TL block 9 Flashcards
1
Q
How to blunt inc in ICP w/ laryngoscopy?
A
Lidocaine 1.5 mg/kg
2
Q
Myasthenic syndrome and myasthenia gravis: gender influences
A
Myasthenic syndrome more likely in males
myasthenia gravis more likely in females
3
Q
Myasthenic syndrome v myasthenia gravis: more likely to have proximal limb weakness
A
myasthenic syndrome
4
Q
Myasthenic syndrome and myasthenia gravis: reflexes
A
myasthenic syndrome: absent/ dec reflexes
MG: normal reflexes
5
Q
Treatment for myasthenic crisis
A
-IVIG
-plasmapheresis
-steroids
-AChE inhibitors
-immunosuppressant agents
6
Q
With AVM resections and neuromonitoring, best way of assessing tolerance to vessel clamping in parietal lobe
A
SSEPs or MEPs
7
Q
What is Demeclocycline used for?
A
Treatment for SIADH
8
Q
What is cabergoline used for?
A
Dopamine agonist -> prolactinoma
9
Q
What is Calcitriol used for?
A
to treat hypoCa in hypoparathyroidism
10
Q
subarachnoid hemorrhage and Hg
A
Admission Hg -> predictor of cerebral infarction and outcomes
11
Q
Where does deep brain stimulation target for tx of Parkinson’s Dx?
A
Subthalamic Nucleus
Internal Globus Pallidus
12
Q
why aneurysm rupture w/ dec in CSF?
A
Cerebral perfusion pressure = MAP - ICP -> loss of CSF dec ICP extensively -> inc transmural pressure across wall of aneurysm -> rupture
13
Q
Why ST changes w/ subarachnoid hemorrhage?
A
inc circulating catecholamines -> demand ischemia
14
Q
Hydrocephalus and EKG
A
QTc prolongation
15
Q
if pt has spinal cord injury and will likely fail extubation, next steps?
A
Trach w/i 7-10 days of injury to reduce sedation needs, red mechanical vent days, improve pulm toilet, and participate in therpay
16
Q
Predictors of complications w/ ICD lead extraction
A
-leads in place for longer period of time
-inexperienced physician
-laser extraction
-pt is female
-larger # of leads requiring extraction
17
Q
Treatment for SVT w/ Wolf-Parkinson White
A
Procainamide
-slows down conduction in the accessory pathway w/o affecting the AV Node
18
Q
What happens if you give someone w/ Wolff-Parkinson White Adenosine?
A
Slows conduction at the AV node -> instead heart conducts through the accessory pathway -> v fib -> cardiac arrest
19
Q
RF for sudden death from congenital long QTc
A
-QTc > 500
-female
-male w/ QT3
-deafness
-widened T waves
20
Q
Acute management of congenital prolonged QT
A
-IV Mag
-replace Ca, K
-AVOID amiodarone
21
Q
Long term management of long QT syndrome
A
-beta blocker
-PM/AICD
-L stellate sympathectomy if refractory
22
Q
A
A: furosemide
B: ACE inh, NG
C: milrinone
D: NE, epi
23
Q
centrifugal v roller pumps in CPB: which varies w/ changes in pump preload and afterload
A
centrifugal
24
Q
which coronary artery is most likely to get an air embolism w/ open heart surgery?
A
RCA
25
Why hypoTN w/ protamine?
Histamine release
26
Treatment for vasoplegia w/ CPB?
Vasopressin and methylene blue
27
what TEE view is used to assess accurate placement of the femoral catheter for CPB
mid-esophageal bicaval view
28
What would you want to look at if you used a transgastric short axis view?
cross section of LV and RV -> assess thickness, contractility, volume status
29
what is seen in the mid-esophageal long axis view?
LA, MV, LV, LVOT, AV, ascending aorta
30
What is an esophageal detector device and hows it work?
