Formulas 2 Flashcards
(107 cards)
1
Q
Axillary
A
Arm abduction (deltoid)
2
Q
Musculocutaneous
A
Elbow flexion (biceps)
3
Q
Median
A
Thumb opposition
4
Q
Radial
A
Elbow extension (triceps) Wrist and finger extension
5
Q
Ulnar
A
Pinky finger abduction
6
Q
Femoral triangle borders
A
SAIL
Sartorious- medial
Adductor longus- lateral
Inguinal ligament- superior, b/w ASIS and pubic tubercle
7
Q
Ankle block nerves clockwise
A
(From achilles) Tibial nerve Saphenous nerve Deep peroneal nerve Superficial peroneal nerve Sural nerve
8
Q
Ankle pneumonic
A
TIPPED
Tibial inversion plantar flexion
Peroneal eversion dorsiflexion
9
Q
Ulnar nerve injury
A
Ulnar- claw hand
most common intraop injury
10
Q
Median nerve injury
A
Median- inability to oppose thumb
AC IV sticks and axillary blockade
11
Q
Radial nerve injury
A
Radial- wrist drop
direct compression on spiral groove of humerus
12
Q
DO2
A
1000 mL/min
normal oxygen extraction ration = 250mL/min (25% of CO)
13
Q
normal CO
A
HR x SV
5-6L/min
14
Q
CaO2
A
20 mL/dL
15
Q
VO2
A
250 mL/min at rest
16
Q
CvO2
A
15mL/dL
17
Q
Ohms law
A
Flow= pressure gradient /resistance
MAP= (CO x SVR) /80) + CVP
18
Q
Poiuselle’s law
A
(pie x R(to the 4th power) x change in pressure) / (8 x n x l)
19
Q
Reynolds number
A
<2000= laminar
2000-4000= transitional
>4000=turbulent
20
Q
CI
A
CO/BSA
2.4-4.2 L/min/m(squared)
21
Q
SV
A
EDV-ESV
CO x (1000/HR)
50-110 mL/beat
22
Q
SVI
A
SV/BSA
23
Q
EF
A
((EDV-ESV)/EDV) x 100
(SV/EDV) x 100
60-70%
LV dysfunction when less than 40%
24
Q
MAP
A
(1/3 x SBP) + (2/3 DBP)
((COxSVR) /80) + CVP
70-105 mmHg
25
Pulse pressure
SBP-DBP
stroke volume output/arterial tree compliance
40 mmHg
26
SVR
((MAP-CVP/CO) x 80
800-1500 dynes/sec/cm to the -5th
arteriolar resistance, doesn't take viscosity or other factors of afterload into account
27
SVRI
((MAP-CVP/CI) x 80
| 1500-2400 dynes/sec/cm to the -5th/m squared
28
Ventricular output measurement
CO, SV, LVSW, RVSW
29
Filling pressure measurement
CVP, PAD, PAOP, LAP, LVEDP
30
End diastolic volume
RVEDV
| LVEDV
31
% of CO in atrial kick
20-30%
32
PVR
((mPAP- PAOP)/CO) x 80
| 150-200 dynes/sec/cm to the -5th
33
Law of Laplace
wall stress= (intraventricular pressure x radius)/ wall thickness
34
SA node blood supply
RCA: 50-60% of people
CxA: 40-50% of people
35
Coronary artery dominance
RCA supplies PDA= right dominance
CxA supplies PDA= left dominance
RCA and CxA supply PDA= co dominance
36
myocardial oxygen extraction
70%
very efficient
coronary sinus saturation= 30%
37
coronary blood flow
coronary perfusion pressure/coronary vascular resistance
38
coronary perfusion pressure
Aortic DBP- LVEDP
| or DVP-PAOP
39
coronary autoregulation
MAP 60-140 mmHg
40
coronary blood flow
225-250mL/min
| 4-7% of CO
41
myocardium O2 consumption
8-10 mL/min/100g
42
conditions that set SVR proximal to systemic circulation
aortic stenosis
hypertrophic cardiomyopathy
coarctation of the aorta
43
Ca-v difference
(1.34 x hgb x SpO2)- (1.34 x hgb x SvO2)
normal CaO2= 20 mLO2/ dL blood
normal CvO2=15 mLO2/ dL blood
normal Ca-v difference= 5 mLO2/ dL blood
44
aortic valve orifice
norm: 2.5-3.5 cm2
