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Pharm For Clinic > Volatiles And Other Anesthetics > Flashcards

Volatiles And Other Anesthetics Flashcards

1
Q

Isoflurane is what type of volatile ?

A

Halogenated Methyl Ethyl Ether.

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2
Q

5 Characteristics of ISO

A

1) Pungent Odor
2) Intermediate Blood solubility
3) Immediate Onset and Recovery
4) Highly Potent
5) Isomer of Enflurane
6) No preservative needed

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3
Q

All CNS effects of ISO (5)

A

No Seizure = Suppress convulsant properties
Increases CBF ( Hello> Everyone> I =Do increase CBF ) at MAC 1.1
Decrease CRMO2 - dose dependent ( ISO=DES=SEVO>Halothane)
Cerebral protection
Increase in ICP ∞ to increase CBF

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4
Q

CV effects of ISO (9) HR, left SV, CO, SVR, PVR, Arrythmia, Coronary, BP, IPC

A

Transiently Increase HR ( Des>ISO) * all the pungents increase HR !!
Decrease Left SV
No change in CO
Most profound Decrease in SVR ( I» don’t > See an SVR )
Little to no effect on PVR
Min to nonexistent Epinephrine induced arrhythmia effect
Most potent coronary dilator : coronary steal, dilates smaller >larger coronaries, ischemis in CAD pts
All volatiles decrease BP
Good cardiac protection APC ( anesthetic pre conditioning )/ IPC (Ischemic pre conditioning)

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5
Q

ISO pulomonary effects (8) RR, TV, Min Vent, CO2, Vent response to CO2, airway resistance, PVR, HPV

A

*Increase Frequency of breathing
Decrease TV
Decrease Minute ventilation = increase PaCO2–Resp acidosis
*Increase CO2
Decrease Ventilatory response to CO2
Decrease airway resistance after antigen bronchoconstriction
Decrease PVR ( ISO>SEVO)
Decrease HPV ( hypoxic pulm vasoconstriction)

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6
Q

Hepatic effects of ISO (3)

A

1-Maintain hepatic artery but increase portal vein blood flow= good for hep oxygenation
2-No transient increase in ALT ( but DES and Enflurane increase ALT)
(All surgical stimulation does increase all LFTS)
3- metabolism to acetylated liver protein similar to halothane = severe antibody response possible in that manner : H>E>I>D
*HEID your liver from antibody attack

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7
Q

Metabolism of ISO

A

Only 0.2% is metabolized
By P450 enzymes
Oxidative metabolism to TRIFLUOROCETIC ACID leads to acetylated hepatic protein AB complexes
Less inorganic fluoride production than Enflurane .

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8
Q

ISO Molecular weight

A

184

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9
Q

MAC of ISO

A

1.17

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10
Q

ISO stability of SODA LIME

A

Yes

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11
Q

Boiling Point

A

48.2

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12
Q

Vapor Pressure of ISO

A

240

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13
Q

Blood: Gas Coefficient

A

1.46

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14
Q

MAC 50-70 % N2Oof ISO

A

0.50

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15
Q

How many stages of anesthesia

A

4 Stages

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16
Q

Stage 1 of anesthesia starts and ends when ?

A

Start at Induction
End at loss of consciousness ( no eyelid reflex)
Can still feel pain

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17
Q

What is Stage 2 of anesthesia

A

Delirium Excitement
Uninhibited excitation
Pupils dilated, divergent gaze
Potentially dangerous response to noxious stimuli: Breath holding, Muscular rigidity, Vomiting Laryngospasm

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18
Q

What is Stage 3 of anesthesia

A

Surgical Anesthesia
Centralized gaze with constriction of pupils
Regular respirations
Anesthesia depth is sufficient for noxious stimuli when the noxious stimuli dose not cause increase sympathetic response.

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19
Q

Pupils dilated with divergent gaze is what stage of anesthesia ?

A

Stage 2

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20
Q

What potential dangerous response to noxious stimuli occur in Stage 2 of anesthesia

A

Laryngospasm
Vomiting
Breath holding
Muscular rigidity

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21
Q

What is Stage 4 anesthesia

A

Stay away from. Too deep
Apnea
Non reactive dilated pupils
Hypotension resulting in complete CV collapse if not monitored closely

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22
Q

What stage is nonreactive dilated pupil ?

