire extinguishers
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22
Q

After the airway fire is extinguished, what are the next steps?

A
  1. Re-establish airway
  2. Check ETT for fragments that may remain
  3. Bronch to assess damage
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23
Q

What does laser stand for?

A

Light
Amplification
Stimulated
Emission
Radiation

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24
Q

Why is a laser different?

A

Monochromatic - one wavelength
Coherent - oscillates in the same phase
Collimated - narrow parallel beam

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25
Q

Difference in short vs long wavelength?

A

Long wavelengths absorb more water and do not penetrate deep into tissue

Short - absorb less and do penetrate deep

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26
Q

What is at risk for short vs long wavelength?

A

Short - retina is at risk

Long - Cornea is at risk

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27
Q

How to remember what goggles must be worn for each laser?

A

Co2 = Clear
Ruby = Red
Argon = Amber
nd:yaG = Green

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28
Q

Are most ET tubes flammable?

A

Yes

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29
Q

Is laser reflective tape used?

A

Not anymore = better to use laser resistant ETT

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30
Q

Are laser resistant ETTs, laser proof?

A

NO

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31
Q

What is the most vulnerable part of an ETT tube?

A

The cuff

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32
Q

Does filling the ETT cuff with saline help prevent fires?

A

Yes - by asboring thermal energy

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33
Q

Do laser resistant ETT reduce the risk of fire when cautery is used?

A

NO

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34
Q

How many cuffs to laser resistant ETTs have? Why?

A

Two - if the first one ruptures hopefully the surgeon can see the saline spill out

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35
Q

Burn image

A
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36
Q

Which burns do not have pain?

A

3rd and 4th degree do not have pain

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37
Q

Which type of burns need skin grafts?

A

2nd degree deep and greater -

2nd degree deep
3rd degree
4th degree

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38
Q

What is the rule of 9 with burns?

A
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39
Q

How is the rule of 9 different with children? What ages?

A
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40
Q

Immediately after a burn, does microvascular permeability increase or decrease ?

A

Increases - which creates a capillary leak which leads to edema

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41
Q

How do burns effect plasma proteins and oncotic pressure?

A

Loss of plasma proteins leads to decreased oncotic pressure which leads to edema

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42
Q

How do burns effect intravascular volume?

A

Loss of intravascular volume leads to hypovolemia and shock

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43
Q

Does hypovolemia cause hemodilution or hemoconcentration?

A

Hemoconcentration (less fluid to diluate Heme)

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44
Q

When are fluid shifts and edema greatest during burns?

A

First 12 hours then stabilize by 24 hours

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45
Q

Should albumin be given in the first 24 hours of a burn?

A

No because it is lost to interstitial space

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46
Q

What does a rising Hgb in the first few days of a burn indicate?

A

Inadequate volume resuscitation

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47
Q

When should transfusion be considered on a healthy patient after a burn? What about someone with pre-existing heart disease?

A

Hct < 20 for healthy

Hct < 30 for disease

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48
Q

What is the parkland formula for resuscitation for burns? First 24 hours? Second 24 hours?

A
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49
Q

What are acceptable urine output goals for an adult with a burn? What about a child?

A

Adult - >0.5mL/kg/hr
Child - >1mL/kg/hr

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50
Q

What are the urine output goals for high voltage electrical injury? Why?

A

> 1-1.5mL/kg/hr

Because of myoglobinuria released from excessive muscle damage. It is a nephrotoxin that needs to be flushed out

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51
Q

Is a burn patient at risk for abdominal compartment syndrome? What is the diagnosis and treatment?

A

Yes - from aggressive fluid resuscitation

Decompression via laparotomy
NMB blockage
Sedation
Diuresis

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52
Q

What are the parameters for intra-abdominal HTN?

A

IAP > 20
or
>12 with evidence or organ dysfunction

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53
Q

What rate does CO bind to Hgb when compared to O2? Which way is the Hgb OxyHgb curve shift?

