Quick Hits Flashcards
Protons, neutrons, and electrons; which are positive, negative, and neutral?
Protons - Positive charge
Neutrons - No charge
Electrons - Negative charge
An ion with a positive charge is called? What about a negative?
Cation - positive (lost electrons)
Anion - negative (gained electrons)
Order bonds from strongest to weakest.
Ionic
Polar covalent
Van der Waals
Covalent
Strongest
1. Covalent
2. Ionic
3. Polar covalent
4. Van der Waals
What type of bond is water?
Polar covalent (hydrogen bonds)
Which law describes the total pressure is equal to the sum of all partial pressures exerted by each gas mixture?
Daltons
Which law describes gas solubility?
Henrys
At a constant temperature, the amount of gas that dissolves in a solution is directly proportional to the partial pressure of that gas over the solution
Anesthetic emergence being prolonged is an example of which law?
Henrys
An over pressurized vaporizer is an example of which law?
Henrys
Increasing FiO2 increases PaO2 is an example of which law?
Henrys
Which law describes the transfer of a gas through a tissue medium?
Ficks
Cardiac output calculation and placental drug transfer is an example of which law?
Ficks
Which law describes why smaller molecules diffuse faster than larger?
Grahams
The lower the molecular weight, the faster it can diffuse
Does a decreased pressure increase or decrease solubility?
Decreases
Does an increased pressure increase or decrease solubility?
Increases
Does a decreased temperature increase or decrease solubility?
Increases
Does a increased temperature increase or decrease solubility?
Decreases
What is the universal gas law?
Pv = nrT
P=pressure
V=volume
n=number of moles
r=constant 0.0821
T=Temperature
An O2 tank exploding is an example of which law?
Gay-Lussacs - at a constant volume the pressure and temperature of a gas are directly proportional
**Heated gas increases the pressure in a container
P/T
LMA cuff rupture in the autoclave is an example of?
Charles - at a constant pressure, the volume and temperature are directly proportional
***Heated gas expands
V/T
Squeezing a bag valve mask
Pneumatic
Bellows
Diaphragm contraction
are examples of?
Boyles - When temperature is held constant, the volume and pressure are inversely proportional
***** As volume decreases, the pressure increases
P*V
Which law descries that the current passing through a conductor is directly proportional to the voltage and inversely proportional to the resistance?
Ohms
Which law takes Ohms law and factors in diameter, viscosity, and tube length?
Poiseuille’s
Doubling the radius of an IV increases flow by how much?
16 times
How does fever effect blood flow?
It decreases viscosity which increases blood flow
Tripling the radius of an IV increases flow by how much?
81 times
Quadrupling the radius of an IV increases flow by how much?
256 times
What s laminar, transitional, and turbulent flow?
Reynolds number
Laminar flow < 2000
Transitional 2000-4000
Turbulent > 4000
If fluid velocity is high, what is the pressure exerted on the walls of the tube? What principle is this?
Bernoulli’s
Pressure is low on the walls of the tube
If flow is low, then the pressure is high on the walls
What is the venturi effect? Ex?
If the pressure inside the tube falls below atmospheric pressure, then the air is entrained in the tube
Jet ventilator, venturi mask, nebulizer
What is the Coanda effect?
The jet flow attaches itself to a nearby surface and follows it
Like a snake
Ex: mitral regurgitation
Which law describes the relationship between wall tension, internal pressure, and radius?
Law of LaPlace
What is the minimum safe distance from radiation source?
6 feet
What is the yearly maximum safe exposure for an adult? Pregnant?
5 rem
.5 rem
What is the most susceptible tissue for radiation? What about pregnancy ?
Eye and thyroid
Baby for pregnancy
What are three ways to limit radiation exposure?
- Increase distance
- Decrease duration
- Wear shielding
Which gases are liquid at room temp?
Nitrous and CO2
What is specific heat?
Amount of heat required to increase temperature of 1gram by 1 degree C
What describes why an O2 tank feels cold when opened?
A gas stored at a high temperature when released fast
Joule-Thompson effect (adiabatic process)
How to convert C to K? K to C?
