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In Training Exam TL > ITE block 7 > Flashcards

ITE block 7 Flashcards

1
Q

Why do infants tolerate dehydration better than adults?

A

Greater total body water to body weight ratio
infants 70% and adults 60%
-10% fluid deficit would be severe dehydration in adults, mod in infants

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2
Q

Best way to assess dehydration in infants

A

weight!
the tachycardia, skin turgor, cap refill can change due to other factors

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3
Q

Signs of mild dehydration

A

Weight loss 5%
fluid deficit 50 cc/kg
normal skin turgor
flat anterior fontanelle
normal eyes
Urine <2 cc/kg/hr
urine specific gravity < 1.02

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4
Q

infant moderate dehydration

A

weight loss 10%
fluid deficit 100 cc/kg
decreased skin turgor
sunken anterior fontanelle
sunken eyes
dry mucous membranes
<1 cc/kg/hr urine
urine specific gravy 1.02-1.03

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5
Q

infant severe dehydratio

A

weight loss 15%
fluid deficit 150 cc/kg
greatly decreased skin turgor
markedly sunken anterior fontanelle
very dry mucous membranes
UOP <0.5 cc/kg/hr
urine specific gravy >1.030

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6
Q

Burn resuscitation

A

4 cc x %TBSA x kg
1st half given in first 8 hours
2nd half given in next 16 hours

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7
Q

Fluid rehydratio in severe dehydration in infants

A

emergency phase: 20-30 cc/kg isotonic fluid bolus
phase I: first 6-8 hrs: 25-50 cc/kg
phase 2: next 24 hours: remainder of deficit

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8
Q

ABA physical requirements to practice

A

no age or physical requirements
-if disability and safe workaround it’s okay
-on a case by case basis determined by practitioner and their employer if can be done safely

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9
Q

When to use blood cyanide levels

A

only as a confirmatory diagnostic
-not helpful acutely due to time it takes to process -> use co-oximetry, ABG/VBG, lactic acidosis, hx of Na nitroprusside use to dx and treat

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10
Q

Tx for cyanide toxicity

A

hydroxocobalamin
sodium thiosulfate
-b/c it causes inhibition of oxidative phosphorylation

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11
Q

Symp of cyanide toxicity

A

HA, confusion, dizziness, sz -> coma
HTN and tachycardia -> hypoTN, arrhythmia, AV block
flushing, cherry red appearence
abd pain, N/V
tachypnea -> bradypnea
pulm edema
cyanosis
renal failure
hepatic necrosis
rhabdo

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12
Q

Decelerations in Fetal heart tracing

A

HR decrease >15 bpm for max of 3 minutes

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13
Q

Variable decelerations when cat II v III?

A

if >15 bpm for < 3 minutes, for <50% of the contractions category II
if >50% of contractions -> category III -> intrauterine resuscitation -> L lateral position, IVF, maternal O2, or poss intra-amniotic infusion

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14
Q

Types of deceleration

A

VEAL CHOP
Variable: Cord compression
Early: Head compression
Accelerations: Okay
Late: Placental insuff

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15
Q

Prolonged decelerations

A

decelerations lasting 2-10 minutes -> severe uteroplacental insuff or umbilical cord compression

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16
Q

Achondroplasia considerations

A

-short stature
-foramen magnum stenosis -> likely to get brainstem compression dep on position
-avoid inc ICP (likely to have hydrocephalus + foramen magnum stenosis)
-choanal stenosis
-central apnea and OSA -> can lead to pulm HTN
-macroglossia, high arched palate
-spinal stenosis
-macrocephaly

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17
Q

Post ROSC what is the next step

A

12 lead EKG
-need baseline if doing hypothermia
-need baseline if going to do PCI

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18
Q

Gold standard for dx of MH

A

halothane and caffeine muscle contracture test

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19
Q

hypothermia causes intraop

A

Decreased wound healing
Increased myocardial O2 consumption (shivering)
clotting issues
inc infectio
risk of arrhythmia or ischemia

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20
Q

Why hypothermia post neuraxial

A

Impaired detection of cold
Vasodilation
Decreased threshold for shivering and vasoconstriction (lower temp required to initiate)
worse w/ higher dermatome

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21
Q

GA v GA and neuraxial hypothermia

A

GA + neuraxial -> worse hypothermia than GA alone
-Get redistribution from both, and lowering vasoconstriction
-Worse central recognition of hypothermia w/ both

