Term
| how long after a major burn can you expect a hypermetabolic state to exist |
|
Definition
| 1-2 years after a major burn |
|
|
Term
| what % of burn area is applied to each lerg |
|
Definition
| 18% to each leg. or 9% to front and 9% to back |
|
|
Term
| what % of burn area is applied to the front torso |
|
Definition
| 18% to front torso, 18% to back torso |
|
|
Term
| what % of burn area is applied to the head |
|
Definition
|
|
Term
| What is the parkland formula |
|
Definition
| fluid replacement for burn patients with at least 20% surface burn of 2nd or 3rd degree in nature. Give 4mL/kg/% burned in 24 hours. Give 1/2 this in first 8 hours and then the remainder in last 16 hours. |
|
|
Term
| is there an increase or decrease in NMB requirements in burn patients? |
|
Definition
|
|
Term
| what is the BMI for a 100 kg adult who is 2.2 meters^2 |
|
Definition
|
|
Term
| write down the BMI formula |
|
Definition
|
|
Term
|
Definition
|
|
Term
| overweight BMI is? While obese is what BMI? |
|
Definition
overweight: 25-29.9
Obese 30-39.9 |
|
|
Term
|
Definition
|
|
Term
| what is the BMI difference between morbid obesity and super obesity |
|
Definition
| Morbid obesity is > 40 while super obesity is > 50 |
|
|
Term
| what is the difference between OSA and obesity hypoventilation (Pickwickian) syndrome |
|
Definition
| pickwickian is normally void of any of hte sx of osa. It is associated with BMI > 30 and with PaCO2 > 45. |
|
|
Term
| Describe the Vd in obese paitents is it higher or lower than normal. What class of drugs does this relate to |
|
Definition
| Higher Vd meaning more Vd for lipid soluble agents to mix with. |
|
|
Term
| Should we dose most medications for obese patients on actual body weight, lean body weight or ideal body weight? Why. Describe the formula for IBW and LBW |
|
Definition
Most meds for obese patients should be based on IBW
IBW Females: 100 lbs for 5 feet, then 5lbs for each inch after
IBW Males: 106 lbs for first 5 feet, then 6 lbs for each inch after
LBW = IBW (kg) x 1.3 |
|
|
Term
| what is the lean body weight of a 6'2" male who weighs 170 lbs? |
|
Definition
LBW = IBW (KG) x 1.3
IBW for 6'2" = 106 + (6x14)
IBW = 190
LBW = IBW (Kg) x 1.3
190/2.2 = kg = 86kg
LWB = 86kg x 1.3
LBW = 111 kg |
|
|
Term
| what is the Ideal body weight of a 5'5" female |
|
Definition
IBW Female = 100 lbs for first 5 feet, then 5lbs x every inch after that.
5 feet = 100 lbs.
5 inches x 5 lbs = 25 lbs
100 lbs + 25 lbs = 125 lbs
IBW of 5'5" is 125 lbs. |
|
|
Term
| the best predictor of a difficult intubation is? |
|
Definition
| NECK CIRCUMFERENCE > 17 inches or 40cm |
|
|
Term
| Describe the physiological changes in geriatric patients regarding svr, pulse pressure and SBP |
|
Definition
decreased arterial elasticity results in
1. increased SVR
2. Increased SBP
3. Increased Pulse pressure |
|
|
Term
| are geriatric patients more or less responsivive to inotropes and chronotropes |
|
Definition
| Less responsive to inotropes and chronotropes b/c they have less receptors resulting in a natural decrease in heart rate. |
|
|
Term
| Geriatric patients have fibrotic changes to the heart which result in cardiac output being dependent on? |
|
Definition
| CO in geriatric, just like pedi, is dependent on heart rate. Geraitric patients have increasing Left ventricular stiffness. |
|
|
Term
If you plan on administering anesthesia drugs to a geriatric patient you can expect an increased or decreased onset of action in
1. inhalation agents
2. IV drugs
WHY?? |
|
Definition
1. Inhalation agents: increased onset b/c slowed CO results in high volatile absorption
2. IV drugs = slowed onset b/c decreased CO results in decreased delivery to receptors. |
|
|
Term
In geriatric patients there is a decreased lung elasticity, decreased surfactant production which results in what physiological changes regarding
1. closing capacity
2. FRC
3. Lung compliance |
|
Definition
| less elasticity and surfactant result in smaller airways closing more frequently. So there is a increase in closing capacity and FRC. The lung tissue without elasticity is MORE COMPLIANT since there is no resistance. |
|
|
Term
| What is the equation for MAC based on age? |
|
Definition
| MAC changes 4% per decade after 40 years. |
|
|
Term
| what is the MAC for a 80 year old? |
|
Definition
