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Flashcards in Jensen1 Deck (240):
1

Bodies response to removal of carotid bodies

little change to ventilation at rest, response to hypoxia is lost and there is a 30% reduction in ventilatory response to CO2

2

chemoreceptors that mediate hyperventilation after carotid and aortic body denervation are located where

medulla oblongata - medullary chemoreceptors

3

PEEP effects (pulmonary)

prevent alveolar collapse, promote gas exchange, increases FRC, increases lung compliance, decreases intrapulmonary shunt, increases PaO2, increases dead space

4

PEEP effects (cardiac)

high airway pressure 2/2 to decreased pulmonary compliance can decrease CO - decreases ventricular filling, decreased coronary blood flow

5

PEEP complications

decreases CO, causes fluid retention (depresses ANF, increases ADH), increases pressure in SVC - can increase ICP, barotrauma

6

PEEP recommended for? not recommended? no evidence?

recommended for pulmonary edema, not recommended for localized lung disease (over-distends normal lung and redirects blood to diseased area, creating V/Q mismatch), no evidence that it increases incidence of ARDS, beneficial routinely, or decreases mediastinal bleeding

7

Eaton-Lambert definition

muscular weakness because of decreased release of acetylcholine 2/2 destruction of pre-synaptic voltage gated Ca channels by IgG antibodies

8

Eaton-:Lambert presentation and associated diseases

bronchial CA (oat cell), SLE, thyroid disease, present with dry mouth, proximal muscle weakness, muscle pain, weakness improves with exercise. more in men, sensitive to all NMBD

9

Eaton-Lambert treatment

excision of cancer, 4-aminopyridine (immunosuppressant) stimulates release of pre-synaptic acetylcholine, acetylcholinesterase is not effective

10

Increased mixed venous

left to right shunt, high cardiac output, cyanide poisoning, CO poisoning, methgb, hypothermia (decreased O2 consumption), sepsis, sampling error (permanently wedged PAC)

11

decreased mixed venous

increased O2 consumption (fever, thyroid storm, MH), decreased O2 delivery (hypoxia, decreased CO, decreased Hgb, abnormal Hgb)

12

mixed venous normal values

O2 40 mm Hg, CO2 45 mm Hg, 65-75% sat

13

shivering, mechanism and treatment

when preoptic region of hypothalamus is cooled, increases metabolic heat production up to 600%, increases O2 consumption and CO2 production, hypoxia inhibits shivering response, treatment with meperidine - decreases the shivering threshold

14

amide locals metabolism dependent on...

liver which is dependent on hepatic blood flow (decreased with NE, propranolol, GA) and extraction capacity (decreased with HF, cirrhosis, hypothermia)

15

ester locals metabolism dependent on...

pseudocholinesterase - low in renal failure, severe hepatic failure, pregnancy

16

which anticholinergic crosses BBB

scopolamine and atropine

17

Cholinergic (parasympathetic) crisis

SLUDEBBP - salivation, sweating, lacrimation, urination, defecation, erection, bradycardia, bronchial constriction, pupillary constriction

18

anticholinergic crisis - central anticholinergic syndrome

atropine and scopolamine because cross BBB, treatment is physostigmine; symptoms are fever (blocks sweating), blurred vision, photophobia, tachycardia, restlessness, somnolence

19

Horner's syndrome

ptosis, miosis, anhidrosis, enophthalmos, flushing of conjunctiva and skin, nasal congestion (engorged blood vessels)

20

O2 consumption decreases with 1 degree centigrade

10%

21

oculocardiac reflex pathway

afferent: ciliary ganglion to ophthalmic division of trigeminal nerve (V), through Gasserian ganglion to sensory nucleus of the 4th ventricle, efferent: vagus nerve --> bradycardia, hypotension, PVCs

22

Phase II block characteristics

fade with twitch and tetanus, TOF <0.7 (T4/T1), post-tetanic potentiation

23

minimum fresh gas flow

150-500 ml/min for metabolic demands and replace anesthetic gas

24

advantages/disadvantages of closed circuit

ad: conservation or heat/humidity, economical, low pollution; dis: anesthetic concentration cannot be changed quickly and delivered anesthetic concentration uncertain, uptake of nitrous oxide can decrease O2

