True Learn Flashcards
(158 cards)
1
Q
Most common papillary muscle that causes mitral regurgitation post MI? What blood supply?
A
Posteromedial pap
RCA
2
Q
Symptoms of MH
A
Increase in ETCo2
Peak T waves
Lactic acidosis
Muscle rigidity
3
Q
What’s the earliest you can restart px heparin after an uncomplicated epidural placement
A
Immediately
(Wait w placement or removal of catheter, immediately start after placement or removal)
4
Q
What’s the most common complication of a celiac plexus block
A
Orthostatic hypotension and diarrhea
5
Q
Reflexive movement as a response to surgical stimulus
(What level of anesthesia)
A
General
6
Q
Safest flow meter arrangement
A
W oxygen closest to the patient/ most downstream
7
Q
What would you expect pulse ox to read in someone w methemoglobinemia
A
85%
8
Q
What cardiac anomaly is most common in carcinoid tumor?
A
Tricuspid regurgitation
Tricuspid stenosis (much less common)
9
Q
Carcinoid triad
A
Wheezing
Flushing
Right heart dx
10
Q
Volume compartments
A
Interstitial > intravascular
Intracellular = extracellular
11
Q
Shunt fraction
A
Qs / Qt = (1n− SaO2) / (1 − SvO2), where Qs = pulmonary physiologic shunt, Qt = cardiac output, SaO2 = arterial oxygen saturation, and Sv02 = venous oxygen saturation
12
Q
Alveolar oxygen equation
A
PaO2 = FiO2 × (Patm − PH2O)−(PaCO2 / R)
FiO2 = Fraction of inspired oxygen
Patm = atmospheric pressure = 760 mmHg
PH2O = partial pressure of water vapor = 47 mmHg
R = constant = 0.8
13
Q
Who qualifies for early invasive cardiac strategies?
A
Worsening underlying heart disease
- recurrent angina or ischemia at rest
- elevated cardiac bio markers
- new ST depression
- new or worsening mitral regurgitation
- hemodynamic instability
- sustained tachy
- pci within 6 mos
- prior coronary artery bypass
- high risk TIMI score > 2
- reduced left ventricular function
14
Q
What is appropriate management of epiglottitis in a pediatric patient
A
DL under deep GA
15
Q
What are the benefits of smoking cessation and what is the optimal time for quitting?
A
Decrease carboxyhemoglobin levels
Increase in ciliary function
Decrease in sputum production
Decrease in stimulation of the cardiovascular system
8 weeks
*reduction in carboxyhemoglobin shifts the oxygen dissociation curve to the right = more oxygen unloading
16
Q
What’s the order of invasive accretas
A
Accreta
Increta
Percreta
17
Q
How does lidocaine cause fetal acidosis
A
Lidocaine crosses the placenta and accumulates to toxic levels due to ion trapping
18
Q
What are the four factors that determine placental transfer of drugs
A
Size : <500 Da
Lipophilicity: lipophilic cross (fentanyl), high ionized do not
Protein binding
Maternal drug concentration
19
Q
What drugs do not cross the placenta
A
Heparin
Insulin
Glycopyrrolate
Nondepolarizing muscle relaxants
Sux
He is going nowhere soon
20
Q
Most common cause of adrenal insufficiency in pts w critical illness
A
Functional adrenal insufficiency : causing corticosteroid def, due to cellular dysfunction, peripheral glucocorticoid resistance, and impaired transport
21
Q
What causes the acid base status w NS infusion
A
Metabolic acidosis due to decreased strong ion difference
SID= strong cations - strong anions
SID takes into account HCO3, albumin, phosphate, unmeasured ions
22
Q
In pt w cirrhosis and BP what is the most common cause of ARF?
A
Type 1 HRS (acute renal failure from a precipitating event related to cirrhosis ; such as bacterial peritonitis)
Type 2 is an insidious onset of renal failure from portal htn caused by splanchnic vasodilation and activation of raas
23
Q
What is the CAM-ICU assessment?
A
The CAM-ICU asks the following:
Is there an acute change in mental status or fluctuating course? (yes/no)
Is the patient inattentive or easily distracted? (yes/no)
Is there an altered level of consciousness or RASS other than zero? (yes/no)
Does the patient experience disorganized thinking? (yes/no)
24
Q
Which drugs are unsafe agents to use in patients with MH?