4% decrease every decade over 40. So MAC for an 80 y/o = 1 MAC - (4 (decades over 40y/o) x 4%)
MAC = 1.0 - 0.16
MAC = 0.84 |
|
|
Term
| What is the equation for PaO2? |
|
Definition
|
|
Term
| What is the PaO2 for a 90 year old |
|
Definition
PaO2 = 100 - (90 x 0.4)
PaO2 = 64 |
|
|
Term
| What are the physiological changes that occur with neuroaxial anesthsia and geriatric patients |
|
Definition
Spinal: Decrease dose
Epidural: Decrease dose, increased spread, decreased duration, less motor block. |
|
|
Term
| describe renal changes in the geriatric |
|
Definition
|
|
Term
| Describe the residual volume equation based on age |
|
Definition
| Residual volume increased 7% per decade starting at birth |
|
|
Term
| describe three vasoactive substances released into circulation after tourniquet deflation |
|
Definition
1. lactic acid ***
2. K
3. CO2 |
|
|
Term
| What type of reaction does cement in ortho cause? will this vasodilate or vasoconstrict blood vessels |
|
Definition
| Cement is an exothermic reaction and causes vasodilation of blood vessels |
|
|
Term
| what are Sx of fat embolism on a patient under general anesthesia |
|
Definition
1. Decrease ETCO2
2. increase PaCO2
3. hypoxia
4. Petechia!!!!! - diagnostic |
|
|
Term
| Name the pathological changes in rheumatoid arthritis |
|
Definition
1. hyperplasia of synovium
2. joint infiltration by lymphocytes and fibroblasts
3. joint destruction |
|
|
Term
| What is the incidence of atlantoaxial subluxation and cervical issues with RA patients |
|
Definition
|
|
Term
| Name airway issues with Rheumatoid arthritis patients |
|
Definition
1. High risk for subluxation (50%)
2. narrowed glottis
3. laryngeal edema
4. increased risk of aspiration |
|
|
Term
| What is the difference in presentation of RA compared to osteoarthritis |
|
Definition
| RA is in the metacarpophalangeal joints while OS is in the distal phalanges |
|
|
Term
| what type of lung disease is assoiciated with RA |
|
Definition
| Restrictive lung disease due to pulmonary fibrosis |
|
|
Term
| The drugs that treat RA patients increase their risk for? |
|
Definition
| Increase risk for infections |
|
|
Term
| what is the difference in the pathophysiology of SLE and RA? |
|
Definition
| SLE has antinuclear Antibodies produced while RA is an autoimmune disorder triggered by an antigen in genetically susciptable patients. |
|
|
Term
| SLE can be exacerbated by? |
|
Definition
1. stress
2. surgery
3. medications |
|
|
Term
| most common sx for sle patients is |
|
Definition
| dermatitis (butterfly rash being one example) |
|
|
Term
| Name five manifestations of SLE |
|
Definition
1. Presence of antinuclear Ab
2. malar rash - butterfly
3. thrombocytopenia
4. serositis
5. nephritis |
|
|
Term
| describe airway concerns with SLE patients |
|
Definition
| 1. laryngeal involvement! mucuosal ulceration, cricoarythenoid arthritis, RLN palsy |
|
|
Term
| name a big difference between RA and SLE patients |
|
Definition
| NO SPINE INVOLVEMENT IN SLE PATIENTS!! |
|
|
Term
| Two major concerns with TURP procedure is |
|
Definition
1. hyponatremia
2. water intoxication |
|
|
Term
| Name three major factors that lead to TURP syndrome |
|
Definition
1. duration of procedure
2. type of irrigation
3. height of irrigation |
|
|
Term
| The ideal irrigation fluid for cysto cases should be |
|
Definition
1. isotonic
2. non-hemolytic |
|
|
Term
| recommended anesthesia for TURP procedure is |
|
Definition
|
|
Term
| What level is necessary for spinal anesthesia for TURP |
|
Definition
|
|
Term
| is ESWL high or low energy shocks |
|
Definition
|
|
Term
| When do you time the ESWL shock to EKG? Why? |
|
Definition
| 20 ms after R wave. b/c this is the absolute refractory period |
|
|
Term
| absolute contraindications for ESWL are |
|
Definition
1. pregnancy
2. coagulopathies
3. active UTI
4. any abdominal implanted pacemaker |
|
|
Term
| name two relative contraindications for ESWL |
|
Definition
1. AAA < 5 cm
2. morbid obesity |
|
|
Term
| Normal intraocular pressure is |
|
Definition
|
|
Term
| is IOP more determined by outflow or choroidal volume |
|
Definition
|
|
Term
| What five things increase IOP |
|
Definition
1. hypercarbia
2. increased CVP
3. valsalva, treden, bucking
4. Sux and ketamine
5. HTN > auto regulation |
|
|
Term
| most common complication and most common side effect of retrobulbar block |
|
Definition
#1 complication is RB hemorrhage