25

right shift oxy-hgb

O2 unloads easily, high H, high CO2, high temp, chronic anemia, high 2,3 DPG

26

left shift oxy-hgb

O2 binds more to hgb, low H, low temp, low 2,3 DPG, met-hgb, fetal hgb, hypophosphatemia, hypothermia

27

TPN complications

hypo/hyperglycemia, hypercarbia, hypophosphatemia (left shift oxy-hgb, muscle weakness), fatty acid deficiency, metabolic acidosis (from amino acid metabolism), sepsis

28

ECT response

parasymp - bradycardia, hypotension, cerebral vasoconstriction, asystole; symp - tachy, HTN, increased cerebral blood flow, increased metabolic demands

29

ECT drugs

ketamine - seizure potential, methohexital lowers seizure threshold, thiopental and propofol tend to suppress seizures, hyperventilation and caffeine can increase seizure duration

30

does not require cross match

FFP, cryo, platelets

31

type specific/Rh required

pRBCs need both, cryo and FFP need ABO (Rh not required), platelets better with both, but not required

32

Induces ADH secretion

Pain, PEEP, decrease intravascular volume, positive pressure ventilation

33

Monophasic vs biphasic defibrillation

Monophasic current travels From one electrode to another in one direction; Biphasic current flows in one direction for 1st phase then reverses for 2nd phase so adjusts for impedance by varying waveform, more effective, less injury prone

34

trigeminal neuralgia

V2 maxillary, can treat with carbamazepine which is membrane stabilizer or gasserian block at middle cranial fossa by meckel's cave (contains CSF)

35

treatment of LA CNS toxicity

intubate, barb/benzo, hyperventilate (alkalosis increases ionized percentage)

36

LA weak acids or bases?

weak bases except for benzocaine

37

co-ox for methgb, carboxhgb, and dyes

methgb absorbs both wave lengths equally 85%, carboxy absorbs red (660) but not infrared (940) so measurement varies, methylene blue can cause 65%

38

carbohgb levels mild? mod? severe?

10-20%, 20-40%, >40%

39

hypercalcemia EKG, symptoms

PR prolonged, QT short, muscle weakness

40

hypocalcemia EKG, symptoms

Qt prolonged, tetany and laryngospasm, seizures

41

H's

Hypovolemia, Hyper/Hypokalemia, Hypothermia, Hydrogen ions, Hypoxia, Hypoglycemia

42

T's

Tension pneumo, Thrombosis (pulmonary, coronary), Trauma, Tamponade (cardiac), Toxins

43

Hyperventilation/hypocarbia

AVCO - apnea, alkalosis, airway constriction, V/Q mismatch, decreased CO, CBF, coronary blood flow, and Ca, oxyhbg left shift

44

Hypoventilation/hypercarbia

A RIPE - acidosis/arrhythmia, right shift oxyhgb, intracerebral steal, PA pressure increase, epi/norepi release (cutaneous vasodilation, splanchnic vasoconstriction)

45

cardioselective beta blockers

Metoprolol, Esmolol, Atenolol, Acebutolol

46

amiodarone mechanism

used for refractory VT/VF, prolongs refractory period and reduces membrane excitability

47

adverse amiodarone effects

pulmonary toxicity due to enhanced O2 free radial formation, increased risk for ARDS

48

digoxin mechanism and therapeutic margin

increases INTRACELLULAR calcium; inhibits the Na-K pump; 0.9-2.0 ng/mL

49

what is calcium hydroxide? advan/disad?

combination of calcium hydroxide, calcium chloride, calcium sulfate, and polyvinylpyrrolidine (lacks strong bases sodium and postassium which ELIMINATES CO and compound A production), 50% less absorptive than soda lime with higher cost