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22
Q

Cirrhosis hemodynamic changes

A

portal HTN -> inc endogenous vasodilators (nitric oxide) -> sensed as volume depleted by kidneys -> inc renin and sodium retention
-vasodilation -> dec SVR -> dec afterload -> inc cardiac output -> inc mixed venous
-inc collaterals produced to avoid portal HTN -> AV collaterals bypass capillary beds -> inc mixed venous
-hyperdynamic cardiac (inc CO and dec SVR)
-inc blood shunted to intestinal system -> inc vasoactive intestinal peptide

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23
Q

Platypnea

A

hypoxia and dyspnea while sitting up, improved while laying flat
-due to inc shunting of blood through lungs
-assoc w/ hepatopulm syndrome

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24
Q

thromboangiitis obliterans

A

small blood vessels become inflamed and swollen -> blood vessels narrow and get blocked
-fingers/toes pale, red, blue, and cold w/ sudden severe pain

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25
When to use a sympathetic block
Neuropathic pain (CRPS, DM, herpes zoster) Visceral pain (cancer pain -> celiac block) Vaso-occlusive dx -> helps relieve pain and improves circulation (CP from chronic angina, Raynauds, vasospasm, thromboangiitis obliterans)
26
Where are sympathetic NS cell bodies located?
T1-L2 in lateral horn
27
Stellate ganglion
C6-7 block used for pain in upper extremity/thorax complications: Horner syndrome, tracheo/esophageal injury, PTX, RCLN injury
28
Celiac plexus
located by aorta and IVC at L1 used to block for abd cancers, usually posterior approach below 12th rib complications: retroperitoneal hematoma, bleeding, chylothorax, PTX
29
Lumbar sympathetic chain
Anterior to L1-5 posterior approach tx: neuropathic pain in lower limbs, phantom pain, visceral pain involving intestinal/urinary compl: genitofemoral n injury, bleeding
30
ABG for pregnant woman
Ventilation changes occur w/i 1st 12 weeks -> 40% inc MV by 12 weeks resp alk -> incompletely compensated w/ metabolic acidosis pH 7.44/ PaCO2 30/ PaO2 105/ HCO3 21 O2 initially inc during 1st and 2nd trimester, by 3rd inc O2 counteracted by the inc O2 demand from fetus
31
Respiratory quotient
Amount of CO2 per unit O2 consumed to a specific energy substrate 0.8: mix of carbs and proteins 0.7: lipids 0.8: protein 1: Carbs **if pt having trouble weaning off vent -> give more lipids, lower CO2 production**
32
Rapid shallow breathing index
RSBI = RR/ TV <105: successful weaning predicted >105: failure predicted
33
In ICU RSBI > 105, TPN due to ileus how to improve chances of vent weaning?
Inc lipid concentration in TPN -> less CO2 produced than if more carbs or protein -> easier to wean b/c less inc in RR encouraged
34
Rf for metformin lactic acidosis
contrast dye renal impairment hepatic impairment 65 or older hypoxic or volume-depleted excessive alcohol** tx: supportive, HD
35
What side ETT fits in a size 4 Unique LMA?
6.0
36
What size ETT fits in a size 4 Ambu LMA?
7.5
37
What size ETT fits in a size 4 ProSeal LMA?
5
38
What size ETT fits in a size 4 iGel LMA?
7
39
Pulmonary compliance equation
inverse of elastance complication = Change in volume/ change in pleural pressure
40
2 most common causes for delay in ambulatory surgery center
pain PONV
41
Best way to wean pt off vent if failed initial SBT
Daily SBTs w/ pressure support assistance (pressure support augmentation w/ pt initiation) -progressive dec in pressure support
42
10 month old for uro procedure long face, high prominent forehead, wide nose, low-set ears, high arched clef palate, micrognathia, deep palmar creases, developmentl delay, systolic murmur? chromosomal abnormality?
Trisomy 8 w/ mosaicism -may have renal issues, assoc w/ AML and MDS, **prenatal corpus callosum agenesis and ventriculomegaly are suggestive** -if you survive beyond first few weeks of life, likely have mosaicism
43
A few day old baby, microcephay, microphthalmia (small eyes), cleft lip, cardiac def, hypoplastic or absent riibs, polydactyly
Patau syndrome (mean surival 7 days) Trisomy 13 **holoprosencephaly, cleft lip, absent ribs, polydactylyl) -if you survive beyond first few weeks of life, likely have mosaicism
44
