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ABA Applied Exam > Grab Bag > Flashcards

Grab Bag Flashcards

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1
Q

Methymethacrylate

A

Bone cement implantation syndrome:
* hypoxia, hypotension
* supportive tx
* anesthesia cannot prevent
* surgeon can lower wash pressure + drill holes

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2
Q

Equation for PaO2 changes with age

A

PaO2 = 100 - (age/3)

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3
Q

Suspect and TX Bronchospasm

A

Suspect @ elevated Paw + near induction/extubation + hypoxia
auscultate chest - can be wheeze

Tx:
* 100% FiO2
* albuterol puffs
* deepen with volatile > propofol
* small bolus epinephrine
* ketamine
* magnesium
* terbultaine

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4
Q

causes of post-op polyruia

A

central DI
nephrogenic DI
SIADH
osmotic - mannitol, glucose
overhydration

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5
Q

Poor R wave progression

A

LVH
RVH
anterior MI
wnl

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6
Q

Causes of PVC

A

increase catecholamines @ sugery/anxiety
∆ lytes : hypoK, hypoMg, hyperC

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7
Q

Normal CBF
Ischemic CBF
death CBF

A

50-55 cc/min/100g
18-20 cc/min/100g
8-10 cc/min/100g

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8
Q

A s/e terbutaline

A

hypotension
palpitations
CP
pulmonary edema
hypokalemia
hyperglycemia

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9
Q

Treat hemophilia A intraop coagulopathy

A

(-) VIII
can give VIII but quickly develop abx and become refractory&raquo_space; treat with PCC (has proteases that will breakdown abx, short life) and VIIa (stabilizes downstream coag pathways)

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10
Q

Oligura ddx PRE/INTRA/POST

A

factor→pre/intra/post:
Usmo→ >500/ <350/∆
UNa→ <10/>10/∆
FeNA → <1/>2%

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11
Q

FeNa formula

A

FeNa = (Una x Pcr) / (UCr x Pna)

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12
Q

lyte ∆ at CRF

A

HYPERK, HYPERPO4, HYPERMg
HYPER uric acid, HYPERlipid, HYPERsulphate

hypoNa, hypoCa, hypoalbimin

AG metabolic acidosis

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13
Q

Neuraxial and LMWH/enoxaparin/lovenox ppx qd

A

HOLD BEFORE NEEDLE: 12 hours
RESTART AFTER NEEDLE: 12 hours
HOLD BEFORE CATH OUT: 12 hours
RESTART AFTER CATH OUT: 4 hours

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14
Q

Neuraxial and LMWH/enoxaparin/lovenox ppx BID

A

HOLD BEFORE NEEDLE: 12 hours
RESTART AFTER NEEDLE: 12 hours
HOLD BEFORE CATH OUT: remove before starting, do not use this does while catheter in. SPINAL HEMATOMA
RESTART AFTER CATH OUT: 4 hours

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15
Q

Neuraxial and LMWH/enoxaparin/lovenox therapeutic

A

dose is 1 mg/kg q12 OR 1.5 mg/kg daily
HOLD BEFORE NEEDLE: 24 hours
RESTART AFTER NEEDLE: 24 after non high bleeding risk surgery OR 72 hours after high bleeding risk surgery
HOLD BEFORE CATH OUT: remove before starting, do not dose this way when catheter in SPINAL HEMATOMA
RESTART AFTER CATH OUT: 4 hours

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16
Q

Neuraxial and SQ heparin ppx BID or TID

A

HOLD BEFORE NEEDLE: 4-6 hours OR check coags
RESTART AFTER NEEDLE: immediately
HOLD BEFORE CATH OUT: 4-6 hours
RESTART AFTER CATH OUT: immediately

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17
Q

Neuraxial and SQ heparin ppx high dose BID or TID

A

HOLD BEFORE NEEDLE: 12 hours and coags
RESTART AFTER NEEDLE: unknown
HOLD BEFORE CATH OUT: unknown
RESTART AFTER CATH OUT: immediately

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18
Q

Neuraxial and SQ heparin therapeutic

A

HOLD BEFORE NEEDLE: 24 hours and coags
RESTART AFTER NEEDLE: not recc with catheter in place
HOLD BEFORE CATH OUT: not recc with catheter in palce
RESTART AFTER CATH OUT: immediately

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19
Q

Neuraxial and bypass heparin

A

HOLD BEFORE NEEDLE: avoid
RESTART AFTER NEEDLE: 60 minutes
HOLD BEFORE CATH OUT: after normal coagulation restored
RESTART AFTER CATH OUT: n/a