50

umbilical artery and vein ABG

artery: 7.28/20/50 sat 40% vein: 7.35/30/40 sat 70%

51

organophosphate mechanism

irreversibly inhibits pseudocholinesterase, acetylcholinesterase, and non-specific plasma cholinesterases, also affects GABA and NMDA

52

organophosphate treatment

pralidoxime (oximes) activates acetylcholinesterase (primarily reverses muscle weakness - nicotinic), atropine helps with other symptoms (muscarinic)

53

stellate ganglion block

covers inferior cervical and first thoracic ganglion, blocks head and upper extremity (T2-T9), block at transverse process of C6 at level of cricoid cartilage

54

CO2 values with apnea

6 mmHg increase after 1 minute, 3 mmHg every minute after

55

ketamine indications

burns, shock, COPD, asthma, CHF, cardiac tamponade, hypothyroidism, TOF

56

ketamine contraindications

heart: HTN, cardiac ischemia, digitalis toxicity, brain: increased ICP, CVA, lungs: pHTN, pulm emboli, endocrine: hyperthyroidism, eye: nystagmus, pregnancy: severe pre-eclampsia

57

ketamine pharmacology

phencyclidine derivative, NMDA receptor antagonist, dissociates thalamus from limbic system (reticular activating system to cerebral cortex), provides analgesia (modest LA action)

58

increased closing capacity

ACLSS - age, chronic bronchitis, LV failure, smoking, surgery

59

decreased FRC

PANGOS - pregnancy, ascites, neonates, GA, obesity, supine position

60

porphyria neurologic problem types, diagnosis, treatment

types 1, 3, 4; check urine for aminolevulinic acid (ALA) and pophobilinogen (both not seen in cutanea tarda type); treat with glucose infusion suppresses ALA synthetase

61

Porphyria triggers (induce ALA synthetase)

barbituates, diazepam, chlordiazepoxideam, meprobamate, glutethimide, hydroxydione, imipramine, pentazocine, OCPs, griseofulvin, phenytoin, methsuximide, sulfonamides, chloramphenicol, estrogens, progesterone, (sulfonylureas) chlorpropamide & tolbutamide, lead, ethanol, ergots, amphetamines, methyldopa, etomidate?, hydralazine, phenoxybenzamine, nifedipine

62

porphyria pathophys

enzymatic defect of heme synthesis resulting in over production of heme precursors (increased ALA synthetase activity)

63

porphyria symptoms

n/v, abdominal pain, dehydration, anxiety, electrolyte abnormalities, confusion

64

complications of mediastinoscopy

(suprasternal incision to pass scope anterior to trachea and posterior to innominate vessels and aortic arch) hemorrhage, pneumo, RLN injury, tracheal collapse, "apparent" cardiac arrest (severe vagal reflex), air embolus

65

mediastinoscopy contraindications

previous mediaastinoscopy, distorted anatomy, SVC syndrome, cerebrovascular disease (risk of carotid compression)

66

special mediastinoscopy considerations

pulse ox on both sides of upper extremities (pressure on right innominate can cause radial pulse to disappear), IV lines placed in LE (resuscitation in UE can increase blood loss in mediastinal cavity)

67

metoclopramide contraindications

Parkinson's (antagonizes dopamine), patients taking phenothiazines, butyrophenones, MAOIs, or TCAs, pheochromocytoma, GIB, bowel obstruction, seizures

68

MAOIs and meperidine

fatal excitatory reactions

69

MOAI food interactions and why

chocolate, beer, wine, cheese because they contain tyramine (monoamine)

70

MOAIs and pressors

see exaggerated response with indirect and direct

71

postural hypotension and MAOIs

accumulation of false neurotransmitter octopamine

72

most common serious adverse flumazenil side effect

convulsions and death (patients with serious underlying disease and s/p ingestion of non-benzo drugs)

73

garlic

used for vasodilatory and anti-cholesterol effects; decreases platelet aggregation

74

ginseng

used for anti-aging, energy, and aphrodisiac; hypoglycemic effect, avoid ASA, NSAIDs, Coumadin, heparin, and neuraxial blocks (like garlic), causes HTN, avoid with MAOIs (manic episodes)

75

ginkgo

used for intermittent claudication, memory loss, tinnitus, impotence; can cause hypema, subarachnoid hemorrhage, and spontaneous subdural hemorrhage, avoid avoid ASA, NSAIDs, Coumadin, heparin, and neuraxial blocks, decreases effectiveness of TCAs and anticonvulsants

76

st. john's wort

used for anxiety, depression, sleep disorders; can cause photosensitivity, do not use with tetracycline or piroxicam

77

banked blood survival

blood bank survival based on 70% RBC survival 24 hours after transfusion

78

CPD-A half-life, ACD half-life?

