Non Chem Flashcards
(176 cards)
1
Q
How does hypothermia effect SNS?
A
Stimulates it (risk for MI and dysrhythmias)
2
Q
How does hypothermia effect OxyHgb Curve ?
A
Shifts it to the left (decreased O2 delivery to cells)
3
Q
How does hypothermia effect vasoconstriction and tissue oxygenation?
A
Causes vasoconstriction and decreases PO2 (surgical site infection)
4
Q
How does hypothermia effect coagulation and plt?
A
Causes coagulopathy and Plt dysfunction (Increased blood loss)
5
Q
How does hypothermia effect Hgb S?
A
Causes sickling (risk for sickle cell crisis)
6
Q
How does hypothermia effect drug metabolism?
A
Slows it down (prolongs effects)
7
Q
How does hypothermia effect solubility of volatile agents?
A
increases (prolongs emergence)
8
Q
How much does shivering increase O2 consumption?
A
500% (increased risk for MI or infarction)
9
Q
What drugs can be used for shivering?
A
Meperidine (kappa)
Clonidine (alpha-2)
Precedex (alpha-2)
10
Q
Is hypothermia good?
A
It can be. Decreasing O2 consumption by 5% for every 1 degree of C reduction)
11
Q
Where should an esophageal temp probe be placed?
A
Distal 1/3 or 40cm past incisors
If it’s too distal then increased temp from stomach
If it’s too proximal then decreased temp for cool inspiratory gas
12
Q
What is probably the best location to measure temperature? Second best ?
A
Pulmonary artery
Tympanic membrane due to close to carotid artery supply
13
Q
The skin is usually how many degrees less than core temp?
A
2-4 degrees C
14
Q
If the skin temperature rises after a regional block, what does this mean? Good or bad?
A
This means the block is working and is good. Due to increased rise in peripheral blood flow
15
Q
What three things are required for an airway fire to occur?
A
Fuel
Oxidizer
Ignition source
16
Q
Examples of a fuel source for an airway fire?
A
Anything that burns
ET tube
Drapes
Surgical supplies
17
Q
Examples of an oxidizer source for an airway fire?
A
O2
Nitrous
18
Q
Examples of a ignition source for an airway fire?
A
Cautery
Laser
19
Q
What is the first step with an airway fire?
A
Stop ventilation and remove ETT
20
Q
What is the second step with an airway fire?
A
Stop flow of all gasses
21
Q
What are the steps in an airway fire?
A
- Stop ventilation and remove ETT
- Stop flow of all gases
- Remove all flammable materials
- Pour water or saline on fire
- Use CO2 fire extinguishers
22
Q
After the airway fire is extinguished, what are the next steps?
A
- Re-establish airway
- Check ETT for fragments that may remain
- Bronch to assess damage
23
Q
What does laser stand for?
A
Light
Amplification
Stimulated
Emission
Radiation
24
Q
Why is a laser different?
A
Monochromatic - one wavelength
Coherent - oscillates in the same phase
Collimated - narrow parallel beam
25
Difference in short vs long wavelength?
Long wavelengths absorb more water and do not penetrate deep into tissue
Short - absorb less and do penetrate deep
26
What is at risk for short vs long wavelength?
Short - retina is at risk
Long - Cornea is at risk
27
How to remember what goggles must be worn for each laser?
Co2 = Clear
Ruby = Red
Argon = Amber
nd:yaG = Green
28
Are most ET tubes flammable?
Yes
29
Is laser reflective tape used?
Not anymore = better to use laser resistant ETT
30
Are laser resistant ETTs, laser proof?
NO
31
What is the most vulnerable part of an ETT tube?
The cuff
32
Does filling the ETT cuff with saline help prevent fires?
Yes - by asboring thermal energy
33
Do laser resistant ETT reduce the risk of fire when cautery is used?
NO
34
How many cuffs to laser resistant ETTs have? Why?
Two - if the first one ruptures hopefully the surgeon can see the saline spill out
35
Burn image
36
Which burns do not have pain?
