Random 2 Flashcards
Peds fluid requirememts
20-40ml isotonic fluid in first 2-4 hours perioperatively. 2-1-0.5mg in next 12 hours postoperatively
Cr function as age?
goes down 10% per decade. lose muscle mass concurrently. blood flow decreases. all in all - Cr number doesnt’ change.
maternal lab finding with terbutaline
hypokalemia, hyperglycemia, pulm edema, hypotension (smooth muscle relaxation), tachycardia
terb is beta selective for B2>B1
what do you do with desflorane vaporizers at altitude?
increase percent volume to account for barometric pressure. heated.
variable bypass vaporizers do NOT need this
CV changes with age
increased beta
decreases parasympathetic, increases sympathetic
decreased baroreflex response bc of decreased HR tone
decreased response to sympathetic stimulation not because of decreased receptors but because of downregulation of coupling
stiff tubes
what causes elevated DLCO?
increase CO/blood flow -> obesity and asthma
polycythemia
L->R shunting
equation for des at altitude
= normal setting (volume percentage x 760) / current barometric pressure
tumescent lidocaine
35-55mg/kg; no more than 0.1% lido; no more than 0.07% epi
pharmacokinetics changes of aging
decreased body water; body mass; renal/hepatic flow, cardiac output, GFR, hepatic function
INCREASED total body fat
exterior branch of superior laryngeal nerve
cricothyroid, tenses (recurrent laryngeal does ALL OTHER laryngeal muscles)
nerves impacted by arm fractures
proximal humerus: axillary
distal humerus: radial
distal radius: median
predictors of difficult mask
BMI >30
age > 55
edentulous
Male
beard
OSA
mallampati 3 or 4
treatment for post herpetic neuralgia
gabapentinoids 1st line
TCA/opiates/capsaicin/lidocaine patches
34% develope PHN. Severe symptoms, severe prodromal sx, distribution (opthalmic), immunosuppression), >60yo
what fluid to use in ESRD?
LR - used to think NS because of extra K (5meq) in LR but the risk of metabolic acidosis and hyperchloremia with large volume NS is worse.
why is NS the preferred crystalloid in neurosurg patients?
hyperosms (308 as compared to 290 physiologically) which theoretically allows for ICP lowering and brain relaxation.
what causes highest likelihood of emergence delirium in kids?
volatile - desflorane and sevo
(other risk factor is age: 2-6)
how does body compensate for anemia?
- increase CO (decreased viscosity -> decreased shear stress and afterload, increased SV) - also hypoxia -> acidosis -> inflammation -> vasodilation, nitric oxide production
- increase oxygen carrying capacity (increased 23DPG)
- regional blood flow
CYP metabolizers
tramadol - 2D6 for ACTIVE metabolite, 3A4 for INACTIVE metabolite
plavix - 2D19
methadone - 2C9 AND 2C19
SSRI, hydrocodone, codeine - 2D6
why is FRC decreased in obesity?
mainly as a result of decrease in ERV
(RV mainly unaffected)
lung volumes below closing capacity -> hypoxemia, R-> L shunt, arteriole collapse
what lung volume is INCREASED in obesity?
inspiratory reserve volume
what’s the bohr effect?
increase in CO2 production leading to Rward shift of oxygen dissociation curve
metoclopramide MOA
dopamine antagonism and serotonin antagonism at higher doses (likely what contributes to antiemetic)
tightens GE sphincter, loosens everything else to promote gastric emptying. do NOT give in obstruction.
blood: gas coefficient partition
ISND
iso: 1.46
Sevo: 0.65
Nitrous: 0.46
Des: 0.42
oculocardiac reflex
“five and dime”
trigeminel -> gasserian -> vagus
treatment: tell surgeon to stop -> anticholinergic -> rarely, epi
vapor pressure (lowest to highest)
SIDN
sevo: 57
Iso: 238
des: 669
Nitrous: 38770
why don’t we want to use LR in patients with TBI?
mildly hypotonic (130) which can cause increased edema
what can potentiate digoxin toxicity?
hypoK (more sites to bind to)
hypoMg
HyperCa
lung ultrasound finding of PTX
barcode in M mode
lack of lung points
A - lines
absence of B-lines
