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Respiratory Flashcards

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1
Q

Match each irrigation solution with their possible complication during a TURP

Solutions:
Glycine
0.9%
Sorbitol
Distilled water

Complications:
Electrocautery
Transient Vision Loss
Osmotic Diuresis
Hemoglobinuria

A

Glycine - transient vision loss
0.9% NS - electrocautery
Sorbitol - Osmotic Diuresis
Distilled Water - Hemoglobinuria

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2
Q

What two Hepatic function tests go with synthetic function?

A

PT
Albumin

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3
Q

What hepatic tests go alongside hepatocellular injury?

A

AST and ALT

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4
Q

What hepatic tests look at hepatic clearance?

A

Bilirubin

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5
Q

What hepatic tests look at biliary duct obstruction?

A

AP, y-gluta, and 5-nucleoside

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6
Q

What increases with prehepatic disease

A

Bilirubin only

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7
Q

What increases with cholestatic disease?

A

increased bilirubin, increased AP, increasesd y-gluta…., increased 5’nucleoside

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8
Q

What are some physiologic derangements seen with intraabdominal compartment syndrome

A

decreased CO
Decreased preload and afterload
decreased coronary artery perfusion
decreased diaphragmatic excursion
Decreased thoracic compliance
decreased lung volumes

Increased pulmonary shunt, increased atelectasis and pulmonary edema

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9
Q

How do you calculate anion gap? What is normal?

A

Na- Cl + HCO3

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10
Q

what is the nmemonic for gap acidosis

A

MUDPILES

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11
Q

How do you determine the amount of bicarb to give?

A
  1. Goal - Starting = Y
  2. Y x kg x 0.3
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12
Q

What effect can excess NS have on the kidneys?

A

hyperchloremic metabolic acidosis

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13
Q

What effect can hydrohexital starch have on the kidneys?

A

increased kidney morbidity

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14
Q

What effect can NSAIDS have on the kidneys?

A

Renal vasoconstriction

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15
Q

What is desiccation? What does it increased risk of?

A

DRY – no color change
increased risk of compound A with Sevo
Increased risk of CO with Des > iso&raquo_space;> Sevo

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16
Q

Describe flow of CSF

A

Formed by the choroid plexus
Right and Left lateral Ventricle
Foramen of Monroe
3rd Ventricle
Aqueduct of Sylvius
4th ventricle
Foramen of Magindine and Luschika
SA space and central canal
Arachnoid vili in SSS reabsorb CSF

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17
Q

What is the patho MG?

A

IgG destruction of post-junctional nicotinic receptors

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18
Q

What are the s/sx of MG?

A

Weakness as the day goes on
Respiratory = #1
Dysphagia and bulbar weakness

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19
Q

If your patient with MG appears weak in the OR, what can you do?

A

Tension test – Edrophonium 1mg

If weakness improves – it is MG crisis
If it gets worse – it is cholinergic crisis and needs to be treated with an anticholinergic like Glyco or atropine

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20
Q

What is the actual treatment for MG?

A

Pyridostigmine

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21
Q

The relatively low PO2 in the tissues contributes to acid base regulation by doing what?

A

Improves Hbg ability to carry CO2 away from tissues

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22
Q

How to differentiate between Bohr and Haldane effect?

A

Bohr is the effect of Co2 on the Oxyhemoglobin curve (BCO)

Haldane is the effect of Oxygen on the CO2 response curve (HOC)

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23
Q

What is the calculation for static compliance?

A

Tidal volume / (Plateau - PEEP)

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24
Q

What is the calculation for dyanmic compliance?

A

Tidal volume / (PIP - PEEP)

