5-Medicine

Question 1

What are the reasons for post-op fever?

Answer 1

Wind (12-24hr): atelectasis
Water (~24 hr): UTI
Walk (~48 hr): DVT/PE
Wound (~72 hrs): post-op infection
Wonder drug (anytime): drug fever

Question 2

What part of the brain regulates the body’s temperature?

Answer 2

hypothalamus

Question 3

What is malignant hyperthermia? name the s/s.

Answer 3

side effect of general anesthesia- tachycardia, hypertension, hyperthermia, muscle rigidity, acid-base and electrolyte abnormalities

Question 4

What is the treatment for malignant hyperthermia?

Answer 4

Dantrolene. (for muscle relaxation

2.5mg/kg IV then 1mg/kg IV rapid push q6h until sx subside or until max dose of 10mg/kg

Question 5

if a risk of malignant hyperthermia is suspected, what preop test may be performed?

Answer 5

CPK- elevated in 79% of patients with malignant hyperthermia

Question 6

what is the moa of local anesthetics?

Answer 6

block VG-Na+ channels and conduction of AP along sensory nerves

Question 7

what is the toxic dose of lidocaine (Xylocaine)? plain and with epi?

Answer 7

plain- 300mg

w/ epi- 500mg

Question 8

what is the toxic dose of bupivicaine (marcaine)?

Answer 8

plain- 175mg

w/ epi- 225 mg

Question 9

how do you convert percentage of solution to mg/mL?

Answer 9

move decimal point of percentage one place to right

e.g. 1% solution has 10mg/mL

Question 10

What are the side effects of lidocaine and bupivicaine associated with systemic exposure?

Answer 10

CNS- initial excitation (dizziness, blurred vision, tremor, seizures) followed by depression (resp. depression, LOC)
CV- hypotension, bradycardia, arrhythmias, cardiac arrest

Question 11

what can be given to help reverse local anesthetic-induced CV collapse?

Answer 11

IV fat emulsion (intralipid)

Question 12

how are amides like lidocaine and bupivicaine metabolized?

Answer 12

liver (p450s)

Question 13

how are esters like Novocain metabolized?

Answer 13

plasma pseudocholinesterase

Question 14

what is the only local anesthetic with vasoconstriction?

Answer 14

cocaine

Question 15

is there a risk with intra-articular injections of bupivicaine?

Answer 15

studies have shown chondrocyte death following prolonged exposure to bupivicaine

Question 16

in what age group should bupivicaine be avoided?

Answer 16

children

Question 17

for anesthesia, what cannot be given to a patient with an egg shell allergy?

Answer 17

propofol (Dipirivan)

Question 18

what is the 1st choice for non-narcotic oral?

Answer 18

tramadol (Ultram) 50mg one to two tabs PO q4-6hr prn

Question 19

what is the 1st choice for non-narcotic IV?

Answer 19

ketorolac (Toradol) 30-60mg IV

Question 20

what therapeutic effects are seen with acetaminophen?

Answer 20

analgesic and anti-pyretic

Question 21

what is the max. daily dose of acetaminophen?

Answer 21

4g