35 days; 21 days

79

changes to banked blood

decreased 2.3 DPG, increased CO2 (acidemia), decreased platelets, increased potassium, decreased factors (esp V and VIII)

80

interscalene block complications

vertebral artery puncture, spinal/epidural injection, brachial plexus injury, phrenic nerve paralysis (100%), pneumo, RLN block, horner's

81

hypophosphatemia

heart failure, respiratory failure, rhabdomyolysis, hyporeflexia, seizures, decreased mental status, n/v, low levels of ATP and 2.3 DPG cause left shift of oxyhgb

82

hyperphosphatemia

tetany, seizures, laryngospasm

83

augment NMB

volatiles, LA (procaine), anticholinesterases, tetracycline, aminoglycosides (gentamycin), lincosamides (clinda), polymixins, lidocaine, quinidine, Ca channel blockers, magnesium, lithium, hypernatremia, hepatic dysfunction, hypothermia, acidosis

84

intraarterial thiopental injection treatment

inject with lido/procaine/papverine (prevent smooth muscle spasm), sympathetic block at stellate/brachial, heparinize (prevent thrombus), possible alpha block (phentolamine)

85

hyperbaric O2

allows arterial O2 tension to increase 3x than at normal barometric pressure, used for decompression sickness, CO poisoning

86

hyperbaric O2 complications

seizures 2/2 CNS O2 toxicity (lower O2 concentration), lung damage (free O2 radicals), hyperoxic myopia (HBO >20-30), middle ear rupture, pneumothorax

87

first stage of labor

T10-L1, uterus, cervix, upper vagina; can use spinal, epidural, paracervical, caudal, general

88

second stage of labor

S2-S4; can use spinal, epidural, caudal, general, pudendal

89

beat to beat variability

best indicator of fetal well being, decreased happens with sleep and prematurity but can also indicate CNS damage, hypoxia, or drug effects

90

length of ETT placement

1 kg 7 cm
2 kg 8 cm
3 kg 9 cm
3.5 kg 10 cm (at term) OR multiply diameter x 3

91

diameter of ETT

(age + 16)/4

92

CDH

1:4000, defect in left posterior foramen of Bochdalek, associated with cardiac defects, pulmonary hypoplasia/HTN, GI abnormalities, spina bifida/hydrocephalus

93

CDH management

insert NG or OG to decompress stomach, maintain preductal O2 sat 90%, airway pressures <25, and PaCO2 60-65

94

pralidoxime dose

15-30 mg/kg over 20 min IM/IV to avoid laryngospasm, HTN, muscle rigidity, repeat after 4 hours or 1 hour if paralysis worsening

95

agent protective against organophophate poisoning

pyridostigmine - carbamylate-complexed acetylcholinesterase resists attack

96

sulfonylureas

glyburide/glipizide increase insulin secretion, contraindicated with sulfa allergy

97

metformin

is a biguanide that decreases GI glucose absorption and decreases liver glucose production --> decreased insulin resistance and blood glucose

98

metformin contraindications

renal insufficiency, metabolic acidosis, hold 48 hours before contrast media (acidosis risk), caution with hypoxemia, liver disease, alcohol abuse (lactic acidosis risk)

99

thiazolidinediones

tro/pio/rosiglitazone reduce insulin resistance, potential liver toxicity

100

alpha glucosidase inhibitors

acarbose and miglitol delay GI absorption and prevent complex carb breakdown, potential liver toxicity