A
- volatile anesthetics
- succinylcholine
25
What are the safe drugs to use in patients with MH
- barbiturates
- inhaled non-volatile anesthetics (NO)
- local anesthetics
- opioids
- non-depolarizing muscle relaxants
- benzos
26
What are the commonly used anesthetics used in ECT and what are their durations
Etomidate- increases seizure duration
methohexital/ ketamine- no/minimal effect on seizure duration
midazolam, propofol, lidocaine, and volatiles- decrease seizure duration
27
When does airway closure begin in patients with emphysema?
earlier/ closer to the alveoli
28
what is the dose for oral midazolam in pediatric patients
0.5mg/kg
IV is 0.05-0.1 mg/kg
29
What are the target sites for sympathetic cardiac innervation?
A1, B1, and B2
sympathetic cardiac innervation originates from T1-T4 and travel through bilateral stellate ganglions prior to ending as cardiac nerves
A1: positive inotropy
B1: positive chronotropy, domotropy (conductivity of a nerve), lusitropy (myocardial relaxation), and inotropy
B2: positive chronotropy > isotropy
30
What is extraction ratio?
fraction of drug removed from blood passing through the liver
31
which drugs have high liver extraction ratio?
bupivicaine, diltiazem, fentanyl, ketamine, meperidine, metoprolol, morphine, nifedipine, and propofol
these are flow dependent
32
what drugs have low hepatic extraction ratios?
diazepam, methadone, roc, alfentanil, and thiopental
33
What medication should be avoided in a thyroid storm?
salicylates (aspirin) because they compete with T3 and T4 for thyroid- binding globulin
34
signs and sxs of a thyroid storm
hyperthermia
hypertension, tachycardia, arrhythmia
mental status change
cardiovascular collapse
congestive hf in pts prone to hf
medications= PTU (more favorable) and methimazole and iodine after antithyroid drugs
35
what are the sympathetic block indications?
vascular: A/V occlusion, intra-arterial injection of irritants, raynauds, throboangiitis obliterans, vasospasm, venous insufficiency
neuropathic: acute herpes zoster, CRPS 1 & 2, phantom limb
visceral: abdominal cancer, chronic pancreatitis, refractory angina/ acute MI if medically indicated
36
What is the oculocardiac reflex
afferent: trigeminal nerve
efferent: vagus nerve causing Brady
Stimuli at the eye -> ciliary ganglion -> ophthalmic division of trigeminal nerve -> Gasserian ganglion -> trigeminal nucleus -> vagus nerve -> bradycardia.
37
What muscle layers are pierced in a TAP block?
EO and IO
local anesthetic is deposited in the plane between IO and transverses abdominis muscles
38
is mitral and aortic stenosis contraindicated in neuraxial anesthesia?
no
only severe aortic stenosis
mild to moderate aortic stenosis favors spinal anesthesia
39
how does Mac change in chronic and acute alcohol intoxication?
chronic- increases Mac
acute- decreases Mac
40
what's the safest option of anesthesia in a pediatric patient undergoing pediatric radiation therapy?
propofol for deep sedation while maintaining spontaneous vent
41
how does intrathecal pumps decrease constipation
avoids first pass effects that you would see in chronic oral opioid therapy, which causes constipation
42
How do you manage the airway in patient's with mediastinal masses?
maintained w SV w local and regional anesthesia techniques. Awake intubation and rigid bronch for advanced airway could be beneficial. Positioning in lateral decubitus is preferred to alleviate airway collapse from a supine position
43
how does abdominal surgery affect hepatic blood flow?
decreases, which will cause increase in liver enzymes
44
Venous compliance equation
change in venous volume/ change in venous pressure
- Angiotensin 2, endothelin1, increased sympathetic tone, Valsalva maneuvers, and inotropes decrease venous compliance
45
Uterotonic medications
Carboprost
Methylergonovine
Misoprostol
Oxytocin
46
Side effects of carboprost and contraindications
SE: bronchospasms and nausea
Contraindication: reactive airway disease
47
SE and contraindications in Methylergonovine
SE: hypertension, vasoconstriction, coronary vasospasms
Contraindicated: hypertension and preeclampsia
48
SE/ contraindications in misoprostol
SE: nausea and fever
no contraindications
49
Oxytocin
SE: hypotension, tachy, coronary vasoconstriction, MI
used for prophylaxis
50
What is sodium bicarb's requirement to normalize pH?
