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Pharmacology Flashcards

TXWES REFERENCE GUIDE

1
Q

BENZOS

Dose (IV, PO), Onset, Duration:
Diazepam

A

Valium
0.1mg/kg IV
Onset 1-5mins ⏐Duration 2-6h

0.2mg/kg PO

Water soluble in solution at pH <3.5; Lipid soluble in plasma at pH >4.

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2
Q

BENZOS

Dose, Onset, Duration:
Lorazepam

A

0.04mg/kg ⏐ Onset 1-5mins ⏐6-10h

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3
Q

BENZOS

Dose, Onset, Duration:
Midazolam

Versed

A

1-5mg or 0.01-0.05mg/kg ⏐Onset 1-5mins ⏐15-80min

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4
Q

BENZOS

Dose, Onset, Duration:
Flumazenil

Romazicon

A

0.2mg ⏐ Onset 1-5mins ⏐30mins!!!

Repeat 0.1 q 1min –> MAX 3mg

BENZO REVERSAL

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5
Q

OPIOIDS

Dose (intraOp, postop), Onset, Duration:
Morphine

A

1-10mg IntraOp
5-20mg PostOp
Onset 10-20mins ⏐ Duration 4-5h

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6
Q

OPIOIDS

Dose, Onset, Duration:
Fentanyl

A

1.5-3mcg/kg
Onset 30-60sec ⏐ Duration 1-1.5h

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7
Q

OPIOIDS

Dose, Onset, Duration:
Sufentanil

A

0.3-1mcg/kg
Onset 30-60sec ⏐ 1-1.5hr

Infusion: 0.5-1mcg/kg/hr (close to intraop dose)

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8
Q

OPIOIDS

Dose, Onset, Duration:
Remifentanil

A

0.5 - 1mcg/kg OVER 1 MIN!!!
Onset 30-60sec ⏐ 6-8min

gtt: 0.125-0.375 mcg/kg/MIN

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9
Q

OPIOIDS

Dose, Onset, Duration:
Meperidine

Demerol

A

12.5mg (Shivering)
Onset 5-15min ⏐ Duration 2-4h

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10
Q

OPIOIDS

Dose (intra, postop), Onset, Duration:
Hydromorphone

Diluadid

A

1 - 4mg IntraOp
1.5 - 4mg PostOp (basically the same)
Onset 5-15min ⏐ Duration 2-4hr

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11
Q

OPIOIDS

Dose, Onset, Duration:
Naloxone

Narcan

A

40-80mcg ⏐ Onset 1-5 min⏐ Duration 30min

Opioid REVERSAL

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12
Q

INDUCTION MEDS

Dose (induction, sedation gtt, TIVA gtt), Onset, Duration:
Propofol

A

1.5-2.5mg/kg Induction
25-100 mcg/kg/min Sedation
100-300 mcg/kg/min TIVA
Onset 30-60sec ⏐ 1-8mins

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13
Q

Induction

Dose, Onset:
Etomidate

A

0.3mg/kg ⏐ Onset 1 min

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14
Q

Induction

Dose (induction, IV analgesia), Onset, Duration:
Ketamine

A

0.5-1.5mg/kg Induction
0.2-0.5 mg/kg IV Analgesia
Onset 1 min⏐ 10-20min

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15
Q

Induction Dose

Dose, Onset, Duration:
Midazolam

Versed

A

0.1-0.2mg/kg
Onset 30-60sec ⏐ Duration 5-10min???