3rd and 4th degree do not have pain
37
Which type of burns need skin grafts?
2nd degree deep and greater -
2nd degree deep
3rd degree
4th degree
38
What is the rule of 9 with burns?
39
How is the rule of 9 different with children? What ages?
40
Immediately after a burn, does microvascular permeability increase or decrease ?
Increases - which creates a capillary leak which leads to edema
41
How do burns effect plasma proteins and oncotic pressure?
Loss of plasma proteins leads to decreased oncotic pressure which leads to edema
42
How do burns effect intravascular volume?
Loss of intravascular volume leads to hypovolemia and shock
43
Does hypovolemia cause hemodilution or hemoconcentration?
Hemoconcentration (less fluid to diluate Heme)
44
When are fluid shifts and edema greatest during burns?
First 12 hours then stabilize by 24 hours
45
Should albumin be given in the first 24 hours of a burn?
No because it is lost to interstitial space
46
What does a rising Hgb in the first few days of a burn indicate?
Inadequate volume resuscitation
47
When should transfusion be considered on a healthy patient after a burn? What about someone with pre-existing heart disease?
Hct < 20 for healthy
Hct < 30 for disease
48
What is the parkland formula for resuscitation for burns? First 24 hours? Second 24 hours?
49
What are acceptable urine output goals for an adult with a burn? What about a child?
Adult - >0.5mL/kg/hr
Child - >1mL/kg/hr
50
What are the urine output goals for high voltage electrical injury? Why?
>1-1.5mL/kg/hr
Because of myoglobinuria released from excessive muscle damage. It is a nephrotoxin that needs to be flushed out
51
Is a burn patient at risk for abdominal compartment syndrome? What is the diagnosis and treatment?
Yes - from aggressive fluid resuscitation
Decompression via laparotomy
NMB blockage
Sedation
Diuresis
52
What are the parameters for intra-abdominal HTN?
IAP > 20
or
>12 with evidence or organ dysfunction
53
What rate does CO bind to Hgb when compared to O2? Which way is the Hgb OxyHgb curve shift?
200 times more
Shifts left - resulting in impaired O2 offloading
54
Which type of pH imbalance occurs with Carbon monoxide poisoning?
Metabolic acidosis
55
What is the treatment for Carbon monoxide poisoning?
Hyperbaric or 100% O2
56
What will the SpO2 read with Carbon monoxide poisoning?
Falsey elevated because it cannot distinguish between the two
57
Is oxidative phosphorylation impaired with Carbon monoxide poisoning?
Yes
58
Can NMB be used in burns?
Succ can be in the first 24 hours but not after due to risk of lethal hyperkalemia
Non depolarizing can be
59
Does non depolarizing NMBs be used in burns? Do you need more or less? Why?
Need more due to upregulation after the first 24 hours
2-3x more drug needed due to more receptors
60
What is the first and second response of ECT treatment? PNS vs SNS?
1st - Increased PNS (15 seconds)
2nd - Increased SNS for several minutes
61
ECT phases photo
62
What are absolute contraindications to ECT?
MI < 6 months ago
Intracranial surgery < 3 months ago
Stroke < 3 months
Brain tumor
Unstable C spine
Pheochromocytoma
63
Is pregnancy and severe pulmonary disease a relative or absolute contraindication to ECT?
Relative
64
What is neuroleptic malignant syndrome? Causes ?
Depletion of dopamine in the basal ganglia and hypothalamus
Dopamine antagonists or withdrawal form dopamine agonists
65
Treatment for neuroleptic malignant syndrome?
Bromocriptine
Dantrolene
Supportive care
ECT
66
MH vs NMS, genetic link?
Just MH
67
MH vs NMS, develops acutely?
Just MH
68
MH vs NMS, associated with psych meds?
Just NMS
69
MH vs NMS, muscle rigidity, hyperthermia, tachycardia, acidosis?
Both
70
MH vs NMS, treat with dantrolene?
Both
71
MH vs NMS, effect if NMB?
NMS - causes paralysis
MH - does not
72
What is serotonin syndrome? Which drugs increase the risk?
