Anesthesia

Question 1

Recruitment maneuvers by Dr. Smith?

Answer 1

Set up intra airway pressure at 20 mmHg

Take 2 breaths at each settings w/ increasing PEEP between breaths

20-5
20-10
20-15
20-20

Question 2

Elements of “bloody vicious cycle” of hemorrhage? 3/3

Answer 2

Coagulopathy
Hypothermia
Acidosis

Question 3

What happens in Class III Hemorrhagic shock: 4/4

Answer 3

Hypotension as EBL reaches 1500-2000 (30-40 of total blood volume of 70 kg male)

HR: 120-140 bpm
RR: 30-40
MS: Anxious and confused

Question 4

Class IV of hemorrhagic shock - signs? Rule of 4

Answer 4

40% of blood volume lost: >2000

HR: 120-140 bpm
RR: >35
MS: confused & lethargic

Question 5

Ratio of blood products transfussion in hemorrhage?

Answer 5

1:1:1

6u FFP : 1u apheresis PLT (=6u of pooled PLT) : for every 6u PRBC

Not completely concluded, but two prospective studies and one systematic review suggested \ in short term mortality from hemorrhage due to trauma.

Question 6

Effect of citrate from blood products and countermeasures?

Answer 6

life threatening hypocalcemia

progressive coagulopathy

1g Calcium chloride p 4u PRBC and frequent electrolytes rechecks

Question 7

Clinical examination in leg compartment syndrome?

Answer 7

Severe, unremitting pain

Exacerbated by passive dorsiflexion of the toes and ankles

Tension/tenderness in leg compartments (*anterior)

Active dorsiflexion may not be possible (pain and peroneal nerve impairment)

If not sure, repeat evaluation in 30 minutes. *Rapidly progressing condition (50% symptoms upon awakening, the rest within 24 hours)

Question 8

Signs of vascular insufficiency and or numbness in leg compartment syndrome?

Answer 8

Not necessary for diagnosis

These are consequences of irreversible injury

(much of the damage is related to reperfussion injury)