A

200 times more

Shifts left - resulting in impaired O2 offloading

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54
Q

Which type of pH imbalance occurs with Carbon monoxide poisoning?

A

Metabolic acidosis

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55
Q

What is the treatment for Carbon monoxide poisoning?

A

Hyperbaric or 100% O2

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56
Q

What will the SpO2 read with Carbon monoxide poisoning?

A

Falsey elevated because it cannot distinguish between the two

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57
Q

Is oxidative phosphorylation impaired with Carbon monoxide poisoning?

A

Yes

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58
Q

Can NMB be used in burns?

A

Succ can be in the first 24 hours but not after due to risk of lethal hyperkalemia

Non depolarizing can be

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59
Q

Does non depolarizing NMBs be used in burns? Do you need more or less? Why?

A

Need more due to upregulation after the first 24 hours

2-3x more drug needed due to more receptors

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60
Q

What is the first and second response of ECT treatment? PNS vs SNS?

A

1st - Increased PNS (15 seconds)
2nd - Increased SNS for several minutes

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61
Q

ECT phases photo

A
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62
Q

What are absolute contraindications to ECT?

A

MI < 6 months ago
Intracranial surgery < 3 months ago
Stroke < 3 months
Brain tumor
Unstable C spine
Pheochromocytoma

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63
Q

Is pregnancy and severe pulmonary disease a relative or absolute contraindication to ECT?

A

Relative

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64
Q

What is neuroleptic malignant syndrome? Causes ?

A

Depletion of dopamine in the basal ganglia and hypothalamus

Dopamine antagonists or withdrawal form dopamine agonists

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65
Q

Treatment for neuroleptic malignant syndrome?

A

Bromocriptine
Dantrolene
Supportive care
ECT

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66
Q

MH vs NMS, genetic link?

A

Just MH

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67
Q

MH vs NMS, develops acutely?

A

Just MH

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68
Q

MH vs NMS, associated with psych meds?

A

Just NMS

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69
Q

MH vs NMS, muscle rigidity, hyperthermia, tachycardia, acidosis?

A

Both

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70
Q

MH vs NMS, treat with dantrolene?

A

Both

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71
Q

MH vs NMS, effect if NMB?

A

NMS - causes paralysis

MH - does not

72
Q

What is serotonin syndrome? Which drugs increase the risk?

A

Excess 5-HT activity in the CNS and PNS

  1. SSRI
    also
    Meperidine
    Fentanyl
    Methylene blue
73
Q

Normal intraocular pressure? How is it determined?

A

IOP - 10 to 20

Choroidal blood volume
Aqueous fluid
Extraocular muscle tone

74
Q

What produces aqueous humor?

A

Ciliary process in the posterior chamber

75
Q

How is aqueous humor reabsorbed?

A

Canal of Schlemm in the anterior chamber

76
Q

Factors of IOP

77
Q

Does LMA placement or removal effect IOP?

A

Not really

78
Q

Should Ketamine be given in eye surgeries? Does it increase IOP?

A

Might increase IOP but unsure

Don’t give because it may cause nystagmus and blepharospasm

79
Q

What causes Glaucoma?

A

Elevated IOP pressure that leads to retinal artery compression

80
Q

What causes closed angle glaucoma?

A

Closure of anterior chamber and creates a mechanical outflow obstruction

81
Q

What causes open angle glaucoma?

A

Sclerosis of trabecular meshwork that impairs aqueous humor drainage

82
Q

Which drugs decrease aqueous humor production?

A

Acetazolamide - inhibits carbonic anhydrase

Timolol - Nonselective beta antagonist

83
Q

Which drugs increase aqueous humor drainage?

A

Echothiopate - irreversible cholinesterase inhibitor

Can prolong duration of succ

84
Q

What is strabismus surgery and what are the risks?