C = K - 273
K = C + 273
How to convert C to F? F to C
C = (f-32) x 5/9
F = (C X 1.8) + 32
What is Avogadro’s number?
1 mole of any gas is made of 6.023x10 to the 23rd atoms
Boiling of water?
212 F
100 C
1 cm H2O is equal to what in mmHg?
1cm H2O = 0.74mmHg
1mmHg = 1.36cm H2O
What type of bond are metals and acids+bases?
Ionic
Complete transfer of valence electrons
What is the number one source of heat loss?
Radiation 60% - Through the skin
Top of head
What is the number two source of heat loss?
Convection 30% - Cold air
What are the 4 ways to lose heat?
Radiation - 60%
Convection - 30%
Water loss - 20%
Conduction - 5%
What is the number one way to minimize heat loss in the OR?
Forced air warmer
Hypothermia is a body temperature less than?
36 C
What is the most accurate site for temperature?
Pulmonary artery
What is the best temperature monitoring site for accuracy and extended timeframe?
Esophageal
(PA is an invasive site)
How much does shivering increase O2 consumption?
500%
Best treatment options for post operative shivering?
Demerol (meperidine)
Clonidine
Precedex
Does a skin measurement monitor the core or peripheral temperature?
Peripheral
*All others monitor core
What three things are needed for an airway fire?
Ignition Source
Fuel
Oxidizer
Examples of fuel for airway fire?
ETT
Surgical supplies
Drapes
Examples of ignition source for airway fire?
Cautery
Laser
Examples of oxidizer for airway fire?
O2
Nitrous
What is the first step with an airway fire? What is a key step when doing this?
REMOVE ETT
DO NOT squeeze the bag while doing so or else it’ll create a blow torch
What does laser stand for?
Light
Amplification
Stimulated
Emission
Radiation
Three types of lasers?
Monochromatic - single wavelength
Coherent - oscillates in same phase
Collimated - narrow beam
Laser Goggles - which structures do they effect
CO2 = Clear lenses (cornea)
Nd:YAG = green goggles (retina)
Ruby = red goggles (retina)
Argon = amber goggles (retina)
Which wavelength penetrates deep and which does not?
Long - absorb more water and do not go deep
Short - absorb less water and do go deep
FiO2 during laser use?
30% or less FiO2
Should nitrous be used around lasers?
No
5 steps with an airway fire?
- Remove ETT
- Stop all gas flow
- Remove flammable material
- Pour water or saline
- Use extinguisher
Burn image
Which burn will have loss of all sensation?
3rd and 4th degree?
Which burns require grafting?
2nd degree deep
3rd
4th
Which burn involves muscle? What about subq tissue?
Subq tissue - 3rd degree
Muscle - 4th degree
Best type of fluid to give in the first 24 hours of a burn?
LR
Best type of fluid to give in the second 24 hours of a burn?
D5W
Which type of fluid is avoided in the first 24 hours of a burn?
Albumin
Fluid status of a burn patient in the first 24 hours?
Hypovolemic
Hemoconcentrated
Edema from loss of albumin
A rising Hgb in the first few days following a burn indicates what?
Inadequate fluid resuscitation
Parkland formula for burns?
1st 24 hours -
4ml LR + % TBSA * kg
2nd 24 hours
D5W
How should fluid be replaced in the first 24 after a burn?
1/2 in the first 8 hours
1/2 in the next 16 hours
Urine output goals for burns
Adult
Children
High voltage burns
Adult - .5mL/kg/hr
Child - 1mL/kg/hr
Electrical- 1.5mL/kg/hr
What is a big nephrotoxin released during electrical burns?
Myoglobinemia - needs to be flushed out
How is abdominal compartment syndrome defined as?
> 20mmHg AND evidence or organ dysfunction
CO binds to Hgb at what rate? How does it effect the OxyHgb curve?
200x more than O2
OxyHgb curve - to the left
Treatment for carbon monoxide poisoning?
100% FiO2
Hyperbaric
Blood gas of a carbon monoxide poisoning?