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20
Q

Neuraxial and IV heparin

A

HOLD BEFORE NEEDLE: 4-6 hours and normal coags
RESTART AFTER NEEDLE: 1 hour
HOLD BEFORE CATH OUT: 4-6 hours and normal coags
RESTART AFTER CATH OUT: 1 hour

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21
Q

Neuraxial level @ C/S

A

T6 hyperbaric

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22
Q

Neuraxial level @ cervical cerclage

A

T10 hyperbaric

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23
Q

Neuraxial level @ hips

A

> T12 isobaric

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24
Q

Neuraxial level @ knees

A

> T12 isobaric

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25
Neuraxial level @ TURP
> T10 of iso or hyperbaric
26
Treat unstable narrow regular tachycardia
SYNC CARDIOVERT 50-100 J
27
Treat unstable narrow irregular tachycardia
SYNC CARDIOVERT 120-200 J
28
Treat unstable wide regular tachycardia
SYNCO 100 J
29
Treat unstable wide irregular tachycardia
DEFIB 360 J (polymorphic VT) Mg at torsades
30
Test dose composition
1.5% lidocaine with 1:200 000 epinephrine
31
Ekg leads to use intraop
V5 - 75% V5 + V4 - 90% V5 + V4 + II - 96% change of detecting ischaemia
32
ddx Myasthenic crisis from cholinergic crisis
use edrophonium or tensilon test MG > weakness will worsen CC > weakness will improve
33
Treat cholinergic crisis
supportive w/ possible intubation d/c anticholinesterase therapy begin anticholinergics IVIG
34
Treat myasthenic crisis
supportive IVIG plasmaphoresis
35
RF in MG for postop mechnical ventilation
* duration of disease > 6 years * pyridostigmine > 750 mg/day (usually q6h regiment) * concomitant pulmonary disease * PIP < -25 cmH2O * VC < 40 /kg
36
Extubation criteria: simplified
* hemodynamically stable * adequately reversed * awake and alert * spontaneously ventilating * VT 6-9 cc/kg * RR 12-20 with ETCO2 35-40 mmHg
37
Extubation criteria: detailed
* VC > 15 cc/kg * pH > 7.3 * PaO2 > 60 mmHg on FiO2 > 50% * Max NIF > -20 * RR < 30
38
Treat venous air embolism
Saline onto surgical field Bone was onto exposed surfaces aspirate from CVL gentle compression of IVC supportive
39
HSV and neuraxial in pregnancy?
Primary and not treated > contraindicated, possible viremia Secondary and treated > indicated, low risk viremia
40
MH vrs thyroid storm
MH: hyperK, rigid, increased CK, lactic acidosis, intraop Thyroid storm: hypoK, not rigid, no CK, no lactate, postop
41
Treat MH
dantrolene 2.5 mg/kg nondepol will not cause paralysis
42
Treat Thyroid storm
PTU beta blockers iodinated contrast steroids acetaminophen reserpine to deplete
43
Treat neuroleptic syndrome
bromocriptine +/- dantrolene stop haldol nondepol MB will result in flaccid paralysis
44
Treat serotonin syndrome
cyproheptadine stop serotonergic meds
45
drugs dosed by IBW
nondepol NB
46
drugs dosed by TBW
sux opioids propofol gtt
47
drugs dosed by LBW
propofol induction
48
TX TURP syndrome
stop irrigation fluid restriction if Na >120 and symptomatic hypertonic saline if Na <120 intubated loop diuretics benzos for seizures
49
Nitroprusside toxicity metabolits
cyanomethemoglobin thiocyanate cyanide toxicity > MvO2 increases
50
Tx Nitroprusside toxicity
stop nitroprusside sodium thiosulfate inhaled amyl nitrates hydroxycobalamine
51
consequences of hyperglycemia
* decreased immune function * increased oxidative stress * endothelial dyd * increased inflammatory factors * increased procoagulant state * fluid shifts * electrolyte ∆ @ surgery * decreased wound healing * increased infections * delayed recovery * end organ failure @ heart, brain, kidney
52
Sx of hypoglycemia under GA
cant see confusion maybe diaphoresis Suspect if concern for light anesthesia = SNS activation
53
causes of intraoperative hypoK
@ high flow urine (osmotic - mannitol, hyperglycemia OR overhydration, DI, SIADH) @ excess mineralocorticolides @ cisplastin/aminoglycosides @ diuretics @ vomiting @ diarrhea @ alkalemia
54
Avoid @ IOP
sux nitrous oxide ketamine retrobulbar block cough buck
55
:) @ IOP
decreased IOP @ volatiles @ narcotics @ barbiturates @ lidocaine @ nondepolMB
56
EKG changes from hypoK
flat/inverted T waves U waves ST depressions
57
treat hypoK