0.2 x patient's weight x base deficit
51
What cardiac changes do you see with abdominal insufflation
bradycardia, bradyarrythmias, and asystole
52
what are the prejunctional neuromuscular disorders
Charcot-Marie-Tooth and Friedreich ataxia
53
what are the postjunctional neuromuscular disorders
DMD, BMD, myotonic dystrophy, myotonia congenita (NNMBD do not alleviate contractures), hyper and hypoK PP
54
What are the metabolic neuromuscular disorders
metabolism and mitochondrial disorders
55
What is the major pulmonary pathophysiology of drowning
pulmonary washout of surfactant
o Drowning aspirate 3-4ml/kg of surviving victims
o 11ml/kg to change blood volume
o 22ml/kg to change electrolytes
56
how does acute cocaine affect mac
increases
treat acute cocaine toxicity w benzos
57
What meld score poses a risk on postop liver failure
>10
>14 is not considered for surgical intervention
58
How does the body compensate for increases in intracranial volume?
redistribution of intracranial venous blood and CSF to extracranial veins and spinal CSF space respectively
59
What procedure is commonly performed in pseudo tumor cerebri
lumbar puncture to improve visual disturbances
60
what cord level injury would you see in paraplegia vs quadriplegia
T1 and below = para
above = quadriplegia
61
How does TENS units work?
involves electrical stimulation of large diameter A-beta cutaneous mechanoreceptors. This inhibits signaling through A-delta and C pain fibers, closing a “gate”
62
what is the most common occurrence leading to a malpractice claim?
death - 29%
nerve injury - 21 %
brain damage - 9%
airway - 6%
63
Where is serotonin stored?
90% of the body’s serotonin is stored in the enterochromaffin cells in the gut wall; it is triggered by toxic substances like hypertonic saline and copper sulfate
64
What reduces the release of serotonin?
GABA-B, 5HT4, alpha 2, VIP, and somatostatin reduce the release of serotonin
65
How does CMRO2 change with temperature
For every 1degree C of temp drop will decrease CMRO2 by 6% and therefore decrease CBF
- CBF rises dramatically when Pa02 decreases below 50 mmhg
66
What effects does large volume NS have on electrolyte and fluid changes
increase in ECF, hemodilution (decreased albumin and hct), increase in chloride, potassium, and decrease in bicarb
- Leads to hyperchloremic metabolic acidosis and reduced renal perfusion
67
What physiology do you see with negative pressure pulm edema?
increased afterload
negative intrathoracic pressure
increased pulmonary vascular resistance (from increased pulmonary vasoconstriction)
increased pulmonary blood flow
68
Diabetes insipidus
deficiency of ADH that can be caused by pituitary disease, infiltrative disease, brain tumors, neurosurgical procedures
present w polyuria, hypernatremia, high plasma osmolality, and low urine osmolality
69
What effect does cardiopulmonary bypass have on blood
causes platelet dysfunction and sequestration
after appropriate reversal of heparin w protamine, treatment of coagulopathy should be treated w platelet transfusion
70
what element/ electrolyte promotes bronchodilation
mag
71
What are the boundaries of the airway
nasopharynx: nasal cavity to soft palate
oropharynx: soft palate to hyoid bone
hypopharynx: epiglottis to the end of the cricoid cartilage
larynx contains the epiglottis and vocal cords and extends from the superior border of the epiglottis to the cricoid cartilage
72
how to treat organophosphate poisoning (anticholinesterase toxicity)
atropine
sxs: Brady, miosis, lacrimation, salivation, bronchorrhea, bronchospasm, urination, emesis, and diarrhea
73
What is the best indicator that metabolic alkalosis is resolved in pyloric stenosis
normalization of chloride
74
how to manage acute epiglottitis airway
upper airways near the glottic opening should be managed by maintaining spontaneous ventilation
Typically managed w inhalation induction in the OR w surgical backup
75
How does metabolic derangements affect wake up?
prolongs it
hyperglycemia or hypoglycemia
hyponatremia
metabolic acidosis
hypercapnia
blood toxicology
hypothermia
hypothyroidism
76
contraindications to percutaneous tracheostomy
infants w abnormal anatomy (subglottic stenosis, tracheomalacia, tracheal stenosis) due to the difficult to palpate landmarks
in addition: operator inexperience, infants, insertion to site infection, severe/uncontrolled coagulopathy, unstable cervical spine injury
77
Multi-drug resistant pathogens causing VAP coverage?