Metabolic acidosis - blood is cheery red
What is the gold standard of assessing the airway of a burn patient?
Fiberoptic bronch
Should a surgical airway be utilized in a burn patient?
Just as a last resort - increases infection rates
When do up-regulation of extra junctional receptors start in burn patients?
After the first 24 hours
Dosing of nondepolarizing NMBs in burn patients?
Increased dose due to more receptors
Hypermetabolic
Burn patients become hypermetabolic
Increased
HR
RR
O2 consumption
Catabolism
PNS VS SNS in ECT treatment - 1st and 2nd phase
1st Phase - increased PNS tone (tonic)
2nd Phase - increased SNS tone (clonic)
What is the minimum seizure recommendation for ECT?
25 seconds
How does hypocapnia and hyperventilation effect seizure duration?
Increases it
Which opioid increases seizure duration?
Alfentanil with propofol
Which drugs increase seizure duration?
Etomidate
Ketamine
Alfentanil with propofol
Aminophylline
Caffeine
Which drugs have no effect on seizures?
Methohexital
Precedex
Clonidine
What is the gold standard of ECT?
Methohexital but does not have an effect on seizure duration
How does lithium effect NMB?
Prolongs both succ and Non depolarizers
What can MAOI’s do during ECT?
Can experience a hypertensive crisis with those who receive indirect acting sympathomimetics
FACT
Not all drug induced hyperthermia is MH - there are other causes
Neuroleptic malignant syndrome causes hyperthermia -why?
Caused by dopamine depletion
Serotonin syndrome causes hyperthermia -why?
Excess 5HT activity
Anticholinergic poisoning causes hyperthermia -why?
Excessive blockage of AcH
How is Anticholinergic poisoning treated?
Physostigmine
How is Serotonin syndrome treated?
Cyproheptadine
How is Neuroleptic malignant syndrome treated?
Dantrolene or bromocriptine
Which diseases have muscle rigidity?
MH
Serotonin syndrome
Neuroleptic malignant syndrome
Neuroleptic malignant syndrome or MH; which has a genetic link?
MH
Neuroleptic malignant syndrome or MH; which develops acutely?
MH
Neuroleptic malignant syndrome or MH; which is associated with psych meds?
Neuroleptic
Neuroleptic malignant syndrome or MH; which has muscle rigidity, hyperthermia, tachycardia, and acidosis?
Both
Neuroleptic malignant syndrome or MH; which is treated with dantrolene?
Both
Neuroleptic malignant syndrome or MH; which can receive NMB?
Neuroleptic
Which two perioperative drugs can lead to anticholinergic poisoning?
Atropine
Scopolamine
S&S of anticholinergic poisoning?
Red, dry, hot skin
Delirium
Mydriasis
Normal intraocular perfusion pressure and how is it measured?
10-20mmHg
MAP-IOP
What positions increase intraocular pressure?
Prone
Trendelenburg
How does O2 effect IOP?
Hypoxemia - increases IOP
How does hypercarbia effect IOP?
Hypercarbia - Increases IOP
How does MAP and CVP effect IOP?
Increased MAP/CVP - Increases IOP
How does succ and Nondepolarizers effect IOP?
Succ - increases
Nondepolarizers - decreases
How does anticholinergics effect IOP?
No effect
How does ketamine effect IOP and the eye?
Does not increase IOP
BUT
causes nystagmus and blepharospasm
How does an LMA/ETT effect IOP?
LMA - no effect
ETT - increases from intubation
Which NMB should be used in an open globe injury?
Roc 1.2mg/kg
Avoid succ because it can raise by 10mmHg for 10 minutes
Concerns for strabismus surgery?
Increased risk of PONV
Increased risk of oculocardiac reflex
Which two drugs decrease aqueous humor production?
Timolol
Acetazolamide
When should nitrous be avoided with a SF6 bubble?
Stop 15 minutes before placement of bubble
Avoid for 7 days
When should nitrous be avoided with a silicone oil bubble?
0 days
When should nitrous be avoided with a air bubble?
5 days
When should nitrous be avoided with a perfluoropropane bubble?
1 month