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25
What is the mnemonic for difficult mask?
BONES Beard Obese No Teeth Elderly Sleep apnea (snoring)
26
What is the nemonic for Difficult DL?
LEMON Look externally Evaluate 3-3-2 Mallamapti Obstruction Neck Mobility
27
What are some contraindications to a combitube use?
Intact gag Prolonged use Esophageal disease Ingestion of caustic substance
28
Name these breathing patterns
1. Ataxic 2. Apneutistic 3. Kussmals 4. Cheyenne Stokes
29
Name the brain waves 1 2 3 4
1 - Beta waves -- seen with light anesthesia 2 Alpha waves -- seen with awake but restful state 3 Delta waves -- seen with deep sleep 4 - Burst suppression
30
When might a surgeon ask for adenosine to be given during a cerebral aneurysm clipping?
Clips are hard to place When the surgeon needs to stop blood flow to the aneurysm (0.3mg - 0.4mg IV) Might request propofol during the initial exposure
31
What are things that will cause a dampened A wave on CVP?
A Fib or V Pacing (with asystole as underlying rhythm)
32
Whare things that will cause an increased A wave
Tricuspid Stenosis ** diastolic dysfunction ** V pacing if asynchronous form or PVCs AV dissociation Junctional rhythm
33
What are some things that will cause a large V wave?
Tricuspid regurgitation RV papillary muscle rupture Acute increase intravascular volume
34
When to measure CVP?
end expiration
35
O2 consumption decreases by ________ for ever 1C degree in body temp
5-7%
36
In an under dampened ABP, what occurs>
Overestimation of BP Increased SBP Decreased DBP MAP Accurate
37
In an overdampened ABP, what occurs?
Underestimation of the ABP decreased SBP increased DBP MAP accurate
38
Describe the relationship between the BP cuff/ABP and the head
For every 1cm change in height, the BP changes 0.74 mmHg For ever 1 inch change in height, the BP changes 2 mmHG
39
Order of operations for treating a low O2 sat during OLV
If immediate drop and significant -- restore 2 lung ventilation If not,
40
How does a NIBP cuff effect BP?
Too small -- overestimates the BP (requires more pressure to occlude the artery Too large -- underestimates BP (requires less pressure to occlude the artery)
41
Most potent vasodilator? Order?
Halothane >> Enflurane > Des ~ Iso > Sevo
42
What increases PVR>
Hypoxemia Acidosis Hypercarbia, Hypoventilaton PEEP Vasoconstrictors SNS Stimulation Pain Mechanical Ventilation Ketamine Des N2O increased intraabdominal pressure
43
What decreases PVR?
increased PaO2 hypocarbia, hyperventilation Alkalosis SV Preventing coughing NO, NGT, PDEI Prostaglandinds CCB ACEI
44
What causes hypercapnia?
Increased K+ Increased Ca2+ Increased alveolar ventilation -- CO2 is a stimulant Increased ICP
45
Steps for treating bronchospasm
100% FiO2 Deepen anesthetic Albuterol Inhaled Ipratropium EPI Hydrocortisone Aminophylline Heliox
46
Transpulm pressures through phases of breathing At FRC: during inspiration: At end inspiration Quiet expiration Forced expiration
During FRC +5 During inspiration +7 End inspiration +8 Quiet exhalation +6 Forced Exhalation -1
47
What are some ABSOLUTE indications for DLT?
Bronchopleural fistula Infection Massive hemorrhage Lavage Bulla/Cyst
48
What are some relative indications for DLT?
Improve surgical expsure Esophageal resection Pulm edema s/p CABG
49
Troubleshooting Desaturation with OLV?
100% FiO2 Check DLT position Apply 10 cmH2O CPAP to non-dependent lung Apply PEEP to dependent lung Ligate or clamp PA of non-dependent Resume two-lung ventilation
50
Sizing of DLT
Male 39 Female 37 PEDS 8-9 =-1 26 10-12 = 28 12-14 = 32
51
Bronchial Blocker indications
Peds <8 Nasal intubation with isolation Tracheostomy with isolation
52
What can you do vs. not do with a bronchial blocker?
CAN isolate pets <8-10 years old CAN insufflate O2 CAN Isolate for nasal intubations CAN suction air from isolated lung Cannot ventilate isolated lung CANNOT suction secretions CANNOT isolate contralateral lung
53
How to treat a laryngospasm?
100% FiO2 Neck Extension, Chin life CPAP 15-20 cmH2O for 10 seconds
54
What is deadspace in spontaneous v. mechanical ventialtion
0.33 in SV 0.5 in MV
55
Mediastinoscopy and placement of lines?