101

repaglinide

is a meglitinide (similar to sulfonylurea) increases insulin secretion , more rapid onset, less risk of hypoglycemia, caution with renal/hepatic dysfunction

102

Artificially increased HbA1c

increased HgF, CRF, splenectomy, dialysis, thalassemia, increased triglycerides

103

decreased HbA1c

chronic blood loss, anemia, HbS

104

why does CO2 leave capillaries to alveoli more than O2 leaves alveoli to capillaries

CO2 20x more diffusible across membranes than O2 --> hypercarbia is never due to defective diffusion

105

Ondine's curse

loss of autonomic control of breathing - always need to be awake and thinking of breathing

106

Bainbridge reflex

increased right atrial pressure (ass with increased filling) leads to increased HR from afferent inhibition of parasympathetics

107

Bezold-Jarisch reflex

triad of apnea, bradycardia, hypotension --> certain noxious stimuli sensed by chemoreceptors/mechanoreceptors in left ventricle stimulates C fibers that increases parasympathetic tone, triggers myocardial infarction/ischemia, thrombolysis, revascularization, syncopy

108

carotid sinus/aortic arch baroreceptor reflex

carotid (IX) and aortic (X) afferent signal relays change in BP to nucleus solitarius in CV center of medulla --> changes parasympathetic tone

109

carotid sinus/aortic arch baroreceptor reflex augmentation

loses function when BP <50, volatiles, CCB, ACE-I, phosphodiesterase inhibitors, chronic HTN decrease baroreceptor reflex

110

chemoreceptor reflex

found in carotid and aortic bodies, respond to changes in pH and PaO2 --> acidotic/hypoxemic causes stim of respiratory center via IX and X (and HR and contractility decrease)

111

cushing reflex

increased ICP causes cerebral ischemia which initially cause sympathetic response (tachy, HTN, increased myocard contractility), then HTN causes bradycardia reflex "HTN and bradycardia"

112

Pulmonary stenosis

2nd left ICS at left sternal border

113

MR

apical (5th ICS midclavicular)

114

AS

2nd right ICS at right sternal boarder

115

VSD

left sternal border ICS 4-6

116

TR

5th ICS at left sternal border

117

acute pericarditis

J point elevation, friction rub, referred pain in area of trapezius

118

CV changes with age

decreased vascular compliance, decreased hepatic blood flow and decreased protein binding

119

carcinoid treatment

bronchospasm - volatiles, steroid, H1&2 blockers, Benadryl, hypotension - volume repletion, HTN (serotonin release) - SNP, NTG --> long acting somatostatin analog, octreotide, treats all

120

pRBCs Hct

60

121

blood volume preterm? newborn? infant? child? adult?

100, 85, 80, 70-75, 70-75

122

DI

absence of ADH or renal insensitivity, see dilute urine, hypernatremia, hypovolemia; treat with IM ADH/DDAVP (vasopressin) or chlorpropamide if renal

123

SIADH

seen with surgery, tumors, hypothyroid, porphyria; see concentrated urine, decreased serum osmolality, hyponatremia; treat with fluid restriction, demeclocyline, hypertonic saline (0.5 meq/hr)

124

protamine

strong base; can cause flushing, edema, bronchospasm, pHTN; IgE mediated histamine release, complement activation, and thromboxane production

125

protamine susceptibility

prior exposure to protamine containing substances (NPH insulin), seafood allergy (derived from salmon sperm), vasectomy; tx: cyclooxygenase inhibitors (NSAIDs, ASA) can decrease adverse

126

retrobulbar complications

retrobulbar hemorrhage, globe perforation, optic nerve atrophy, convulsions, oculocardiac reflex, trigeminal block, respiratory arrest, acute neurogenic pulmonary edema

127

thermodilution inaccuracies

atrial fibrillation, TR, intracardiac shunts

128

neuromonitoring sensitivity

Visual>SSEP>MEP>BAEP

129

pulse ox limitations

no pulse - need arterial pulsations to distinguish from background venous (hypotension, hypothermia), hemoglobin variants, severe anemia (Hgb 3, Hct 10), venous pulsations (R heart failure, TR), fluorescent light underestimates, nail polish varies