A

Stage 4

too deep

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23
Q

Molecular weight of Nitrous Oxide

A

44

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24
Q

MAC of N2O ( Nitrous Oxide )

A

104

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25
Q

Therapeutic Index is described as

A

As the ratio between LD50 and ED50 LD50/ED50

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26
Q

What is LD50

A

Dose of the drug required to produce to death in 50 % of patients.

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27
Q

What is ED 50

A

Dose of a drug required to produce desired drug effects in 50 % of patients

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28
Q

Why is LD50/ED50 not clinically useful in anesthesia

A

Because we expect 100% of patients to fall asleep and nobody to die

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29
Q

Cricoid Pressure , also called Sellick Maneuver . How and what force what gets displaced where?

A

Downward Pressure with the thumb and Index finger on the cricoid cartilage
Approx 5 kg pressure or 30 Newton
Displaced posteriorly and the esophagus is thus compressed against the underlying cervical vertabrae
To prevent spillage of gastric content during induction .

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30
Q

Difficult Airway Algorithm . The 4 steps to consider

A
  1. Assess basic management problems : diff consent, diff mask ventilation, Diff SGA placement, Diff Laryngoscopy , Diff intubation , Diff SUrgical airway access
  2. Active seek O2 delivery throughout Diff airway
  3. Consider Feasibility : awake vs post induction intubation , non-invasive vs Invasive , VL as an initial approach , Preservation vs ablation of Ventilation
  4. Develop primary and alternative strategies
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31
Q

Difficult Airway Algorithm, what are the primary vs alternative strategies ? ( 2 main ones )

A

1) Awake Intubation :
A) noninvasive approach&raquo_space;
A1 ) Succeed&raquo_space; confirm Ventilation, Tracheal intubation or SGA place with exhaled CO2
A2) Fail&raquo_space; 1) cancel case, 2) feasibility of other options like face mask or SGA 3) Invasive airway : surgical or percutaneous airway, jet ventilation, retrograde intubation .
B) Invasive Airway Acces

2) Intubation after Induction of Anesthesia

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32
Q

Difficult Airway Algorithm: 2nd alternative algorithm

A

2) Intubation after induction of anesthesia :
A1) Initial Intubation successful&raquo_space; Confirm ventilation with exhaled CO2
B) Initial Intubation attempts unsuccessful&raquo_space; consider 1) call for help 2) Returning to spontaneous ventilation 3) Awakening the patient Then :
B1) face mask ventilate adequate&raquo_space; Nonemergency pathway&raquo_space; Ventilation adequate&raquo_space; alternative approach to intubation&raquo_space; Successful intubation
B2) Face mask ventilation adequate&raquo_space; Non emergency pathway&raquo_space;Intubation unsuccessful&raquo_space;alternative approach to intubation&raquo_space; Fail after multiple attempts&raquo_space; 1) Invasive airway 2) Feasible other options 3) Awaken patient.
A2) Face Mask Ventilation not adequate&raquo_space; SGA&raquo_space; SGA adequate&raquo_space; Non emergency pathway&raquo_space; Ventilate adequate&raquo_space; Alternative Intubation approach&raquo_space; Successful intubation
A2b) Face mask Ventilation not adequate&raquo_space; SGA» SGA not adequate&raquo_space; EMERGENCY pathway&raquo_space; Ventilation not adequate / Intubation unsuccessful&raquo_space;call for help&raquo_space; Emergency noninvasive airway (SGA)&raquo_space; Successful ventilation = 1) invasive airway access 2) feasibility of other options 3 Awaken patient .
A2c) Face mask Ventilation not adequate&raquo_space; SGA» SGA not adequate&raquo_space; EMERGENCY pathway&raquo_space; Ventilation not adequate / Intubation unsuccessful&raquo_space;call for help&raquo_space; Emergency noninvasive airway (SGA)&raquo_space; Fail = Emergency invasive airway

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33
Q

Trachea extends from the ___overlies what vertebra__how long ___how many cartilages ___sensory innervation

A 
Larynx to the carina 
The 5th thoracic vertebra
10 - 15 cm long 
16-20 horseshoe shaped cartilages 
Sensory innvervation by the RLN a branch of CN X vagus
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34
Q 
Mallampati 1 ( there 4 classes ) 
Purpose
A

