Oral Board SOE high yield Flashcards by Matthew Vengalil

Can you dart the patient…

IM ketamine (5mg/kg)
or IM precedex (2mcg/kg)
or IM midazolam (0.1mg/kg)

How well did you know this?

Not at all

Perfectly

Sodium Nitroprusside toxicity

Think: cyanide toxicity (prevent cells from using O2)…give Vitamin B12

How well did you know this?

Not at all

Perfectly

Neonatal extubation critiera

TV 6cc/kg
RR 30-40
O2 sat 90%, 50% FiO2, PEEP 5
Awake, reflexes intact

How well did you know this?

Not at all

Perfectly

Neonatal vent settings

-O2 sat >90% (no hyperoxia)
-RR 30-40
-PIP <25

How well did you know this?

Not at all

Perfectly

Neonatal vitals

HR: 120-160
BP: 80 and 60/30
O2 sat: 95% in newborn, 90% in premies
RR: 40-60

How well did you know this?

Not at all

Perfectly

Tetralogy of Fallot…how to induce

Slow controlled IV induction…less control with mask induction (could overly reduce SVR)

Any R to L shunt…have preductal and postductal monitors

How well did you know this?

Not at all

Perfectly

CDH

Assume RTL shunt until proven otherwise

For preop management
: follow preductal sat

Intubation:
AFOI, vs RSI

Monitors:
Central line, including umbilical vein catheter
Pre and post ductal pulse ox

How well did you know this?

Not at all

Perfectly

Thoracic PFTs…predictors of badness

FEV1<30%
DLCO<40%
VO2 max <10cc/kg/min
***
May should not do surgery

Predictors of need for postop ventilation
-FEV1 <2L
-MMEFR (maximal mid expiratory flow rate)<50%

How well did you know this?

Not at all

Perfectly

Thoracic primer: complications

-Cardiac herniation
-PTX
-Broncho-pleural fistula
-RHF (2/2 chronic hypoxia, pHTN)
-Post-op afib (from stress of surgery, fluids, manipulation of the heart)

How well did you know this?

Not at all

Perfectly

Heart transplant…how to preverse roc

Give glyco with neostigmine as there is some cardiac reinveration over time + want to reverse other effects of neostigmine

How well did you know this?

Not at all

Perfectly

Washing out aspirin and plavix

Aspirin: 10 days
Plavix: 7 days

How well did you know this?

Not at all

Perfectly

OLV goals

-PEEP 5 to 10
-TV 5cc/kg
-Pplt <25-30

How well did you know this?

Not at all

Perfectly

TEF…don’t forget

VACTERL

How well did you know this?

Not at all

Perfectly

ESOPHAGECTOMY

Epidural + OLV

How well did you know this?

Not at all

Perfectly

Premie considerations

Neuro: IVH, retinopathy of prematuirty
Cards: cardiac anomalies,
Pulm: respiratory insufficency, RDS, postop apnea
GI: necrotizing enterocolitis
GU: AKI
MSK: hypothermia
Endocrine: Hypoglycemia

How well did you know this?

Not at all

Perfectly

Ligation of PDA…how to maintain anesthesia…

Low dose gas (0.2-0.3 MAC gas), remi gtt, some fentanyl/dilaudid at end of case

How well did you know this?

Not at all

Perfectly

vWF undifferentiated bleeding

Give** humate P** (vWF-Factor 8 concentrate)

How well did you know this?

Not at all

Perfectly

Neuro monitoring…

Usually: EEG, SSEP, MEP, EMG
For aneurysm: EEG, SSEP (have to paralyze)

How well did you know this?

Not at all

Perfectly

Larson’s maneuver

Jaw thrust + firm pressure behind the earlobes…to break laryngospasm

How well did you know this?

Not at all

Perfectly

SVC compression

Must get lower extremity IV access
Consider AFOI

How well did you know this?