130

CVP waves

All College Xams Vary Yearly - a wave atrial contraction, c wave tricuspid closure, x descent atrial relaxation, v wave atrial filling, y descent atrial emptying

131

a wave absent

atrial fibrillation or flutter

132

cannon a waves

junctional rhythms, TS, RVH, pulmonary/mitral stenosis, pHTN

133

artificially high PCWP > LVEDP

mitral stenosis, atrial myxoma, PEEP

134

artificially low PCWP < LVEDP

noncompliant LV, LVEDP >25, AI, premature closure of mitral valve

135

sensitivity to air embolism

TEE (gold standard), TT Doppler (0.25 ml), decreased ETCO2, increased nitrogen, increased PA pressure, hypotension, mill-wheel murmur

136

retrobulbar blocked nerves

II, III, V, VI

137

concentration effect

the higher the concentration of gas used the faster the alveolar concentration of that gas

138

2nd gas effect

large volume uptake of one gas accelerates the rate of increase of a concurrently administered gas

139

underdamped

short tubing (1.5 mm), long tubing (1.5 m), stiff tubing, big catheter (18g)

140

overdamped

high viscosity, soft/high compliance tubing

141

preductal measurement

(proximal to ductus arteriosus) right radial or temporal aa

142

awareness

routine monitoring of brain not recommend, small percentage of patients that report awareness will file a claim, they are only 2% of the claims, awareness is more likely under TIVA than volatiles, hemodynamics are also unreliable markers

143

ROP retinal O2 tension goals

60-90 mm Hg

144

hyperventilation disadvantages

Bohr effect results in a left shift of the hgb to have a greater affinity for O2, reducing the amount of O2 delivered to organs, PaCO2 < 30 mmHg, CBF can fall below a critical level and cause cerebral ischemia; pulmonary effects of alkalosis include increased permeability, decreased surfactant and decreased pulmonary compliance - acute lung injury.

145

VATER

VSD, vertebral defects, vascular problems, Anal stenosis, TEF, Esophageal atresia, Radial/renal anomalies

146

TEF complications

pre surgery: aspiration, PNA, congenital anomalies, post surgery: pneumo, atelectasis, anastomotic leaks, esophageal strictures

147

Lead V1-V2 changes

LCA:LAD septal branch, damage HIS, BB, septum

148

Lead V3-V4 changes

LCA:LAD diagonal, damage anterior wall

149

Lead V5-V6 changes

LCA:circumflex branch, damage high lateral wall

150

II, III, aVF changes

inferior wall LV, post LV

151

V4R (II, III, aVF) changes

RCA proximal branches damage RV, inferior wall, LV, posterior wall LV

152

V1-V4 changes

LCA circumflex or RCA posterior descending branch, damage posterior wall LV

153

R-L shunt effect on alveolar concentration

decreases 2/2 blood bypassing lungs, most effect on least soluble agents

154

CO2 response left

increased sensitivity to CO2: arterial hypoxemia, metabolic acidemia, central causes (ICP, anxiety, fear, cirrhosis), drugs (doxapram, strychnine, picrotoxin-analeptics

155

CO2 response right

decreased sensitivity to CO2: aminophylline, salicylates, catecholamines, opioids, Physiologic changes (metabolic alkalemia, denervation of peripheral chemoreceptors, normal sleep, drugs, hypothermia)

156

CO2 response down and right

high dose opioids, potent anesthetics - higher doses curve become horizontal (enflurane>halothane>isoflurane), neuromuscular blockade

157

no effect CO2 response

droperidol

158

sphincter of Oddi spasm

narcotics: morphine>fentanyl=alfentanyl>meperidine>butorphanol>nalbuphine, can be reversed with naloxone (except meperidine), glucagon, atropine, volatiles

159

dorsal colum medial lemniscal

tactile sense and limb proprioception

160

anterolateral (spinothalamic)

pain and temperature

161

signs of successful stellate block

best-temperature increase, can also use horners, cobalt sweat test, psychogalvanic reflex, plethysmography, and thermography

