ITE Truelearn Flashcards
MOCA Minute Requirement
120 questions per year (max 30 questions per quarter)
Myasthenic Crisis Treatment
Cholinesterase inhibitors, corticosteroids, immunosuppressant, IVIG, plasmapheresis
Myesthenic Gravis: postoperative mechanical ventilation indicators
Duration of myasthenia gravis>6 years
Chronic resp disease
Pyridostigmine >750mg/day
Vital capacity <2.9L
Pregnancy Coagulation factors
Only 2 coagulation factors decrease (XI and XIII). Other factors will increase (VII, VIII, IX, X, andXII
Volume Control Vent: Complications
Hypoxia and increased PIP in intubated ICU patients with VCV are typically caused by VILI, VAP, or auto PEEP.
Morbid Obesity DVT
Morbidly obese patients have an increased risk of DVT d/t higher circulating pro-coagulation factors
Tracheoesophageal fistula: ETT positioning
Advance ETT beyond the fistula and position the bevel of the tube anteriorly
Cardiac Physiology: Synchronicity
Aortic valve opens after Isovolumentric contraction. C-wave on CVP after the QRS complex
Mitral valve opens after isovolumetric relaxation has occurred. Which corresponds with v-wave on CVP plus T wave on ECG
Nausea and vomiting: Droperidol
D2 antagonist used as antiemetic. SE are anxiety, restlessness, akathisia, dystonia, QT prolongation.
Concern if patient has hypomagnesemia (QT prolongation)
Anesthetic technique: Influence on Labor
Neuraxial analgesia may increase duration of second stage of labor
CO Poisoning: Dx
History of elevated HbCO blood levels. Note standard pulse ox may indicate (incorrectly) a normal to high SpO2. Co-oximeter may be utilized to determine true SpO2.
Standard Pulse oximetry
Red light (660 nm) and infrared (R 940 nm)
Neonatal apnea hypoxemia Physiology
Bradycardia is thought to occur 2/2 carotid body chemoreceptor stimulation.
Anesthesia Complications: Sheared Catheter
With a retained epidural catheter tip in an asymptomatic patient, observation is considered acceptable
Morbid Obesity: CV effects
Increased adipose tissue in morbidly obese patients results in numerous CV effects. Increased total blood volume increases CO which causes increased ventricular workload. Initial decrease in SVR but RAAS and SNC increase ventricular workload. Lead to ventricular hypertrophy.
Newborn Emergencies: Tracheoesophageal fistula
Lung protective strategies (Low Vt, PEEP, low peak pressures). Secure ETT past fistula.
12 lead EKG and echo should be done prior to surgery.
Hepatic Blood Flow: Regulation
Hepatic arterial buffer response (HABR) is compensatory mechanism to maintain perfusion of the liver by hepatic arterial vasodilation via reduction of portal venous perfusion.
Adenosine is released at a constant rate into fluid within the space of mall that surrounds the hepatic resistance vessels and portal venules. If blood flow is reduced in portal vein less adenosine is washed away so higher adenosine levels leads to dilation of hepatic artery.
Neuropathic pain states: post-stroke
Post-stroke pain is d/t latent brain plasticity after a CVA.
Postoperative Hepatic Dysfunction
The new halogenated inhalation anesthetics such as desflurane, isoflurane, and sevofluane have fewer cases of hepatotoxicity. Desflurane forms nontoxic trifluoroacetic acid (TFA), while sevoflurane forms hexafluoroisopropanol (HFIP).
Hepatopulmonary Syndrome: Pathophysiology
Hypoxia in the setting of cirrhotic liver disease that is primarily due to a dysregulation of pulmonary vascular tone (resembles a large AV fistula**). Increased right to left intrapulmonary shunt and hypoxia that is resistant to increased FiO2.
Valsalva Maneuver: Hemodynamics
HR decreases during valsalva d/t baroreceptor reflex.
During initial phase the transient increase in LV output 2/2 to compression of the thoracic aorta. Baroreceptor then decreases HR.
During 2nd phase: Decrease in venous return, RV and LV output, SV, MAP, pulse pressure. Baroreceptor then increase HR.
During 3rd phase: Arterial pressure decrease 2/2 thoracic aorta compression. Result in tachycardia
Bezold Jarisch reflex
Triad hypotension, bradycardia, coronary artery dilation 2/2 noxious stimuli within LV
Bainbridge reflex
Right atrial stretch receptors. Vagal afferent signals to the medulla cause inhibition of PNS result in tachycardia
Propofol: Indications and CI
CI: soybean oil, glycerol, lecithin.
Formulation of lecithin emulsion formulation of soybean oil, glycerol, egg phosphide
**note egg white (egg albumin) is most common allergy not the egg lecithin (egg yolk).
