Miscellaneous Miscellaneous Lol Flashcards
(135 cards)
1
Q
how is most heat lost under GA? second most heat lost how?
A
Radiation
convection
2
Q
how much can shivering increase O2 consupmtion? what is the clinical significance?
A
400-500% increased risk of MI and infarction
3
Q
E. temp probe should be how deep
A
38-42cm past incisors, temp will increase if advanced too far into the stomach and will be too low if not advanced far enough
4
Q
does skin temp correlate wtih body temp?
A
no
5
Q
how can hypothermia affect autonomic nervous system
A
hypothermia can cause SNS stimulation
6
Q
drugs to treat shivering
A
meperidine
clonidine
dexmedetomidine
7
Q
O2 consumption decreases how much for every 1 degree decrease in body temp
A
5-7% decrease in O2 consumption for every 1 degree decrease in body temp.
8
Q
how far to insert rectal thermometer
A
8cm in adult
3cm in child
9
Q
what is the most reliable core temp? what can make it less accurate?
A
PA
CPB and thoractomy can affect this
10
Q
how would a properly execute regional block affect skin temp?
A
will increase skin temp from SNS blockade and associted incraes in blood flow from the relative increase in PNS activity
11
Q
waht does LASER stand for?
A
light
amplification
stimulated
emission
radiation
12
Q
what three things are unique about lasers?
A
monchromatic
coherent
collimated
13
Q
long laser wavelengths penetrate deep or shallow? why?
A
long wavelength absorb more water so the do NOT pentrate deep
14
Q
short laser wavelengths penetrate deep or shallow? why?
A
short wavelengths absorb less water and penetrate deep
15
Q
CO2 laser can damage what part of the eye?
A
cornea
16
Q
lasers besides CO2 can damge what part of the eyee?
A
retina
17
Q
what color proteective lense for each kind of laser?
A
CO2 clear
Nd:YAG Green
Ruby Red
Argon Amber
18
Q
is laser refelctive tape reccomended?
A
not anymore
19
Q
what laser resistent tube is best for CO2 laser?
A
laser flex
20
Q
what laser resistent tube is best for Nd:YAG?
A
lasertubus
21
Q
what is used to cool laser tip and what is the clincal implication?
A
gas may be used to cool the tip, this creates risk for gas emoblus espcially during laparascopic uterine surgery.
22
Q
do laserresistent tubes reduce risk of fire with electrocautery?
A
no
23
Q
laser eye protection points for patients?
A
avodi petroleum based lubes
cover eyers with saline soaked gauze
24
Q
CO2 laser typically used for?
A
orpharyngeal and vocal cord surgery
25
Nd:YAG laser usually used for?
tumor debulking and tracheal surgery
26
Ruby laser usualy used for?
retinal surgery
27
Argon laser usually used for?
vascular surgery
28
1st 2nd 3rd and 4th degree burn layers damaged
1st only epidermis
2nd epidermis and into dermis
3rd complete destruction of epidermis and dermis
4th extends to muscle and bone
29
fluid loss after burn is greatest when? when does it start to stabilize?
greatest in first 12 hours, starts to stabilize by 24hrs
30
should you give albumin during first 24hrs after burn?
no, it is lost to the interstitial space
31
what fluids to use in burns
LR for the first 24hrs and then use D5w
32
hemolysis is common during initial stage of burn, but patients can still be hemoconcentrated. why?
the profound hypovolemia promotes hemoconcentration
33
increasing Hgb during first few days after burn is suggestive of what?
inadequate volume resuscitation
34
tranfusion trigger in burn patients
Hgb <20 or <30 if hx of CV disease
35
parkland formula and modified brooke formula
4ml x %BSA x Kg
1/2 in first 8hrs, 2nd half in next 18hrs
modified brooke is 2ml instead of 4
36
how does myoglobin affect the kidneys?
it is nephrotoxic
37
how do electrical burn affect the body?
little damage on skin but lots of internal damage
38
what is somethign that can cause abdominal compartment syndrome in burns?
aggresive fluid resuscitation
39
Increaesd intraabdominal pressure is pressure > ?