I : Soft Palate , Fauces, Uvula , Tonsillar pillars

Evaluate oropharyngeal space to predict ease of DL and Endotracheal Intubation

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35
Q

Mallampati II

A

Soft palate , Fauces, Uvula , * you lost the pillars

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36
Q

Mallampati III

A

Predicts diff DL and intubation

Soft palate and base of Uvula . * you lost Pillars and Fauces

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37
Q

Mallampati IV

A

Soft palate not visible

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38
Q

Four grade Views

A

1: Most glottis visible
2: Only Posterior Glottis is visible
3: Epiglottis but no part of Glottis can be seen
4: No airway structures

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39
Q

Grade View I

A

Most of glottis is seen

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40
Q

Grade View II

A

Only posterior Glottis seen

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41
Q

Grade View III

A

Epiglottitis but no part of glottis seen

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42
Q

Grade IV view

A

No airway structures seen

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43
Q

Patient with Hx or anticipated difficult Airway consider

A

1) Awake Intubation vs Intubation post induction
2) Initial Intubation via noninvasive vs invasive technique
3) VL as an initial approach
4) Maintaining vs ablating spontaneous breathing

  • what is the pt corporation and * always have a diff to intubate cart ready
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44
Q

Where is the narrowest region in the Infant airway ?

A

Cricoid ring

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45
Q

Macintosh style vs Miller style

A

Macintosh : curved blade : less trauma to teeth , more room for ETT , larger flange= increase ability to sweep the tongue , less bruising of epiglottis bc the tip blade doesn’t touch the epiglottis directly . It’s placed in the valleculla : between the base of the tongue and pharyngeal structure of the epiglottis
Miller : Straight blade : better exposure of glottic opening , smaller profile = good for patients with small mouth opening . The tip passed beneath the LARYNGEAL structure of the epiglottis , directly elevates the epiglottis to expose the glottic opening

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46
Q

Where is the Valleculla ?

A

Between the base of the tongue and the pharyngeal structure of the epiglottis

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47
Q

What are the standard intubating blade sizes.

A

Sized by their length
MAC 3 and Miller 2
For larger patients
MAC 4 and Miller 3

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48
Q

Obesity , define … Extreme Obesity may have what accompanying issues (8) what special equipments might you need ?

A 
Obesity is a BMI ≥
Extreme Obesity is a BMI ≥40 : 
1)OSA, 
2)HF , 
3)DM, 
4)HTN, 
5)Pulm HTN, 
6)Difficult Airway, 
7)Decreased arterial Oxygenation , 
8)Increased gastric volume 
Special equipments : Oversized BP cuffs, Airway management devices, large procedure tables and gurneys.
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49
Q

Diabetes HG A1C is

A

≥ 7 %

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50
Q

Incisor Distance

A

Incisor gap less than 3 to 4.5 cm = difficult achieving line view for DL
Overbite = reduces interincisor gap when pt head and neck optimally positioned for DL

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51
Q

Upper Lip Bite Test ( ULBT) ( 3 classes )

A

I : Lower incisors can bite above the vermillion border and upper lip
II: Lower incisors cannot reach vermillion
III: Lower incisors cannot bit lip

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52
Q

Lower incisors cannot bite lip

A

ULBT III

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53
Q

Lower Incisors can bite Upper lip and Vermillon border

A

UBLT II

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54
Q

Lower incisors cannot reach Vermillion

A

UBLT II

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55
Q

Thyromental/Sternomental Distance

A

Mentum To thyroid cartilage
< 6 to 7 cm or < approximately 3 Fingerbreaths = poor laryngoscopic view
Normal TMD is 3 FB or more *
Normal Sternomental distance > 12.5 to 13.5 cm

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56
Q

The ___ is the predominant cause of airway restance in the oropharynx. It obstruction happens because of the relaxation of the _____muscle during anesthesia

A

Tongue

genioglossus muscle

57
Q

What structure demarcates the border between the oropharynx and the hypopharynx

A

the epiglottis

58
Q

What nerve innervated the Post 1/3 of tongue, Soft palate, and the oropharynx

A

Glossopharyngeal Nerve CN IX

59
Q

Soft Palate separates ____from the ______

A

Nasopharynx from the Oropharynx

60
Q

Internal Branch of SLN provides sensory to

A

1) Hypopharynx
2) Base of Tongue
3) Posterior surface of epiglottis
4) Aryepiglottic folds
5) Arytenoids
6) Epiglottis
7) Mucosa above the glottis
8) Cricothyroid Joint
9) Thyroepiglottic Joint
* * no motor anywhere