MRSA coverage
- Vancomycin 15 mg/kg IV every 8-12 hours
OR
- Linezolid 600 mg IV every 12 hours
PLUS
Antipseudomonal β-lactam-based agents
Antipseudomonal penicillins
- Piperacillin-tazobactam 4.5 g IV every 6 hours
OR
Cephalosporins
- Cefepime 2 g IV every 8 hours
- Ceftazidime 2 g IV every 8 hours
OR
Carbapenems
- Imipenem 500 mg IV every 6 hours
- Meropenem 1 g IV every 8 hours
OR
Monobactams
- Aztreonam 2 g IV every 8 hours
PLUS
Antipseudomonal non-β-lactam-based agents
Fluoroquinolones
- Ciprofloxacin 400 mg IV every 8 hours
- Levofloxacin 750 mg IV every 24 hours
OR
Aminoglycosides
- Amikacin 15-20 mg/kg IV every 24 hours
- Gentamicin 5-7 mg/kg IV every 24 hours
- Tobramycin 5-7 mg/kg IV every 24 hours
OR
Polymyxins
- Colistin 5 mg/kg IV load followed by a maintenance dose which is based on creatinine clearance
78
What are the relative contraindications to MAC?
inability to lie still, inability to cooperate, inability to communicate with the care team
79
FeNa<1 vs FENa >1
<1= poor renal perfusion and hypovolemia
>1= acute tubular necrosis or other intrinsic renal
80
pre renal kidney injury
BUN:Cr >20
Fena <1
UNa <20
UOsm >400
81
intrinsic renal injury
BUN:Cr >15
Fena >1
UNa >20
UOsm <400
82
Postrenal kidney injurt
BUN:Cr >15
Fena >4
UNa >40
UOsm <400
83
CVP waveforms
3 waves (a, c, v), 2 descents (x, y)
a- atrial contraction
c- right ventricle contraction, tricuspid bulging
-QRS complex
v- filling of right atrium
-end of T wave
x- emptying of right ventricle
y- passive emptying of right atrium
84
First step in PCA adjustments
adding basal infusion of opioid
then adding multimodal such as ketamine
85
Increases in cardiac output in the labor period
latent labor = 15% increase
active labor= 30% increase
expulsive labor= 45% increase
contractions= 10-25% increase
86
Changes in CV physiology during pregnancy
Blood volume + 35-40%
Cardiac output + 40-50%
Central venous pressure No change
Diastolic blood pressure - 10-20 mm Hg
Heart Rate + 15-20%
Femoral venous pressure + 15 mm Hg
Mean arterial blood pressure - 15 mm Hg
Plasma volume + 50%
Red blood cell volume + 20%
Systolic blood pressure - 0-15 mm Hg
Total peripheral vascular resistance - 15 mm
87
risk factors for postop apnea in infants
GA or regionalA w IV sedation
hx of prematurity
Post conceptual age <60 esp <42-44 wks
hx of apnea
anemia
88
Factors to consider in HLHS
its a ductal dependent systemic blood flow and control of Qp:Qs ratio is imperative
(pulmonary:systemic flow)
89
risk for emergence delirium
children 2-6 years old
volatile anesthetics
90
transplanted hearts
denervated and respond to direct acting agents (isoproterenol) but not vagal stimulation or indirect agonists
91
What medication potentiates NMB?
magnesium - bc it inhibits calcium channels which triggers the release of acetylcholine and a subsequent action potential
gentamicin
acute phenytoin use
92
retained epidural catheter tip
observation is acceptable in an asymptomatic patient
93
what factors will change the confidence interval
narrowing: decreasing variation, increasing sample size, reducing confidence level
94
Indication for FFP administration
TP or hemolytic uremic syndrome (HUS)
Multiple coagulation factor deficiencies with microvascular bleeding and PT and/or aPTT
>1.5-2 times normal
Urgent reversal of warfarin therapy
Correction of microvascular bleeding during massive transfusion (> 1 blood volume) when
PT/aPTT are not readily obtained
Treatment of heparin resistance in a patient requiring heparin
Single coagulation factor deficiencies when specific concentrates are not available
Management of trauma-related or massive blood loss
95
When is FFP not recommended for management?
