Pain

Question 1

Dose for intralipid

Answer 1

1.5ml/kg over 1 minute then 0.25ml/kg infusion

Question 2

Block for pelvic cancer pain

Answer 2

superior hypogastric plexus block

Question 3

Advantages with epidurals

Answer 3

fewer DVTs
better pain
fewer side effects

Question 4

Last dose of heparin to remove epidural

Answer 4

UFH = 4-6 hours
LMWH day = 12 hours
Higher doses = remove before starting therapy and wait 24 hours

Question 5

How does warfarin work?

Answer 5

blocks factors 2, 7, 9, and 10, Protein C, S

Question 6

How do you reverse warfarin?

Answer 6

Vit K
FFP
Factor concentrate (K-centra 4 factor concentrate)

Question 7

Ways to prevent LAST

Answer 7

Limit dose given
Use ultrasound
Small incremental doses
Addition of epi or fent as markers of systemic absorption 
Avoid excessive sedation

Question 8

Max dose of bupivicaine

Answer 8

2.5 - 3mg/kg

Question 9

Max dose of lidocaine and mepivicaine

Answer 9

5 - 7mg/kg

Question 10

Max dose if ropivicaine

Answer 10

2.5 - 3.5mg/kg

Question 11

Pancreatic cancer pain not controlled with MSContin, what are you other options?

Answer 11

Adjuvant therapies - anticonvulsants, antidepressants
Corticosteroids
Opioid rotation
TENS
Celiac plexus block

Question 12

Where is the celiac plexus located?

Answer 12

Anterior body of L1

Question 13

What are the complications of a celiac plexus block?

Answer 13

Paralysis
Postural hypotension
Retroperitoneal hemorrhage
Intravascular injection
Diarrhea

Question 14

What are the diagnostic criteria for CRPS-1?

Answer 14

Noxious event
Burning pain, allodynia or hyperalgesia 
Cyanosis
Edema
Sweating
Skin changes

Question 15

Hows does CRPS-2 differ from CRPS-1?

Answer 15

By nature of injury
1 = crush, laceration, fractures, surgery, burn, sprains
2 = nerve injury

Question 16

Complications of stellate ganglion block?

Answer 16

Expect Horners syndrome - good block
- myosis, ptosis, anhydrosis, nasal stuffiness

Intrathecal, epidural, intravascular injection

transverse process of C6
UL inc temperature
Dx and Tx of UL CRPS

Question 17

Mechanism for peripheral nerve sensitization? Central sensitization?

Answer 17

Peripheral - inflammatory mediators sensitize nerves

Central - lower threshold for pain + allodynia + hyperesthesia

Question 18

What are trigger points?

Answer 18

Hyperirritable nodules in muscle + focal point tenderness

Question 19

How does TENS therapy work?

Answer 19

Inhibition of pain signals at presynaptic level

Release of endogenous substances involved in pain control

Question 20

What is the treatment for phantom limb pain?

Answer 20

Spinal cord stim
Heat
Acupuncture 
PT
Hypnosis
Biofeedback
Antidepressants
Anticonvulsants

Question 21

How would you treat opioid withdrawal?

Answer 21

Tx any dehydration
Clonidine
Anti-emetic
Anti-diarrheal
Addiction specialist

Question 22

Do you need to intubate pt with seizure from suspect LAST?

Answer 22

Probably.

I would want to avoid acidosis, hypoxia which enhance the cardio-depressant effects of LAs. (increase free fraction of LAs)

Question 23

How would you distinguish opioid requirements from addiction? Tolerance? Dependence?

Answer 23

I would assess for compulsive behaviors suggestive of cravings, harmful effects of use like failure to meet work or family obligations

Tolerance
- Need for escalating doses for same clinical response

Dependence
- Patient still has control over use but experiences withdrawn without the medication