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TL2 Flashcards

1
Q

Protamine reactions

A

type 1: Systemic hypotension from mast cell degranulation and histamine release caused by rapid administration
Type 2: Anaphylaxis from IgE-mediated dose-independent reaction. Previous exposure to protamine or a similar protein (such as neutral protamine Hagedorn found in NPH insulin
Type 3: Pulmonary hypertensive crisis causing pulmonary hypertension, vasoconstriction, and possible right heart failure. The mechanism for this reaction is thromboxane A2 released from platelets and macrophages stimulated by protamine-heparin complexes

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2
Q

hypokalemic periodic paralysis triggers

A

stress, cold environment or hypothermia, carbohydrate load, infection, glucose infusion, metabolic alkalosis, alcohol, strenuous exercise, and steroids

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3
Q

hyperkalemic periodic paralysis triggers

A

hyperkalemia, potassium-rich meals or exogenous potassium administration, rest after exercise, stress, metabolic acidosis, and succinylcholine use. Factors that can worsen a HKPP episode include acetylcholinesterase inhibitors, extremes of temperature, and hypoglycemia.

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4
Q

most sensitive for detecting cardiac ischemia

A

TEE>EKG>PCWP

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5
Q

Vec metabolite

A

Vecuronium has three active metabolites, 3-desacetyl-, 17-desacetyl-, and 3,17-desacetyl vecuronium. Among these, the 3-desacetyl metabolite is the most important since it has nearly 80% of the activity of vecuronium

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6
Q

types of von willebrands

A

Type 1 VWD: partial decrease in VWF concentrations
Type 2 VWD: qualitative defect in VWF
Type 3 VWD: total depletion of VWF

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7
Q

von Willebrand intraop bleeding

A
  • von Willebrand factor concentrates or desmopressin.
  • cryoprecipitate may also be used to replete von Willebrand factor
  • Adjuvant therapies include antifibrinolytics (TXA and aminocaproic acid) and topical clotting products.
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8
Q

SVT in WPW treatmen

A
  • procainamide
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9
Q

Carotid body chemoreceptors

A

When PaO2 is around 55

  • afferent impulses via the glossopharyngeal nerve to CNS ventilatory centers
  • impaired by opioids, benzos and volatiles (b/l CEA also)
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10
Q

Adult blood:gas coefficients

A

higher than peds

- leads to a slower rise in the FA:FI ration

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11
Q

Faster inhalational induction in peds

A
  1. Increased minute ventilation relative to FRC (most important)
  2. Increased blood flow to vessel-rich organs
  3. Decreased blood:gas partition coefficients
  4. Decreased tissue:blood partition coefficients
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12
Q

Cushings triad

A

-HTN, bradycardia and irregular respiratory pattern 2/2 to elevated ICP

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13
Q

CPDA for blood storage

A
  • Citrate is the anticoagulant (binds calcium necessary for clot formation
    • Phosphate is incorporated for cellular function and ATP production
    • Dextrose is the nutrition source for glycolysis
    • Adenine is incorporated for ATP production
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14
Q

imaging for retained epidural catheter

A

CT scan

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15
Q

ETCO2 measured

A

by infrared spectrophotometry.

-inverse relation between amount of energy detected and gas partial pressure

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16
Q

American Spinal Injury Association (ASIA) score

A

A Complete cord injury with complete motor and sensory deficits in S4 and S5 nerve roots
B Incomplete cord injury with sensation preserved below the level of injury; intact S4 and S5 nerve roots
C Incomplete cord injury with motor function preserved below the level of injury; < 3 out of 5 motor strength in half of the major muscle groups
D Incomplete cord injury with motor function preserved below the level of injury; ≥3 out of 5 motor strength in half of the major muscle groups
E No evidence of cord injury with intact motor and sensory innervation

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17
Q

SIADH lab values

A

Hyponatremia with urine sodium greater than 20 mmol/L

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18
Q

LES and RSI

A
  • Sux increases LES

- cricoid pressure decreases LES tone

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19
Q

qSOFA

A

Hypotension SBP < 100
AMS
Tachypnia RR>22

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20
Q

Decreased FRC

A

PANGOS

pregnancy, ascites, neonates, GETA, Obesity, Supine

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21
Q

patient population to be concerned with vasopressin administration

A

Caution must be used when administering vasopressin to patients with coronary artery disease as it may precipitate myocardial ischemia by vasoconstriction of the coronary arteries.