hemophilia A - due to large quantities required and the risk for infection
96
Management of VAE
flood field w saline
bone wax applied to exposed bone
lower surgical site below the level of the heart
careful application of peep and compression of jugular veins
*aspirating air is rarely successful except in the setting of a massive VAE
97
Are there mortality differences in resuscitation with albumin and saline?
no
98
What is bronchopulmonary displasia and what causes it
chronic condition following respiratory distress syndrome characperibronchiolar fibrosis, disorganized pulmonary vasculature, airway smooth muscle hyperplasia, and enlarged alveoli, more common to occur in neonates <32 weeks
caused by oxygen toxicity, infection, inflammation, barotrauma
99
Layers of the spinal cord
meninges composed of 3 different layers
dura mater
arachnoid
pia
Pia then extends to film terminale after L1
100
What is the treatment for pruritus from neuraxial morphine
nalbuphine
antihistamines have little to no effect
101
how does diuretics change the frank-starling curve
leads to movement downward along the curve
102
difference between type 1 and 2 CRPS
type 1- absence of nerve trauma
type 2- presence of nerve injury
103
What is adenosine used to treat
SVT (the most common arrhythmia in pregnancy)
104
How long does dual anti-platelet therapy need to be held for elective surgery?
after six months needs to be held for 5-7 days but aspirin may be continued
105
What processes cause a decreased production of CO2
hypothermia
hypothyroid
neuromuscular blockade
106
What impairs co2 elimination
cardiovascular collapse
massive VAE: increased end tidal nitrogen
large PE: ecg showing s1-q3 pattern
dislodged or kinked ETT, esophageal intubation: low and rapidly falling SpO2
107
What are pts who get multiple transfusions at risk for?
alloimunization against minor red blood cell antigens which delay the crossmatch process
108
how should the hospital manage a sudden hospital disaster? especially in the setting of viral pathogens?
tiered staffing
109
How does burns affect fibrinogen?
triggers an inflammatory response that then increases fibrinogen (AFR) which propagates platelet aggregation, causing thrombocytopenia
110
Parkland formula
4ml/kg x % of TBSA
1/2 given in first 8hrs, rest given in 16 hrs
after 24hrs, use colloid for resuscitation
111
Carbamazepine toxicity
hyperthermia, flushing, dry mouth, midriasis, urinary retention, widened QRS, prolonged QT, ventricular arrhythmia, tacky, hypotension
112
What physiological changes are seen after brain death?
myocardial dysfunction
catecholamine storm followed by hemodynamic instability
hypovolemia
pulm edema
hyperglycemia
hypernatremia
polyuria - due to DI 2/2 posterior pituitary ischemia
113
What do you avoid intraoperatively in pts w VPS
elevation in pc02
intraabdominal pressure
intrathoracic pressure
114
subdural spinal injection
presents with varying degrees of motor, sensory, and sympathetic block with a much slower onset (10-30 min) than w intrathecal
115
What do you use to treat hypernatremic, hyperosmolar, polyuric pts w seizures
free water at 1-3mmol/ hr
116
What to give in pt w radiation-induced injury to the thyroid
potassium iodide
117
How does hypocalcemia affect ecg
prolongs QT
118
What usually causes anaphylactic reactions to blood transfusions
IgA deficiency
119
sacral spinal nerves
includes the parasympathetic nerve fibers that promote sexual arousal, intestinal peristalsis, defecation, and urination
120
Classic findings of trisomy 21
single palmar crease, upslanting palpebral fissures, endocardial cushion defects, atlantoaxial instability, and sleep apnea
121
classic findings of trisomy 18
VSDs, "rocker-bottom" feet, and clenched hand with overlapping digits
122
classic findings of trisomy 13
holoprosencephaly, cleft lip, absent ribs, and polydactyly.
123
Classic finding of trisomy 8
long face, wide nose, thick lower lip, and cleft palate
124
medications that stimulate the SNS and when to use cautiously
in hyperthyroidism
- pancuronium, ketamine, atropine, epinephrine, and ephedrine
125
medications to prevent and treat high altitude pulmonary edema (HAPE)
- HAPE results from diffuse hypoxic pulmonary vasoconstriction in response to the low partial pressure of oxygen at altitude which results in increased hydrostatic capillary pressure, causing pulmonary edema
px tx= nifedipine and PDE5 inhibitors
126
What causes an increase in both peak inspiratory and plateau pressures?