162

major CV risk

acute/recent MI, unstable/severe angina, decompensated HF, significant arrhythmia, severe valvular disease

163

intermediate CV risk

mild angina, previous MI, compensated/prior CHF, DM, CKD, CVA

164

minor CV risk

advanced age, abnormal ECG, rhythm other than sinus, low functional capacity, uncontrolled HTN

165

exaggerated x and y descents

restrictive pericarditis

166

abolished y descent

cardiac tamponade

167

carbon monoxide half-life

4-6 hours with air, 40-80 min with O2, 15-30 min HBO

168

CO HBO indications

Co >40%, pregnant >15%, coma

169

mannitol onset,peak,duration

onset 15 min, peak 30-60 min, duration 3-6 hours

170

CSF drain

placed 15-20 cm above ext auditory meatus to avoid big drops in ICP, leave it closed until dura is open

171

transmural pressure

difference between arterial pressure minus CSF pressure

172

normal PaO2

102-(age/3)

173

abciximab, tirofiban, eptifibatide

platelet GIIb/IIIa inhibitors

174

ticlodipine, clopidogrel

inhibits binding of ADP to platelet receptors

175

ASA

irreversible inactivation of COX enzyme which decreases prostaglandin and thromboxane

176

common finding with epidural and first stage of labor

fever more common than prolonged labor

177

one lung ventilation indications

hemorrhage, abscess/infection, bronchopleural fistula, lung cyst, tracheobronchial disruption (tracheoesophageal fistula), unilateral bronchial lavage

178

relative one lung ventilation

thoracic aortic aneurysm, upper lobectomy, pneumonectomy, esophageal resection, middle/lower lobectomy

179

NO mechanism and precautions

NO stim cGMP which decreases intracellular Ca, NO is tightly bound to hemoglobin, limit of NO exposure is 2 ppm, >150 ppm fatal

180

laminar flow equation

Flow(Q) = pi/8 x (change in pressure x r^4)/(viscosity x L)

181

turbulent flow

when Reynolds number is >2000, Reynolds number = (V x r x density)/(viscosity)

182

cm to mm Hg conversion

1.36 cm = 1 mm Hg

183

treatment of pneumothorax

decompression at mid axillary line of 2nd intercostal space at right sternal border (can hit internal mammary artery aka internal thoracic artery)

184

NO expansion

34 x more soluble than nitrogen and 30 x more soluble than CO2, this will occur more rapidly in blood (PA catheter/air embolus expand faster than pneumo)

185

Etomidate on neuro monitoring

increased amplitude and increased latency

186

pediatric airway

more cephalad, larger tongue/epiglottis/tonsils/adenoids, cricoid most narrow, narrow, more anterior glottis, more angled (adult perpendicular)

187

hyperglycemic hyperosmolar non-ketotic coma

BG >600, serum osm >310, no acidosis, serum bicarb >15, normal anion gap

188

propofol CNS effects

decrease CMRO2, CBF (via cerebral vasoconstriction, ICP, CBV, and EEG activity

189

pRBCs component disappearance

I, V, VIII, platelets

190

whole blood component disappearance

platelets, I, V, VIII

191

LA toxicity ECG changes

prolonged PR, wide QRS

192

definitive test for acute hemolytic reaction

direct coombs (RBCs into serum) to rule out attachment of attachment of RBC antibody to donor RBCs

193

acute AF treatment

digitalis, verapamil, propranolol, D/C countershock, pacing (a flutter not AF), avoid lidocaine because increases AV conductance

194

digitalis uses

CHF and AF to slow ventricular response

195

dig toxicity symptoms

ventricular arrhythmias, anorexia, n/v

196

dig toxicity causes and treatment

hypokalemia, hypomagnesemia, hypothyroid, hypercalcemia - treat with potassium, magnesium, lidocaine, phenytoin, fab fragment antibodies (no cardioversion because can cause Vfib)

197

TET spell pathophys

2/2 spasm of RV outflow tract and infundibulum --> increased outflow resistance, decreased pulm blood flow, increased R-L shunt

