Term
| Name 3 hyper-coagulable states: |
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Definition
Anti-thrombin III deficiency
Protein C deficiency
Protein S deficiency |
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Term
| Name 2 anti-clotting factors that are vitamin K dependent: |
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Definition
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Term
| Protein C inhibits what clotting factors? |
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Definition
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Term
| Major Anesthetic implications in HIV/AIDS? |
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Definition
1. Drug holiday
2. Complete workup (echo?)
3. AIDS= NO SAB/epidural
4. Caution w/SUCC's= autonomic instability d/t upregulation *ALINE
5. Meticulous pulmonary care & early extubation
6. Elective C/s vs. Vag delivery, SAB/epidural w/blood patches safe |
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Term
| Treatment for vWF deficiency? |
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Definition
DDAVP (onset in 30 minutes, lasts 4-6 hours)
Cryoprecipitate
Concentrated Factor VIII |
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Term
| Vitamin K dependent factors include? |
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Definition
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Term
| Factors in cryoprecipitate? |
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Definition
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Term
| Vitamin K begins working w/in ? |
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Definition
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Term
| Name 2 conditions associated with anti-thrombin III deficiencies |
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Definition
| Liver cirrhosis & Nephrotic syndrome |
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Term
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Definition
| Generalized lymphadenopathy |
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Term
| Treatment of Tetanus includes? |
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Definition
1. Early intubation/supportive airway measures
2. Valium or NDMR for spasms
3. Beta-antagonists (esmolol) for tachycardia & htn
4. PCN tx exotoxin
5. Aline
6. Volatiles
7. Lidocaine (arrythmias), magnesium, nipride, nicardipine |
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Term
| Treatment for necrotizing soft tissue infections?> |
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Definition
1. Surgical intervention
2. Broad spectrum coverage
3. Natural honey to digest necrotic tissue
4. Hyperbaric
5. CL/Aline, blood products
6. Catecholamine/cortisol depeletion & DIC may occur |
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Term
| Subclass of sepsis that are surgical emergencies? |
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Definition
Necrotizing soft tissue infections:
1. gas gangrene
2. toxic shock syndromes
3. severe cellulitis
4. flesh eating infections |
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Term
| Treatment goals for sepsis include? |
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Definition
1. MAP >65
2. CVP 8-12
3. u/o at least 1ml/kg/hr
4.mixed venous sat > 70% |
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Term
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Definition
| Antibiotic administration (baseline labs) |
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Term
| Indications of SIRS include? |
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Definition
1. WBC <4 or >11 (or > 20% immature forms)
2. Temp < 36 or > 38
3. HR >90
4. RR > 20 or paCO2 < 32 |
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Term
| SSI prevention measures include: |
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Definition
1. antibiotic administration w/in 1 hour of incision
2. increased tissue oxygen tension (*colorectol)
3. Pain control
4. avoid hypocapnia
5. avoid hypothermia
6. avoid hyperglycemia
7. wound probing |
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Term
| Risk factors for SSIs include: |
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Definition
1. extremis of age
2. Diabetes
3. Corticosteroid therapy
4. Immunocompromised
5. Chronic illness |
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Term
| 5th Generation cephalosporin's (names) and benefit? |
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Definition
| Best for MRSA, newest (Teflaro/ceftarolin) |
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Term
| 4th Generation cephalosprin (name) and benefit? |
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Definition
| Maxipime/cefipime, extended activity & more resistance to Beta lactamase |
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Term
| 3rd generation cephalosporins (names & benifit) |
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Definition
cefotaxime & ceftriaxone
less g- coverage
better against beta lactamase producers |
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Term
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Definition
2nd generation, good g- coverage.
1-2 gm's, redosed @ 4 hours |
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Term
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Definition
2nd gen, good g- coverage
1-2gm's, short 1/2 life, redose @ 2 hours |
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Term
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Definition
| 1st gen cephalosporin, broad spec, low incidence of SEs, ideal for prophylaxis, penetrates most tissue except CNS, 1gm (2gm >100kg), redose @ 3 hours, lg blood loss/admin, 2nd procedure |
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Term
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Definition
| Lancosamide, G+ anaerobic coverage, GI SEs, CDIFF, NDMR prolongation, not 1st line, 600-900mg w/in 60 min of incision, give over 30 min, redose @ 3 hours |
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Term
| What antibiotic blocks the release of acetycholine at the NMJ prolonging the effects of NDMR's |
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Definition
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Term
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Definition
1st line for anaerobic bacteria, protazoal, and parasitic infections
500mg w/in 60 min of incision
Avoid alcohol (disulfiram like reaction)
GI symptoms common |
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Term
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Definition
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Term
| Risk factors for gentamycin toxicity include? |
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Definition
1. Elderly
2. Renal compromised pts
3. high dose > 5 days |
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Term
| This drug inhibits re-junctional release of Ach & reduces post-synaptic sensitivity to Ach prolonging NDMR activity? |
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Definition
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Term
| Treatment for pronlonged NDMR action in pt's taking aminoglycosides? |
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Definition
| Calcium & Neostigmine (improves muscle strength) |
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Term
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Definition
G- coverage, polar -poor GI absorption, Lg daily dose, 1.5mg/kg w/max 240mg, Qday dosing, give over 30-60 min, & w/in 1 hour of incision
NEPHROTOXIC & OTOTOXIC |
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Term
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Definition
G+ bacteriocide, MRSA, dose 1gm q 12 hours. Give over 1 hour, too fast will result in tachycardia & hypotension.
