APA 1 Flashcards
(98 cards)
1
Q
Tight table strap nerve inj
A
Lateral femoral cutaneous
2
Q
Stirrups nerve inj
A
Common peroneal
3
Q
Arm board/shoulder brace nerve inj
A
Brachial plexus
4
Q
BF cuff/tourniquets/firm surfaces nerve inj
A
Radial nerve
5
Q
Map dec by____ mmHg for Q ___ inch increase in height
A
2, 1
6
Q
Mask on face/ revisor bag/ no rebreathing/ Insp unidirectional valve only = ____ system
A
Semi-open
7
Q
Components of an anesthetic (4)
A
Immobility, amnesia, analgesia, unconsciousness (if general)
8
Q
O2 flush valve delivers how much?
A
35-75 L/min
9
Q
V5 placement
A
5th intercostal space, anterior axillary line
10
Q
PVR equation
A
[(MPAP-PAOP)/CO] X 80
11
Q
CO eq
A
HR X SV
12
Q
CI eq
A
CO / BSA
13
Q
SVR eq
A
[(MAP - CVP) / CO] X 80
14
Q
SVRI eq
A
[(MAP - CVP)/ CI] X 80
15
Q
PVRI
A
[(MPAP-PAOP)/CI] X 80
16
Q
Normal CVP
A
2-6
17
Q
Normal CO
A
4-8 L/min
18
Q
Normal CI
A
3 L/min
19
Q
Causes of dampened A-line tracing
A
Bubble/ Bent extremity/ Thrombus/ Kink/ Long tubing
20
Q
Top 4 PNI in order
A
- Ulnar 2. Brachial plexus 3. Lumbosacral 4. Spinal cord
21
Q
Top 3 litigation reasons in order
A
- Death 2. PNI 3. Brain damage
22
Q
Most common anesthetic injury
A
Eye or dental
23
Q
High risk awareness
A
Major trauma (43%) OB (1.5%) Cardiac (.4%) Females, young adult, obese, hx awareness,
24
Q
Best indicator of awareness
A
ET anesthetic conc. (1/3 MAC amnesia)
25
Most common cause of post-op vision loss
Ischemic optic neuropathy ?
26
Type 1 allergic rxn
IMMEDIATE (atrophy (?), urticaria-angioedema, ANAPHYLAXIS)
27
Type 2 allergic rxn
CYTOTOXIC (transf. Rxn, HIT, autoimmune, hemolytic anemia)
28
Type 3 allergic rxn
IMMUNE COMPLEX (RA and serum sickness)
29
Type 4 allergic rxn
DELAYED, CELL-MEDIATED (Contact dermatitis- latex, poison ivy)
30
Anaphylaxis vs anaphylactoid
Anaphylactoid does NOT depend on IgE antibody
31
Dantroline dosing and frequency
2.5 mg/kg STAT Repeat q5 min to max of 10 mg/kg Continue 1 mg/kg q6 hrs for 24 hrs
32
3 things for fire
Ignition source Oxidizing agent Fuel
33
Total body water: Man ___ Woman ____ Infant \_\_\_\_
55% 45% 80%
34
Intracellular vol. % body weight Extra cellular vol. % body weight
ICV= 40% ECV= 20%
35
Plasma vol \_\_\_% of ECV Interstitial vol \_\_\_% of ECV
25% 75%
36
Hypovolemia vs Dehydration
Hypovolemia= vol depletion, absolute fluid loss Dehydration= concentration disorder, low H2O compared to Na
37
Most important osmotically active substance influencing H2O content in brain
Na
38
1 u PRBC raises Hgb \_\_\_\_
1 g/dL
39
1 UNIT plts raises plt count \_\_\_\_
5,000-10,000 \*often use 6 u/bag \*still need type and cross
40
Estimated blood volume EBV male ___ to ___ mL/kg EBV female ___ to ___ mL/kg EBV obese ___ to ___ mL/kg
M: 70-75 ml/kg F: 65-70 ml/ kg O: 55 ml/kg
41
ABL (allowable blood loss) formula
(EBV X (starting hct- target hct)) / hct starting
42
Maintenance fluids: Based on weight 1st 10 kg ___ 2nd 10 kg ____ Every kg after 20 \_\_\_
40 ml/hr 20 ml/hr 1 ml/kg/ hr ————— Add together to get deficit
43
Deficit fluid formula
Maintenance X hrs NPO (Replace this much in 1st 3 hrs) (1/2 in 1st hr, 1/4 in 2nd hr, 1/4 in 3rd hr)
44
3rd space loss based on \_\_\_\_\_
Surgery
45
Minimal trauma surgery loss
3-4 ml/kg/hr (Knee, shoulder, hernia)
46
Moderate trauma surgery loss
5-6 ml/kg/hr
47
Severe trauma surgical loss
7-8 ml/kg/hr (Open belly, cardiac, thoracic)
48
A alpha fibers
Motor/proprioception (largest)
49
A beta fibers
Fine touch/ proprioception (2nd largest)
50
A gamma fibers
Motor/ Muscle spindle fibers (3rd largest)
51
A delta fibers
Sharp pain, cold, touch (Smallest of As)
52
B fibers
Sympathetic stimulation (Preganglionic autonomic)
53
C fibers
Temp and dull pain and touch (UNMYLEINATED!)