It's a ballon, you squeeze it, if in the lungs reinflates, if in esophagus remains collapsed
-can be beneficial to confirm ETT placement during cardiac arrest
31
Hemodynamic goals w/ cardiac tamponade
-augment preload
-avoid hypoTN, HTN
-inotropy
-maintain HR higher (b/c limited by SV, cardiac output more dpt on HR)
32
O2 extraction following aortic cross clamping
decreased b/c blood not flowing to half the body -> so less O2 is utilized
33
Hemodynamic effects of aortic cross clamping
1. inc arterial BP above clamp
2. inc coronary artery BF
3. inc LV wall stress
4. inc CVP
5. Inc PCWP
6. Dec arterial BP below clamp
7. Dec cardiac output
8. Dec renal BF
34
Brugada Syndrome
35
Brugada syndrome
ST elevations in V1-V3
pseudo RBBB
36
tx of Brugada syndrome
ppx AICD
37
what lytes cause exacerbation of long QT syndrome?
hypoK
hypoMg
hypoCa
38
What can trigger fatal arrythmias in Brugada syndrome?
propofol
local anesthetics
39
Fenoldopam
-MOA
-effects
-what pt population beneficial in?
DA agonist
-dec in peripheral vascular resistance
-natriuresis, diuresis
-beneficial in pts undergoing TAA repairs w/ resistant HTN
40
CI to Fenoldopam
inc in IOP -> don't use in pts w/ glaucoma or intraocular HTN
41
low pitched mid diastolic rumble at PMI
MS
42
troponin and size of MI
levels correlate w/ size of MI!
43
troponin and long term outcome
-predictive and prognostic of short and long term outcomes
44
troponin peak levels
24 hours
45
Myoglobin peak levels
4 hours
46
Inamrinone MOA
PDE III inhibitor -> inc cAMP levels -> inc cardiac Ca levels -> improves contractility (inotropy)
-in peripheral vasculature inc in cAMP -> vasodilation -> dec in SVR -> inc cardiac output
47
SE of inamrinone if used for longer than 24 hrs
thrombocytopenia
48
Digoxin and WPW
Digoxin is contraindicated
-the slowing of AV conduction w/ inc atrial conduction = inc conduction in accessory pathway
49
energy for sync cardioversion
100J
50
When are you most likely to get R on T phenomena?
when PM is asynchronous and pt's HR is higher than set paced HR
51
What happens if you get R on T phenomena?
V tach or V fib
52
What medication predisposes pts to anaphylaxis from protamine?
NPH insulin
53
what causes the pulm HTN possible RV failure rxn to protamine?
Thromboxane
-released from plts and macrophages after stimulation by protamine-heparin complexes
54
thermodilution assessment of cardiac output: if smaller amount of injectate is used, CO will be?
overestimated
-b/c return to temp faster
55
thermodilution assessment of cardiac output: if injectate is warmer than programmed?
overestimation
-b/c won't get as cold -> so it thinks b/c the hard moving so much
56
thermodilution assessment of cardiac output: if give a room temp bolus before assessment of cardiac output?
underestimate b/c all fluid colder than anticipated
57
if doing a TAVR and sudden hypoTN w/ contrast extravasation retroperitoneally what happened?
perforation at ilio-femoral axis
58
hypo or hyperthermia inc pulm vascular resistance?
hypothermia
59
Recommended size of defibrillation pads
8-12 cm
60
Factors that improve successful defibrillation
-adequate pad size
-gel b/w pads and pt
-biphasic debrillatoin
-quick defibrillation (faster the more likely to be successful)
61
monophasic or biphasic defibrillation for V tach?
Biphasic: more success and can be done w/ less energy
62
reverse piezoelectric effect
creates u/s waves during transmission
63
direct piezoelectric effect
converts sount waves to electric current during reception
64
How to assess % of PONV pt is likely to have?
Each RF is 20%
-female
-nonsmoker
-hx of motion sickness/hx of PONV
-gyn surgery
-young, age < 50
-opioid use
65
Lidocaine and ET
dec duration of sz
66
Obese pts and succ
require inc doses
-inc extracellular fluidi and inc in pseudocholinesterase
67
how should NDNMB be dosed?
ideal body weight
68
Below what age can a double lumen tube not be used?