One week old baby, microcephaly, micrognathia, VSD/ASD, inguinal hernia, renal malformation, rocker bottom feet, clenched hand w/ overlapping fingers, intellectual disability
Edwards Syndrome Trisomy 18 (mean surival 14 days) ***VSD, rocker bottom feed, clenched hand w/ overlapping digits*** -if you survive beyond first few weeks of life, likely have mosaicism
45
peds single palmar crease, upslanting palpebral fissures, endocardial cushion defects, atlantoaxial instability and sleep apnea, dx?
Trisomy 21
46
How much of a hospital pharmacy budget is anesthesia medication
10-13%
47
What's cheaper TIVA or inhaled anesthesia?
TIVA 10-100x more expensive -meds, pumps, tumbing -does not result in signicant PACU savings
48
Cost of iso v sevo
sevo 10x more expensive des 25x more
49
MC cause of death in preeclampsia
Stroke -93% hemorrhagic -why we give meds to get BP <160 but by non more than 15-25%
50
MC cause of maternal death in US
cardiac dx
51
MC cause of maternal death worldwide
PPH
52
Lab tests that indicate preeclampsia with severe features
-plts < 100 -Cr > 1.1 -doubling of Cr -doubling of LFTs -pulm edema -cerebral/visual symp
53
How is serotonin involved w/ nausea and vomiting
When toxic substances come into constant w/ enterochromaffin cells in gut walls -> release serotonin
54
Chemoreceptor trigger zone, how nausea?
Outside of BBB -> direct action of drugs and toxins on CRTZ **doesn't come in contact w/ bloodstream materials
55
Carcinoid tumor symptoms
flushing, diarrhea, wheezing, abd cramping **NO N/V
56
What inhibits serotonin nausea?
GABA, vasoactive intestinal peptide, somatostatin
57
Pacemaker nomenclature
I: Paced II: Sensed III: Resp to sensing IV: rate modulation (O or R) V: multisite pacing PCR -> PaCeR
58
What is pacemaker syndrome?
VVI Ventricles are pacing w/o atrial coordiation -> loss of cardiac output
59
Central line placement, what do after after manometry use?
Confirmed -> no further steps necessary, can dilate and place line
60
Why RIJ over LIJ?
Direct route to heart Higher apex of lung on L Thoracic duct on L
61
Difference b/w V-V and V-A ECMO
V-V is respiratory support -> native and artificial lung in series V-A is cardiopulm support -> native and artifical lung in parallel both drained through venous system, just about where it goes back **in both native lungs can be completely or partially bypassed
62
Flows for V-A ECMO
peds; 100 cc/kg/min adults: 60 cc/kg/min
63
Flows for V-V ECMO
peds: 120 cc/kg/min adults: 60-80 cc/kg/min
64
Advantage of centrifugal pumps over roller pumps
smaller priming volume lack of gravity drainage prolonged operation
65
Disadvantage of centrifugal pumps
blood stagnation and heating (inc risk of thrombi) cavitation (air bubbles) hemolysis - dec w/ modern changes
66
Sympathetic innervation of heart
T1-T4 alpha 1: positive inotropy beta 1: positive chronotropy, dromotropy (n conduction), lusitropy (relaxation), inotropy beta 2: positive chronotropy > inotropy
67
Dromotropy
Conduction of a nerve
68
Sympathetic innervation T1-T4 of heart
n travel through b/l stellate ganglions R stellate ganglion: effect on HR L stellate ganglion: MAP and contractility -> block can be done to red risk of arrhythmias w/ long QT
69
What matters w/ turbulent flow
Density -> why helium moves more
70
What matters w/ laminar flow?
Viscosity
71
Which medication increases sz duration
Etomidate
72
Which meds have no effect on sz duration
Methohexital Ketamine
73
Dec sz duration in ECT
Propofol Midazolam Lidocaine Volatiles
74
What is given to prevent post sz myalgias from ECT?
peds: ketorolac elderly: acetaminophen
75
Contraindications to acute normovolemic hemodilution
Preop anemia Active infxn Cardiac hx (MI, uncontrolled HTN, aortic stenosis) recent CVA clinically significant kidney or liver dx
76
Tx for cardiac embolism in pt after CABG
support hemodynamics re-heparinize and go back on bypass
77
Tx for protamine induced pulm HTN
milrinone epi NG
78
How to tx vasoplegia coming off bypass
Vasopressin and methylene blue
79
Which coronary artery is most susceptible to embolism post bypass
RCA
80
Osmolality gap
Used to figure out if non-measured solutes impacting OG = measured serum osmolality - calculated osmolality **MC ethanol, ketones, lactate -> DM2 does NOT cause a gap, DKA does!
81
Osmolality calculation