{substance P}
54
Blockade sequence
1st B
2nd A & C
55
Blockade sequence pneumonic
ATP, TP, MVP Autonomic, touch, pain Temp, pressure Motor, vibration, proprioception
56
Adding epi to LA
Vasoconstriction Prolonged duration Increased intensity Decreased systemic tox Decreased surgical bleeding Assists with test dose
57
Adding sodium bicarbonate to LA
Increases pH & :. Non-ionization inc. Speeds onset Decreases injection burn
58
Adding opiate to LA
Increases strength and duration Mostly for neuraxial blocks
59
GCS Categories
Eye (max 4 points) Verbal (max 5 points) Motor (max 6 points) 15 perfect 3 worst
60
Systolic murmur
Mitral regurgitation Or Aortic stenosis
61
Diastolic murmur
Atrial regurgitation Or Mitral stenosis
62
S3 sound
Early diastole Sudden deceleration of blood flow from LA to LV [overly compliant LV] (Indicates systolic CHF in elderly/ normal in young people or athletes or pregnant)
63
S4 sound
Just before S1 Blood forced from LA into NONCOMPLIANT LV (Diastolic HF or active ischemia, can be sign of LV hypertrophy)
64
Gauge range and length for spinal needles
22-29 g 3.5-5 inches \*mostly use 25-27 g and 3.5 inch
65
Pencil point needle advantages
Non-cutting tip Less PDPH Drags less contaminants into subdues tissue Pierce dura with clearly perceptible “POP”
66
Pencil point - Whitacre
67
Pencil point - gertie marx
68
Quincke (in spinals) or quincke-babcock has a “cutting bevel tip” - hold the bevel direction parallel to the longitudinal dural tissue fibers to minimize the risk of PDPH
bevel can cut- so direct which way it goes
69
Touhy needle (turns for catheter)
[for Epidurals]
(like 17 g)
70
Differential Blockade order
top: autonomic
2-3 lower: sensory
2-3 lower: motor
71
72
Spinal complications
Failure of block- may try again or another method of anesthesia/
Post – dural puncture headache POSITIONAL when sitting up/
High spinal/
Nausea – COMMON r/t hypotension and decreased perfusion, block symp outflow to GI but not parasymp outflow to GI/
Urinary retention /
Hypoventilation/
Backache/
Hematoma/
Orthostatic hypotension
73
Hematoma Recognition/Treatment
New onset weakness to lower limbs and sensory deficit, OR spinal never wears off (should wear off 1-4 hrs), OR get feeling again then starts to get numb
New onset back pain
New onset bowel or bladder dysfunction
Must diagnose and surgically decompress hematoma within 8 hours for best outcome
Can cause paraplegia
Consult neuro and send for MRI
74
how long to NSAIDS stop before neuraxial
no contraindication
75
how long to stop asprin before neuraxial
no contraindication
76
how long to stop Clopidogrel (Plavis) before neuraxial
7 days pre-op
77
how long to stop heparin before neuraxial
place a needle or catheter 1 hour prior to administration of heparin. Catheters should be pulled when heparin activity is at a minimal level (10-12 hrs). (An hour before the next dose) Monitor aPTT
78
how long to stop Coumadin before neuraxial
monitor anticoagulation with Pt and INR
79
how long to stop ticlopidine before neuraxial
14 days pre-op
80
how long to stop Abciximab before neuraxial
7 days pre-op
81
how long to stop Eptifibatide before neuraxial
4-8 hrs pre-op
82
how long to stop tirofiban before neuraxial
14 days pre-op
83
how to treat post-dural puncture headache
analgesics, bed rest, oral hydration, or oral caffeine 1st
then blood patch
84
85
short acting L.A.s
lido and procaine
86
longer lasting L.A.s
bupivacaine and tetracaine
87
structures exterior to interior to pass needle through for subarachnoid block
1. skin
2. subcutaneous
3. supraspinous ligament
4. interspinous ligament
5. ligamentum flavum
6. dura mater
7. arachnoid mater
8. subarachnoid space
88
if doing an epidural stop needle after what structure?
ligamentum flavum
89
PCWP should be take when?
end of expiration
90
CVP a wave
RA contraction
91
CVP c wave
Ventricular contraction
92
CVP x wave
atrial relaxatiom
93
CVP v wave
RA filling
94
CVP y wave
tricuspid valve opening
95
96
what happens if insp. valve of AGM sticks open?
exp. volume goes out isp. limb
therefore increased EtCO2
97
what happens if exp. valve of AGM sticks open?
breath will take path of least resistance and skip going to patient- right out exp. limb
98
L.A. caridotoxicity order (most to least)
#1. Bupivicaine/Ropivacaine, Cocaine/Tetracaine
#2. Lidocaine/Mepivacaine
#3. Prilocaine
#4. Procaine/Chloroprocaine