12
69
DL tube what view?
R upper lobe
70
DL what view?
carina
71
DL tube, looking at what?
L secondary carina w/ L upper and L lower bronchi
72
Treatment of Methanol poisoning
1. supportive
2. prevent conversion of methanol to toxic metabolites (ethanol or fomepizole)
3. severe sympm HD
73
What is fomepizole used for?
Methanol poisoning
74
What pressure is indicative of compartment syndrome?
> 30
75
What compartment perfusion pressure is indicative of compartment syndrome?
< 21
76
MAC care claims in ASA Closed Claims Project most common cause of litigation?
Death (2/2 Respiratory events)
77
Lipid emulsion bolus for LAST dose
1.5 cc/kg for 2-3 minutes (if over 70 kg bolus 100cc)
-infuse .25 cc/kg/min
78
Bone cement implantation syndrome
similar to fat embolism syndrome but occurs during cement implantation in OR
-hypoTN, tachycardia, resp distress
79
What NT is not metabolized in lungs?
Dopamine, Epinephrine, Histamine
80
Norepi metabolism in lungs
30% on first pass
81
Serotonin metabolism in lungs
> 95% first pass
82
Tourniquet pain and spinal anesthesia
Can still get! Especially if tourniquet is on for over an hour
83
After how long w/ tourniquet do you see n and m compression injuries?
2 hours
84
Major Diagnostic criteria for fat embolism syndrome
-require at least 1,
-pulm edema or resp insuff
-hypoxia
-petechial rash
-central nerve system depression
85
How to diagnose fat embolism syndrome
-1 of major criteria (hypoxemia, resp insuff, AMS,petechial rash)
-4 minor critera (tachycardia, fever, dec hct or plts, inc ESR, retinal fat emboli, fat in urine, fat in sputum)
-fat in blood
86
Hormones after brain death
Brain stem herniation -> ischemia, edema, and pituitary compression -> Diabetes Insipidus -> hypoTN and hyperNa
-give vasopressin to donors
-large inflammatory and catecholamine surge -> give steroids
87
Goal temp for induced hypothermia for out of hospital cardiac arrest?
32 to 36C
88
fastest way to cool someone for induced hypothermia?
Endovascular cooling
89
when do most people die w/ induced hypothermia?
with too rapid rewarming
90
When should cervical spine injuries be suspecteD?
-Other people died at scene of the accident
-fall from > 10 ft
-pelvic/long bone fx
-accident at > 35 mph
-significant closed head injury or intracranial hemorrhage
-neurological signs consistent w/ cervical spine inur
91
pt gets CT w/ contrast, 4 days later gets a rash what sup?
delayed hypersensitivity due to T cell rxn
92
Privileged conversation
conversation b/w 2 individuals in private and can't be used in a court of law
-husband and wife, priest and church goer, person and their lawyer
93
Why do elderly have higher initial peaks of medication conc?
-decreased albumin conc
-decreased volume of distribution
-dec circulation time
94
Factors in Child-Pugh score
-bilirubin
-ascites
-encephalopathy
-INR
-albumin
95
MELD score factors
I Crush Beer Daily
INR
Creatinie
Bilirubin
Dialysis
96
spinal/epidural in ALS
has been shown to exacerbate dx
97
best way to assess progression of ALS
PFTs -> more reliable of progression than musculature to understand severity of the dx
98
What types of surgery should ASA be held
neurosurg
posterior eye
middle ear surgery
intramedullary spinal surgery (SC)
prostate surgery
99
Main risks to anesthesia personnel constantly exposed to radiation
Cataracts
Cancer
100
elderly dead space
increased
101
elderly TV
no change
102
elderly residual volume
increased
103
elderly FRC
increased
104
elderly TLC
unchanged
105
lyte changes w/ hypothermia
hypoK, Mg, Phos
106
U waves on EKG
hypoK
107
hypothermia and Ca
hyperCa b/c lack of Na/K ATPase -> inc in Ca
108
What n likely to be damaged if doing a brachial arterial line?
median n
109
epidurals and n blocks in MS
no association w/ exacerbation!!