Excess 5-HT activity in the CNS and PNS
1. SSRI
also
Meperidine
Fentanyl
Methylene blue
73
Normal intraocular pressure? How is it determined?
IOP - 10 to 20
Choroidal blood volume
Aqueous fluid
Extraocular muscle tone
74
What produces aqueous humor?
Ciliary process in the posterior chamber
75
How is aqueous humor reabsorbed?
Canal of Schlemm in the anterior chamber
76
Factors of IOP
77
Does LMA placement or removal effect IOP?
Not really
78
Should Ketamine be given in eye surgeries? Does it increase IOP?
Might increase IOP but unsure
Don't give because it may cause nystagmus and blepharospasm
79
What causes Glaucoma?
Elevated IOP pressure that leads to retinal artery compression
80
What causes closed angle glaucoma?
Closure of anterior chamber and creates a mechanical outflow obstruction
81
What causes open angle glaucoma?
Sclerosis of trabecular meshwork that impairs aqueous humor drainage
82
Which drugs decrease aqueous humor production?
Acetazolamide - inhibits carbonic anhydrase
Timolol - Nonselective beta antagonist
83
Which drugs increase aqueous humor drainage?
Echothiopate - irreversible cholinesterase inhibitor
Can prolong duration of succ
84
What is strabismus surgery and what are the risks?
Corrects misalignment of extraocular muscles
-Increased PONV
-Increased risk of oculocardiac reflex (CN5+CN10)
85
What type of TAP block is required for a midline incision
or laparoscopic surgery ?
Bilateral
86
What are TAP blocks best suited for?
Abdominal that involves T9 - L1
87
What are the layers of a TAP block?
Subq
External oblique
Internal oblique
Transverse abdominis
Peritoneum
88
What are the landmarks of a TAP block that create the triangle of Petit?
External Oblique
Internal Oblique
Iliac crest
89
What is allodynia and what is an example?
- Pain due to a stimulus that does not normally produce pain
Fibromyalgia
90
What is dysesthesia and what is an example?
Abnormal or unpleasant sense of touch
Burning from diabetic neuropathy
91
What is neuralgia and what is an example?
Localized pain to a dermatome
Herpes zoster (shingles)
92
What are the defining characteristics of type 1 and type 2 complex regional pain syndrome?
Type 1 - reflex sympathetic dystrophy
Type 2 - causalgia
Neuropathic pain with autonomic involvement.
TYPE 2 is ALWAYS preceded by nerve injury where type 1 is not
93
Where is local injected for a thoracic paravertebral block? What does it target?
Into the paravertebral space which is a potential space
Targets the ventral ramus of the spinal nerve
94
How many dermatomes does a paravertebral block target?
One dermatome - it is a single shot block.
Need to perform one injection for each dermatome level
95
What surgeries are paravertebral blocks good for?
Breast
Thoracotomy
Rib fracture
96
What structures does a celiac plexus block? What type of patients?
It innervates the upper abdominal viscera except the left sign of the colon
Good for cancer
97
What does a celiac plexus block NOT innervate?
Pelvic organs
Good for
98
Which nerve innervates the pelvic organs? What type of patients?
Superior hypogastric plexus block
Good for cancer patients
99
What are the two treatments for a post-Dural punctures headache?
1. Epidural blood patch
2. Sphenopalatine block
100
What causes post-retrobulbar block syndrome?
The optic nerve is apart of the CNS unlike other CN
It is enveloped by a meningeal sheath and bathed CSF which permits it to drain directly into the brain
101
Can a PCN allergic patient receive cephalosporins?
Yes if;
1. Was not an IgE mediated response (anaphylaxis, bronchospasm, urticaria)
2. Did not produce exfoliative dermatitis (Stevens-Johnson syndrome)
102
What antibiotics are good alternatives to a patient with a PCN allergy and cephalosporins?
Vanco or clinda
103
Which antibiotic is used to treat MRSA? How should it be given?
Vanco
In order to reduce histamine release -
Give it slow over 1 hour, give Benadryl and cimetidine
104
What is the most common cause of HIV exposure in healthcare? What are the odds?