*may precede dose w/ Fentanyl 50-100mcg

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16
Q

Dose:
Dexmedetomidine

Precedex

A

Bolus 0.5-1mcg/kg over 10mins

Usually on-hand 200mcg/2ml > mix with 48cc NS > 4mcg/ml

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17
Q

Inhalation

MAC, VP, Blood:Gas Co.:
Sevoflurane

A

MAC 1.8
VP 157
Blood Coefficient 0.69

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18
Q

Inhalation

MAC, VP, Blood:Gas Co.:
Desflurane

A

MAC 6.6
VP 669
Blood Coefficient 0.42

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19
Q

Inhalation

MAC, VP, Blood:Gas Co.:
Isoflurane

A

MAC 1.17
VP 238
Blood Coefficient 1.46

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20
Q

Inhalation

MAC, VP, Blood:Gas Co.:
Nitrous Oxide

A

MAC 104
VP 🚀 38,770 gas
Blood Coefficient 0.46

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21
Q

Muscle Relaxants

Dose, Onset, Duration:
Succinylcholine

Anectine

A

1-1.5 mg/kg
Onset 30-60sec ⏐Durations 5-10min

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22
Q

Muscle Relaxants

Dose, Onset, Duration:
Cisatricurium

Nimbex

A

0.2 mg/kg
Onset 2-3min ⏐ Duration 40-75min

Hoffman Elimination

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23
Q

Muscle Relaxants

Dose, Onset, Duration:
Vecuronium

Norcuron

A

0.1 mg/kg
Onset 2-3min⏐ 45-90min

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24
Q

Muscle Relaxants

Dose (1st & 2nd), Onset, Duration:
Rocuronium

Zemuron

A

0.6 mg/kg Onset 2-3mins
1.2 mg/kg Onset 1.5 mins
Duration 35-75mins

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25
Q

Muscle Relaxants

Dose, Onset, Duration:
Pancuronium

Pavulon

A

0.1 mg/kg
Onset 2-3min ⏐Duration 60-120min

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26
Q

Muscle Relaxants Reversals

Dose, Onset, Duration, Anticholinergic buddy:
Neostigmine

A

0.04-0.07 mg/kg
(40-70 mcg ~100 kg pt)
Onset 5-10min ⏐ Duration 60min

Glycopyrrolate 0.2mg/ml of Neo to avoid bradycardia

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27
Q

Muscle Relaxants Reversals

Dose, Onset, Duration, Anticholinergic buddy:
Sugammadex

A

2-16 mg/kg (depends on TOF & PTP)
Onset 1-4min ⏐ Duration 1.5-3hrs

NONE 🙃

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28
Q

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Lidocaine

A

Amide
5, 7

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29
Q

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Prilocaine

A

Amide.
6, 8.5

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30
Q

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Mepivicaine

A

Amide.
5, 7

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31
Q

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Bupivicaine

A

Amide.
2.5, 2.5

EPI DONT MAKE NO DIFFERENCE! 😅

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32
Q

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Ropivicaine

A

Amide.
3, 4

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33
Q

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Procaine

A

Ester.
7, 8.5

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34
Q

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Chloroprocaine

A

Ester.
6, 14!

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35
Q

REGIONAL MEDS

Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Tetracaine

A

Ester.
3, 3

EPI MAKES NO DIFFERENCE 😅

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36
Q

CSE LABOR ANALGESIA

Epidural (%) & Spinal (mg) doses?
Bupivicaine

A

0.0625-0.125%
1.25 - 2.5 ml

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37
Q

CSE LABOR ANALGESIA

Epidural (%) & Spinal (mL) doses?
Ropivicaine

A

0.08 - 0.2%
2.5-4.5 mL

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38
Q

CSE LABOR ANALGESIA

Epidural (%) & Spinal (mL) doses?
Lidocaine + Epi

A

2% in 5cc bolus
N/A

No spinal dose.

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39
Q

CSE LABOR ANALGESIA

Epidural & Spinal doses? (mcg)
Fentanyl

A

50-100 mcg
10-25 mcg

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40
Q

CSE LABOR ANALGESIA

Epidural & Spinal doses? (mcg)
Sufentanil

A

5-10 mcg
1.5 - 5 mcg

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41
Q

CSE LABOR ANALGESIA

Epidural (%) & Spinal (mg) doses?
Morphine

A

NO epidural dose.
Spinal: 0.1 - 0.2 mg

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42
Q

ANTIEMETICS

Dose, Onset, Duration:
Droperidol

Inapsine

A

0.625mg, 1-5min, 2-3hrs

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43
Q

ANTIEMETICS

Dose, Onset, Duration:
Promethazine

Phenergran

A

6.25 -12.5 mg, 1-5mins, 4-6hrs

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44
Q

ANTIEMETICS

Dose, Onset, Duration:
Ondansetron

Zofran

A

4mg, 10mins, 4-9hrs

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45
Q

ANTIEMETICS

Dose, Onset, Duration:
Dexamethasone

Decadron

A

4mg, 10-30mins, 2-10hrs

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46
Q

ANTIEMETICS

Dose, Onset, Duration:
Metoclopramide

Reglan

A

10-20mg, 10mins, 2hrs

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47
Q

ANTIEMETICS

Dose, Onset, Duration:
Scopolamine

A

Patch, 2-4hrs, 72hrs!

Non-hairy area - dont touch eyes after handling –> can cause mydriasis.

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48
Q

ANTIEMETICS

Dose, Onset, Duration:
Propofol

Diprivan

A

10-15mg IV followed by 10mcg/kg/min

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49
Q

List some PONV risk factors.