#1 side effect is ecchymosis |
|
|
Term
| the occulocardiac reflex is mediated via what nerves |
|
Definition
Five and Dime
Afferent is cranial nerve V
Efferent is cranial nerve X |
|
|
Term
| Most common side effects from eye injury during post op period |
|
Definition
1. Corneal abrasion #1
2. acute glaucoma 2nd |
|
|
Term
| What happens to premies when given hyperoxia |
|
Definition
| high FiO2 results in retinal vessel proliferation. As these vessels bulk up they can detach the retina causing blindness. |
|
|
Term
| you should limit O2 administration until a premie is how developed? |
|
Definition
| 44 weeks post conceptual age |
|
|
Term
| the goal for premie babies is the keep PaO2 around? and SaO2 around? |
|
Definition
PaO2 60-70
SaO2 88% or better. But not too high |
|
|
Term
| peak absorption of CO2 in lap cases will be seen when |
|
Definition
| 20 minutes after insufflation |
|
|
Term
| max insufflation pressure is? |
|
Definition
|
|
Term
|
Definition
1. INTENSE HYPOTENSION
2. Transient increase in ETCO2 followed by DECREASE b/c drop in bp resulting in less circulation to lungs
3 |
|
|
Term
| MG involves destruction of what |
|
Definition
| Antibodies destroying nicotinic receptors |
|
|
Term
|
Definition
| by a positive tensilon test |
|
|
Term
if a patient has MG do you give more or less
1. Sux
2. NDMB |
|
Definition
1. GIVE MORE SUX
2. LESS NDMB |
|
|
Term
| what muscular disease is described as a progressive muscle atrophy |
|
Definition
|
|
Term
| Pts with duchennes are at increased risk for what associations |
|
Definition
1. MH
2. cardiac involvement
3. mitral valve disease
4. restrictive lung disease |
|
|
Term
| what heart anomaly is associated with duchennes |
|
Definition
|
|
Term
| what muscle disease is associated small cell cancer of the lung |
|
Definition
|
|
Term
| What class of drugs do you avoid in duchenes disease |
|
Definition
|
|
Term
| Does eaton lamber syndrome of MG improve with exercise? |
|
Definition
| Eaton lambert. B/c acetylcholine release is on a positive feedback system. Exercise illicits more and more Ach release. Nicotinic receptors will respond |
|
|
Term
| What is the pathophysiology of eaton lambert syndrome |
|
Definition
| antibodies against presynaptic calcium channels |
|
|
Term
increase or decrease sensitivity to nondepolarizers
1. eaton lambert
2. MG |
|
Definition
1. increase sensitivity to non depolarizers in eaton lambert
2. MG have increased sensitivty |
|
|
Term
| depolarizers and eaton lambert and MG..increased or decreased sensitivity |
|
Definition
1. Eaton lambert: Increased sensitivity since nicotinic receptor upregulated from lack of Ach normally there
2. MG: Decrease sensitivity. Nicotinic receptors are attacked and not all working properly so response to Sux is not as intense |
|
|
Term
| in myotonic dystorphy there is a risk of prolong contracture or myotonic contractures when? |
|
Definition
| Those can occur with giving Sux so avoid it, also can occur with giving reversal since the increase in Ach can cause contractures directly too |
|
|
Term
| If someone suffers from perioidic paralyis the culprit is what electrolyte? What anesthesia drug should you avoid? |
|
Definition
| periodic paralysis can occur from high or low K levels. Avoid sux! |
|
|
Term
| the earliest sign of malignant hyperthermia is |
|
Definition
|
|
Term
|
Definition
1. hyperkalemia
2. hypercarbia
3. rhabdomyolysis
4. acidosis
5. DIC
6. Fenal failure |
|
|
Term
| MH is associated with what other diseases 6x |
|
Definition
1. duchenees
2. myotnia congentia
3. central core disease
4. SIDS
5. Strabismus
6. osteogenesis imperfecta |
|
|
Term
| whats the incidence of masseter spasm with MH |
|
Definition
|
|
Term
|
Definition
| 2.5 mg/kg. Total dose of 10mg/kg over 24 hours. |
|
|
Term
| What type of allergic reaction is immediate? it is mediated by what? |
|
Definition
| Type I is immediate and mediated by IgE |
|
|
Term
| most common drug in anesthesia to cause anaphylaxis is? |
|
Definition
|
|
Term
| Difference between anaphylaxis and anaphylactoid reactions |
|
Definition
| anaphylactoid does not invovle antibody mediated attacks |
|
|
Term
| Cytotoxic medated reactions are what type of allergic reaction |
|
Definition
|
|
Term
| Serum sickness is what type of allergic reaction |
|
Definition
|
|
Term
| contact dermatitis falls under what type of allergic reaction group |