A

Corrects misalignment of extraocular muscles

-Increased PONV
-Increased risk of oculocardiac reflex (CN5+CN10)

85
Q

What type of TAP block is required for a midline incision
or laparoscopic surgery ?

86
Q

What are TAP blocks best suited for?

A

Abdominal that involves T9 - L1

87
Q

What are the layers of a TAP block?

A

Subq
External oblique
Internal oblique
Transverse abdominis
Peritoneum

88
Q

What are the landmarks of a TAP block that create the triangle of Petit?

A

External Oblique
Internal Oblique
Iliac crest

89
Q

What is allodynia and what is an example?

A
  • Pain due to a stimulus that does not normally produce pain

Fibromyalgia

90
Q

What is dysesthesia and what is an example?

A

Abnormal or unpleasant sense of touch

Burning from diabetic neuropathy

91
Q

What is neuralgia and what is an example?

A

Localized pain to a dermatome

Herpes zoster (shingles)

92
Q

What are the defining characteristics of type 1 and type 2 complex regional pain syndrome?

A

Type 1 - reflex sympathetic dystrophy

Type 2 - causalgia

Neuropathic pain with autonomic involvement.

TYPE 2 is ALWAYS preceded by nerve injury where type 1 is not

93
Q

Where is local injected for a thoracic paravertebral block? What does it target?

A

Into the paravertebral space which is a potential space

Targets the ventral ramus of the spinal nerve

94
Q

How many dermatomes does a paravertebral block target?

A

One dermatome - it is a single shot block.

Need to perform one injection for each dermatome level

95
Q

What surgeries are paravertebral blocks good for?

A

Breast
Thoracotomy
Rib fracture

96
Q

What structures does a celiac plexus block? What type of patients?

A

It innervates the upper abdominal viscera except the left sign of the colon

Good for cancer

97
Q

What does a celiac plexus block NOT innervate?

A

Pelvic organs

Good for

98
Q

Which nerve innervates the pelvic organs? What type of patients?

A

Superior hypogastric plexus block

Good for cancer patients

99
Q

What are the two treatments for a post-Dural punctures headache?

A
  1. Epidural blood patch
  2. Sphenopalatine block
100
Q

What causes post-retrobulbar block syndrome?

A

The optic nerve is apart of the CNS unlike other CN

It is enveloped by a meningeal sheath and bathed CSF which permits it to drain directly into the brain

101
Q

Can a PCN allergic patient receive cephalosporins?

A

Yes if;

  1. Was not an IgE mediated response (anaphylaxis, bronchospasm, urticaria)
  2. Did not produce exfoliative dermatitis (Stevens-Johnson syndrome)
102
Q

What antibiotics are good alternatives to a patient with a PCN allergy and cephalosporins?

A

Vanco or clinda

103
Q

Which antibiotic is used to treat MRSA? How should it be given?

A

Vanco

In order to reduce histamine release -
Give it slow over 1 hour, give Benadryl and cimetidine

104
Q

What is the most common cause of HIV exposure in healthcare? What are the odds?

A

Needle stick with hollow bore needle

  1. Percutaneous injury (needle stick) - 0.3%
  2. Mucous membrane exposure - 0.09%
105
Q

How many types of WBC are there? Most abundant type?

A

5

Neutrophils - 60% of all WBC

106
Q

What are neutrophils? What do they do?

A

WBC that fights bacterial and fungal infections

107
Q

What WBC is the primary component to hypersensitivity reactions?

108
Q

What are basophils?

A

WBC

Release histamine, serotonin, heparin, bradykinin

Epi prevents degranulation by binding to beta-2 receptors

109
Q

What are Eosinophils?

A

WBC

Fight against parasites

110
Q

What are monocytes?

A

WBC

Release cytokines and perform phagocytosis

Present pathogens to T lymphocytes

111
Q

What are lymphocytes?

A

WBC

B cell

T cell

112
Q

What type of immunity are B lymphocytes ? Do they produce antibodies?

