random 4

Question 1

triggers for acute intermittent porphyria?

Answer 1

ketamine, etomidate, barbiturates, ketorolac,

AIP, AD, build up of porphilobiligen

5Ps: pain, precipitated by meds, psych, polyneuropathy, port wine urine

Question 2

when is ABC preferred over CAB in BLS?

Answer 2

suffocation, asphyxiation, drowning

Question 3

vwb types and treatments

Answer 3

MC bleeding disorder, worst case can resemble hemophilia A
type 1: not enough -> DDVAP (encourages release of vwf from endothelial cells)
type 2a/b: shitty -> factor 8-vwf conc
type 3: qualitative -> factor 8-vwf conc

(cryo has clinically significant amts of vwf but increased risk of infection so factor is preferred. ffp and plts have a little bit but would require large volumes)

Question 4

why do we avoid succs and volatile in myotonic dystrophies/

Answer 4

succs -. hyperkalemia
volatile - rhabdo

they commonly have cardiac issues

Question 5

barbiturate coma

Answer 5

decrease CMR and O2 use, decrease ICP, cause hypotension, titrated to burst suppression

Question 6

management of CDH in infants

Answer 6

optimize, surgery within 24-48 usually, PIP <25, gentle ventilation, SPO2 85-95%, spontaneous, permissive hypercapnia.
lap usually fails (cant ventilate). 80% L lung, hypoplastic so it’s not like it just pops right back up