|
Definition
|
|
Term
| Which type of allergic reaction is cell mediated |
|
Definition
|
|
Term
| Most commonly transmitted viral infection in blood transfusions is |
|
Definition
|
|
Term
| RBCs are preserved with what four things |
|
Definition
1. citrate
2. adenine
3. dextrose
4. phosphate |
|
|
Term
| citrate intoxication seen in transfusions is seen when you administer blood at what rate |
|
Definition
|
|
Term
| ABO incompatibilities usually results in what type of transfusion reaction |
|
Definition
|
|
Term
| white cell or pletelet related sensitization reactions in transfusions cause what kind of transfusion reaction |
|
Definition
|
|
Term
| anaphylactic reactions in transfusions often seen in what patients |
|
Definition
|
|
Term
| Antigen issues in transfusions usually cuase what type of transfusion reactions |
|
Definition
| delayed hemolytic reactions |
|
|
Term
| what is the P50 for sickle cell people |
|
Definition
|
|
Term
| hematocrit goal for sickle cell patients is |
|
Definition
|
|
Term
| management of sickle patients |
|
Definition
AVOID
1. low flow states
2. hypothermia
3. hypotension
4. hypovolemia
5. hypoxemia
6. tourniquets
7. acidosis |
|
|
Term
| hemophilia is most commonly associated with a deficiency in factor? |
|
Definition
| Factor VIII (85%) or factor IX |
|
|
Term
| What coags are changed in hemophilia |
|
Definition
| elevated PTT. Normal PT and Plt |
|
|
Term
|
Definition
1. recombinant factor
2. DDAVP
FFP and cryo NO LONGER INDICATED |
|
|
Term
| can you give toradol to hemophilia patients? |
|
Definition
| NO since it causes some anti platelet activity |
|
|
Term
| most common form of von willebrand disease? Which invovles low levels of what 3x things |
|
Definition
| Type I which is low levels of Factor VIII, vWf, Factor VIII C. |
|
|
Term
| Is von willibrands type I autosomal dominant or recessive |
|
Definition
|
|
Term
| DDAVP sitmulates production of? |
|
Definition
|
|
Term
| what is the pathophysiology of immune thrombocytopenic purpura |
|
Definition
| IgG antibodies that attack platelets |
|
|
Term
| two major characteristics of DIC are |
|
Definition
1. formation of fibrin
2. consumption of clotting factors |
|
|
Term
| ECT treats what three types of patients |
|
Definition
1. depression
2. mania
3. affective disorders in schizophrenics |
|
|
Term
| a minimum seizure of ____ seconds is recommended for an effective ECT |
|
Definition
| 25 seconds minimum. More seizure the better |
|
|
Term
| what IV med can prolong seizures |
|
Definition
|
|
Term
| what drugs should be avoided in patients on psych meds |
|
Definition
| avoid demerol and indirect acting pressors |
|
|
Term
| propofol is not ideal for ECT b/c ___ but if you have to use it use a dose < ___ |
|
Definition
| propofol has some anti-seizure properities but if you need to use then use a dose < 0.75mg/kg. B/c memory loss is associated already with ECT |
|
|
Term
| lethal triad of trauma is |
|
Definition
1. hypothermia
2. acidosis
3. coagulopathy |
|
|
Term
| What type of Le Forte fxs is nasal intubation contraindicated with? |
|
Definition
| Cannot nasal intubate in Le Forte II or III |
|
|
Term
list in order most blood loss in femoral fractures
1. subtrochanteric
2. subcapital
3. transcervical |
|
Definition
| Most blood loss is sub or intertrochanteric > transcervical > Subcapital |
|
|
Term
| major bleeding is associated with what % of pelvic fractures? |
|
Definition
|
|
Term
| classic triad of fat embolus |
|
Definition
1. dyspnea
2. petechiae
3. confusion |
|
|
Term
| MAP and PaO2 goal in head trauma patient |
|
Definition
|
|
Term
| A conscious pt with moderate head injury is a GCS of what range |
|
Definition
|
|
Term
| Which class of hemorrhage is associated with narrowing pulse pressure and increased HR? What % blood loss |
|
Definition
|
|
Term
| Hypotension seen in what % of blood loss and what class of hemmorhage is this? |
|
Definition
| Class III which is a EBL of 30-40% |
|
|
Term
| two muscular diseases that cause restrictive disease is |
|
Definition
1. duchennes
2. myotonic dystrophy |
|
|
Term
| Risks for MG pts and the meds they take |
|
Definition
| cholinergic crisis... salivation,meoisis, bradycardia, diarheea |
|
|
Term
| temp decreases how much in the first hour of general |
|
Definition
| 1-2 degrees C in first hour of general |
