PBR1 Flashcards
TRALI blood labs
transient leukopenia and thrombocytopenia 2/2 pulmonary sequestration
EMLA drug interactions
lido/prilocaine (methgb) known history of sensitivity to amide LA, class I anti-arrhythmic drugs (tocainide and mexiletine) - toxic effects are additive/synergistic
vasopressin effects
cause systemic vasoconstriction via systemic V1 and cause pulmonary vasodilation via pulmonary V1
NO side effects
methgb, inhibit platelet function, inactivate surfactant, cytotoxic, immunosuppressant, mutagenesis, rebound pHTN
factors increasing energy expenditure
elective surgery, sepsis, >60% burn, long bone injuries
DDAVP contraindications
type 2b vWF disease because it increases abnormal vWF and may lead to thrombocytopenia
treatment of intrathecal pruritis
not antihistamines as histamine is not the cause of pruritis with intrathecal opioids
fasting requirements
clear fluids 2 hr, breast milk 4 hr, formula 6 hr, light meal 6 hr, heavy meal 8 hr
long context sensitive half life
thiopental > midaz, prop, etom, ketamine
factor XIII def labs
PT, PTT, TT, bleeding times all normal - diagnose with levels 1% of normal
vit k def
marked prolonged PT, prolonged PTT, normal TT and fibrinogen
factor VII def
prolonged PT, normal PTT, TT, fibrinogen
factor VIII and IX def
prolonged PTT, normal PT, TT, fibrinogen
CO2 absorbent CO production vs not
potassium/sodium hydroxide (abstracts proton from difluoromethoxy group on anesthetic) produce CO vs barium/calcium hydroxide do not
Blood gas partition coefficients
Desflurane 0.45 Nitrous Oxide 0.47 Sevoflurane 0.65 Isoflurane 1.4 Halothane 2.5
Tracheobronchomalacia
obstructive ventilatory defect resulting in a prolonged expiratory time (a decreased FEV1) and normal FVC, resulting in a decreased FEV1/FVC
Examples of restrictive lung disease
parallel reduction in FVC and FEV1 and normal or greater than normal FEV1/FVC; examples myasthenia, PNA, kyphoscoliosis, pulmonary edema
post-operative respiratory failure
Abdominal aortic anerurysm cases > thoracic surgery, neurosurgery, upper abdominal surgery and peripheral vascular surgery
addisons disease symptoms
adrenal insufficiency - low blood pressure, salt craving, weight loss, GI problems, muscle/joint pains, hyperpigmentation, low BP
addisons lab abnormalities
hyponatremia, hyperkalemia, hyperchloremia, acidosis
acetazolamide
inhibits carbonic anhydrase - decreases sodium bicarb reabsorption, hcl is reabsorbed, potassium is wasted, water also excreted
addisons causes
autoimmune most common in US, TB is most common worldwide
narcs to avoid in liver failure
morphine, meperedine (accumulates - CNS depressive effects), alfentanil (clearance decreased); fentanyl and sufentanil ok to give
albumin
make 15g a day, half life 20 days, percentage degraded daily is 4%
first abnormal coag test in liver failure
PT - usually reflects low VII (half life 4 hr -shortest) [fibrinogen half life 4 days]
prerenal labs
urine osm >450, serum osm 280-300 (urine to plasma osm ratio >1.5, urine sodium <35%
uremic and bleeding
DDAVP - given over 15-30 min IV, improves within 1 hr and lasts 4-24 hr, tachyphylaxis after 2nd dose (2/2 to depleted endothelial stores)
propofol infusion syndrome
after 48hrs of >4mg/kg/hr; acute refractory brady leading to asystole, metabolic acidosis, rhabdomyolysis, hyperlipidemia, cardiomyopathies, skeletal myopathy, hyperkalemia
AFE most common symptoms
cardiopulmonary arrest, hypotension, fetal compromise, pulmonary edema/ARDS
lidocaine and ECT
dose related decreases in duration of motor and seizure activity
ECT EKG changes
tachy, ST depression, T wave inversion (parasymp - brady, asystole, PACs/PVCs)
refeeding syndrome
result of hypophosphatemia 2/2 shift from fat to card metabolism -> ATP and 2,3 DPG depleted leading to impaired myocard contractility, CV collapse, resp failure, rhabdomyolysis, seizures, delirium
botulinum A mechanism
inhibits release of acetylcholine from presynaptic membrane of NMJ
IM NMBD
rocuronium
sacral hiatus
unfused laminae S4/5
contraindicated congenital long QT
