2 Flashcards
(140 cards)
1
Q
supraclavicular blocks what part of BP
A
trunks and divisiojns
2
Q
infraclavicular blocks what part of BP
A
cords
3
Q
what part of arm does infraclav block
A
upper arm, elbow, forearm, wrist, hand
4
Q
what block is best for copd
A
infra > supra
or ax if limited mobility
5
Q
landmarks for infraclavicular
A
clavicle and coracoid process
6
Q
complications of infraclavicular
A
chylothorax
this block has highest risk of vascular injection!! and patient discomfort (piercing pec muscles)
7
Q
axillary block tagets what part of BP
A
terminal branches
8
Q
where does axillary miss
A
medial upper arm- axillary and deltoid
9
Q
what nerve is often missed with the axillary block
A
musculocutaneous- lateral foreram- 2nd injection needed
10
Q
complications for axillary block
A
median nerve injury
hematoma and last also
phrenic n injury and pneumothorax not common
11
Q
forearm blocks: radial, median, ulnar
A
radial- proximal to radial styloid- field block as many branchs of radial n.
median- between flexor carpi radialis and flexor palmaris longus
ulnar- between ulnar styloid and flexor carpi ulnaris
12
Q
what is important to know abut digital nerve blocks
A
no epi!! ischemia
13
Q
what type of procedures should bier block be used for
A
minimal operative pain procedures: carpel tunel release, dupuytren’s contraction
14
Q
what cannot be used in bier block
A
no epi or bupivicaine in bier block
15
Q
when does pain begin with bier block
A
25-60 mins
16
Q
what nerve helps tolerate touorniquet pain but often needs to be blocked seperate
A
T2- intercostobrachial n
17
Q
what does femoral n do
A
hip flexion and knee extension
18
Q
sciatic n
A
hip extension and knee flexion
19
Q
what controls toe extension/ flexion, abduction and adduction
A
tibial
20
Q
what controls ankle eversion
A
superficial peroneal
21
Q
what controls ankle dorsiflexion and inversion
A
deep peroneal
22
Q
excess pain response to stimuli
A
hyperalgesia- remi
23
Q
pain from nonpainful stimuli
A
allodynia- fibromyalgia
24
Q
pain localized to peripheral nerve
A
neuralgia- herpes zoster
25
abnormal sensation occuring spontaneously
paresthesia
26
what appears anechoic on US
vessel, cyst (black)
27
all post ganglionic sympathetic nerve fibers are
c fibers; unmyelinated
28
which ankle nerve block requires 2 shots
common peroneal
29
a femoral knee block is great for
knee
30
pressure against the distal lateral humerus can cuase injury to what nerve
radial
31
lipid solubility of a LA is an indicator of
potency
32
what part of LA structure interfers solubility
benzene ring
33
what block is best for forearm/ wrist surgery
axillary
34
dermatome for c section
t6
35
what nerve trunk is most commonly missed with ISB HOT SPOT
ulnear n c8-t1
36
what nerve must be blocked for awake nasal intubation
infraorbital v2 maxillary trigeminal
37
landmarks for caudal (multi select)
superior posteior iliac spine
sacral cornu
sacrococcugeal ligament
sacral hiatus
38
what is c/i in bier block
epi and bupivicaine
39
what are intracellular ions
k, mag, phosphate
40
extracell
na, ca, cl, hco3
41
normal plasma osmolarity
280-290
42
what is the dominant extracellular ion
Na
43
increase na by no more than ___
2 meq/hr
44
a na < __ is very bad
<115 seziures coma cerebral edema
45
a na > __ = hyperreflexia; > __ = seizures coma
> 401-430 hyperreflexia, muscle twitches; >431 seizures coma
46
normal ionized ca
2.2-2.6
47
what phase of cardiac cell ap is ca involved in
ii
48
role of pth
raises serum ca
49
calcitonin role
lowers serum ca
50
acidosis means __ ionized ca
increased
alkalosis = decreased ionizedd ca
51
hyperventilation= high or low ca
low ca
52
hypocalcemia s/s
tetany, laryngospasm, seizures, chvostek (eye twitch), cramps, trousseaus (wrist), qt prolongation
53
tx for hypocalcemia
calcium and vit d
54
hyperca s/s
abd pain, htn, psychosis, seizures, qt shortening
55
hyperca tx
0.9% nacl; furosemide (loop)
56
hypomag symptoms
sizures, tetanty, dysryhythmias, long QT
57
hypermag s/s
diminished dtr, lethargy, hotn, resp depression, coma, ht block, can potentiate sux and ndmr (lower dose if emergent c section)
58
tx of hyper mag
ca gluconae or ca cl
59
hyperventilation causes
hypok, hypoca, inc cerebral blood flow
60
acute resp acidosis every __ inc in paco2 ph changes by
every 10 mmhg inc paco2; ph decreases by 0.08
61
practice fluid
62
what forms clot
fibrinogen (1)-> fibrin-> clot
63
what busts clot
plasminogen -> plasmin -> fibrinolysis
64
von willebrand factor (vwf)
plt adhesion
65
vwd tx
1- vwf / vii
2 desmopressin
3 cryp
4 ffp
66
intrinsic pathway is activated by
factor 12 hageman factor
67
what pathway is the longer one
intrinsic 6 minutes
68
intrinsic pathway factors
12, 11, 9, 8
69
what measures intrinsic pathway
aptt, act - inhibited by heparin
70
what activates extrinsic pathway
tissue factor iii
71
what masures extrinisc pathway
pt and inr- inhibited by warfarin
72
what factors are included in extrinsic pathway
3 and 7
73
how long is extrinsic pathway
15 seconds- shorter
74
what is the final common pathway