Needle stick with hollow bore needle
1. Percutaneous injury (needle stick) - 0.3%
2. Mucous membrane exposure - 0.09%
105
How many types of WBC are there? Most abundant type?
5
Neutrophils - 60% of all WBC
106
What are neutrophils? What do they do?
WBC that fights bacterial and fungal infections
107
What WBC is the primary component to hypersensitivity reactions?
Basophils
108
What are basophils?
WBC
Release histamine, serotonin, heparin, bradykinin
Epi prevents degranulation by binding to beta-2 receptors
109
What are Eosinophils?
WBC
Fight against parasites
110
What are monocytes?
WBC
Release cytokines and perform phagocytosis
Present pathogens to T lymphocytes
111
What are lymphocytes?
WBC
B cell
T cell
112
What type of immunity are B lymphocytes ? Do they produce antibodies?
Humoral immunity - DO produce antibodies
113
What type of immunity are T lymphocytes ? Do they produce antibodies?
Cell mediated immunity - do not produce antibodies
114
How does the GI system respond to anaphylaxis?
Cramping
N/V
Diarrhea
115
How does the skin system respond to anaphylaxis?
Flushing
Urticaria (hives)
Erythema
Pruritus
116
How does the CV system respond to anaphylaxis?
Hypotension
Tachycardia
Arrhythmia
Cardiac arrest
117
How does the respiratory system respond to anaphylaxis?
Bronchospasm
Laryngeal edema
Mucus production
118
With a bronchospasm, what will be seen with ETCO2, SaO2, and PIP?
EtCO2 - Decreased
SaO2 - Decreased
PIP - increased
119
Does anaphylaxis require a prior exposure or cross sensitivity
Yes
120
Does anaphylactoid reactions require a prior exposure or cross sensitivity
No
121
What does the H1 receptor do?
-Vasodilation
-Increased vascular permeability
-Smooth muscle contraction (not vascular)
122
What does the H2 receptor do?
- Tachycardia
- Increased gastric acid secretion
123
What are two arachidonic acid metabolites? What do they cause the body to do?
leukotrienes and prostaglandins
Produce bronchoconstriction and vasodilation
124
How many types of hypersensitivity reactions are there?
4
125
What is type 1 hypersensitivity reaction? Ex?
- Immediate hypersensitivity
(antigen+ previous exposure to antibody)
Ex: anaphylaxis, extrinsic asthma
126
What is type 2 hypersensitivity reaction? Ex?
Antibody mediated
(IgG and IgM antibodies bind to cell surfaces)
Ex ABO- incompatibility or HIT
127
What is type 3 hypersensitivity reaction? Ex?
Immune complex is formed outside the body then placed inside
Ex: snake venom or protamine
128
What is type 4 hypersensitivity reaction? Ex?
Delayed - 12 hours after exposure
Ex: Graft vs Host, Contact dermatitis, Tissue rejection
129
First step for treatment of intraoperative anaphylaxis?
D/C offending agent
130
Steps for treatment of intraoperative anaphylaxis?
1. D/C offending agent
2. Airway support
3. Epi
4. IV hydration
5. H1 antagonist
6. H2 antagonist
7. Hydrocortisone
8. Albuterol for bronchospasm
9. Vasopressin
131
Epi dose for anaphylaxis?
5-10mcg for hypotension
.1-1mg for CV collapse
132
Example and dose of H1 antagonist? H2?
Benadryl - 1mg/kg
Ranitidine - 50mg
or
Famotidine 20mg
133
What are the three most common causes of intraoperative anaphylaxis?
1. NMB (succ #1)
2. Latex
3. Antibiotics
134
Highest risk groups for latex allergy?
Spina bifida/myelomeningocele
Atopy
Health care workers
Food allergy to banana, kiwi, papaya, pineapple, tomato
135
Chemo man
136
What is gastrin? What does it do?
Responds to food entering the stomach
Stimulates chief cells to secrete pepsinogen which is converted to pepsin in the presence of stomach acid
137
What is secretin? What does it do?