|
|
Term
| anticholinesterase therapy will do what to lambert compared to MG |
|
Definition
| improves MG while does nothing for lambert |
|
|
Term
| anesthetic concerns with RA patient 7x |
|
Definition
1. cervical spine involvement
2. synovitis of temporomandibular joint
3. cricoarytenoid arthritis - hoarseness
4. pericarditis
5. aortic regurgitation
6. peripheral nerve compression
7. anemia
8. drug induced effects from aspirin and steroids. |
|
|
Term
|
Definition
| makes you more senstiive to non depolarizers |
|
|
Term
| how long do you run flows thru machine for MH patient |
|
Definition
|
|
Term
| incidence for MH in adults and kids |
|
Definition
1 in 15000 kids
1 in 50,000 for adults |
|
|
Term
| most common opthalmic proceudre requiring surgery |
|
Definition
|
|
Term
| three As for retrobulbar block |
|
Definition
akinesthesia
analgesia
abolish oculocardia reflex |
|
|
Term
| what pre meds do you avoid with acute angle glaucoma |
|
Definition
|
|
Term
| what is the IOP associated with chemosis |
|
Definition
|
|
Term
| seven complications of retrobulbar block |
|
Definition
1. stimulation of oculocardiac reflex
2. retrobulbar hemorrhage
3. puncture of the posterior globe
4. central retinal artery occulusion
5. penetration of the optic nerve
6. brain stem anesthesia
7. intraocular injection |
|
|
Term
| how can you get a total spinal from retrobulbar block |
|
Definition
| accidental perforation of the mengeal sheaths that surround the optic nerve |
|
|
Term
| How does CVP, CO2 and BP affect rate of aqueous humor formation and secondarily intraocular pressure |
|
Definition
1. CVP: Increase CVP = decrease drainage of aquaeous humor and then increase IOP
2. CO2: increase co2 = increase IOP
3. Increase BP = Increase IOP |
|
|
Term
| most profound effect on IOP is from co2, cvp or BP |
|
Definition
|
|
Term
| # 1 cause of blindness of pts over 65 is |
|
Definition
|
|
Term
| why is ketamine not a great drug for intraocular cases |
|
Definition
| small increase in IOP but causes nystagmus which makes surgery difficult |
|
|
Term
| what is the gas used for bubble in eyes |
|
Definition
|
|
Term
| what is sulfur hexafluroide |
|
Definition
| an inert gas that is less oluble in blood than nitrogen. |
|
|
Term
| where is sulfur hexafluroide injected |
|
Definition
| into the posterior chamber of the eye during vitreous surgery or retinal detachment surgery |
|
|
Term
| what gas law applies to sulfur hexafluoride buble in eye cases |
|
Definition
|
|
Term
| how soon before air bubble inserted into eye should you stop nitrous |
|
Definition
|
|
Term
| how much does sux increase IOP |
|
Definition
|
|
Term
| what syndrome is associated with chronic use of hydralzine |
|
Definition
| SLE syndrome in 10-20 % of patients |
|
|
Term
| describe what the two phases of ECT induced seizures |
|
Definition
1. first is tonic
2. second is clonic |
|
|
Term
| 6s absolute contraindications for ECT |
|
Definition
1. pheochromocytoma
2. AAA > 5cm
3. Not NPO
4. recent MI < 4-6 weeks
5. CVA < 3 months
6. intracranial surgery < 3 months
7. intracranial mass
8. unstable ccervical spine |
|
|
Term
| two main goals of anesthesia for ECT |
|
Definition
1. partial neuromucular blockade to help prevent fractures / skeletal muscle injury
2. make patient unconscious for the shock |
|
|
Term
| dose of methohexital for ECT |
|
Definition
|
|
Term
| list three drugs that prolong seizures that we commonly come across |
|
Definition
1. ketamine
2. etomidate
3. caffeine |
|
|
Term
| drugs that decrease seizure during ECT that we use but should avoid |
|
Definition
1. lidocaine
2. versed
3. fentanyl |
|
|
Term
|
Definition
| first parasympathetic then one minute later then SNS |
|
|
Term
| ECT does what to cerebral blood flow |
|
Definition
| Dramatic increase in blood flow so terrible if space occupying lesion |
|
|
Term
| how does epi help with anaphylaxis reaction |
|
Definition
1. increase CAMP
2. decrease mast / basophils degranulation |
|
|
Term
| increase resistance or senssitivity to non depolarizers with 3rd degree burn patients |
|
Definition
|
|
Term
| how long will CO dissaossicate from Hb on room air compared to 100% FiO2 |
|
Definition
| on room air 5 hours while giving 100% o2 will decrease this to one hour. |
|
|
Term
| What is the difference between 1st, 2nd, and 3rd degree burns |
|
Definition