Not at all

Perfectly

Mediastinoscopy…and A line

Only time you need to consider L aline…but have RUE pulse ox

Cystic fibrosis…organ involvement

Lungs: bronchiectasis, PTX
GI: diabetes, meconium ileus
Heme: coagulopathy

Carotid endarterectomy…monitors/wakeup..unique consideration

If asleep: EEG, SSEP, cerebral oximeter
Wakeup: consider TIVA for smooth wakeup

Unique considerations: cerebral hyperperfusion syndrome

Carotid sinus vs Carotid Body

Carotid Sinus: related to HR/BP

Body: resp drive

BLocks

Don't forget to check coags...confirm laterality

Porphyria

Hematin...inhibits porphyrin synthesis

Dyspnea in a 4 yo...4 things

-URI -Foreign body aspiration -Asthma -Anaphylaxis

Carcinoid syndrome

-Avoid adrenergic agents (epi, ephedrine) -Treatment of crisis: octreotide, benadryl, fluids...AVOID epinperhine Premed: Octreotide at least a few days prior

Pheochromocytoma...what meds to avoid

Morphine/succinylcholine...may cause release of catechoalmines Premed: Alpha 1 blocker for a week, followed by beta blocker

Pyloric stenosis...induction plan

RSI vs AFOi...suction prior in multiple positions Medically optimize: euvolemic, pH 7.3-7.5, bicarb <30 Don't forget about postop apnea...<60 weeks is a risk

Severe AS

-Valve area under 1.0, transvalvular gradient >40 (subject to LV fxn, hemodynamics)

Pacemaker

Favor bipolar cautery

Epi dosing for bradycardia

2-10mcg/min gtt

Neonatal Resuscitation

-Supplemental O2 per preductal oxygen level -Epi 0.01mg/kg

Stellate Ganglion Block SOB ddx

-Phrenic nerve palsy -LAST -Epidural/spinal injection

Sick Euthyroid

Nl TSH, low T3, T4

Thyroid surgery and ETT

-Need an ETT with nerve monitoring capabilities -Potentially an armored ETT for compression -TIVA for maintenance (smooth wakeup, for nerve monitoring)

Thyroidectomy, stridor in PACU

-Hypocalcemia -Hematoma -B/l recurrent laryngeal nerve injury -Airway edema -Upper airway obstruction

Aprepitant MOA

Neurokinin antagonist

How to wean off bypass?

-Rewarm the patient (give midaz) -Correct anemia -Correct electrolyte derangement, give mag and calcium -TEE to guide preload, afterload, inotropy -Reinitiate lung ventilation -Pacer and pads for chronotropy, arrhythmia

Anterior Mediastinal Mass: How to approach airway

-Awake fiberoptic, that way can assess level of compression, get tube distal (may even have to advance to patent bronchus)

Anterior Mediastinal Mass: Airway Attempted, running into issues...ddx

Apnea Laryngospasm Bronchospasm Mass Compression

Tet spell, physiology...Tetralogy of Fallot

-Increased RV outflow obstruction -Decreased SVR * Txt: -increase SVR (knees to chest) -esmolol to decrease inotropy (relieve RV outflow obstruction)

Pediatric CPR

epi 0.01mg/kg Compression rate, like adults, is 100-120 (vs neonatal is 120)

Anesthesia machine: how do you do a machine check

-Check monitors -Calibrate CO2 and O2-analyzers -Check for leaks in the high and low-pressure system -Confirm adequate CO2 absorbent

Sevoflurane vs desflurane vaporizer

Sevoflurane is a **variable-bypass vaporizer...** a variable amount of fresh gas flow mixes with the volatile agent Desflurane is a gas-vapor blender

CABG heparin dosing

300units/kg ACT>400

Neonate and fluid

Should always have D5 1/2 NS maintenance going...no fat stores, high risk for hypoglycemia

vWF and epidural placement

-vWF and Factor 8 level should be 80% -If needed, give DDAVP or replacement

TEG

Prolonged R->give FFP Prolonged K/decreased alpha angle->give cryoprecipitate Short MA->give platelets Rapid loss of amplitude->give TXA