PBR2 Flashcards
amiloride mechanism
potassium sparing diuretic, directly decreases cGMP gated sodium channel activity, decreases lithium entry into tubular cells (reverse lithium-induced nephrogenic DI)
spironolactone/eplerenone
potassium sparing diuretics that competitively inhibit mineralocorticoid receptor
pacemaker indication
long QT, SA/AV node disease, reduce outflow obstruction with HOCM, treat dilated CM, mobitz type II because usually progresses to complete
ultrasound
attenuate least - water (echo lucent)
L5 distribution
lateral aspect of knee, dorsum of foot
dose dependent effects on SSEPs
barbs, propofol, volatiles, benzos, nitrous
leak for neonate ETT
15-25 cm H2O
type II error
failing to reject the null when it is actually false
barb use with aneurysm clipping
indicated when prolonged vessel occlusion is unavoidable and when EEG slowing occurs with occlusion - reduces metabolic activity (ischemic protection)
nitrous and CMRO2
increases metabolic rate, vasodilator - increases ICP
CBF and PaO2
CBF remains constant at a PaO2 greater than 50
Higher chance of latex allergy
mango, kiwi, chestnut, avocado, passion fruit, and banana
NMB recovery signs most reliable
sustained head lift for 5 seconds, sustained leg lift for 5 seconds, sustained handgrip for 5 seconds, maximum inspiratory pressure 40 to 50 cm H2O or greater
CCB and dantrolene
lethal ventricular fibrillation due to hyperkalemia in anesthetized swine
Garlic, ginkgo, and ginseng how long to wait
Garlic 7 days, ginseng 24 hours, and Ginkgo lasts 36 hours
rapid shallow breathing index
RSBI = respiratory rate/tidal volume; less than 100/105 with max FiO2 0.4
Phenoxybenzamine and pheo
Reduction in mortality is potentially reduced from 40-60% to 0-6% with the preoperative implementation of alpha-adrenergic receptor blockade, typically performed 10-14 days prior to surgery
Protein binding in preg
Maternal and fetal albumin levels are comparable; as opposed to alpha-1-acid glycoprotein which is at much higher levels in maternal plasma; bound to albumin more likely to cross placenta
Decreased preeclampsia risk
Cigarette smoking
LIM can detect
high current fow >2mA
most anesthesia drugs transported across placenta
via diffusion
increase intraocular pressure
hypercapnea, decreased PaO2, elevated CVP, succhinylcholine, some anticholinergics (IV atropine does not)
acquired antithrombin deficiency
nephrotic syndrome, cirrhosis, DIC (may have resistance to heparin)
pulmonary artery rupture risk
age >60, pHTN, hypothermia, anticoagulation, overinflation of balloon
compartment syndrome symptoms
sensory deficits before motor, manifest distal to involved compartment
brain dead and acetylcholine
lack release of endogenous acetylcholine - need to use direct agonists like isoproterenol to treat bradycardia
RBC salvage contraindications
ruptured AAA, infection, GI perforation, malignancy (can use for patient with alloantibodies which may make transfusion difficult)
HOCM treatment
CCB, beta blockers
ass with increased K after suc
massive trauma, encephalitis, ruptured cerebral aneurysms, metabolic acidosis & hypovolemia
additional amiodarone se
thyroid dysfunction (drug has lots of iodine), peripheral neuropathy, bradyarrhythmias
lidocaine arrhythmia use
useful for ventricular not supraventricular
brain death criteria
coma, absent motor activity, absent brain stem, absence of ventilatory effort despite CO2 60 or 20 above baseline
zero lumbar drain
phlebostatic axis at level of right atrium
classic hemodynamics of constrictive pericarditis
equalization of ventricular diastolic pressure
jet ventilation risks
barotrauma, pneumothorax, gastric distention, hypoxia
R (reaction time)
time zero to the beginning of clot formation, signifies contributions of the intrinsic and extrinsic coagulation cascades, and the final common pathway to fibrin formation ((1-3 minutes is normal for use of Tissue Factor activator, 7-14 minutes for Celite, Kaolin)
K (coagulation time)
measure of speed of clot formation and strengthening, equal to the time from amplitude 2mm to 20mm, relies on fibrinogen
alpha angle
measure speed of clot formation, this relies on fibrinogen, normal is 45-55 degrees.
MA (maximal amplitude)
measures maximal clot strength, equal to the max width of TEG, represents clot strength as determined by platelet number and function, as well as fibrin cross-linking to form a stable clot, normal is 50-60mm; after MA measures clot lysis
continuous wave Doppler vs pulsed wave
continuous uses 2 crystals and prevents determination of maximal velocity; pulsed uses 1 crystal and high velocities are often measured as negative (aliasing)
circumflex branch leads
I and aVL
V1 uses
ileus, abd distention, esophageal varices, shock, Vfib/PEA
V2 uses
DI and vWF def
hypocalcemia
prolonged QT and ST, inverted T, bradycardia
wall tension equation
= (pressure x radius)/(2 x wall thickness)
heparin rebound after protamine
heparin can bind to protein which protects it from binding with protamine, when these dissociate can get rebound
HOCM presentation
dyspnea, angina, dizziness, sinus tachy, double-impulse peripheral pulse, hypotension, low JVP, heart failure stigmata, murmurs (LV obstruction and MR)
CPB and coagulation
platelet dysfunction common cause of post CPB bleeding - return to norm 2-4 hr post
recombinant factor VIIa
binds onto tissue factor and initiates coagulation by amplifying factor IX and X leading to thrombin generation, used to decrease massive hemorrhage
antibiotics - no NMB
PCN and cephalosporins
Hering Breuer reflex
when pulmonary stretch receptors sense overinflation - inspiration is inhibited so expiration can occur
high frequency ultrasound
poor penetration (cannot be used for deep structures)
ultrasound attenuation
proportional to frequency and path length of ultrasound wave
morphine IV:PO conversion
1:3
most common postpartum foot drop
lumbosacral trunk damage - weakness of ankle dorsiflexion and dermatome L5 sensory loss - 2/2 head compression by pelvic brim by head
increased potassium with suc
hypovolemia and metabolic acidosis, severe abd infections, closed head injury, major trauma, neuromuscular disease
garlic discontinued
1 week before surgery
valerian root discontinued
tapered over several weeks or will see symptoms similar to benzo withdrawal
ginseng drug interaction
interferes with warfarin anticoag - may need more warfarin to achieve same results
herbals interfere with coag
ginger, gingko, ginseng, garlic, saw palmetto
kava/valerian
potentiate sedation
echinacea
interfere with effectiveness of immunosuppressants
st. john’s wort
induction of cytochrome p450, delayed emergence
GBS treatment
plasmapheresis - can have hypotension and pulmonary edema, IVIG - less side effects, corticosteroids do not help
myasthenia clue
disease >6 yrs, pyridostigmine >750 mg daily, preop vital capacity <3 L, pulmonary disease unrelated to myasthenia