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22
Q

Exacerbation of MS

A

in the perioperative period caused by surgery and the use of general or spinal anesthesia. Succinylcholine should be used cautiously or avoided

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23
Q

Neonatal life support

A

Infants with a heart rate < 60/min despite adequate ventilation should be treated with chest compressions and endotracheal intubation. Epinephrine and volume expansion can also be considered if the infant is not showing improvement. Naloxone and sodium bicarbonate are not recommended.

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24
Q

pyloric stenosis

A

Correction of hypovolemia and electrolyte abnormalities is best achieved with an infusion of 10 to 20 mL/kg/hr of normal saline with 20 mEq/L of potassium.

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25
Q

Posterior fossa brain ischemia monitoring

A

Auditory evoked potentials

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26
Q

gabapentin side effect

A

nausea, sedation, dizziness, ataxia, nystagmus, peripheral edema, and weight gain.

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27
Q

gabapentin MOA

A

Gabapentin is an anticonvulsant originally approved for the treatment of partial seizure epilepsy and later for treatment of neuropathic pain. It binds and inhibits the alpha2-delta subunit of the voltage-gated calcium channel. This results in a decreased release of the excitatory neurotransmitter glutamate.

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28
Q

albumin in pregnancy

A

Serum albumin concentration decreases during pregnancy because of plasma expansion. Many other serum constituents such as fibrinogen, transferrin, and globulins increase, most likely due to the hormonal changes secondary to the pregnant state.

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29
Q

Hemophilia A

A
  • deficient factor VIII
  • treat with desmopressin, cryo
  • if antibodies to factor VIII: porcine factor VIII, recombinant factor VIIa, or recombinant factor IIa
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30
Q

risk for accreta with prior c sections

A

0 = 3% incidence, 1 = 11%, 2 = 40%, 3 = 61%, 4+ = 67%

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31
Q

pulses paradoxus

A
  • seen in cardiac tamponade

- A decrease >10 mm Hg of systemic blood pressure during inspiration

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32
Q

persistent fetal circulation

A

Hypoxemia, hypothermia, and acidosis are all associated with persistent fetal circulation. This is due to increased pulmonary pressures, which favor flow through shunts that are only functionally closed and not yet anatomically closed

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33
Q

premature ductal closure

A

maternal NSAID use

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34
Q

long term TPN

A

Hyperalimentation is commonly associated with hypophosphatemia, hypo or hyperglycemia, and acute liver injury. Patients on total parenteral nutrition (TPN) require vitamin K supplementation and often have an elevated prothrombin time.

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35
Q

Cryo contains

A

von Willebrand factor (vWF), fibrinogen, fibronectin, factor VIII, and factor XIII.

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36
Q

Cryo indications

A
  • Microvascular bleeding with hypofibrinogenemia *
  • Bleeding due to uremia that is unresponsive to DDAVP
  • Factor XIII deficiency
  • Prophylaxis before surgery or treatment of bleeding with congenital dysfibrinogenemias
  • Prophylaxis before surgery or treatment of bleeding with Von Willebrand disease **
  • Prophylaxis before surgery or treatment of bleeding with hemophilia A **
  • Use in fibrin sealant production
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37
Q

mid-esophageal aortic valve short axis view (ME AV SAX cusps

A

The non-coronary cusp of the aortic valve is adjacent to the inter-atrial septum, the right coronary cusp is most anterior, and the left coronary cusp is adjacent to the pulmonary artery

38
Q

cerebral palsy

A

Cerebral palsy (CP) patients have an increased incidence of gastroesophageal reflux and aspiration. “Succinylcholine has been used in children with CP for more than 50 yr without a single report of a hyperkalaemic response.

39
Q

Uremia and clotting

A

Uremia interferes with platelet activation and aggregation (primarily via effects on vWF and GPIIb-IIIa) and leads to increased production of platelet inhibitors (e.g. prostacyclin and nitric oxide)

40
Q

Fenoldopam

A
  • DA-1 receptor agonist
  • Decreases peripheral vascular resistance
  • Increases renal blood flow
  • Increases diuresis (urine production)
  • Increases natriuresis (urine sodium excretion)
    (will lead to intraocular pressure)
41
Q

MELD vs Child Pughs

A

MELD: “I Crush Beer Daily” - INR, Creatinine, Bilirubin, Dialysis
Child-Pugh: “Pour Another Beer At Eleven” - PT, Ascites, Bilirubin, Albumin, Encephalopathy

42
Q

GERD in parturients

A

due to increase in progesterone

43
Q

transdermal fentanyl patches

A

patient with chronic/cancer pain taking more than 45mg morphine daily

44
Q

Coronary perfusion

A

LV during diastole

RV continuously as RV pressure does not normally exceed systemic pressures

45
Q

muscle dystrophy

A

avoid sux, neostigmine and potassium containing solutions

46
Q

ECT

A

elevations in CBF and ICP, long and short-term memory loss, and autonomic stimulation with initial bradycardia, followed by hypertension and tachycardia

47
Q

Evoked potential sensativity

A

BAEP < SSEP < MEP < VEP, (SSEP = somatosensory evoked potential, MEP = motor evoked potential). Another way to remember: BAEP are Barely affected, SSEP are Somewhat affected, MEP are Mostly affected, and VEP are Very affected.