>20
40
CO binds Hgb how much more than O2?
200x
41
FiO2 priority in burns?
high FiO2 is priority in all burns
42
how should NDNMB dose be altered in burns?
incrased because they have more receptors
43
absolute contraindications to ECT?
pheo
unstable c-spine
MI in past 4-6months
brain tumor
stroke in last 3 months
44
relative CI to ECT
pregnancy
pacemaker
CHF
glaucoma
45
best response from ECT if seizure is longer than?
25seconds
46
what is tonoic phase?
stiff
47
what is clonic phase?
jerking
48
how does lithium affect paralytics?
prolongs both sux and NDNMBs
49
what causes neuroleptic malignant syndrome?
dopamine depletion in basal ganglia or hypothalamus
50
neuroleptic malignant syndrome tx?
dantrolene and bromocriptine
51
serotonin syndrome tx
cryohepatadine
52
anticholinergic poising tx
physostigmine
53
what can cause anticholinergic poising?
centrally acting anticholinergics like atropine and scopolamine
54
do MH serotonin syndrome and NMS all have muscle rigidity?
yes
55
is NMS acute?
no
56
any genetic link in NMS?
no
57
how can you treat NMS?
paralyitic???
58
normal intraocular pressure
10-20
59
^IOP with open globe injry can cause...
permanent blindness
60
how does sux affect IOP?
increase IOP 5-15 for up to 10min
61
okay to use suz with open globe injury and full stomach?
yes
62
what is glaucoma?
chronic incrased IOP > retinal artery compression
63
what is strabismus surgery for?
correct visual axis
64
eye surgery with high risk of PONV?
strabismus surgery
65
two drugs that decrease aqueous humor production?
acetazolamide
timolol
66
drugs that increase aqueous humor drainage
echothiopate
67
consideration to be aware of with ecothiopate?
can prolong sux and exter LAs
68
N20 considerations with eye bubbles
DC N20 for 15min before SF6
avoid N20 7-10 days after SF6
other bubbles avoid N20 for
silicone: 0 days
air bubble: 5 days
perfluropropane: 30days
69
Tap blocks targer what dermatomal distribution?
T9-T11
70
risk of TAP block I dont think about very often?
liver hematoma
71
allodynia is what?
pain from stimulus that is not normally painful
72
what is dysethesia?
abnormal or unpleasant sense of touch
73
what is nerualgia?
pain localized to a specific dermatome
74
what is neuropathy?
impaired nerve function
75
phamtom limb pain is what?
neuropathic pain
76
biggest SE from TCAs
QT prolongation and orthostatic hypotension
77
with is CRPS
neuropathic pain with autonomic invovlevement
78
which type of CRPS is always preceded by nerve injury
Type 2
79
celiac plexus block is good for?
cancer pain of upper abdomindal organs
80
how an retrobulbar block cause apnea? how soon will this happen? how long until recovery?
LA can reach brainstem causing apnea
apnea occurs 2-5min after injection
spon ventilation may return in 15-20min but could take up to an hour
81
sup hypogastricc block is good for?
cancer pain of pelvic organs
82
what should you do right before retrobulbar block? why?
assess contralateral pupil, if it dilates shortly after teh block you should anticipate apnea
83
most common SE of prophylactic ABX use
psuedomembranous colitis
84
allergic reaction from ABX is most common with which kind of ABX?
beta-lactams
85
when is anceg okay in pt with penicillin allergy?
as long as it was not IgE mediated meaning no anaphylaxis, bronchospasm, or urticaria. Or steveons johnsons syndrome (exfoliative dermatitis)
86
alternate for ANCEF?
clindamycin or vanco
87
what ABX are CI in pregnancy?
chloromphenicol
erythromycin
fluoroquinolones
tetracyclines
88
name the beta lactams
penicillin
cephalosporin
ampicillin
89
most common source of blood stream infection in hospitalized patient?
CVC
90
colorectal patients need temp above what in pacu? why?
>36 degrees for infection prevention
91
how long do alcohol based products dry?
at least 2 min
92
other parts of body TB can infect?
brain, kidney, joints, GI tract
93
what should you do if putting pt with TB under GA?
