Oral Board SOE high yield Flashcards
Can you dart the patient…
IM ketamine (5mg/kg)
or IM precedex (2mcg/kg)
or IM midazolam (0.1mg/kg)
Sodium Nitroprusside toxicity
Think: cyanide toxicity (prevent cells from using O2)…give Vitamin B12
Neonatal extubation critiera
TV 6cc/kg
RR 30-40
O2 sat 90%, 50% FiO2, PEEP 5
Awake, reflexes intact
Neonatal vent settings
-O2 sat >90% (no hyperoxia)
-RR 30-40
-PIP <25
Neonatal vitals
HR: 120-160
BP: 80 and 60/30
O2 sat: 95% in newborn, 90% in premies
RR: 40-60
Tetralogy of Fallot…how to induce
Slow controlled IV induction…less control with mask induction (could overly reduce SVR)
Any R to L shunt…have preductal and postductal monitors
CDH
Assume RTL shunt until proven otherwise
For preop management
: follow preductal sat
Intubation:
AFOI, vs RSI
Monitors:
Central line, including umbilical vein catheter
Pre and post ductal pulse ox
Thoracic PFTs…predictors of badness
FEV1<30%
DLCO<40%
VO2 max <10cc/kg/min
***
May should not do surgery
Predictors of need for postop ventilation
-FEV1 <2L
-MMEFR (maximal mid expiratory flow rate)<50%
Thoracic primer: complications
-Cardiac herniation
-PTX
-Broncho-pleural fistula
-RHF (2/2 chronic hypoxia, pHTN)
-Post-op afib (from stress of surgery, fluids, manipulation of the heart)
Heart transplant…how to preverse roc
Give glyco with neostigmine as there is some cardiac reinveration over time + want to reverse other effects of neostigmine
Washing out aspirin and plavix
Aspirin: 10 days
Plavix: 7 days
OLV goals
-PEEP 5 to 10
-TV 5cc/kg
-Pplt <25-30
TEF…don’t forget
VACTERL
ESOPHAGECTOMY
Epidural + OLV
Premie considerations
Neuro: IVH, retinopathy of prematuirty
Cards: cardiac anomalies,
Pulm: respiratory insufficency, RDS, postop apnea
GI: necrotizing enterocolitis
GU: AKI
MSK: hypothermia
Endocrine: Hypoglycemia
Ligation of PDA…how to maintain anesthesia…
Low dose gas (0.2-0.3 MAC gas), remi gtt, some fentanyl/dilaudid at end of case
vWF undifferentiated bleeding
Give** humate P** (vWF-Factor 8 concentrate)
Neuro monitoring…
Usually: EEG, SSEP, MEP, EMG
For aneurysm: EEG, SSEP (have to paralyze)
Larson’s maneuver
Jaw thrust + firm pressure behind the earlobes…to break laryngospasm
SVC compression
Must get lower extremity IV access
Consider AFOI
Mediastinoscopy…and A line
Only time you need to consider L aline…but have RUE pulse ox
Cystic fibrosis…organ involvement
Lungs: bronchiectasis, PTX
GI: diabetes, meconium ileus
Heme: coagulopathy
Carotid endarterectomy…monitors/wakeup..unique consideration
If asleep: EEG, SSEP, cerebral oximeter
Wakeup: consider TIVA for smooth wakeup
Unique considerations: cerebral hyperperfusion syndrome
Carotid sinus vs Carotid Body
Carotid Sinus: related to HR/BP
Body: resp drive
BLocks
Don’t forget to check coags…confirm laterality
Porphyria
Hematin…inhibits porphyrin synthesis
Dyspnea in a 4 yo…4 things
-URI
-Foreign body aspiration
-Asthma
-Anaphylaxis
Carcinoid syndrome
-Avoid adrenergic agents (epi, ephedrine)
-Treatment of crisis: octreotide, benadryl, fluids…AVOID epinperhine
Premed:
Octreotide at least a few days prior
Pheochromocytoma…what meds to avoid
Morphine/succinylcholine…may cause release of catechoalmines
Premed:
Alpha 1 blocker for a week, followed by beta blocker
Pyloric stenosis…induction plan
RSI vs AFOi…suction prior in multiple positions
Medically optimize: euvolemic, pH 7.3-7.5, bicarb <30
Don’t forget about postop apnea…<60 weeks is a risk
Severe AS
-Valve area under 1.0, transvalvular gradient >40 (subject to LV fxn, hemodynamics)
Pacemaker
Favor bipolar cautery
Epi dosing for bradycardia
2-10mcg/min gtt
Neonatal Resuscitation
-Supplemental O2 per preductal oxygen level
-Epi 0.01mg/kg
Stellate Ganglion Block SOB ddx
-Phrenic nerve palsy
-LAST
-Epidural/spinal injection
Sick Euthyroid
Nl TSH, low T3, T4
Thyroid surgery and ETT
-Need an ETT with nerve monitoring capabilities
-Potentially an armored ETT for compression
-TIVA for maintenance (smooth wakeup, for nerve monitoring)
Thyroidectomy, stridor in PACU
-Hypocalcemia
-Hematoma
-B/l recurrent laryngeal nerve injury
-Airway edema
-Upper airway obstruction
Aprepitant MOA
Neurokinin antagonist
How to wean off bypass?
-Rewarm the patient (give midaz)
-Correct anemia
-Correct electrolyte derangement, give mag and calcium
-TEE to guide preload, afterload, inotropy
-Reinitiate lung ventilation
-Pacer and pads for chronotropy, arrhythmia
Anterior Mediastinal Mass: How to approach airway
-Awake fiberoptic, that way can assess level of compression, get tube distal (may even have to advance to patent bronchus)
Anterior Mediastinal Mass: Airway Attempted, running into issues…ddx
Apnea
Laryngospasm
Bronchospasm
Mass Compression
Tet spell, physiology…Tetralogy of Fallot
-Increased RV outflow obstruction
-Decreased SVR
*
Txt:
-increase SVR (knees to chest)
-esmolol to decrease inotropy (relieve RV outflow obstruction)
Pediatric CPR
epi 0.01mg/kg
Compression rate, like adults, is 100-120
(vs neonatal is 120)
Anesthesia machine: how do you do a machine check
-Check monitors
-Calibrate CO2 and O2-analyzers
-Check for leaks in the high and low-pressure system
-Confirm adequate CO2 absorbent
Sevoflurane vs desflurane vaporizer
Sevoflurane is a variable-bypass vaporizer… a variable amount of fresh gas flow mixes with the volatile agent
Desflurane is a gas-vapor blender
CABG heparin dosing
300units/kg
ACT>400
Neonate and fluid
Should always have D5 1/2 NS maintenance going…no fat stores, high risk for hypoglycemia
vWF and epidural placement
-vWF and Factor 8 level should be 80%
-If needed, give DDAVP or replacement
TEG
Prolonged R->give FFP
Prolonged K/decreased alpha angle->give cryoprecipitate
Short MA->give platelets
Rapid loss of amplitude->give TXA