61
Q

Superior Laryngeal External Branch Sensory and Motor innervation

A

Sensory: Anterior Mucosa below the glottis

Motor : Cricothyroid Membrane

62
Q

Recurrent Layngeal Sensory and Motor

A 
Sensory : Mucosa below the glottis 
Motor : 
1)Thyroarethnoid membrane, 
2)Lateral crycoarythenoids membrane, 
3)Interarytenoid membrane, 
4) Posterior Cricoarythenoid membrane
63
Q

Larynx is located at the level of

A

The 3rd to the 6th cervical vertabrae

64
Q

What are the cartilages of the larynx

A

3 paired : Cuneiform , arytenoids, corniculate

3 Unpaired : epiglottis , thyroid and cricoid

65
Q

The 3 paired cartilages of the larynx

A

Arytenoids
Corniculate
Cuneiform

66
Q

The 3 unpaired cartilages of larynx

A

Epiglottis
Thyroid
Cricoid

67
Q

Narrowest portion of the adult airway

A

Vocal cords Which are formed by the thryroarytenoid ligaments

68
Q

Only cartilage of the larynx that is a full ring

A

Cricoid

Shaped like a signet

69
Q

Anterior 2/3 of the tongue innvervated by

A

Sensory : Lingual nerve (trigemminal branch ) and chorda tympani
Motor :

70
Q

ETT size calculation for infants Uncuffed and cut length

A

(Age+16)/4 (per M&P)= mm or 4 + Age/4 (per PP )= mm
Cut length in cm
14+ Age/2 = cm

71
Q

ETT size calculation cuffed

A

Subtract 1/2 a size from the regular formula result

(Age + 16)/4 Then always have .5 size smaller and .5 size bigger available

72
Q

Superior Thyroid Artery is found

A

1) along the lateral edge of the cricothyroid membrane.

2) Crossing the upper cricothyroid membrane

73
Q

14 + Age/2

A

Cut length

74
Q

(16+ Age)/4

A

ETT size in mm

75
Q

The thyroid cartilage shields the

A

Conus elasticus

76
Q

Parasympathetic Nerves

A

1973

X IX VII III

77
Q

Which nerve provides sensory Below the cords

A

RLN

78
Q

Which nerve provides Sensory above the cords ?

A

SLN — Internal Branch

79
Q

After Subtotal Thyroidectomy what damages ?

A

Unilateral Recurrent Nerve Damage

Superior Laryngeal Nerve damage

80
Q

Why does SAT drop quickly after induction

A

Because of decreased FRC and Increased O2 consumption.

81
Q

Pre- Oxygenation : how many breaths ?

A

8 Vital Capacity breaths of 100% O2 for 1 minutes = 3 minutes of normal TV of 100% O2 for 3 minutes

82
Q

LMA contraindications

A

Relative contraindications include:
patients with pharyngeal pathology (ex, abscess)
pharyngeal obstruction
full stomachs (ex, pregnancy, hiatal hernia)
low pulmonary compliance (ex, restrictive airways disease) requiring peak inspiratory pressures greater than 30 cm H2O.

83
Q

What nerve damage after LMA

A

Lingual
Hypoglossal
RLN

84
Q

Murphy eye of TT is to

A

Prevent occlusion

85
Q

Explain sniffing position

A

Moderate head elevation (5-10 cm above the surgical table) and extension of the atlantooccipital joint place the patient in the desired sniffing position.

The lower portion of the cervical spine is flexed by resting the head on a pillow or other soft support

86
Q

Best confirmation/definitive test of Tracheal placement of a TT
Earliest evidence of brachial intubation is

A

The persistent detection of CO2 by a capnograph is the best confirmation/definitive test of tracheal placement of a TT, it cannot exclude bronchial intubation.
The earliest evidence of bronchial intubation often is an increase in peak inspiratory pressure.

87
Q

Proper tube location can be reconfirmed by

A

Proper tube location can be reconfirmed by palpating the cuff in the sternal notch while compressing the pilot balloon with the other hand. The cuff should NOT be felt above the level of the cricoid cartilage, because a prolonged intralaryngeal location may result in postoperative hoarseness and increases the risk of accidental extubation.

