Clinical

Question 1

What physiological changes occur in beach chair position

MAP
CVP
Pull artery occlusion pressure (PAOP)
SV
CO
PaO2

PAO2-PaO2
Plum vascular resistance
Peripheral resistance

Answer 1

They all decrease except the alveolar-arterial O2 gradient, plum and peripheral resistance increase

Under non anesthesia, these are compensated by increase SVR but this autonomic response is blocked by anesthetic which further companies CO

Question 2

What’s the score MELD for? It helps you in …. when having a patient with liver disease?

Answer 2

The Model for End-Stage Liver Disease (MELD) score is an objective measurement that uses serum bilirubin, INR, serum creatinine, and serum sodium levels to determine 90-day mortality in patients with advanced liver disease. The MELD calculation is commonly used in assessing candidates for transplant livers.

Question 3

What’s the only (maybe) transfusion reaction that is the donor Abs attacking recipient WBC Ag? (The other are recipient reacting to donors product)

Answer 3

TRALI

Question 4

TBS % burn in adults

1st degree
2nd degree
3rd degree

Answer 4

Red + sunburn-> 1st
Red, blistering, swollen, painful -> 2nd

In senate, dry, painless, leathery -> 3rd

Rule of 9% (all 9% except trunk, back, each leg are 18% double 9, and 1% genitalia)

Question 5

How hypoCa developed in massive transfusion

Answer 5

Packed red blood cells are preserved and anticoagulated using sodium citrate and citric acid. These agents are rapidly cleared by the liver, kidney, and skeletal muscles and usually generate no adverse effects. However, patients who receive massive transfusions (usually >10 units) or those with certain underlying conditions (eg, hepatic disease, renal failure, hypothermia, shock) can fail to clear citrate quickly enough to prevent physiologic effects. As citrate binds ionized calcium, these patients are at risk for symptomatic hypocalcemia due to ionized (free) calcium deficiency.