1st: red or pink. only epidermis
2nd: blister! blanches maybe slow, white.MOIST
3rd: Sub Q, white/black/tan/brown DRY and Leather like |
|
|
Term
| The OR room temp for a burn pt should be |
|
Definition
|
|
Term
| Which degree burn involves blisters that blanch |
|
Definition
|
|
Term
| which burn degree is white and moist |
|
Definition
|
|
Term
| at what point post major burn injury will protein levels decrease |
|
Definition
| AFter 48 hours protein levels will start to decrease and any drug that is highly protein bound may become toxic |
|
|
Term
| in the first 30 minutes cardiac out decreases by how much |
|
Definition
|
|
Term
| CO is removed from Hb in 5 hours on room air, if you give a patient 100% FiO2 this can be done in how much time |
|
Definition
| on 100% you can remove CO from Hb in one hour |
|
|
Term
| What level of CO toxicity can cause death |
|
Definition
|
|
Term
| Highest loss of body heat in burns via what type of heat loss |
|
Definition
|
|
Term
| Fluid shifts is greatest how long after burn insult |
|
Definition
|
|
Term
| THe obese patient BMI is? |
|
Definition
|
|
Term
| Two main findings of OSA are |
|
Definition
1. daytime somulence
2. Ssytemic HTN |
|
|
Term
| For obese patients what drugs do you dose based on TBW |
|
Definition
1. Propofol (maintenance)
2. Sux
3. Precedex
4. Neostigmine |
|
|
Term
| Dose lipid soluble drugs on which weight for obese patients |
|
Definition
|
|
Term
| does what drugs on lean body weight for obese patients |
|
Definition
|
|
Term
| is there an increae or decrease in local anesthetic requiremetns for obese patietns |
|
Definition
| increase because they have increase alpha 1 proteins |
|
|
Term
| what happens to the chest wall compliance in obese patients over time |
|
Definition
| Decrease chest wall compliance do to obesity causing accentuation of thoracic kyphosis, lumbar lordosis. |
|
|
Term
| STOP BANG stands for? Relates to what? |
|
Definition
IDentifies those at risk for OSA
S: Snoring
T: Tired during the day
O: Observed apnea
P: Pressure (HTN)
B: BMI > 25
A: Age > 50
N: Neck > 16 in women 17 in men
G: Gender (Male) |
|
|
Term
| Obese pts have CO that are typically around |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Organ function decreases over time by how much |
|
Definition
| Organ function decreases 1% each year after age 30 |
|
|
Term
| Describe the VOD for water and lipid soluble drugs in geriatrics |
|
Definition
1. Decrease VOD for water soluble drugs
2. Increase VOD for lipid soluble drugs |
|
|
Term
| List four reasons why geriatric patients are at increase risk for hypothermia |
|
Definition
1. decrease metabolic rate
2. increase ratio of body surface area to body mass
3. decrease effectiveness of vasoconstriction response to cold
4. hypothalamus reset to lower temp |
|
|
Term
| How does MAC change over aging |
|
Definition
| MAC decreases by 4% every decade after 40 years |
|
|
Term
|
Definition
|
|
Term
| how much does PaCO2 change with age |
|
Definition
| No change. PaCO2 uneffected |
|
|
Term
| What are the changes in geriatrics with spinals and epidurals |
|
Definition
Spinals increase sensitivity, decrease dose.
Epidurals: Increase spread, decrease duration, less motor block. |
|
|
Term
| PaO2 equation based on age |
|
Definition
|
|
Term
| best indicator of renal function in elderly is |
|
Definition
|
|
Term
| With age what happens to BUN And Cr |
|
Definition
| Increase in BUN, no change in Cr. |
|
|
Term
| Name three things that happen during bone cememnt syndrome |
|
Definition
1. hypotension
2. arrythmias
3. hypoxia |
|
|
Term
| Tourniquet pain is hard to suppress with neuroaxial anesthesia. Why? |
|
Definition
| b/c it travels via C fibers. C fibers are hard to block with locals! |
|
|
Term
| Most common to see fat embolism during what part of the procedure for ortho |
|
Definition
| hammering of the femoral prosthetic |
|
|
Term
| How long after ortho case do you often see a fat embolism |
|
Definition
|
|
Term
| List the three substances released when tourniquet dropped |
|
Definition
|
|
Term
| what is the anesthetic concern if patient is taking azathiprine |
|
Definition
| increases sensitivity to non depolarizers |
|
|
Term
| What are some cardiac concerns with a patient who has RA |
|
Definition
1. Aortic Regurgitation
2. CAD
3. Pericardial effusions
4. Conduction abnormalities |