88
Q

FOI is ideal for:

A

A small mouth opening
Minimizing cervical spine movement in trauma or rheumatoid arthritis
Upper airway obstruction, such as angioedema or tumor mass
Facial deformities, facial trauma

FOI can be performed awake or asleep via oral or nasal routes.
Awake FOI: predicted inability to ventilate by mask, upper airway obstruction
Asleep FOI: Failed intubation, desire for minimal C spine movement in patients who refuse awake intubation
Oral FOI: Facial, skull injuries
Nasal FOI: A poor mouth opening

89
Q

Surgical Airway Jet ventilation

A

A 16- or 14-gauge intravenous cannula is attached to a syringe and passed through the CTM toward the carina. Air is aspirated. If a jet ventilation system is available, it can be attached. The catheter MUST be secured, otherwise the jet pressure will push the catheter out of the airway, leading to potentially disastrous subcutaneous emphysema.
Short (1 s) bursts of oxygen ventilate the patient. Sufficient outflow of expired air must be assured to avoid barotrauma. Patients ventilated in this manner may develop subcutaneous or mediastinal emphysema and may become hypercapnic despite adequate oxygenation.
Transtracheal jet ventilation will usually require conversion to a surgical airway or tracheal intubation.

90
Q

If jet ventilation is not available

A

Should a jet ventilation system not be available, a 3-mL syringe can be attached to the catheter and the syringe plunger removed. A 7.0-mm internal diameter TT connector can be inserted into the syringe and attached to a breathing circuit or an ambu bag. As with the jet ventilation system, adequate exhalation must occur to avoid barotraumas.

91
Q

Extubating Awake Patients

A
  • Extubating an awake patient is usually associated with coughing (bucking) on the TT. This reaction increases the heart rate, central venous pressure, arterial blood pressure, intracranial pressure, intraabdominal pressure, and intraocular pressure.
  • It may also cause wound dehiscence and increased bleeding. The presence of a TT in an awake asthmatic patient may trigger bronchospasm.
  • Some practitioners attempt to decrease the likelihood of these effects by administering 1.5 mg/kg of intravenous lidocaine 1-2 min before suctioning and extubation; however, extubation during deep anesthesia may be preferable in patients who cannot tolerate these effects (provided such patients are not at risk of aspiration and/or do not have airways that may be difficult to control after removal of the TT).
92
Q

2 types of patients you do not deep extubate

A

Difficult airway

At risk for aspiration

93
Q

Extubation criteria

A

RR< 30
NIF> 20 mmHg
Vital Capacity >15 ml/kg
Tidal Volume > 6ml/kg
Hemodynamically stable with no significant inotrope
Adequate NMB reversal (5 sec head lift )
Adequate gas exchange : no acidosis and o2 >93%

94
Q

Ventricular Bigeminy during intubation means

A

Light anesthesia

95
Q

What is Laryngospasm

A

Laryngospasm is a forceful involuntary spasm of the laryngeal musculature caused by sensory stimulation of the superior laryngeal nerve

96
Q

Treatment of laryngospasm

A

Treatment of laryngospasm includes providing gentle positive-pressure ventilation with an anesthesia bag and mask using 100% oxygen.
Administering intravenous lidocaine (1-1.5 mg/kg). If laryngospasm persists and hypoxia develops, small doses of succinylcholine (0.25-0.5 mg/kg) may be required (perhaps in combination with small doses of propofol or another anesthetic) to relax the laryngeal muscles and to allow controlled ventilation

97
Q

Proper TT placement capnography

A

Waveform decreases to 0 during inspiration and a Peak Plateau > 20 mmHg during exhalation

98
Q

Sevo induction technique

A
  • A technique for induction of anesthesia with sevoflurane includes priming the circuit (emptying the reservoir bag and opening the adjustable pressure-limiting [“pop-off”] valve), dialing the vaporizer setting to 8% while using a fresh gas flow of 8 L/min, and maintaining this flow for 60 seconds before applying the face mask to the patient.
  • At this point a single breath from end-expiratory volume to maximum inspiration followed by deep breathing typically produces loss of consciousness in 1 minute.
99
Q

What is MS MAID for ?