prothrombin (2) - acitvates thrombin 2a
thrombin 2a converts fibrinogen 1 to fibrin
activated fibrin stabilizing factor 13 crosslinks fibrin
75
normal act
90-120 sec
76
normal aptt
25-32 sec
77
normal pt
12-14
78
warfarin works on
pt/ inr- extrinsic pathway
79
normal inr
1 sec
80
bleeding time looks at
plt function and aspirin
2-10 minutes
81
d dimer
< 500 - measures fibrinolysis -> if elevted fibrinolysis is occuring
82
when should you stop clopidogrel
5-7 days before
83
what drug class is clopidogrel
adp receptor inhibitors
84
what type of drug is abciximab
gpiib/ gpiiia receptor antagonists
85
how long to stop abciximab
3 d
86
how long to stop asa/ nsaids
7 days
87
what class is asa/ nsaidss
cox inhibitors
88
how long to stop celecoxib/ rofecoxib
none
89
what drug class is celecoxib/ rofecoxib
cox 2 inhibitors
90
how long to stop unfractionated heparin
6 hrs
91
how long to stop lmwh/ enoxaparin
1-2 d
92
how long to stop argatroban, bivalirudin
2-6 hrs
93
what drug class is argatroban/ bivalirudin
thromnin inhibitors
94
what drug class is fondaparinux
factor 10 inhibitors
95
how long to stop fondaparinux
4 days
96
how long to stop warfarin
2-4 days
97
what type of drug is warfarin
vit k antagonist
98
what type of drug is tpa
plasminogen activator
99
how long to stop tpa
1 hr
100
how long to stop stroptokinase
3 hrs
101
what type of drug is streptokinase
plasminogen activator
102
phospholipids produce ___ which acitvates platelets
thromboxane a2
103
what causes plt acitvation and aggregation
adp
104
what does serotonin do for plt
activates neaby plt
105
what helps with plt aggregation
txa2 and adp
106
what is the universal donor and recpient with plasma
universal donor- AB+
universal recipient- O-
107
when should mom get rhogam
28 weeks for 2nd pregnancy
108
what is the risk with rh incompatability
next rh+ fetus- reythroblastosis fetalis
109
role of citrate
anticoagulant- binds ca (factor 4) - hypocalcemia and hyperkalemia
110
what is hct in prbc
70%
111
what is number 1 infectious complications of transfusions
cmv
cmv > hep b > hep c > hiv
112
what is leukoreduction
removes wbc from prbcs and plt-> decreases risk of hla sensitization, transfusion rx, cmv
113
what is washing
removes remaining plasma and antigens from donor rbcs- decreases anaphylaxis in igA deficient patients
114
what is irradication
destroys donor leukocytes- dec risk of graft vs host disease in immunocompromised
115
pt has fever chills n/v after transfusion
fever non hemolytic rxn
just give tylenol
116
pt has urticaria and facial swelling after transfusio
allergic transfusion rxn- need antihistamines
117
pt has non cardiogenic plm edema after transfiion
#1 mortality- frm hla and neutrophil antibodies
biggest risk with ffp and plt!!!!
118
transfuion overload after transfusion
taco
119
hemoglobinuria, hotn, flushing after trasnsfurion
stop it, uop > 75 ,ml/ hr with bolus, mannitol 12.5-25 g, furosemide 40 mg, alkalize urine
120
benefits of intraop blood salvage
inc o2 carrying capacity, inc 2,3 dpg and atp, better able to keep shape
121
estimated blood volume
premie 100
neonate 90
infant 80
women 65
man 70
all ml/kg
122
citrate metabolizes to ->
hco3 in the liver
123
what are the consequences of mass transfusion
alkalosis- r/t citrate
hypothermia- cold blood
hyperglycemia- from dextrose
hypocalcemia- citrate binds to ca
hyperkalemia- old lysed blood- prbcs < 7 d old should be used
124
trauma triad
HAC
hypothermia, acidosis, coagulopathy
125
what is ffp used for
acute warfarin reversal, coagulopathy (pt or aptt > 1.5), antithrombin def, dic, c1 esterase deficiency (hereditary angioedema)
factor 7 (shortest half life)
126
what is cyro used for
fibrinogen (1), factor 8, factor 13, vwf
hypofibrinogenemia <80, vwd, hemophelia
127
gap acidosis
inc h+ ions- lactate, dka, renal failure
128
non gap acidosis
low hco3 or inc cl (diarrhea, renal tubular necrosis, high na admin)
129
what works on pct
carbonic anhydrase inhibitors- acetazolamide
osmotic diuretics- mannitol
130
what works on thick ascending loop
loop diuretics- furosemide, bumetanide
131
what works on dct
hctz- thiazide diuretic
spirnolactone- aldosterone antagonist
eplerone (or collecting duct?)
132
blood supply vs oxygen for hepaic v and a
hepatic v- 75% blood; 50% oxygen
hepatic a. - 25% blood; 50% oxygen
133
what is graves
hyperthryoid
134
what is hashimotos
hypothyroid
135
how does calcitonin lower calcium
inhibits osteoclast activity and dec kidney reabsorption
136
is pth high or low with hyperparathyroid
high pth-> inc ca retention-> hypercalcemia
blocks ca absorption in intestines-> dec renal ca excretion-> inc ca reabsorption by kidneys-> inc osteoclast activity-> inc serum ca
137
mineralcorticoid potency
aldosterone 3000
fludorocortisone 250
cortisol 1
prednisone 0.8
methylprednisone 0.5
138
what drugs have no mineralcorticoid effects
decadron, betamethasone, triamcinolone
139
what is reduced from anterior pituitary
flat peg
fsh, lh, acth, tsh, prolactin, edorphins, growth hormone
140
somatostatin inhibits what in posterior pituitary
growth hormone, tsh, insulin