|
|
Term
| Described the patho physiology of SLE |
|
Definition
| antinuclear Ab production |
|
|
Term
| two main characteristics of SLE |
|
Definition
1. Polyarthritis
2. dermatitis |
|
|
Term
| Three categories that can exacerbate SLE |
|
Definition
1. Drugs
2. Stress
3. Surgery |
|
|
Term
| List three ariway concerns with a SLE patient |
|
Definition
1. RLN Palsy
2. mucosal ulceration
3. cricoartenoid arthritis |
|
|
Term
| What is the mainstay treatment for SLE |
|
Definition
|
|
Term
| how much bleeding occurs during a TURP procedure |
|
Definition
|
|
Term
| how much irrigate is absorbed during a TURP procedure |
|
Definition
|
|
Term
| Three tings that soribitol cause |
|
Definition
1 hyperglycemia
2. lactic acidosis
3. osmosis |
|
|
Term
|
Definition
|
|
Term
| Early neurological Sx of TURP Syndrome |
|
Definition
1. headache
2. restlessness
3. irritability
4. confusion |
|
|
Term
| What can cause coagulation from TURP proceudres |
|
Definition
1. dilutional thormbocytopenia
2. primary and secondary fibrinolysis |
|
|
Term
| Pt begins having hiccups during TURP procedure what do you suspect? |
|
Definition
|
|
Term
| most common nerve to be injuries in the lithotomy position |
|
Definition
|
|
Term
| ABsolute contraindications for ESWL 4x |
|
Definition
1. pregnancy
2. coagulopathies
3. ACtive UTI
4. Pacemakers in ABD
5. AAA > 5 cm |
|
|
Term
| Neuroaxial for ESWL need to blook at what dermatone |
|
Definition
|
|
Term
| name two relative contraindications for ESWL |
|
Definition
1. MORBID obesity
2. AAA < 5 cm |
|
|
Term
| Most common injury from ESWL on left side is? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Most significant determinant of IOP is |
|
Definition
|
|
Term
| What drugs increase IOP 2x |
|
Definition
|
|
Term
| a intraoperative blood loss of ___ is associated with vision loss |
|
Definition
|
|
Term
| #1 cause of blindness in adults > 65 years of age |
|
Definition
|
|
Term
| what % of premies get retinopathy |
|
Definition
|
|
Term
| Judicious use of O2 in premies should continue until how long |
|
Definition
| 44 weeks post conceptual age |
|
|
Term
| Contraindications for laparoscopy 5x |
|
Definition
1. sickle cell
2. VP shunt
3. Super sick
4. CHF
5. Increase ICP |
|
|
Term
| What two anesthetic drugs do you have to be careful in administering to a patient with MG |
|
Definition
| MG is a disease where nicotinic receptors are attacked by IgG antibodies. These less than effective receptors don't work well and patients get muscle weakness. To overcome this we treat them with antichoniesterase drugs to flood the junction with more Acetylcholine. Down side is theses drugs inhibit pseudocholinesterase as well. So if we give Sux or Ester locals then we have less drugs enzyme to break them down. THEREFORE THE DURATION OF ACTION OF SUX AND LOCAL ESTERS IS PROLONGED |
|
|
Term
| Two most common sx of MG patients are |
|
Definition
|
|
Term
| Which type of muscle issue is caused by increased permeability and fatty infiltration of the muscle |
|
Definition
|
|
Term
| what muscle disease has a cardiac involvement with deep Qs in the precordial leads |
|
Definition
|
|
Term
| This muscle disease presents with weakness in the pelvic girdle and lower limbs |
|
Definition
|
|
Term
| which disease do we not want to warm in the operating room |
|
Definition
|
|
Term
| which muscle disease is PAINFUL |
|
Definition
|
|
Term
| This muscle disease has Sx that are truncal and wide stance issues |
|
Definition
|
|
Term
| This muscle disease is associated with small cell CA of the lungs |
|
Definition
|
|
Term
| Which muscle issue has facial weakness and expresionless facies |
|
Definition
|
|
Term
| Which muscle disease has high incidence in asian men |
|
Definition
|
|
Term
| What is the incidence of MH in kids and adults |
|
Definition
Kids: 1:15,000
Adults: 1:50,000 |
|
|
Term
| What electrolytes increase in MH |
|
Definition
1. increase K
2. Increase Mag
3. Increase Phos |
|
|
Term
| MH is associated with what 6x diseases |
|
Definition
1. duchennes
2. central core syndrome
3. myotonia congenita
4. SIDS
5. Strabismus
6. Osteogenesis imperfecta |
|
|
Term
| What percent of MH patients have masseter rigidity |
|
Definition
|
|
Term
| Stop cooling an MH when their temp reaches |
|
Definition
|
|
Term
| What chormosome associated with MH |
|
Definition