A

Preparation for Anesthesia

Machine
Suction

Monitor
Airway
IV
Drugs

100
Q

Patients not good candidate for MAC

A 
Children
Confused
Uncooperative
Retarded
Patients with tremors
Patients unable to lie down flat
Unmanageable Anxiety –previous poor anesthesia outcome
PTSD
101
Q

Never do MAC with deep sedation on

A 
Never do this on:
Patients with gastroesophageal reflux
Sleep apnea
Sick sinus syndrome
Mediastinal masses or tumors
102
Q

Urinary Output

A

0.5- 1 ml/kg/hr

103
Q

Is HCT a good indicator of Blood Volume ?

A

Hemoconcentration (hct is a poor indicator of blood volume). High Hct means the patient is dry

104
Q

Physical signs and symptoms of Hypovolemia:

A

Supine Hypotension
(implies blood volume deficit greater than 30%)
Orthostasis or Positive tilt test
( increases in HR greater than 20 beats/min and decreases in systolic BP greater than 20 mmHg when the patient assumes the standing position)
Oliguria

105
Q

Lab evidence of hypovolemia

A

Hemoconcentration (hct is a poor indicator of blood volume). High Hct means the patient is dry
Azotemia (nitrogenous products in blood)
Low urine sodium concentration (less than 20 meq for every 1000 ml of urine)
Metabolic alkalosis
Metabolic acidosis (reflects hypoperfusion). Due to Na++ reabsorption

106
Q

Crystalloids last for

A

20 - 30 minutes

107
Q

Be careful using LR in

A

Lactated Ringers-
use caution in renal patients d/t K+ accumulation
Has electrolyte composition most resembling ECF
pH is around 6.6 (kind of acidic)
Lactate is converted to bicarbonate= can cause metabolic alkalosis !!

108
Q

1/2 life of colloids

A

3 - 6 hours

109
Q

The predicted daily maintenance fluid requirements for healthy adults may exceed

A

2500ml/day.

110
Q

Maintenance Fluid

A

Maintained with isotonic solution
4cc/kg for the 1st 10kg of body weight (Up to 10 kg)
2cc/kg for the next 10kg of body weight second 10 kg
1cc/kg for the rest of the body weight (21 kg and above)
This formula works for children and adults
In an adult weighing over 20kg, just add 40 to the weight to find the maintenance rate

111
Q

Shortcut math for Maintenance

A

In an adult weighing over 20kg, just add 40 to the weight to find the maintenance rate

112
Q

Another option for hourly maintenance (approximation) in the adult patient is to use

A

1.5 cc/Kg/hr

113
Q

NPO Deficit =

A

Hr. maint. X Hrs. NPO

114
Q

NPO replacement and Maintenance

A

Hr 1 = ½ NPO def + hr maint.
Hr 2 = ¼ NPO def + hr maint.
Hr 3 = ¼ NPO def + hr maint.

115
Q

Adjusted Body weight

A

Actual Body weight + Ideal Body weight
—————————————————
2

116
Q

Ideal Body Weight

A

First 5 feet = 100 pounds then
For females add 5 pounds for every inch above 5 feet
For males add 7 pounds for every inch above 5 feet

117
Q

What is Obesity

A

Obesity is 20 % above the ideal body weight
Morbid obesity is twice the IDEAL BODY WEIGHT
For obese patients calculate fluid and drugs required according to the adjusted body weight

118
Q

Add it all together

A 
NPO Deficit +
Hourly maintenance +
Third space losses =
Rate of fluid administration 1st/2nd/3rd/4th hour+
Blood loss
119
Q

Normal Blood volume in male, female, adult, Infant, Full term, Premature

A

Adult male: 75 ml X Wt in Kg
Adult female: 65 ml X Wt in Kg
Obese: 70 X Wt in Kg

Infant: 80 ml X Wt in Kg
Full term: 85 ml X Wt in Kg
Premature: 95 ml X Wt in Kg

120
Q

Allowable Blood Loss

A

Allowable
Blood = EBV X (Starting hct-Target hct)
—————————————
Loss starting hct

121
Q

Sponges and Lap sponges soaked

A

Fully soaked sponge (4 x 4) 10 ml of blood
Fully soaked lap sponge 100 – 150 ml of blood
To be more accurate weigh sponges/laps. Most commonly done in pediatrics

122
Q

You can or replace blood loss with crystalloid when ?

