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Flashcards in PBR1 Deck (71):
1

TRALI blood labs

transient leukopenia and thrombocytopenia 2/2 pulmonary sequestration

2

EMLA drug interactions

lido/prilocaine (methgb) known history of sensitivity to amide LA, class I anti-arrhythmic drugs (tocainide and mexiletine) - toxic effects are additive/synergistic

3

vasopressin effects

cause systemic vasoconstriction via systemic V1 and cause pulmonary vasodilation via pulmonary V1

4

NO side effects

methgb, inhibit platelet function, inactivate surfactant, cytotoxic, immunosuppressant, mutagenesis, rebound pHTN

5

factors increasing energy expenditure

elective surgery, sepsis, >60% burn, long bone injuries

6

DDAVP contraindications

type 2b vWF disease because it increases abnormal vWF and may lead to thrombocytopenia

7

treatment of intrathecal pruritis

not antihistamines as histamine is not the cause of pruritis with intrathecal opioids

8

fasting requirements

clear fluids 2 hr, breast milk 4 hr, formula 6 hr, light meal 6 hr, heavy meal 8 hr

9

long context sensitive half life

thiopental > midaz, prop, etom, ketamine

10

factor XIII def labs

PT, PTT, TT, bleeding times all normal - diagnose with levels 1% of normal

11

vit k def

marked prolonged PT, prolonged PTT, normal TT and fibrinogen

12

factor VII def

prolonged PT, normal PTT, TT, fibrinogen

13

factor VIII and IX def

prolonged PTT, normal PT, TT, fibrinogen

14

CO2 absorbent CO production vs not

potassium/sodium hydroxide (abstracts proton from difluoromethoxy group on anesthetic) produce CO vs barium/calcium hydroxide do not

15

Blood gas partition coefficients

Desflurane 0.45
Nitrous Oxide 0.47
Sevoflurane 0.65
Isoflurane 1.4
Halothane 2.5

16

Tracheobronchomalacia

obstructive ventilatory defect resulting in a prolonged expiratory time (a decreased FEV1) and normal FVC, resulting in a decreased FEV1/FVC

17

Examples of restrictive lung disease

parallel reduction in FVC and FEV1 and normal or greater than normal FEV1/FVC; examples myasthenia, PNA, kyphoscoliosis, pulmonary edema

18

post-operative respiratory failure

Abdominal aortic anerurysm cases > thoracic surgery, neurosurgery, upper abdominal surgery and peripheral vascular surgery

19

addisons disease symptoms

adrenal insufficiency - low blood pressure, salt craving, weight loss, GI problems, muscle/joint pains, hyperpigmentation, low BP

20

addisons lab abnormalities

hyponatremia, hyperkalemia, hyperchloremia, acidosis

21

acetazolamide

inhibits carbonic anhydrase - decreases sodium bicarb reabsorption, hcl is reabsorbed, potassium is wasted, water also excreted

22

addisons causes

autoimmune most common in US, TB is most common worldwide

23

narcs to avoid in liver failure

morphine, meperedine (accumulates - CNS depressive effects), alfentanil (clearance decreased); fentanyl and sufentanil ok to give

24

albumin

make 15g a day, half life 20 days, percentage degraded daily is 4%

25

first abnormal coag test in liver failure

PT - usually reflects low VII (half life 4 hr -shortest) [fibrinogen half life 4 days]

26

prerenal labs

urine osm >450, serum osm 280-300 (urine to plasma osm ratio >1.5, urine sodium <35%

27

uremic and bleeding

DDAVP - given over 15-30 min IV, improves within 1 hr and lasts 4-24 hr, tachyphylaxis after 2nd dose (2/2 to depleted endothelial stores)

28

propofol infusion syndrome

after 48hrs of >4mg/kg/hr; acute refractory brady leading to asystole, metabolic acidosis, rhabdomyolysis, hyperlipidemia, cardiomyopathies, skeletal myopathy, hyperkalemia

29

AFE most common symptoms

cardiopulmonary arrest, hypotension, fetal compromise, pulmonary edema/ARDS

30

lidocaine and ECT

dose related decreases in duration of motor and seizure activity

31

ECT EKG changes

tachy, ST depression, T wave inversion (parasymp - brady, asystole, PACs/PVCs)

32

refeeding syndrome

result of hypophosphatemia 2/2 shift from fat to card metabolism -> ATP and 2,3 DPG depleted leading to impaired myocard contractility, CV collapse, resp failure, rhabdomyolysis, seizures, delirium