A

Female, <40yrs, Hx of PONV or Motion Sickness, vertigo, non-smokers

Surgeries: Laparotomy, Laparoscopy, Major Breast, Strabismus, Intraocular, Middle Ear, Tonsils, Adenoids, Neuro (intracranial), Gynecologic, Testicular, Scrotum, Kidney stones

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50
Q

If I have 0 PONV risk factors, what is the chance I will have PONV?

A

10%

This requires NO pre-treament drugs.

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51
Q

If I have 3 PONV risk factors, what is the chance I will have PONV?
What drugs will you pre-treat your patient with?

A

> 60% chance.
Give at least 3 pre-treament drugs: 5HT blocker, steroid, propofol + TIVA??

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52
Q

My patient requires 2 pre-treatment drugs for PONV; I gave zofran and decadron before her surgery.

How many risk factors do you think she has?
What are her chances of developing PONV based on this info?

A

2 risk factors = 40% chance of developing PONV

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53
Q

My chance of PONV is 20%.

How many risk factors do I have?
What drug(s) will you give me?

A

I have 1 risk factor and you should give me a 5HT-blocker like zofran :)

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54
Q

NON OPIOID ANALGESICS

1x Dose & daily MAX dose.
Acetaminophen

Ofirmev

A

1000mg q 4-6hr
MAX: 3-4g qd

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55
Q

NON OPIOID ANALGESICS

1x Dose & daily MAX dose.
Ketorlac

Toradol

A

15-30mg q6h
60-120mg qd

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56
Q

NON OPIOID ANALGESICS

1x Dose & daily MAX dose.
Ibuprofen

Caldor

A

200-800mg q6h
3200mg qd

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57
Q

List some symptoms of LAST.

Local Anesthetic Systemic Toxicity

A

Analgesia, lightheadedness, tinnitis, tongue/circumoral numbness, tingling of mouth, funny/metallic taste, SZ, LOC, respiratory arrest, cardiovascular arrest.

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58
Q

Explain the lipid rescue for LAST.

A

In addition to CPR -
1. bolus 20% intralipids 0.25ml/kg/min
2. circulate lipids w/ CPR
3. repeat bolus q3-5 mins UP TO 3ml/kg total dose until ROSC.
4. ⬆ infusion to 0.5ml/kg/min if BP declines - continue infusion until hemodynamically stable.

*MAX DOSE: 8ml/kg

If you dont have 20% lipids immediately handy - give what you have until you obtain the 20%.

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59
Q

List the formula for Farenheit from Celcius.

A

°F = [(9/5) x °C) + 32]

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60
Q

If my patient’s temp is 96.8°F, what is it in °C?
94°F?

A

36°C
34.5°C

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61
Q

What is the formula for Celcius from Farenheit?

A

°C = [(5/9) x (°F - 32)]

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62
Q

If my patients temp is 38°C, what is it in °F?
40°C?

A

100 °F
104 °F

63
Q

A nice pattern to help do quick temp conversions.

A
  1. If you start at 95°F - celcius is 35.
  2. As you increase in 0.9°F, each °C goes up by 0.5°
    :)
64
Q

AIRWAY CLASSIFICATION

Describe a Mallampati 1.

A

Soft palate, fauces, uvula, anterior & posterior tonsilar pillars

65
Q

AIRWAY CLASSIFICATION

Describe a Mallampati 2.

A

Soft palate, fauces, & uvula only.

66
Q

AIRWAY CLASSIFICATION

Describe a Mallampati 3.

A

Soft palate & base of uvula.

67
Q

AIRWAY CLASSIFICATION

Describe a Mallampati 4.

A

Soft palate only.

68
Q

AIRWAY CLASSIFICATION

Describe a Mallampati 5.

A

Lolz, gotcha.

69
Q

AIRWAY CLASSIFICATION

List the Cormack-Lehane view grade: Full view of entire glottic opening.

A

Grade 1

70
Q

AIRWAY CLASSIFICATION

List the Cormack-Lehane view grade:
Neither glottis nor epiglottis seen.

A

Grade 4.

71
Q

AIRWAY CLASSIFICATION

List the Cormack-Lehane view grade:
Only epiglottis seen.

A

Grade 3.

72
Q

AIRWAY CLASSIFICATION

List the Cormack-Lehane view grade:
Only posterior portion of glottic opening.

A

Grade 2.

73
Q

List the normal blood gas values:
pH
PaO2
PaCO2

A

pH: 7.35-7.45
PaO2: 90-100
PaCO2: 35-45

74
Q

List the normal blood gas values:
HCO3-
BE
SaO2

A

HCO3-: 22-26
BE: -2 to 2
SaO2: 95-98%

75
Q

Formula for VO2

A

10 x kg(3/4) = VO2

76
Q

Formula for VCO2

A

8 x kg(3/4) = VCO2

77
Q

What does this formula describe?