A

Humoral immunity - DO produce antibodies

113
Q

What type of immunity are T lymphocytes ? Do they produce antibodies?

A

Cell mediated immunity - do not produce antibodies

114
Q

How does the GI system respond to anaphylaxis?

A

Cramping
N/V
Diarrhea

115
Q

How does the skin system respond to anaphylaxis?

A

Flushing
Urticaria (hives)
Erythema
Pruritus

116
Q

How does the CV system respond to anaphylaxis?

A

Hypotension
Tachycardia
Arrhythmia
Cardiac arrest

117
Q

How does the respiratory system respond to anaphylaxis?

A

Bronchospasm
Laryngeal edema
Mucus production

118
Q

With a bronchospasm, what will be seen with ETCO2, SaO2, and PIP?

A

EtCO2 - Decreased

SaO2 - Decreased

PIP - increased

119
Q

Does anaphylaxis require a prior exposure or cross sensitivity

120
Q

Does anaphylactoid reactions require a prior exposure or cross sensitivity

121
Q

What does the H1 receptor do?

A

-Vasodilation
-Increased vascular permeability
-Smooth muscle contraction (not vascular)

122
Q

What does the H2 receptor do?

A
  • Tachycardia
  • Increased gastric acid secretion
123
Q

What are two arachidonic acid metabolites? What do they cause the body to do?

A

leukotrienes and prostaglandins

Produce bronchoconstriction and vasodilation

124
Q

How many types of hypersensitivity reactions are there?

125
Q

What is type 1 hypersensitivity reaction? Ex?

A
  • Immediate hypersensitivity
    (antigen+ previous exposure to antibody)

Ex: anaphylaxis, extrinsic asthma

126
Q

What is type 2 hypersensitivity reaction? Ex?

A

Antibody mediated
(IgG and IgM antibodies bind to cell surfaces)

Ex ABO- incompatibility or HIT

127
Q

What is type 3 hypersensitivity reaction? Ex?

A

Immune complex is formed outside the body then placed inside

Ex: snake venom or protamine

128
Q

What is type 4 hypersensitivity reaction? Ex?

A

Delayed - 12 hours after exposure

Ex: Graft vs Host, Contact dermatitis, Tissue rejection

129
Q

First step for treatment of intraoperative anaphylaxis?

A

D/C offending agent

130
Q

Steps for treatment of intraoperative anaphylaxis?

A
  1. D/C offending agent
  2. Airway support
  3. Epi
  4. IV hydration
  5. H1 antagonist
  6. H2 antagonist
  7. Hydrocortisone
  8. Albuterol for bronchospasm
  9. Vasopressin
131
Q

Epi dose for anaphylaxis?

A

5-10mcg for hypotension

.1-1mg for CV collapse

132
Q

Example and dose of H1 antagonist? H2?

A

Benadryl - 1mg/kg

Ranitidine - 50mg
or
Famotidine 20mg

133
Q

What are the three most common causes of intraoperative anaphylaxis?

A
  1. NMB (succ #1)
  2. Latex
  3. Antibiotics
134
Q

Highest risk groups for latex allergy?

A

Spina bifida/myelomeningocele
Atopy
Health care workers
Food allergy to banana, kiwi, papaya, pineapple, tomato

135
Q

Chemo man

136
Q

What is gastrin? What does it do?

A

Responds to food entering the stomach

Stimulates chief cells to secrete pepsinogen which is converted to pepsin in the presence of stomach acid

137
Q

What is secretin? What does it do?

A

Tells the pancreas to secrete bicarb and the liver to secrete bile

138
Q

What is cholecystokinin? What does it do?

A

Tells the pancreas to release digestive enzymes and the gallbladder to contract

139
Q

What is gastric inhibitor peptide? What does it do?

A

Slows gastric emptying and stimulates pancreatic insulin release

140
Q

What is somatostatin? What does it do?

A

Universal OFF switch

141
Q

What is gastric barrier pressure? How is it determined?