| severe stenosis: <0.8cm2
45
triad of aortic stenosis
Syncope-3 years
Angina- 5 years
Dyspnea- 2 years
46
mitral valve
normal orifice: 4-6 cm2
severe stenosis: <1cm2
LAP-LV gradient exceeds 10 mmHg
PASP >50mmHg
47
greatest risk factor for cardiac probs with non cardiac surgery
unstable angina
48
best EKG leads to monitor for ischemia
V3>V4>V5>III>aVF
49
best EKG leads to assess for ST changes in patients with CAD
5 lead: V3, aVf, MCL5 or III
| 3 lead: aVf and MCL5
50
best leading for monitoring arrhythmia
II
51
ventricular compliance
ventricular volume/ventricular pressure
52
most common cause of secondary hypertension
renal artery stenosis
53
CCB impairing contractility
verapmail>nifedipine>dilt>nicardipine
54
Beck's triad
muffled heart tones- from fluid accumulation in pericardial sack
jugular vein distention- decreased venous return in R heart
decreased SV- hypotension
55
Pulsus paradoxis
decreased SBP by >10mmHg during inspiration
56
Kussmahl's sign
increased JVD and and CVP during inspiration
57
determinants of outflow through LVOT
systolic LV volume
force of LV contraction
transmural pressure
58
duration after cardiac stents to wait for elective surgery
bare metal stent: 30 days
| DES:first generation 12 months, second generation 6 months, 12 months minimum with acute coronary syndrome
59
Becks syndrome
```
From Artery of Adamkiewciz occlusion of anterior cord in T11-T12
Bowel and bladder dysfunction
Flaccid paralysis of lower extremeties
loss of temp/pain
Preserved touch and proprioception
```
60
Gas vapor pressures
Sevo- 157
Iso- 238
Des- 669
Nitrous- 38770
61
Gas blood gas solubility
```
Sevo- 0.65
Iso- 1.45
Des-0.42
Nitrous- 0.46
Nitrogen- 0.014 (N2O enters space 34x more than nitrogen can exit)
```
62
CO per tissue group
VRG- 75% CO, 10% body mass
Muscle and skin- 20% CO, 50% body mass
Far- 5% of CO, 20% body mass
Non VRG- <1% CO, 20% body mass
63
MAC values
Sevo- 2
Iso- 1.2
Des- 6.6
Nitrous- 104
64
Meyer overton hypothesis
lipid solubility is proportional to the potency of anesthetic agent
65
Ficks law of diffusion
Directly proportional- partial pressure difference, solubility coefficient, membrane surface area
Inversely proportional- membrane thickness, molecular weight
66
ideal gas law
PV=nrT
n= number of moles
r=0.0821 liter-atm/K/mole
conceptually P=T/V
67
law of Laplace in L ventricle
(LV pressure x radius)/ (LV wall thickness x 2)
68
Exposure to radiation
5 rem per yer
| 0.5 rem per year in pregnancy, 0.05 rem per month
69
Distance from radiation
6 ft away= 9 inches of concrete of 2.5mm lead
| intensity- 1/distance squared
70
Critical temp of common gasses
```
N2O- 36.5
CO2- 31
Oxygen- -119
Air= -140
N2= -147
```
71
Celsius and Kelvin
Celsius= K - 273.15
72
Celsius and Fahrenheit
F= (C x 1.8) +32
73
Boiling point of H2O
100 degrees C
| 212 degrees F
74
Freezing point of H2O
0 degrees C
| 32 degrees F
75
Pressure
Force/area
76
Pressure conversion
1 atm= 760 mmHg= 760 torr= 1 bar = 100kPa= 1033 cm H20 = 14.7 lb/inch squared
1mmHg= 1.36 cm H20
77
Avogadros number
6.023 x 10 to the 23rd atoms
78
Molecular weights