A

Acute blood losses in the range of 1500 to 2000ml (or approximately 30% of EBV) exceed the ability of crystalloids to replace without jeopardizing O2 carrying capacity of the blood
Compensatory mechanisms maintain homeostasis up until that point

123
Q

When to consider blood replacement

A

15 % loss should be consideration for replacement. The Hct should be used as a guide for determining blood replacement

124
Q

How many % blood loss is well tolerated ?

A

10 %

125
Q

Once anemia risk is greater than risk of transfusion, blood loss is replaced with blood to maintain:

A

Hgb 7 – 8 grams/dl

Hct 21 – 24 %

126
Q

Blood, Colloid, Crystalloid ratio

A

Blood is replaced unit per unit loss with PRBCs 1:1
Crystalloids 3:1
3 ccs of crystalloids (LR or NS) per each 1 cc blood loss
Colloids 1:1
1 cc of colloid per each cc of blood loss, until transfusion point is reached
They do not have O2 carrying capacity. Colloids stay intravascularly.

127
Q

Whole Blood

A

Whole blood
Not readily available because it is better utilized by components
450ml blood with 63ml anticoagulant
Generally WB will increase HCT 3-4% per unit in a 70kg non-bleeding adult
Indicated in acute blood loss >30% of EBV
If over 24hrs old, no viable platelets, and factors V and VIII are markedly reduced

128
Q

PRBC

A

Packed RBCs
Remember PRBCs restore O2 carrying capacity but do not contain any plasma proteins important for coagulation
Removal of plasma removes fibrinogen (factor I)
High viscosity, so many providers dilute with 100-200ml of appropriate crystalloid
HCT of PRBCs 60-70%

129
Q

1 unit PRBC will raise the HgB and the HCT by ?

10ml.kf PRBC will raise the HgB and the HCT by ?

A

1 unit of PRBCs will raise the Hgb 1 Gm/dl
1 unit of PRBCs will raise the Hct approx. 3%
10 ml/kg transfusion PRBCs will increase hgb by 3 g/dl
10 ml/kg transfusion of PRBCs will raise hct by 10%

130
Q

1 unit platelet will raise PLT by

A

One unit increases PLT count 5-10k

131
Q

FFP Dose , all coag present except …, what lab indicates need to replace ? Risk ?

A

Fresh Frozen Plasma
Dose 10-15 ml/kg
All coagulation factors except platelets are present
Most providers judge need based on PT and PTT being 1.5 times greater than preoperative level
Risk of viral illnesses (Hepatitis) and transfusion reaction

132
Q

5 rights

A 
PATIENT
DRUG
DOSE
ROUTE
TIME
STILL MUST CHECK BLOOD WITH A LICENSED PERSON.  MUST CHECK BY BLOOD BAND…..EVERY TIME
133
Q

MH

A

INCREASE AND CONTINUOUS LEAKING OF CALCIUM FROM FROM RYANODINE RECEPTORS OF THE SARCOPLASMIC RETICULUM.

SUSTAINED CONTRACTION

INCREASE IN METABOLISM

  • mostly young male
134
Q

Late sign of MH

A

PROLONGED MUSCLE RIGIDITY CAUSES INCREASE IN TEMPERATURE (LATE SIGN). CORE TEMP CAN RISE AS MUCH AS 1o C every 5 minutes.

135
Q

Earliest sign of MH

A

EARLIEST SIGN: SUCCINYLCHOLINE INDUCED MASSETER MUSCLE RIGIDITY (MMR) AND/OR OTHER MUSCLE RIGIDITY

136
Q

Most sensitive sign

A

UNANTICIPATED DOUBLING OR TRIPLING OF ETCO2 IN ABSENCE OF VENT CHANGES IS ONE OF THE EARLIEST AND MOST SENSITIVE INDICATORS OF MH

137
Q

Most MH deaths are due to

A

DEATHS ARE DUE TO DIC AND ORGAN FAILURE D/T DELAYED OR NO TREATMENT WITH DANTROLENE

138
Q

Muscolosketal diseases that increase risk of MH

A

MUSCULOSKELETAL DISEASES:
Central-Core Disease
Multi-Minicore Myopathy
King-Denborough Syndrome

139
Q

ANY PATIENT WHO DEVELOPS MMR DURING INDUCTION SHOULD BE CONSIDERED POTENTIALLY SUSCEPTIBLE TO MH

A

True

Pharm For Clinic (2 decks)

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