amiodarone - prolongs QT interval
congenital long QT treatment
flecainide, mexiletine, nicorandil, beta blockers
FDA approved recombinant factor VII uses
bleeding patients with hemophilia A/B who have factor VII or IX inhibitors, patients with acquired hemophilia, patients with congenital factor VII def
tet spell treatment
fluid bolus to improve RV filling and pulm blood flow, morphine, IV beta blockers, phenylephrine
pregnancy pulmonary changes
FRC down 20%, Vt increase 40%, RR increase 15%, PaO2 increases 10%, VC unchanged
surfactant production starts
30 weeks, 34 weeks sufficient for extrauterine life
lowest PO2 of the body
coronary sinus with PO2 18-20
hypothyroid CV changes
decreased HR, contractility, SV, CO (prone to overdose with more soluble volatiles from increased alveolar rate), intravascular volume (mottled extreme from vasoconstriction)
hyperkalemia EKG progression
peaked T waves, wide QRS, prolonged PR, ST depression, sine wave, v fib, asystole
adrenal insufficiency labs
baseline cortisol below 15 mcg/dL and increase 34 (low prob of adrenal insuff)
H cylinders
6000-8000 L, high pressure system used for hospital wide gas, attached to manifold that reduces high pressure 2000 to 55, usually O2 (nitrous usually E)
maximum current leakage in OR
10 microamps
fibrillation current threshold
100 milliamps
cyanide poisoning treatment
sodium nitrite & amyl nitrite (create methgb which combines with cyanide to make cyanomethgb - nontoxic), hydroxycobalamin/B12, sodium thiosulfate (facilitates metabolic disposal of cyanide via kidneys)
ankylosing spondylitis ass prob
problem of spine, hips, shoulders, TMJ, AI, cardiac conduction abn, pleural effusions, HTN, CAD
ankylosing spondylitis and lung
increased FRC and RV due to fixation of ribs in inspiratory position
AI/MR anesthetic goals
relatively fast HR, increased preload, decreased afterload, maintenance of contractility and pulmonary vasc resistance
AI treatment
nifedipine and ACE-I can slow progression of AR and influence LV size - improve survival (bebat blocker relatively contraindicated)
potentiate NMB
magnesium, alkalosis, acidosis, hepatic dysfunction (not erythromycin)
testes block
T10-L2 2/2testes descending from abdomen near origin of kidney and upper ureter
hereditary angioedema treatment
C1 inhibitor concentrate is best prophylactic treatment, FFP can be given but may worsen attack, danazol used if started 5-7 days before procedure
tumescence lido max
0.1% lido with 1:1,000,000 epi max is 35 mg/kg (toxic level 5 mcg/ml)
a-a gradient
directly proportional to shunt, greater the shunt less likely hypoxemia will respond to increasing FiO2, indirectly proportional to MvO2, normal is <15, increases with age
rescue median blocks
antecubital crease medial to biceps insertion or at wrist medial and deep to palmaris longus tendon
radial rescue
AC space at lateral aspect of biceps tendon or at level of ulnar styloid between radial artery and flexor carpi radialis tendon
ulnar rescue
one finger breadth proximal to the arcuate ligament or immediately lateral to flexor carpi ulnaris
NMDA inhibitors
ketamine, xenon, nitrous, diethyl ether
edrophonium
used to distinguish myasthenia gravis from cholinergic crisis
omphalocele
failure of gut migration from yolk sac into abdomen, 40-60% have ass anom, defect lies within umbilical cord (beckwith-widemann, exostrophy of bladder, congen heart disease)
2 most important in hospital mortality risk factors
chronic heart failure, unstable coronary syndrome
loss of twitch 2,3,4
90%, 80%, 75% blocked
estimated sodium deficit
TBW x (ideal sodium - patient’s sodium)
which valve surgery greatest risk of complete heart block
AV 2/2 bundle of His adjacent to non-coronary cusp
milrinone se
(inotrope, phosphodiesterase inhibitor) hypotension, atrial and ventricular arrhythmias
contraction alkalosis management
potassium repletion, chloride repletion, volume repletion, acetazolamide,
PVCs treatment
beta blockers are first line, amiodarone next (avoid fecainide/encainide because proarrhythmic), also lidocaine