Tells the pancreas to secrete bicarb and the liver to secrete bile
138
What is cholecystokinin? What does it do?
Tells the pancreas to release digestive enzymes and the gallbladder to contract
139
What is gastric inhibitor peptide? What does it do?
Slows gastric emptying and stimulates pancreatic insulin release
140
What is somatostatin? What does it do?
Universal OFF switch
141
What is gastric barrier pressure? How is it determined?
The higher the barrier pressure, the lower likelihood of reflex
=LES pressure - intragastric pressure
142
Where does the vomiting center reside? What are the three most common inputs?
Medulla (nucleus tractus solitarius)
1. CTZ
2. GI tract
3. Vestibular system
143
What is the mechanism of NK-1 antagonists? Ex?
They block substance P in the CTZ
Ex: Aprepitant
144
Pathways of GI tract for PONV?
5-HT3
NK-1
145
Pathways of CTZ for PONV?
5-HT2
NK-1
DA-2
Noxious chemicals
146
Pathways of vestibular for PONV?
H1
M1
147
What are the main risks for PONV?
Female
Nonsmoker
History of PONV
History of motion sickness
Youth
148
Which procedures increase PONV?
Over an hour
GYN
Laparoscopy
Breast
Plastics
Peds
149
Which drugs increase PONV?
Halogenated anesthetics
Nitrous > 50%
Opioids
Etomidate
Neostigmine
150
Which two antiemetics prolong QT?
Droperidol and zofran
151
Two contraindications for Reglan?
Dopamine antagonist which is contraindicated in Parkinson's
Prokinetic agent - Avoid in bowel obstruction
152
Where is the P6 acupressure point for reducing PONV?
153
How long must a Bier block be inflated for? Why?
At least 20 minutes or else risk for seizure and cardiac arrest
154
Bier block pressures for UE and LE?
UE - 250mmHg or 100mmHG over SBP
LE - 350mmgHG or 2x over SBP
(Which ever is higher)
155
Does releasing a tourniquet cause hyper or hypotension?
Hypotension due to the reperfusion of the extremity
156
Does releasing a tourniquet cause an increase or decrease in end tidal?
Increased due to the products of cellular hypoxia being brought back into circulation
157
Does releasing a tourniquet cause an increased or decreased in core body temperature?
Causes decreased Core body temperature
158
Does releasing a tourniquet cause metabolic acidosis or alkalosis?
Metabolic acidosis
159
How does releasing a tourniquet effect SvO2 and SaO2?
Usually just decreased SvO2
160
Is COX 1 or COX 2 always present?
COX 1 is always present to maintain normal physiologic function
161
When is COX2 expressed?
During inflammation
162
Is there a ceiling effect to COX inhibitors? What about opioids?
COX inhibitors has a ceiling effect where opioids do not
163
What suffix do COX2 inhibitors end in?
"Coxib"
Celecoxib
164
COX1 or COX2, impairs Plt function, reduces renal blood flow, and causes gastric irritation?
COX1
165
COX1 or COX2, causes analgesia, anti-inflammatory, and antipyretic effects?
COX2
166
Are there specific COX1 inhibitors?
No
167
COX photo
168
What is the precursor to COX 1 and COX 2?
Arachidonic Acid which comes from phospholipids and phospholipase A2
169
How much Ketorolac is equal to 10mg morphine?
30mg
170
What is Samter's triad? Why is it important?
Aspirin exacerbated respiratory disease
1. Asthma
2. Allergic rhinitis
3. Nasal polyps
**May lead to bronchospasm after giving aspirin
171
Which 4 supplements may lead to bleeding?
Garlic
Ginger
Gingko biloba
Saw palmetto
172
Which 2 supplements reduce MAC?
Kava Kava
Valerian
173
Which herbal medication can mimic Conn's?
Licorice
174
What is the Alderete score? Which score is safe for discharge?
Assesses readiness for D/C from PACU
9 or higher can be D/C
175
Alderete Scoring photo
176