110
what schedule narcotic is cocaine
Schedule II
111
What schedule controlled substance is oxycodone?
Schedule II
112
What schedule controlled substance is Ketamine?
III
113
What schedule controlled substance is midazolam?
Schedule IV
114
What schedule controlled substance is cough meds?
V
115
BEST sensitivity to least detection of venous air embolism?
TEE > precordial doppler > Pulm artery catheter > EtCO2 > EKG
116
Dose of Dantrolene for treatment of MH?
2.5 mg/kg
-can be repeated every 5-10 minutes until signs have abated
117
spinal: arterial or venous vasodilation?
BOTH
118
If extensive burns, what drugs can you give less of?
Midazolam (highly albumin bound)
119
Which drugs do you need to give more of in burn victims?
hypoalbumin -> beta blockers, local anesthetics
-insulin resistance -> insulin!
120
Qualifying circumstance that affects billing and payment for GA?
emergency
extremes of age
deliberate hypothermia
controlled hypoTN
121
Dec BP but keep ICP low
Clevidipine
Nicardipine
Beta blockers
122
Meds contraindicated when giving dantrolene
CCB! Verapamil, Diltazem
123
what local anesthetic least likely to cross the placenta?
Chloroprocaine -> gets metabolized by plasma cholinesterases rapidly
124
What nerve runs lateral to the biceps tendon in the antecubital fossa?
radial n
125
Treatment of hyperMg for preeclampsia
1. stop Mg
2. give Ca
3. give furosemide and fluids (eliminate Mg w/ loop diuretic!)
126
postintubation croup cuffed v uncuffed ETTs?
less w/ cuffed
127
why hypoTN after spinal
arterial and venous vasodilation
-arterial will only cause a minor dec in SVR, so doesn't make a huge diff
-venous vasodilation -> significant diff and sign decreases preload -> hypoTN
**most of the total body volume blood lies in venous system
128
How does lactulose lower ammonia in acetaminophen OD
prevents the ammonia from getting absorbed in the first place -> dec intestinal pH -> makes it ionized -> cant be absorbed
129
If pt oliguric but taking diuretics best test to assess cause?
fractional excretion of urea
130
Anion gap
Na - (Cl + lactate)
131
TPN and acid base status
-has a large amount of Cl -> can get an anion gap metabolic acidosis
132
Carbamazepine toxicity
-anticholinergic symp (mydriasis, no sweating)
-QT prolongation, tachycardia, hypoTN
-neuro: nystamus, AMS, delirium
133
PAO2 equation
PAO2 = FiO2 (Patm -PH2O) - (PaCO2/0.8)
134
Changes w/ heparin in pregnancy
-inc heparin-binding proteins
-inc renal excretion
-inc enzymes to break down heparin
-inc plasma volume
**dec bioavailability -> dosing needs to be increased
135
Scleroderma and TEE
contraindication!
136
Fent v Morphine epidural SE
Fent less N/V and pruritis
137
qSOFA
RR > 22
BP systolic < 100
AMS, GCS < 15
138
Anatomic landmarks for infragluteal sciatic n blocks
ischial tuberosity
greater trochanter of femur
sciatic groove
139
SIADH labs
-Na < 135 (dilutional hypoNa)
-Urine osm > 100
-FeNa > 1%
-Urine Na > 20
-low serum urine acid and BUN
140
which factor is assoc w/ vWD?
factor VIII!!!
141
What's in cryo?
factor VIII
vWF
factor XIII
fibrinogen
142
Arytenoid dislocation symptoms
neck pain and strained voice, NO difficulty breathing
143
early post-extubation stridor
laryngeal edema