HEPA filters and bacterial filter on the expiratory limb
94
name the granuolocytes and their function
neutrophils: immune defense
basophils: essentila component of allergic reaction
eosinophils: immune defense against parasites
95
name the a-granulocyts and their functions
monocytes: immune defense
lymphocyts:
B cells: humoral immunity
T cells: cellular immunity
NK: limit spread of tumor and microbial cells
96
Type 1 Hypersensitivity rxn
anaphylaxis and extrinsic astham
IgE mediated
97
type 2 hypersensitivity reaction
antibody mediated for example ABO incompatability
IgG and IgM mediated
98
type 3 hypersensitivity reaction
immune complex mediated i.e snake venom rxn
99
type 4 hypersensitivity reaction
delayed contact dematitis
100
anaphylaxis tx
dc offendign agent
epi
H1 and H2 blockers
hydrocortisoine 250mg
albuterol for bronchospasm
vasopression for refractory HoTN
101
three benefits of epi in anaphylaxis?
prevents degranulation
CV support
bronchodilation
102
epi dose for anaphylaxis
start with 5-10mcg,
100mcg - 1mg for CV collapse
103
allergic reactions to meds are most likley from?
1. NMBS
2. latex
3. ABX
104
whta two meds are bad in cancer?
VAs and opioids
105
what secretes gastrin and what does it do?
G cells in stimulates pepsinogen secretion
106
what secretes secretin and what does it do?
S cells
stimulates pancrease to secrete bicarb
stimulates liver to secret bile
107
what secretes cholecystokinin and what does it do?
I cells makes gallbladder contract
stimulates pancrease to secrete digestive enzymes
108
what secretes gastric inhibitory peptide and what does it do?
K cells
slows gastric emptying
stimulates pancrase to release insulin
109
what secretes somatostatin and what does it do?
D cells
universal off switch
110
how to anticholinergic affect barrier pressure?
decrease barrier pressure
111
risk of dopamine antagonists?
extrapyramidal side effects
112
list some antidopaminergics
butyrophenones (droperidol_
phenothiazines
metoclopramide
113
motion induced nause is from what receptors?
H1 and M1 receptors in the inner ear
114
s/s of BCIS
bradycardia, dysrhythmias, systemic HoTN, PHTN, hypoxia, cardiac arrest
115
s/s fat embolic syndrome
resp insuficency
neurologic changes
petechial rash
116
what ot know about tourniquets in ortho
max time is 2hrs
UE 70-90 >SBP
LE 2x SBP
117
what to know about tourniquet for beir blocks
must stay on for at least 20min after block
UE 250 or 100 >SBP
LE 350-400
118
s/s tourniquet pain
HTN and tachycardia
cant treat with pain meds
consider esmolol if pt has CAD
119
which surgery has the highest risk of BCIS?
Hip
120
what neve fibers transmit tourniquet pain?
C fibers (slow pain)
121
side effects of drugs that inhibit COX 1
platelet dysfuncion
decreased renal blood flow
gastric irritation
122
COX2 selective drugs do what?
decrease pain fever and inflammation
123
30 ketorolac is = to how much morphine?
10mg
124
how many days in a rwo an you take ketorolac?
5 days is the max
125
are teh G herbals CI to neuraxial anesthesia?
No, not if they are not taking any other blood thiners
126
two herbals that decrase MAC?
kava kava
valerian
127
ideally stop herbals for how long before surgery?
2 weeks
128
number one cause of anesthetic mortality?
human error
129
safey rates by ASA status out of 10,000
1 0.04
2 0.5
3 2.7
4 5.5
130
close claimes info
regional 20%
resp events 17%
CV events 13%
equipment failure 10%
131
MRI zones
1hallway outside MRI suite
2 entrance to MRI suite
3 control room
4 scanner
132
what metals are safe in MRI?
stainless steel
aluminum
copper
133
what min modified aldrete score to be discharged from PACU?
9
134
opiods inhibit what immune cells?
natural killer cells
135
what syndrome can increase gastrin secretion?
zollinger-ellision syndrome