helium= 4 g
| oxygen=16 g, 1 mole=32 g
79
Mechanisms of heat transfer
Radiation (60%) >convection (15-30%) > evaporation (20%) > conduction (<5%)
80
ingredients to produce fire
ignitor
fuel
oxidizer
81
Burn body % adult
```
Head 10%
Trunk 36%
Leg 18%
Arm 9%
Perineum 1%
```
82
Burn body % kid
```
Head 19%
Trunk 32%
Leg 15%
Arm 9.5%
for every year >1 year up to 10 years, head BSA decreases by 1% and leg increases by 0.5%
```
83
Fluid replacement in burns
24 hours: 2 ml x % TBSA burned x kg
or 4 mL, use crystalloid (1/2 in first 8 hours, rest in 16 hours)
2nd 24 hours: D5W maintenance rate, 0.5mL x % TBSA burned x kg
84
TAP block districution
T9-L1
85
Barrier pressure
lower esophageal sphincter pressure - intragastric pressure
| Reduced barrier pressure= increased reflux
86
Samter's triad
Aspirin exacerbated respiratory disease
| nasal polyps, allerigic rhinitis, and asthma
87
BMI
kg/m2
| 1 inch= 2.54cm
88
IBW
men (kg)= height in cm- 100
| women (kg)= height in cm -105
89
CO increase per kg of fat
100 mL/min
90
Drug dosage calc in obesity
Water soluble drugs calculated to IBW
Fat soluble drugs calculated to TBW
Vd for lipid soluble drugs >> Vd for water soluble drugs (but both increase)
91
TBW drugs
```
Prop induction
Midazolam
Succ
Fent
Cis
```
92
LBW drugs
```
Prop maintenance
Remi
Roc
Vec
Fent maintenance
```
93
Apnea/hypopnea index
```
mild= 5-15 episodes/hr
moderate= 15-30
severe= >30
```
94
STOPBANG
```
Snore?
Tired?
Observed apnea?
Pressure?
BMI >35?
Age>50?
Neck circum >45cm?
Male gender?
```
high risk= >3 questions answered yes
95
6 elements of informed consent
```
competence
decision making capacity
disclosure of information
understanding of disclosed info
voluntary consent
documentation
```
96
4 pieces of malpractice
1. duty
2. breech of duty
3. causation
4. damages
97
res ipsa loquitur
"the thing speaks for itself"
injury would not have occurred without negligence
injury causes by something under the complete control of the provider
pt did not contribute in any way to injury
evidence for explanation of event solely under control of provider
98
Causes of anesthesia related lawsuit
1. death
2. nerve damange
3. permanent brain damage
4. awareness
99
increased risks of dying within 7 days of surgery
1. physical status
2. emergency vs. elective surgery
3. major vs. minor surgery
4. patient age (80 vs 60)
100
airway management claims
most common for cause of death
1. inadequate ventilation
2. unrecognized esophageal intubation
3. difficult airway
101
paren patriae
father of the country
| government serves as legal protector of citizens who can't protect themselves
102
% of anesthesia mistakes related to human error
70%
103
Lifetime rem
(N-18) x 5
| n=age in years
104
Noise limits
8 hour exposure= 90dB
| single noise= 115dB
105
Triple aim
improving patient experience
improving population health
reduced per capita costs
106
6 domains of high quality health care
```
patient centered- dignity, respect, informed sharing, collaboration
safe
effective
timely
efficient
equitable
```
107
BP changes with cuff height
10 cm= 7.4 mmHg
| 1in= 2cm Hg
