Random Flashcards
In patients with chronic respiratory acidosis, what does their bicarb do and why?
It is increased (>26) due to renal compensation (have to be able to retain, have to be well perfused)
How is ED95 different in NMB?
Typically effective dose required for 95% of population to have desired effect. In NMB, 95% reduction in maximal twitch response from baseline in 50% of the population
MELD score includes 4 things
INR, Na, bilirubin, Cr
Child-Pugh score includes
“Pour Another Beer At Eleven”
Prothrombin time Albumin Bilirubin INR Encephalopathy Presence of ascites
Subjective measures (encephalopathy), ceiling values (3 for bili regardless of how high), prothrombin time
Dose required to produce desired effect
potency
smaller dose needed for same effect, more potent
Maximum effect of a drug
Efficacy
does NOT depend on dose -> eg, a full agonist is more efficacious than a partial agonist (flatter dose-effect curve)
what does tissue inflammation do to local anesthetics?
SLOWS it.
inflammation is acidic -> more ionized
increased blood flow -> washes away LA
Local Anesthetic
ONSET
POTENCY
DURATION
ONSET: pKa (lipid solubility, concentration, pH)
POTENCY: lipid solubility
DURATION: protein binding
Patients who receive INCREASED dose of acetylcholinesterase inhibitor (neostigmine) are at a higher risk of what
prolonged weakness
don’t exceed 0.07mg/kg (5mg MAX) -> depolarizing blockade
time constant
circuit capacity/fresh gas flow
treatment of methemoglobinemia in patients with G6PD deficiency
ascorbic acid (vitamin C)
treatment of cyanide toxicity
amyl nitrate (oxidizes O2+ to O3+) -> induce methemoglobinemia to soak up cyanide
almond smelling breath
Urology just asked you to give a dye - what happens to your pulse ox?
reads 84-86% for ~30 seconds (up to 20 min!) Caused by indigo carmine, methylene blue, indocyanine green
Stress Response hormone chart - what hormones DECREASE
T3 and GRH
what urine to plasma osmolality ratio indicates prerenal?
> 1.5
Can kidneys retain Na and water?
definition of OSA
Complete apnea for 10 seconds at least 5 times an hour resulting in a decrease of Sa02 4%
gold standard: full polysomnography
how does citrate work?
chelates calcium and magnesium (hence, why it’s used as an anticoagulant in blood storage)
majority is in FFP and platelets (not so much PRBCs).
usually rapidly metabolized by liver - but NOT if liver dysfunction, hypothermia, peds, hyperventilation
hyperkalemia from blood infusions occurs at what rate?
120ml/min
Mapleson Circuit Mnemonics
SEMI-open - part of the gases will be exhaled, part will be inhaled. Basic parts: inlet for fresh gas outlet for expiratory gases patient end bag end
Best for spontaneous ventilation efficacy:
ADCB: All Dogs Can Bite
Best for controlled ventilation
A: only one where fresh gases coming in distal end
B: both (inlet and outlet together by patient end)
C: corrugated-less, closed
D: opposite of A (fresh gas by patient, exhaled away)
E: valveless, no bag, peds
F: valveless, + bag. infants
what is the pacemaker for the healthy heart?
the SA node
BP conversion factor when cuff is ABOVE (or below) level of heart
0.75hg per cm
Meyer-Overton Correlation
Oil: gas coefficient, potency, lipid solubility of volatiles correlate
Iso (1.1) 91
Sevo (1.8) 47
Des (6.6) 19
what volatile property most correlates with speed of onset and offset?
blood:gas coefficient
highest: iso > svo > des
speed: des > sevo > iso
fentanyl in epidural?
because trapped in placenta - very local