A

The higher the barrier pressure, the lower likelihood of reflex

=LES pressure - intragastric pressure

142
Q

Where does the vomiting center reside? What are the three most common inputs?

A

Medulla (nucleus tractus solitarius)

  1. CTZ
  2. GI tract
  3. Vestibular system
143
Q

What is the mechanism of NK-1 antagonists? Ex?

A

They block substance P in the CTZ

Ex: Aprepitant

144
Q

Pathways of GI tract for PONV?

145
Q

Pathways of CTZ for PONV?

A

5-HT2
NK-1
DA-2
Noxious chemicals

146
Q

Pathways of vestibular for PONV?

147
Q

What are the main risks for PONV?

A

Female
Nonsmoker
History of PONV
History of motion sickness
Youth

148
Q

Which procedures increase PONV?

A

Over an hour
GYN
Laparoscopy
Breast
Plastics
Peds

149
Q

Which drugs increase PONV?

A

Halogenated anesthetics
Nitrous > 50%
Opioids
Etomidate
Neostigmine

150
Q

Which two antiemetics prolong QT?

A

Droperidol and zofran

151
Q

Two contraindications for Reglan?

A

Dopamine antagonist which is contraindicated in Parkinson’s

Prokinetic agent - Avoid in bowel obstruction

152
Q

Where is the P6 acupressure point for reducing PONV?

153
Q

How long must a Bier block be inflated for? Why?

A

At least 20 minutes or else risk for seizure and cardiac arrest

154
Q

Bier block pressures for UE and LE?

A

UE - 250mmHg or 100mmHG over SBP

LE - 350mmgHG or 2x over SBP

(Which ever is higher)

155
Q

Does releasing a tourniquet cause hyper or hypotension?

A

Hypotension due to the reperfusion of the extremity

156
Q

Does releasing a tourniquet cause an increase or decrease in end tidal?

A

Increased due to the products of cellular hypoxia being brought back into circulation

157
Q

Does releasing a tourniquet cause an increased or decreased in core body temperature?

A

Causes decreased Core body temperature

158
Q

Does releasing a tourniquet cause metabolic acidosis or alkalosis?

A

Metabolic acidosis

159
Q

How does releasing a tourniquet effect SvO2 and SaO2?

A

Usually just decreased SvO2

160
Q

Is COX 1 or COX 2 always present?

A

COX 1 is always present to maintain normal physiologic function

161
Q

When is COX2 expressed?

A

During inflammation

162
Q

Is there a ceiling effect to COX inhibitors? What about opioids?

A

COX inhibitors has a ceiling effect where opioids do not

163
Q

What suffix do COX2 inhibitors end in?

A

“Coxib”

Celecoxib

164
Q

COX1 or COX2, impairs Plt function, reduces renal blood flow, and causes gastric irritation?

165
Q

COX1 or COX2, causes analgesia, anti-inflammatory, and antipyretic effects?

166
Q

Are there specific COX1 inhibitors?

167
Q

COX photo

168
Q

What is the precursor to COX 1 and COX 2?

A

Arachidonic Acid which comes from phospholipids and phospholipase A2

169
Q

How much Ketorolac is equal to 10mg morphine?

170
Q

What is Samter’s triad? Why is it important?

A

Aspirin exacerbated respiratory disease

  1. Asthma
  2. Allergic rhinitis
  3. Nasal polyps

**May lead to bronchospasm after giving aspirin

171
Q

Which 4 supplements may lead to bleeding?

A

Garlic
Ginger
Gingko biloba
Saw palmetto

172
Q

Which 2 supplements reduce MAC?

A

Kava Kava
Valerian

173
Q

Which herbal medication can mimic Conn’s?

174
Q

What is the Alderete score? Which score is safe for discharge?

A

Assesses readiness for D/C from PACU

9 or higher can be D/C

175
Q

Alderete Scoring photo

Miscellaneous (10 decks)

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