replete Mg replete K correct alkalemia stop over diuresis stop offending drugs
58
A s/e of hypoK
cardiac hyperrepolarization and excitability muscle weakness digoxin toxicity
59
Max FiO2 on NC
RA ie 21% + 2-3% for each L max 6 L max FiO2 35%
60
Max FiO2 on FM
RA + 2-3% for each L max 10 L max FiO2 45%
61
Drugs to avoid at Pheochromocytoma
avoid tumour stimulation: no sux avoid SNS stimulation: no ketamine, ephedrine, atropine avoid histamine release: no sux, morphine, atracurium, cisatracurium specific to pheo: no metoclopramide, droperidol
62
weird random drugs to avoid in pheochromocytoma
metoclopramide, droperidol
63
normal PaO2 on RA
80-100 PaO2 = 100 - (age/3)
64
SSEP evaluation
* keep anesthesia stabilized * decreased amplitude, increased latency > talk to surgeon
65
Describe burst suppression
periods of isoelectricity with slow high voltage wave oscillations
66
Why burst suppression
neuroprotective thought to reduce ICP via reduciton of CMRO2 and CBF
67
Treatment of refractory ICP
barbiturates decompressive craniotomy
68
cisatracurium intubating dose
0.15 mg/kg takes 2 mins onset lasts 60 mins
69
Triad for CSWS
hyponatremia volume contration low to normal urine osm
70
Triad for SIAD
hyponatremia hyperosmolar urine eu or hypervolemic
71
Respiratory changes in pregnancy
* mucous capillary engorgement * MMP 1+ during labour * aspiration risk * decreased FRC, ERV * unchanged TLC bc chest expands * diaphragm movement not restricted * compression by fetus * increased metabolic demand and increased minute ventilation * rapid onset with volaties (avoid volatiles after birth > relaxation)
72
EKG at hyperK
peaked T waves prolonged PR flat wave widened QRS
73
K for intervention
EKG changes OR >6 first EKG usually at 6.5
74
Result of alkalinization fo local anesthetics
less cations lipid soluble can cross membrane easier more rapid onset
75
name of syndrome in paralyzed patients that you always forget
autonomic hyperreflexia = loss of descending inhibitory pathways = uninhibited spinal cord reflexes with substantial increased in BP above level of lesions, overzealous vagal response - bradycardia, heart block vasodilation
76
Level for at risk of autonomic hyperreflexia
T7
77
Describe response to pain in a paraplyzed patient at level T7 or higher
spinal relexes unchecked by descending inhibitory pathways Hypertension then exagerrated vagal response - brady, heart block, vasodilation
78
Celiac plexus block indicatiosn
SNS drive pain T5-T12, pancreatic cancer
79
S/e celiac plexus block
most common - orthostatic hypotension second most common - diarrhea LAST intrathecal perforation Ao, IVC, viscera PTX, chylothorax paraplegia
80
postpone surgery for URTI?
postponing for 2 - 3 weeks is reasonable; can have hyperreactivity for up to 8 and icnreased respriatory complications
81
Preop meds for COPD
bronchodilators anticholinergics preop low dose steroids
82
Steroids periop?
systemic steroids for more than 2 weeks in last six months induction: 100 mg hydrocortisone postop: 100 mg q8h for 48 hours.
83
Principles of anesthetic management for asthmatic patient x3
Block airway reflexes before DL and intubation Relax airway smooth uscle prevent release of biochemical mediators
84
Induce an asthmatic
albuterol induce with 2.5 mg propofol oxygen and sevo to deep (iso and des more pungent) lidocaine OR LMA
85
what NMB to use in asthmatics?
avoid those that cause histamine release: pancuronium, atracurium, sux, mivacurium USE vec, roc, cisatraciurium
86
ventilatory mode in COPD
PC > can achieve tidal volumes at lower PIP increased expiratory time on I:E may need increased minute ventilation to keep normocarbia PEEP is controversial > can reduce work of breathing, extrinsic peep shouldnt be more than intrinsic peep, watch out for VR watch out for autoPEEP
87
first line treatment for bronchospasm
100% FiO2 and deepen anesthesia b/c most usually due to light anesthesia
88
pain control to avoi in asthmatics
nsaids morphine (histamine)
89
supplemental oxygen and COPD postop
tend to take smaller tial volumes.l
90
signs and symptoms of hepatopulmonary syndrome
platypnea/dyspnea in upright position hypoxia PaO2 < 70 on RA fatigue digital clubbing spider angiomata orthodeoxia - desat upright