[FiO2 x (Pb - PH2O)] - PaCO2 / 0.8

A

Alveoar Gas/Air Equation

https://youtu.be/vrjK4gxa-48

78
Q

Formula for arterial O2 content/dL

A

(hgb x 1.34 x SaO2) + (PaO2 x 0.003)

79
Q

PBW (predicted body weight) equation for a male.

A

50 + 0.91(cm height - 152.4)kg = male PBW

PBW is used to determine your tidal volume (5 - 8cc/kg).

80
Q

PBW (predicted body weight) equation for a female

A

45.5 + 0.91 (cm height -152.4)kg = female PBW.

PBW is used to determine your tidal volume (5 - 8cc/kg).

81
Q

Formula for MAP.

What is the normal adult range?

A

[SBP + (2xDBP) / 3]

Normal range: 70-105mmHg

82
Q

Normal CO

A

4-8 L/min

83
Q

Formula for CI

Normal range for CI?

A

(CO / BSA)

2.5 - 4 L/min

84
Q

Normal CVP range?

A

2-6 mmHg

85
Q

Normal PCWP?

What does PCWP measure?

A

8-12 mmHg

Helps measures LA pressure, along with L heart function (mitral valves & LV filling pressure).

86
Q

Normal PVR?
(pulmonary vascular resistance)

A

50 - 350 dynes/cm/sec^-5

87
Q

Normal SVR?

A

700 - 1400 dynes/cm/sec^-5

88
Q

Normal EF?

A

55-70%

89
Q

Normal mPAP? sPAP? dPAP?

A

mPAP: ~15mmHg
sPAP: 15-30 mmHg
dPAP: 5-15 mmHg

90
Q

Formula for Shock Index

A

(HR / SBP)

> 1 = increased M&M & chance of Mass Transfusion protocol (MTP)

91
Q

EBV of preemie

A

95ml/kg

92
Q

EBV of term infant

A

85ml/kg

93
Q

EBV of infant - 12mo

A

80kg/ml

94
Q

EBV of male adult/child

A

75ml/kg

95
Q

EBV of female adult/child

A

65ml/kg

96
Q

EBV of morbid obese (BMI >40)

A

60ml/kg

97
Q

Allowable blood loss (ABL) formula

A

[(initial Hct - final Hct) x EBV / initial Hct]

98
Q

Fluid Replacement Equivalent

Crystalloids

A

3ml / 1ml EBL

99
Q

Fluid Replacement Equivalent

Colloids

A

1ml / 1ml EBL

100
Q

Fluid Replacement Equivalent

Whole Blood

A

1ml / 1ml EBL

*same as colloids

101
Q

Fluid Replacement Equivalent

PRBC

A

0.5ml / 1ml EBL

PRBC Hct = 70%

102
Q

Fluid Replacement Equivalent

How much EBL is in a fully soaked 4x4 guaze?

A

10 ml

103
Q

Fluid Replacement Equivalent

How much EBL is in a fully soaked ‘lap’ pad?

A

100-150cc

104
Q

What is the 4-2-1 rule for maintenance fluids?

A

1st 10kg = 4cc/kg/hr
2nd 10kg = 2cc/kg/hr
Every kg >20 = 1cc/kg/hr

105
Q

How do you accomodate for an NPO deficit with maintenance fluids?

A

(maintenance rate x #hrs NPO)

106
Q

What are the estimated evaporated losses?
(minimal, moderate, severe)

A

Minimal = 0.2 mL/kg/hr
Moderate = 2 - 4 mL/kg/hr
Severe = 4 - 8 mL/kg/hr

107
Q

BMI formula(s)

A

1in = 0.025meters

108
Q

Healthy BMI range

A

18.5 - 25

109
Q

Overweight BMI

A

> 25

110
Q

Obese BMI

A

> 30

111
Q

Morbidly obese BMI

A

> 35-40

112
Q

Super morbidly obese

A

> 55

113
Q

List the IBW formulas.
(male, female)

A

Male: (cm Ht - 100)=kg
Female (cm Ht - 105)=kg

1in = 2.5cm

114
Q

Dose of ephedrine for HoTN?
Main receptor(s)?

A

5mg
⍺ & β

115
Q

Dose of Neosynephrine for HoTN?
Main receptor(s)?

A

100mcg
⍺

116
Q

Labetalol dose for HTN?
Main receptor?

A

5mg
β

117
Q

Esmolol dose for HTN?
Main receptor?

A

10mg
β1

118
Q

Hydralazine dose?
Main receptor?

A

5mg
Directly vasodilates on the smooth muscle of the arterioles.