48
Q

Sickle cell avoid

A

hypothermia, hyperthermia, hypoxemia, hypotension, hypovolemia, and acidosis can all promote erythrocyte sickling

49
Q

improve defibrillation

A

quick defibrillation, the use of electrode gel, biphasic defibrillation, and larger electrodes

50
Q

Regional in TURP

A

1) monitoring for bladder/prostatic perforation (nit higher than T 10)
2) decreased blood loss
3) decreases DVT

51
Q

Autonomic hyperreflexia

A

Anesthetic management of patients at high risk for AH includes neuraxial anesthesia with local anesthetic and/or deep general anesthesia. Opioid-only anesthetics administered intravenously or neuraxially do not reliably prevent AH. Symptoms of AH are related to the profound vasoconstriction that occurs below the level of the lesion (e.g. headaches, hypertensive crisis, MI) and the vasodilation that occurs above the level of the SCI (e.g. diaphoresis of upper body, nasal congestion). Treatment includes fast-acting vasodilating agents such as nitroprusside, nitroglycerin, and nicardipine.

52
Q

Ductus arteriosus

A
  • Indomethacin to close

- prostaglandins (PGE1) to keep open: Side effects include apnea, hypotension, fevers, and CNS irritability.

53
Q

Dantrolene doses

A
  1. 5mg/kg up to 10mg/kg

- infusion at 0.25mg/kg/hr

54
Q

most accurate in predicting AKI

A

creatine clearance= urine cr * urine volume/ Plasma creatine

55
Q

FENA

A

FENa = (Urine sodium * Plasma creatinine) / (Urine creatinine * Plasma sodium)
FENa < 1% = Prerenal
FENa >1% = Intrinsic (e.g., acute tubular necrosis)
FENa >4% = Postrenal

56
Q

Differentiate ESLD vs DIC

A

Factor VIII

- Consumed in DIC, normal or high in liver disease

57
Q

Maternal side effects of B adrenergic receptor agonists

A 
Hypotension
Tachycardia
Increased cardiac output
Hyperglycemia
Hypokalemia
Pulmonary edema
58
Q

Factors that decrease in pregnancy

A

factor XI and factor XIII

59
Q

Obtorator nerve block

A

inject between add longus and brevis (primary location)

and between addbrevis and magnus

60
Q

Radiation intensity

A

I ∝ 1 / r^2

61
Q

Triggers for nonshivering thermogenesis in neonates and infants

A
  • Norepinephrine, glucocorticoids, and thyroxine

- inhibited by inhalational anesthetics and β-blockers

62
Q

caudal dosing for kids

A

0.5 mL/kg of local anesthetic will cover the sacral dermatomes, 1 mL/kg will cover up to the low thoracic dermatomes, and 1.25 mL/kg will cover up to the mid thoracic dermatomes

63
Q

spinal stimulation contraindications

A

sepsis, coagulopathy, previous surgery or trauma obliterating the spinal canal, localized infection, and spinal bifida
- relatively contraindicated in the setting of cognitive and psychological disability

64
Q

chronic opioid therapy

A

increased prolactin levels, and decreased testosterone, estrogen, cortisol, LH, and FSH.

65
Q

Risk factors for acute MR following MI

A
  • Advanced age
  • Prior myocardial infarction
  • Infarct extension
  • Inferior or posterior MI
  • Multiple vessel coronary artery disease
  • Recurrent ischemia
66
Q

femoral triangle anatomy

A

femoral triangle is bordered by the inguinal ligament superiorly, the adductor longus muscle medially, and sartorius muscle laterally