osmolality = (2 x Na) + (Glucose/18) + (BUN/2.8)
82
Which is more liver specific AST or ALT?
ALT AST is present in cardiac, skeletal m, brain, kidney, pancreas
83
RF for postop hepatic dysfxn
#1 type of surgery: more likely in cardiac 2nd: presence of acute or chronic hepatitis/cirrhosis **asymp inc in < 2x AST is NOT
84
Pulm pathophysiology of drowning
Surfactant washed out -> dec compliance and V/Q mismatch -> hypoxia
85
How long after drowning process started irreversible brain damage?
LOC: 2 min damage irreversible: 4-6 minutes
86
Cardiac changes w/ drowning
Initially tachycardia to compensate for hypoxia -> more acidosis -> bradycardia -> PEA -> asystole
87
O2 content
CaO2 = (hg x 1.34 x SaO2) + (.003 x PaO2) SaO2: O2 saturation PaO2: partial pressure of O2 mmHg (O2 dissolved in blood)
88
What affects myocardial blood supply
1. HR: supplies during diastole 2. CPP = Aortic DP - LVEDP 3. Coronary vascular resistance (inc w/ vasospasm or atherosclerosis) 4. Hg: affects O2 content
89
RF for infant postop apnea
<60 weeks post conception hx of apnea or bradycardia GA regional w/ sedation anemia
90
protective factor against infantile postop apnea
small for gestational age
91
RF for multi-drug resistant pathogens causing VAP
5 or more days in hospital IV abx in 90 days septic shock ARDS or acute renal replacement therapy
92
If concern for multi-drug resistant MAP what abx?
MRSA coverage + 2 anti-pseudomonal (Vanc or Linezolid) + (Pip-tazo or penem or cephalosporins or aztrenoam) + (floxacin or gent or colistin)
93
American Spinal Injury Association scoring system, what impairment is A
A: Complete cord injury w/ complete motor and sensory deficits in S4/5 B: Incomplete cord injury w/ sensation preserved below level of injury, intact S4 and S5 C: Incomplete cord injury w/ motor function preserved below level of injury, < 3 out of 5 motor strength in 1/2 major muscle groups D: Incomplete cord injury w/ motor function preserved below level of injury, > 3 out of 5 motor strength in 1/2 major muscle groups E: No evidence of cord injury w/ intact motor and sensory innervation
94
Which lead alone has the highest sensitivity for myocardial ischemia?
V5
95
Preferred intraop lead monitoring
II: biggest p wave V4: sens for ischemia
96
Carbamazepine MOA
Blocks sodium channels -> inhibit generation and propagation of action potentials
97
Carbamazepine tx
tx: sz, trigeminal neuralgia, bipolar d/o, neuropathic pain
98
Carbamazepine P450
P450 inducer -> inc metabolism of other antiepileptic drugs
99
Carbamazepine toxicity
Cardiac: wide QRS, prolonged QT, vent arrhythmias, tachycardia, hypoTN Neurologic: nystagmus, AMS, delirium Anticholinergic: mydriasis, hyperthermia, flushing, dry mouth, urinary retention
100
Superior way to dx brain death
Clinical exam is considered superior to all imaging when dx brain death -ancillary studies can be used to support when prereqs for clinical exam can't be met or when apnea test invalid due to chronic CO2 retainers (cerebral angio gold)
101
When in a disaster planning, what is the first staff that is short-handed?
Nursing due to direct pt contact
102
In a disaster which pts arrive at the hospital first?
Those that can bring themselves: minimally injured 2nd wave of very sick pts that require help w/ transportation
103
Prep for mass casuality
1. staffing: nurses run out 1st, getting ppl mentored for ICU coverage 2. space: being able to make non ICU places have resources to cover ICU pts 3. stuff: resources, must get enough stuff to have 72 hrs w/o help 4. strategy:
104
Palpable taut band w/ radiating pain
myofascial pain syndrome -localized pain in single m or region w/ trigger pts -can do dry needling or local anesthesia injxn
105
Lean body weight
weight - adipose tissue usually 80% of obese male, 70% of obese female
106
What meds doses by lean body weight?
Induction Thiopental and prop, fent, remi, vec, roc, cistatracurium
107
What meds dosed by total body weight?
Maintenance thiopental, prop, succ
108
What molecules inactivated w/ pass through lungs?
Serotonin (98%) Norepi (30%) Bradykinin
109
What intranasal meds are vasoconstrictors to prevent epistasxis with fiberoptic
oxymetazoline and phenylephrine

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