Aline and Pulse ox on Right Arm Left Arm NIBP Large IVs in legs PRBCs in room for hemorrhage
56
What can you do with an airway exchange catheter?
Read ETCO2 Jet ventilate insufflate O2
57
What is the number one cause of nerve injury from LMAs and which nerves are at risk
Cuff overinflation Lingual, hypoglossal and RLN
58
LMA and laparoscopic sx
<15 minutes < 15 cmH2o insufflation < 15 degree tilt
59
What is important to know about the pro seal?
gastric drain + reusable + built in bite block
60
What is important to know about the supreme?
Gastric Drain, disposable version of proseal
61
What is important to know about Flexible LMA?
Wire reinforced Head and neck Sx
62
Ideal body weight drugs
ROC
63
What meds are LBW in obese pts?
Prop induction Roc and vec sufentanil
64
What meds are total body weight in obese pts?
Prop maintenance fentanyl succs Midaz Sufentanil Atracirum Cisatracurium
65
What is Cryo used to replace clotting factors in?
Hemophilia A Hemophilia B vWD
66
What eye muscle is most likely to elicit the oculocephalic reflex?
Medial rectus
67
Types of Hypersensitivity reactions and their exes:
Type 1 - Immediate hypersensitivity anaphylaxis *requires previous interaction* Type 2- Anibody mediated ABO Incompatability Type 3 Immune complex Mediated EXP: Snake venom Type 4: delayed EXP: Graft v host or contact dermatitis
68
What is the most common type of Electrolyte disorder?
hypokalemia
69
Discuss fluid compartment
Total 42: Divides into Intracellular (28L) Extracellular (14L) Intracellular divides into interstitial (11L) and Plasma (3L)
70
What is the most abundant: Intracellular cation? Extracellular cation Most abundant electrolyte period?
Intracellular - K Extracellular - Na Most abundant - Ca+
71
When is intraop blood salvage used?
In surgeries expected to be >1000 EBL or >20% of pt's EBV
72
What is the most devastating transfusion reaction? Why?
Acute hemolytic reaction ABO INCOMPATABILITY STOP Maintain UOP >75 ml Alkalize urine with NaCO3 Send urine and plasma hemoglobin samples check PT, PTT and Fibrinogen Send unused blood back to blood bank Support HDS and fluids
73
Risk of transfusion infections
Most common: CMV > Hep B. > Hep C > HIV
74
Most common transfusion reaction
acute febrile txn - give tylenol
75
How long do each blood matching tests take to run?
Type specific - 5 minutes Screen - 45 minutes Crossmatch - 45 minutes
76
Difference between Hemophilia A and B
Hemophilia A is linked to Factor 8 (Antihemophilic) Hemophilia B is linked to factor 9 (Christmas)
77
Where are clotting factors synthesized?
All except three and four are made in the liver three found in the vascular wall (extrinsic injury) Four found in food (calcium)
78
Rhymes for the intrinsic, intrinsic and common final pathway?
You can buy the Extrinsic Pathway for 37 cents The usual $12 Intrinsic is now on sale for $11.98 The Final common pathway can be purchased at the Five and dime for 1 or 2 dollars on the 13th of every month"
79
What are the names of the clotting factors?
1 - Fibrinogen 2 - Prothrombin 3- Tissue Factor 4 - Calcium 5 - Labile 6 NONE 7 - Tissue factor (stable) 8- Antihemophilia factor 9 - Christmas factor 10 - Stewart Prower factor 11 - Plasma Thrombin ante decadent 12 - Hageman's factor 13 - Fibrin stabilizing factor
80
Tell me about the TEG and its components
Tests the strength of the clot R time = time to make clot (FFP and PCC) MA - Strength of clot greatest vertical amplitude reached (tells you if you need DDAVP or Plt_
81
What nerve do you use to go to sleep? Which to wake up?
Intubation: Facial -- orbicularis oculi or corrugated supercollider Wake up: adductor policies or flexor hallicus
82
What are the vapor pressures of the inhaled anesthetics?
Des 699 Iso 238 Sevo 157 N2O 38,770
83
What are the Blood:gas solubility coefficients of the inhaled anesthetics
Des 0.42 N2O 0.46 Sevo 0.65 Iso 1.46
84
What are the MAC of the anesthetic gases?
Des 6.6 N2O 104 Sevo 2.0 Iso 1.2
85
What will speed up your inhalation anesthetic induction?
Increased Fa/Fi Curve Increased Alveolar ventilation Decreased CO Low solubility
86
Hepatic biotransformation of the volatiles?
Des 0.02 Iso 0.2 Sevo 2-5 Halo 20%

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