| Chromosome 19 responsible for defect in MH |
|
|
Term
| #1 anesthesia drug that triggers MH is |
|
Definition
|
|
Term
| What type of hypersensitivity is arthus reaction |
|
Definition
|
|
Term
| What is a type III Hypersensitivity reaction |
|
Definition
| Cell mediated via T cells and macrophages |
|
|
Term
| What type of hypersensitivity reaction involves transfusions |
|
Definition
| Type II with is cytotoxic which via IgG activates complement system |
|
|
Term
| What type of hypersensitivity reaction involves MG patients |
|
Definition
| Type II with is cytotoxic which via IgG activates complement system |
|
|
Term
| What type of hypersensitivity reaction involves HIT |
|
Definition
| Type II with is cytotoxic which via IgG activates complement system |
|
|
Term
| What type of hypersensitivity reaction is invovled with latex allergy |
|
Definition
1. type I IgE
or
2. Cell mediated Type IV Cell mediated |
|
|
Term
| TB is what type of hypersensitivity |
|
Definition
| Type IV which is Cell mediated via T cells and macrophages |
|
|
Term
| What are the perservativies for pRBCs 4x |
|
Definition
1. adenine - precursor for ATP
2. citrate - anticoagulant
3. Dextrose - energy
4. phosphate - buffer |
|
|
Term
| citrate intoxication is seen with rapid transfusion of? |
|
Definition
|
|
Term
| Citrate intoxciation will result in alkalosis or acidosis? |
|
Definition
| alkalosis bc citrate metabolism creates bicarb in liver |
|
|
Term
| citrate toxicity does what to the heart |
|
Definition
1. prolongs QT
2. decrease heart contractility |
|
|
Term
| What are the Sx of hemolytic Rx in the anesthetized patient |
|
Definition
1. hematuria
2. bleeding diathesis
3. unexplained tachy
4. hyperthermia
5. hypotension |
|
|
Term
| Sx of hemolytic reaction of blood transfusion in awake pt |
|
Definition
1. chills
2. fever
3. chest and flank pain
4. nausea |
|
|
Term
| Which type of transfusion reaction is due to ABO incompatiblity |
|
Definition
|
|
Term
| which type of transfusion reaction is due to antigen groups on donated blood |
|
Definition
| delayed hemolytic reaction |
|
|
Term
| when would a transfusion cause a anaphylactic reaction |
|
Definition
| pts with IgA deficiencies |
|
|
Term
|
Definition
|
|
Term
| Sickle cell disease is homozygous or heterzyhous |
|
Definition
|
|
Term
| normal lifespan of RBC is? Normal lifespan of sickled hb is? |
|
Definition
| 10-15 days for sickle. 120 days for normal RBCs |
|
|
Term
| mortality of acute chest sydnrome |
|
Definition
|
|
Term
| what is the difference between hemophilia A and B |
|
Definition
| Hemophilia A: Factor VIII def Hemophilia B: Factor IX def |
|
|
Term
| What coag test is elevated in hemophilia |
|
Definition
|
|
Term
| Normal Pt, PTT, INR and ACT..and which is intrinsic or extrinsic |
|
Definition
PT: 8-12 sec
PTT: 25-35 sec: intrinsic
INR: 0.8-1.2: Extrinsic
ACT: 90-120: Intrinsic |
|
|
Term
| extrinsic pathway invovles what facotrs |
|
Definition
1. Factor III
2. Factor VII |
|
|
Term
| Most common type of Von Willibrand disease is? |
|
Definition
| Type I which is low levels of FActor VIII |
|
|
Term
| Describe general difference in three types of von willibrand disease |
|
Definition
1. Type I: low levels
2. Type II: fucntional abnormality
3. Type III: Defective synthesis |
|
|
Term
| First line of therapy for ITP is |
|
Definition
|
|
Term
| Two main causes of polythemia |
|
Definition
1. chronic hypoxic state
2. plasma volue depletion |
|
|
Term
| at a HCT of ___ blood flow can slow causing hypoxia in distal cells |
|
Definition
|
|
Term
| Giver fibrinogen in DIC if |
|
Definition
|
|
Term
| Primary platelet plug occurs in? Definitive platelet plug occurs in? |
|
Definition
PRimary platelet plug: 5 min
Def platelet plug: 1-2 hours |
|
|
Term
| 1 tesla is how many guass |
|
Definition
|
|
Term
| Annual exposure to magnet cant be more than? |
|
Definition
|
|
Term
|
Definition
1. depression
2. mania
3. affective disorders in schizo |
|
|
Term
|
Definition
1. Pheo
2. recent brain surgery
3. brain lesion
4. not NPO
5. recent MI
6. AAA > 5 CM
7. unstable C-spine |
|
|
Term
| What anesthetic agents may increase ICP |
|
Definition
1. ketamine
2. nitrous
3. Sux |
|
|
Term
| The lethal triad of trauma |
|
Definition
1. coagulopathy
2. hypotherima
3. acidosis |
|
|
Term
| classic triad of fat embolism |
|
Definition
1. petechia
2. confusion
3. dyspnea |
|
|