elastic resistance (compliance) decreases
- abd insufflation
- ascites
- intrinsic lung disease
- obesity
- pulm edema
- tension pneumo
- trendelenburg
*bronchospasm, ETT kink, mucus plus, secretions, airway obstruction would have a normal plateau pressure
127
What is Goldenhar syndrome
oculo-auriculo-vertebral spectrum (OAVS)
characterized by hemifacial microsomia as well as mandibular hypoplasia, epibulbar dermoid, and vertebral anomalies
128
What percentage of spinal cord blood supply comes from the anterior spinal artery
75%
arterior spinal artery: supplies the motor tracts in the spinal cord
posterior SA: sensory tracts
129
Stroke volume variation
SVmax- SVmin/ (average of SVmax of Svmin)
130
cryoablation
disintegration of the myelin sheath leading to wallerian nerve degeneration
131
what area does sciatic block not cover
medial lower leg
132
interscalene block
what structure is posterior-lateral to the brachial plexus
- middle scalene muscle
133
internal defibrillation biphasic shock sequence
5J, 10J, 20J, 30J, 50J
134
When do you use retrograde cardioplegia
aortic insufficiency
severe CAD
135
sacroiliac pain
provocation of compression and distraction and gaenslen's test
136
serial lumbar plexus block is used for
CRPS
can lead to sympathetic dysfunction
137
what happens with hydromorphone in renal failure
hydromorphone-3-glucoronide causes dysfunction and myoclonus
138
What is one of the greatest risks for malpractice in anesthesia
residual anesthetic medication in the recovery room
139
Normal hemodynamic values
CVP: 2-6mmHg
PCWP: 6-12mmHg
CI:2.5-4L/min/m2
SVR: 800-122 dynes
140
Static compliance equation
TV/ Pplateau-PEEP
141
How much uterine blood flow does ovarian arteries supply
15%
uterine artery supplies 85%
- uterus receives up to 20% of maternal CO
-vili form on the fetal side of the placenta, resp for gas, nutrients, and waste with the intervillous space
142
blood gas for methemoglobinemia
only thing that will change is the partial pressure of oxygen PaO2
143
what does citrate do to the body?
citrate is added to prbcs for storage and is metabolized into bicarb and may cause metabolic alkalosis
144
what medication can increase lower esophageal sphincter tone
metoclopramide
145
what medication can worsen acute hypertension during adrenalectomy for pheochromocytoma
b-blockers especially w/o adrenergic activity
- alpha antagonism should be first
146
What are the most common risks of MAC
airway fire and respiratory depression
147
Carotid body chemoreceptors
afferent glossopharyngeal nerve
- increases ventilation when pao2 decreases
function impaired by opioids, benzos, volatile anesthetics, and bilateral carotid endarterectomy
148
What genetic syndrome is associated with vocal cord paresis
acromegaly - due to stretching of the recurrent laryngeal nerve
149
What is the most common cause of maternal death due to preeclampsia
CVA
150
what is the issue with using radioactive iodine alone for thyrotoxicosis
it can worsen it
151
difference between acute and delayed hemolytic transfusion reactions
Acute hemolytic transfusion reactions develop due to ABO incompatibility while delayed hemolytic transfusion reactions occur due to alloantibodies to minor red blood cell antigens such as Rh, Kell, Kidd, Duffy, and other antigens
152
What is acog definition of preeclampsia
gestational hypertension with proteinuria or with severe End organ dysfunction
153
What is the frankenhauser ganglion?
uterovaginal plexus - blocked by injecting anesthetic lateral to the cervix in the fornix of the vagina.
can cause fetal bradycardia associated with fetal deoxygenation and acidosis
154
Klippel-Feil syndrome
congenital condition associated with cervical spine fusion
155
What produces more carbon monoxide between barium hydroxide and soda lime? and why?
Barium hydroxide due to the decreased water content of barium hydroxide absorbents
- in addition barium hydroxide has the highest risk for fire production and produces the most compound A with sevoflurane
156
HHS
occurs in type 2 diabetes, ph >7.3, bicarb >18, serum osm >320
neurological sxs occur including seizures due to extracellular shift of cerebral fluid
157
MOA of local anesthetics
reversibly binds the intracellular portion of voltage gates sodium channels
158
La place law
PR/2h=wall tension
H= wall thickness
Aortic stenosis - phenylephrine to increase pressure at the coronary Ostia to increase precision