119
Q

LABS

Hct (male, female)

A

male: 42-52 g/dL
female: 37-47 g/dL

120
Q

LABS

Hgb (male, female)

A

male: 14-18 g/dL
female: 15-16 g/dL (seems high…I use 13-16 lolz)

121
Q

LABS

WBCs

A

4k-11k microL

122
Q

LABS

Plts

A

150k-450k microL

123
Q

LABS

K+

A

3.5-5 mEq/L

124
Q

LABS

Mg

A

1.5-2.5 mEq/L

125
Q

LABS

Ca++

A

8.5-10.5 mg/dL

126
Q

LABS

iCa++

A

4.8 - 5.3 mg/dL (easy to remember bc it’s 1/2 of normal Ca++ level)
or
1.1 - 1.3 mmol/L (used often)

127
Q

LABS

Phos

A

1.8 - 2.6 mEq/L

128
Q

LABS

Cl-

A

100-108 mEq/L

129
Q

LABS

BUN
&
Creatinine

A

BUN: 10-20 mg/dL
Creatinine: 0.6-1.3 mg/dL

130
Q

LABS

Albumin

A

3.5-5.5 g/dL

131
Q

LABS

PT

A

11-14 sec

WEPT (warfarin, extrinsic, PT level)

132
Q

LABS

INR

A

1 sec

Normal INR on Warfarin: 2-3secs

133
Q

LABS

PTT

A

21-34 sec

On heparin = varies (~60-100 secs) depending on your coag goals!

134
Q

LABS

ACT

Activating Clotting Time

A

80-120 secs

> 160-180sec for ECMO

> 400sec for CPB

Used for large heparin doses.

135
Q

LABS

FSP

Fibrin Split Products

A

<10 µ/dL

Fragments from dissolved clots. Used often for DIC

136
Q

LABS

Fibrinogen

A

160-450 mg/dL

(the netting that covers the clot)

137
Q

LABS

Plasminogen

A

62-130%

Plasminogen makes Plasmin. Plasmin degrades fibrin (or clots)

138
Q

LABS

FDP

Fibrin Degredation Products

A

<10 µ/mL

basically FSP but resulted in different units.

139
Q

LABS

D-Dimer

A

<250 ng/dL

Only detectable if you are currently breaking down lots of clots.

140
Q

LABS

TSH
T3
T4

A

TSH: 0.4 µ units/mL
T3: 90 -230 ng/dL
T4: 13 - 15 µ/dL

Control metabolism, temp, mood, weight, neuro fxn, & muscle strength.

T3 = MORE active, 7%, majority made in cells.
T4 = main circulating thyroid hormone, 93%, can be converted to T3 using iodinase.

141
Q

LABS

AST
ALT

A

<35 IU/L

Liver function - ALT more specfic to liver, AST involves other organs including the liver.

142
Q

LABS

Fill in the blanks:

A
143
Q

LABS

Fill in the blanks:

A
144
Q

LABS

Fill in the blanks:

A
145
Q

List triggers for MH.

A

Volatile Anesthetics & SCh

146
Q

List signs of MH crisis

A
  1. tachycardia
  2. rapidly increasing ETCO2
  3. skin mottling
  4. tachypnea
  5. increase in temp
147
Q

List the treatment regimen for MH.

A
  1. STOP THE TRIGGER
  2. 100% O2 hyperventilation
  3. Dantrolene 2.5mg/kg IV (repeat 5-10mins; MAX 10mg/kg)
  4. Actively cool pt
  5. correct hyperkalmia and metabolic acidosis
  6. Monitor labs and maintain UO >2cc/kg/hr (hydration, mannitol, lasix) watch for rhabdo
148
Q

What is the dose of Dantrolene for MH?

A

2.5mg/kg IV (repeat q5-10mins prn)

MAX 10mg/kg

149
Q

PEDI ETT

How can you determine the ETT length?

A

(Tube size x 3)

150
Q

PEDI ETT

List the ETT sizes:
Preemies (≤ 1kg)
Preemies (1-2.5kg)
Term Neonate

A

2.5
3
3-3.5

151
Q

PEDI ETT

List the ETT sizes:
6mo-1yr
1-2yr

A

3.5-4
4-4.5

152
Q

ETT SIZING

How do you determine ETT for >2yrs?

A

[(age + 16) / 4]

153
Q

PEDI LMA SIZES

List the size & max cuff air volume:
0-5kg
5-10kg
10-20kg
20-30kg
>30kg
Adult

A

1 (4cc)
1.5 (7cc)
2 (10cc)
2.5 (14cc)
3 (20cc)
4 (30cc)

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