91
cause of hepatorenal syndrome
functional renal vasoconstriction 2/2 splanchnic vasodilation
92
diagnosis fo hepatorenal syndrome
* cirrhosis with ascites * serum Cr > 1.5 * no improvement of Cr with 2 days fo diuretic, volume expansion with albumin * absence of shock * no nephrotoxic drugs * no parenchymal kidney disease * doestn respond to fluid bolus like prerenal
93
TEST DOSE
3 cc 1.5 % lidocaine with 1:200 000 epinephrine
94
Dose for labour epidural
bupi 0.0625%+ 0.1% fent at rate of 6 cc/hour with bolus 2-3 cc q20 mins
95
treat diabetes insipidus
maintainence fluids with D51/2NS and monitor gluc and K crystalloid for 2/3 last hours UOP If > 350-400 cc/ hour >> DDAVP
96
Treat MH
stop triggers increased oxygen flow to 10-15 ppm and FiO2 100 DANTROLENE 2.5 mg/kg q5 min until ETCO2 decreased or temp stops rising treat hyperK be prepared to treat arrhythmias cool maintain UOP 1-2 cc/kg ICU for 24 hours with dantrolene 0.25 mg/kg/h and bolus q4-6 hours
97
hypothyroidism consequences
hyponatremia hypoglycemia impaired drug metabolism
98
clonidine preop
maintain > can have rebound hypertension if stopped
99
limitations of PULSE OX accuracy
1) no pulse present; low perfusion pressure (hypotension, hypothermia, hypovolemia) 2) hemoglobin variants/dyes 3) severe anemia < 3-4 4) venous pulsation ie RHF and TR
100
intrathecal morphine dose for c/s
morphine 100 mcg
101
ex: TCAs
amitriptyline nortriptyline
102
ex: SNRIs
duloxetine fluoxtine
103
Ex: Anticonvulsants
gabapentin pregablin
104
Treat chronic radicular back pain
PT opiods and NSAIDS epidural steroid injections
105
Steroid used for chronic pain epidural steroid injections
methylprednisilone
106
treat facet syndrome
median branch blocks (also dxtic)
107
treat myofascial pain syndrome
massage needling dry or LA
108
treat fibromyalgia
SNRI anticonvulsants TCAs support, educate, exercise, CBT
109
treat diabetic neuropathy
glucose control anticonvulsants TCA > SNRI
110
Treat CRPS
SNS nerve blocks PT medication of all sorts
111
Treat phantom pain
TENS spinal cord stimulator biofeedback
112
Treat cancer pain
appropriate tumour specific neoplastic therapy WHO ladder opioids, TCA, SNRI, anticonvulsants, NSAIDs, corticosteroids, oral locals, topicals interventional (celiac, superior hypogastric, ganglion impar) behaviour and pscyh hospice
113
When to use spc stimulator
intractabel pain of trunks or limbs that fail other management @ post laminectomy syndrome @ CRPS @ neuropathic pain syndrome @ angina @ chronic critical limb ischaemia and pain
114
when to use intrathecal drug delivery
chronic pain w/o response to high dose or unacceptable s/e
115
PAC indications for the boards
measuring PCWP CO measurement mixed venous oxygen saturation measurement pHTN pacing
116
Bucking on the tube
light sedation pain control inadequate non paralyzed
117
treat afib
amiodarone beta block CCB digoxin electricty
118
assess hypoV in infants
number of diapers PO intake tachycardia cap refil fontanelles cold skin mottling cyanosis altered consciousness HYPOTENSION IS OMINOUS (35% volume lost before this occurs)
119
risk factors for airway hyperreactivity with URTIS peds
< 1 year old smoker in household bronchopulmonary dysplasia asthma
120
epinephrine dose arrest IV peds
0.01-0.03 mg/kg
121
epinephrine dose arrest ETT peds
0.1 mg/kg
122
Atropine dose IV peds
0.01-0.02 mg/kg
123
atropine dose ETT peds
0.3 mg/kg
124
adenosine peds dose
0.1 mg/kg max 6 mg
125
defibrillation peds dose
2-4 Jkg
126
APGAR score
A - appearance/cyanotic + fingers and toes blue only + pink all over P - pulse/ none + < 100 + 100-140 G - grimace - none / weak / strong A - activity - floppy / some flexion / resists extension R - respirations / none + slow and irregular / strong cry
127
associated with TEF
VACTERL veretbral anal atresia cardiac TEF renal and radial limb 20% have cardiac
128
goal for oxygenation in preterm infant
avoid retionopathy PaO2 50-80 mmHg + SaO2 87-94%
129
cobb angle values with implications
SCOLIOSIS > 10 abnormal > 45-50 surgery > 60-65 pulmonary dyd > 70 pHTN at exercise > 110 pHTN at rest
130
CO2 laser
corneal injury

ABA Applied Exam (5 decks)

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