33

botulinum A mechanism

inhibits release of acetylcholine from presynaptic membrane of NMJ

34

IM NMBD

rocuronium

35

sacral hiatus

unfused laminae S4/5

36

contraindicated congenital long QT

amiodarone - prolongs QT interval

37

congenital long QT treatment

flecainide, mexiletine, nicorandil, beta blockers

38

FDA approved recombinant factor VII uses

bleeding patients with hemophilia A/B who have factor VII or IX inhibitors, patients with acquired hemophilia, patients with congenital factor VII def

39

tet spell treatment

fluid bolus to improve RV filling and pulm blood flow, morphine, IV beta blockers, phenylephrine

40

pregnancy pulmonary changes

FRC down 20%, Vt increase 40%, RR increase 15%, PaO2 increases 10%, VC unchanged

41

surfactant production starts

30 weeks, 34 weeks sufficient for extrauterine life

42

lowest PO2 of the body

coronary sinus with PO2 18-20

43

hypothyroid CV changes

decreased HR, contractility, SV, CO (prone to overdose with more soluble volatiles from increased alveolar rate), intravascular volume (mottled extreme from vasoconstriction)

44

hyperkalemia EKG progression

peaked T waves, wide QRS, prolonged PR, ST depression, sine wave, v fib, asystole

45

adrenal insufficiency labs

baseline cortisol below 15 mcg/dL and increase 34 (low prob of adrenal insuff)

46

H cylinders

6000-8000 L, high pressure system used for hospital wide gas, attached to manifold that reduces high pressure 2000 to 55, usually O2 (nitrous usually E)

47

maximum current leakage in OR

10 microamps

48

fibrillation current threshold

100 milliamps

49

cyanide poisoning treatment

sodium nitrite & amyl nitrite (create methgb which combines with cyanide to make cyanomethgb - nontoxic), hydroxycobalamin/B12, sodium thiosulfate (facilitates metabolic disposal of cyanide via kidneys)

50

ankylosing spondylitis ass prob

problem of spine, hips, shoulders, TMJ, AI, cardiac conduction abn, pleural effusions, HTN, CAD

51

ankylosing spondylitis and lung

increased FRC and RV due to fixation of ribs in inspiratory position

52

AI/MR anesthetic goals

relatively fast HR, increased preload, decreased afterload, maintenance of contractility and pulmonary vasc resistance

53

AI treatment

nifedipine and ACE-I can slow progression of AR and influence LV size - improve survival (bebat blocker relatively contraindicated)

54

potentiate NMB

magnesium, alkalosis, acidosis, hepatic dysfunction (not erythromycin)

55

testes block

T10-L2 2/2testes descending from abdomen near origin of kidney and upper ureter

56

hereditary angioedema treatment

C1 inhibitor concentrate is best prophylactic treatment, FFP can be given but may worsen attack, danazol used if started 5-7 days before procedure

57

tumescence lido max

0.1% lido with 1:1,000,000 epi max is 35 mg/kg (toxic level 5 mcg/ml)

58

a-a gradient

directly proportional to shunt, greater the shunt less likely hypoxemia will respond to increasing FiO2, indirectly proportional to MvO2, normal is <15, increases with age

59

rescue median blocks

antecubital crease medial to biceps insertion or at wrist medial and deep to palmaris longus tendon

60

radial rescue

AC space at lateral aspect of biceps tendon or at level of ulnar styloid between radial artery and flexor carpi radialis tendon

61

ulnar rescue

one finger breadth proximal to the arcuate ligament or immediately lateral to flexor carpi ulnaris

62

NMDA inhibitors

ketamine, xenon, nitrous, diethyl ether

63

edrophonium

used to distinguish myasthenia gravis from cholinergic crisis

64

omphalocele

failure of gut migration from yolk sac into abdomen, 40-60% have ass anom, defect lies within umbilical cord (beckwith-widemann, exostrophy of bladder, congen heart disease)

65

2 most important in hospital mortality risk factors

chronic heart failure, unstable coronary syndrome

66

loss of twitch 2,3,4

90%, 80%, 75% blocked

67

estimated sodium deficit

TBW x (ideal sodium - patient's sodium)

68

which valve surgery greatest risk of complete heart block

AV 2/2 bundle of His adjacent to non-coronary cusp

69

milrinone se

(inotrope, phosphodiesterase inhibitor) hypotension, atrial and ventricular arrhythmias

70

contraction alkalosis management

potassium repletion, chloride repletion, volume repletion, acetazolamide,

71

PVCs treatment

beta blockers are first line, amiodarone next (avoid fecainide/encainide because proarrhythmic), also lidocaine