given w/in 60-120 min of incision time
Redman syndrome is most common ADE, d/t histamine release (benadryl helps) |
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Term
| The susbtitute for pts with cephalosporin allergies? |
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Definition
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Term
| This drug must be given slowly |
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Definition
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Term
| Drug most commonly used for MRSA |
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Definition
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Term
| What neck position would cause the trachea to move downward? & how would this effect ETT placement |
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Definition
| Extension, ETT will move upward ** Risk inadvertent extubation |
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Term
| Moving the head side to side affects the trachea how? |
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Definition
| Trachea will move upward, a fixed ETT will sink deeper |
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Term
| the Carina is located where? |
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Definition
| T4-5, @ angle of louis- articulation of 2nd rib |
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Term
| Mucous secreting goblet cells (broncial glands) are innervated by what? |
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Definition
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Term
| Mast cells are located where, how do they affect respiratory smooth muscle? |
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Definition
Near branches of small vessels & near vagus nerve, throughout smooth muscle, intestinal mucosa & skin.
Key role in allergic reactions
Secrete Vaso active substances that produce respiratory smooth muscle vasoconstriction |
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Term
| What happens to airway pressure when compliance is reduced but volume remains unchanged? |
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Definition
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Term
| True/False. A compliant lung will receive more volume than a non compliant lung |
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Definition
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Term
| What accounts for 2/3 of the total lung compliance? |
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Definition
| Surface tension (force that must be overcome to open & inflate alveoli) |
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Term
| True or False: the larger the surface area, the more the surface tension |
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Definition
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Term
| Name the respiratory tract segment that is surrounded by spiral muscle fibers; making it susceptible to collapse based on intraplueral and intraalveolar pressures? |
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Definition
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Term
| What is the purpose of the canals of lambert & where are they located? |
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Definition
| collateral ventilation below sites of obstruction- which is not affected by smooth muscle contractions, found between the terminal bronchioles and adjacent alveoli. |
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Term
| Location & purpose of the Pores of Kohn? |
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Definition
| Located in alveoli- allow interface between adjacent alveoli, the number & size of openings increase with age & certain diseases ABSENT in NEWBORNS |
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Term
| The pressure difference between the mouth and the alveoli? |
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Definition
Transairway pressure (3mmHg= 760-757)
If alveolar pressure is less than atm air moves in |
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Term
| Pressure in the fluid of the pleural space? |
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Definition
| Pleural pressure/intrathoracic pressure. normally negative 5. w/chest expansion becomes more negative to -7.5. W/exhalation, becomes LESS negative |
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Term
| Flexion of the neck causes the trachea to move _______ and ________. Moving the ETT ________. |
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Definition
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Term
| The pressure difference b/t alveolar pressure & pleural pressure |
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Definition
Transpulmonary pressure/recoil pressure.
measures elastic forces in the lungs that tends to collapse the lungs
volume increases as alveolar and pleural pressures become slightly more negative. Lung volume will decrease as the 2 pressures become slightly more positive. |
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Term
| For every 1cmH20 of TPP change the lung will expand ______ ml over ____ to ____ seconds. |
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Definition
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Term
| How is distending (inflating) pressure r/t alveolar radius? |
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Definition
| INDIRECTLY. As the radius increases, the TPP needed to keep it open decreases; once critical pressure has been reached (laplace) |
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Term
| General Causes of surfactant deficiency? |
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Definition
Acidosis
Hypoxia
Hyperoxia
Atelectasis
Pulmonary Congestion |
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Term
| Specific causes of surfactant deficiency? |
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Definition
ARDS
RDS
Pulmonary Embolism
Pulmonary edema
Pneumonia
Excessive lavage
Extracorporeal oxygenation
Drowning |
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Term
| Give 2 examples where compliance is dcreased d/t decreased chest wall expansion/compliance? |
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Definition
Narcotic chest wall rigidity
Obesity-supine position |
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