67
Q

calculated on ABG

A

base deficit, bicarb and SAO2

68
Q

breast milk vs clears

A
  • breast milk leads to higher gastric volumes
69
Q

Superior laryngeal nerve damage

A
  • most common during thyroid or parathyroid surgery
  • voice easily tires
  • no respiratory distress
70
Q

jugular bulb venous oxygenation

A
  • measure global cerebral oxygen extraction

- balance between oxygen supply and demand

71
Q

Nuclear detonation

A
  • potassium iodine to save the thyroid

- strontium lactate for bones

72
Q

Soidum Nitroprusside toxicity

A

elevated mixed venous oxygen (PVO2), SNP tachyphylaxis, and metabolic acidosis

73
Q

VonWilllebrands treatments

A

Type I: trial of DDAVP
Type II: trial of DDAVP, avoid if known type IIB
Type III: vWF concentrate (DDAVP has no effect)
Acquired vWF Deficiency: trial of DDAVP, switch to vWF concentrate if not responding
Antibody-Mediated Acquired vWF Deficiency: IVIG
Minor Bleeding/Surgery: DDAVP, follow clinically, vWF concentrate if bleeding continues
Major Bleeding/Surgery: use vWF concentrate and continue in the perioperative period

74
Q

when is fetal heart rate monitoring feasable

A

18-20 weeks

75
Q

Blood volume

A 
Premature infant	90-105 mL/kg
Full-term newborn	80-90 mL/kg
Infant 3-12 months	70-80 mL/kg
Child 1-12 years	70-75 mL/kg
Adult male	65-70 mL/kg
Adult female	60-65 mL/kg
76
Q

increases cerebral perfusion and oxygenation

A

Of the vasoactive medications that cause vasoconstriction, vasopressin may preserve cerebral blood flow and oxygenation while also increasing cerebral perfusion pressure. This effect is likely mediated by local nitric oxide release stimulated by the direct action of vasopressin on the cerebral vasculature

77
Q

temp vs pH and CO2

A

pH is increased by 0.015 for each degree below 37 °C. PaCO2 is decreased by 2 mm Hg for each degree below 37 °C.

78
Q

Spinal cord stimulators

A

Spinal cord stimulators activate the larger Aα and Aβ fibers to a greater degree compared with the smaller nociceptive Aδ and C fibers. This closes the gate in and impedes conduction of pain sensation past the substantia gelatinosa of the dorsal horn of the spinal cord.

79
Q

HIgh frequency ventilation

A

High frequency ventilation utilizes the delivery of rapid subphysiologic tidal volumes to achieve gas exchange via multiple complex mechanisms including: cardiogenic mixing, Pendelluft ventilation, Venturi effect, and Taylor dispersion

80
Q

Carbamazepime overdose

A

neurological, cardiac and anticholinergic symptoms

81
Q

acromegaly

A

skeletal overgrowth, soft-tissue overgrowth, connective tissue overgrowth, peripheral neuropathy, visceromegaly, glucose intolerance, osteoarthritis, osteoporosis, hyperhidrosis, skeletal muscle weakness, and increased lung volumes

82
Q

adenosine doesn’t terminate what?

A

atrial flutter

83
Q

refeeding syndrome

A

Refeeding syndrome is a term that refers to various metabolic abnormalities that may complicate carbohydrate administration in subnourished patient populations. Hypophosphatemia is the most well known, and perhaps most significant, element of the refeeding syndrome, and may result in sudden death, rhabdomyolysis, red cell dysfunction, and respiratory insufficiency.

84
Q

ALS anesthesia options

A

Denervating neuromuscular disease can result in extrajunctional receptor formation, which leaves patients susceptible to exacerbated hyperkalemic response to depolarizing neuromuscular blocking drugs. Strokes, CNS tumors, burns, crush injuries, and prolonged immobility are among other causes of the formation of extrajunctional acetylcholine receptors. Spinal anesthesia is typically avoided in patients with ALS

85
Q

diagnostic signs of compartment syndrome

A

compartment pressure >30 mmHg, creatine phosphokinase level >5000 U/ml (possibly as little as >1000 U/ml), loss of normal phasic patterns of tibial venous blood flow, loss of distal pulses in the setting of closed extremity injury, and compartment perfusion pressure < 21 mmHg.

86
Q

leading maternal cause of death with preeclampsia

A

-stroke

87
Q

treat and prevent myotinic crisis

A

phenytoin
-phenytoin, quinine, procainamide, direct infiltration of the affected muscle with local anesthetic, or a high concentration of volatile anesthetic

88
Q

myotonic crisis cause in myotonic dystrophy

A

shivering from hypothermia, succinylcholine, neostigmine, and direct surgical stimulation of muscle

89
Q

salicylate poisoning

A

mixed respiratory alkalosis and metabolic acidosis

90
Q

adult to ped liver donation

A

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