198

TET spell treatment

beta blocker to decrease HR and stop infundibular spasm, phenylephrine to increase SVR and decrease R-L shunt

199

Cushings symptoms

HTN, hypokalemic alkalosis, hyperglycemia, hypernatremia, osteoporosis, easy bruising, polyuria, buffalo hump, moon facies, hirsute, menstrual abnormalities

200

standard deviation

measure of variability: 1 68%, 2 95%, 3 99%

201

type I error

null incorrectly rejected (probability of this error - alpha)

202

type II error

null incorrectly accepted (probability of this error - beta)

203

p value

probability that result could have happened by chance is less than 1/5 in 100

204

compare means of two different groups (continuous)

unpaired t-test

205

compare means of >2 groups (continuous)

ANOVA

206

Wilcox rank sum

used like a t-test when the data is normally distributed

207

compare means of two different groups (categorical)

chi-square

208

power

= 1 - beta

209

confidence interval 95

95% chance that true population parameter is contained within interval

210

normal urine osm

300

211

normal urine sodium

>20

212

FeNa

1% (>ATN or other kidney injury)

213

antibiotic prophylaxis

1. prosthetic cardiac valve 2. previous IE 3. congenital heart disease - unrepaired, repaired with device in last 6 months, repaired with residual defect 4. cardiac transplant with valvulopathy

214

ROP presentation and pathophys

usually <1500g, norm retinal vasc develops 40-44 wks, hyperoxia disrupts this process

215

ROP management

O2 sat 93-95%, PaO2 50-80 mm Hg

216

tocolytics

beta agonists, magnesium, ethanol, prostaglandin synthetase inhibitor, NSAIDS, CCB

217

ethanol as tocolytic

given in 10% solution of D5W, probably inhibits oxytocin

218

prostaglandin synthetase inhibitor SE

premature close of PDA, primary pHTN, inhibits cox, which decreases thromboxane production - decrease platelet adhesiveness

219

ephedrine in pregnancy

beta agonist that crosses placenta, increases beat to beat variability and fetal HR

220

epiglotitits

supraglottic inflammation, H. Influenza, intubation in OR, thumb sign

221

croup

laryngo-tracheo-bronchitis, barking cough, narrowing of subglottic inlet - steeple sign , treat with racemic epi neb, cool mist, steroids, intubation in OR

222

esmolol metabolism

RBC esterases, short half life

223

rhabdomyolysis triggers

suc, volatiles, ketamine, propofol

224

termination of thoracic duct

left subclavian and left jugular veins

225

paresthesia vs dyesthesia

parethesia no unpleasant vs dyesthesia unpleasant

226

dibucaine

amide local that inhibits pseudocholinesterase - 80 homozygous normal

227

3rd degree heart block vessel

RCA - most often supplies SA and AV nodes

228

best TEE view for ischemia

Transgastric mid short axis view

229

volatile metabolism

methoxyfluran 40%, halothane 20%, enflurane 2%, iso 0.2%, des <0.2%

230

mivacurium

anticholinesterase and NDMR will prolong duration 2/2 mivacurium metabolized by pseudocholinesterase

231

cocaine intoxication contraindicated drugs

beta blockers, beta agonists, alpha agonists, meperidine

232

dexmedetomidine

alpha agonist that causes analgesia and sedation with little resp depression - supraspinal site of action for sedation (locus coeruleus)

233

dexmed metabolism

liver

234

dexmed side effects

transient HTN and bradycardia followed by decrease in BP and stabilization of HR

235

dexmed contraindications

patients with bradycard disorders, severe ventricular dysfunction, CHF - conditions where need sympathetic tone

236

sentinel event

unexpected occurrence involving death or serious physical or psychological injury or risk thereof

237

bleomycin

pulmonary fibrosis

238

doxirubicin

cardiomyopathy, GI upset, alopecia, myelosupression

239

dead space on ventilator

distal to y-piece

240

Guanethidine

antihypertensive drug that reduces the release of catecholamines