Basics Final

Front 1

Formula for IBW

Back 1

Male: 50kg + 2.3 kg for each inch over 5 ft.
Female: 45.5 kg + 2.3 kg for each inch over 5 ft.

Front 2

When do you use ABW instead of IBW? And what is the formula?

Back 2

When the actual weight is 30%> than IBW.
ABW is IBW + 0.4(actual weight - IBW)

Front 3

4:2:1 rule for maintenance fluid

Back 3

4 ml/kg/hr for first 10 kg
Add 2 ml/kg/hr for 10-20 kg
Add 1 ml/kg/hr for every kg above 20.

Front 4

Calculating insensible loss/3rd space loss for surgeries.

Back 4

0-2 ml/kg/hr for pansy surgery
3-4 ml/kg/hr for real surgery
5-8 ml/kg/hr for hardcore

Front 5

EBV for males, females, full term neonates, premies, and infants/children

Back 5

Adult female: 65 ml/kg
Adult male: 75 ml/kg
Infant/child: 80 ml/kg
Full term neonate: 85 ml/kg
Premie 95 ml/kg

Front 6

Calculating allowable blood loss:

Back 6

ABL=ARCL x 3
ARCL is derived by finding the Estimated Red Cell Mass
ERCM = EBV x crit/100
To calculate ERCM at "target" crit you do:
ECRMtarget = EBV x crit target/100
ARCL = ERCM - ERCMtarget

Front 7

Calculating fluid deficit

Back 7

Hourly maintenance x hours NPO

Front 8

TBW calculations

Back 8

Weight x .6 = TBW
TBW is broken down into ECF (1/3) of TBW, 2/3 is ICF
ECF is further broken down into interstitial (3/4) Plasma (1/4) and Transcellular.

Front 9

Phase III Low plateau
Anything that causes CO2 to fall suddenly close to zero....

Back 9

IMMINENT DISASTER!!!
Complerte OT disconnection
OT obstruction/kinked tube
Vent malfunction
Esophageal intubation
Capnograph malfunction (last consideration)

Front 10

Sudden decrease in CO2 but not closer to zero...

Back 10

OT cuff leak
Partial disconnect
Leak in circuit or sampling tube allowing for room air entrainment

Front 11

Slow decrease in CO2 approaching zero

Back 11

Sudden increase in dead space: PE, severe hypotension, MI

Front 12

Gradual decrease not approaching zero

Back 12

Hyperventilation
Hypothermia
Decrease CO2 production

Front 13

Sustained low CO2

Back 13

Emphysema

Front 14

Irregular plateau on capnograph

Back 14

Poor mask fit
Surgeon bumping chest
Retractors pushing on chest
Inadequate muscle relaxation "Curare clefts"

Front 15

Slanted plateau on capnograph

Back 15

Asthma of bronchospasm

Front 16

Formula for Pi02

Back 16

(PB-PH20)FiO2

Front 17

Formula for PAO2

Back 17

Pi02-(PaCO2/RQ)

Front 18

Formula for A-a gradient and formula for estimating A-a gradient for age.

Back 18

PA02-PaO2 and
(age + 10)/4 and .21(age+2.5)
The higher the A-a gradient the poorer the transfer of gases across the alveoli

Front 19

Zones and relative A, a, and v pressures

Back 19

Zone 1- PA>Pa>Pv
Zone 2- Pa>PA>Pv
Zone 3- Pa>Pv>PA

Front 20

Does increasing Fi02 in a patient with a shunt help the patient significantly?

Back 20

No

Front 21

Hypothermic change under GA

Back 21

1-1.5 C in the first hour

Front 22

When is qualitative monitoring of ventilation sufficient?

Back 22

When there is no sedation; ex regional/local anesthesia

If moderate/deep sedation must have CO2 monitoring

Front 23

Circulation monitoring requirements:

Back 23

Every patient gets EKG, HR, and BP at least q 5 minutes until they leave the anesthetizing location.
GA patients need more (usually pulse ox)

Front 24

Lambert-Beer law

Back 24

Explains light absorption in IR/NIR spectrums to get a pulse ox. Evaluates the absorption of light as it passes trough clear solvent.

Front 25

Contraindications for TEE

Back 25

Absolute: Esophageal pathology
Relative: Coagulopathy/heparin or left atrial myxoma w/ hx of embolization

Front 26

SSEP

Back 26

SQ electrodes near median, ulnar, and posterior tibial nerves. Recording electrodes on scalp.
Use less than 1 MAC, benzos and opiods have minimal effect and NMB have no effect

Front 27

MEP

Back 27

Motor evoked potentials. Stimulates electrodes on scalp, records on specific muscle(s). Inaccurate. NMB block it, duh.

Front 28

EEG BIS numbers

Back 28

0= EEG suppression
100= awake
40-60 is what you shoot for w/ GA

Readings are affected by caudery, EMG, pacers, EKG, movement.

Front 29

Clinical indications your CO2 absorber has given up the ghost:

Back 29

Increased RR
Initial increase in HR and BP, followed by a decrease
Increased sympathetic drive: skin flushing, sweating, tachyarrhythmias, hypermetabolic state (rule out MH)
Respiratory acidosis
Increased surgical bleeding due to HTN and coagulopathy

Front 30

Expected increase in patient's platelets with one unit of platelets?

Back 30

7-10K

Front 31

Coagulation will function normally above what percentage of normal?

Back 31

30%

Front 32

How to treat a high K

Back 32

Administer calcium (about a gram)
Insulin and glucose (10 units regular IV and D50, 25g)
Bicarb/hyperventilate if needed for acidosis.
Kayexylate
Dialysis

Front 33

How to calculate fluid deficit:

Back 33

Determine the patient's hourly maintenance fluid needs and then multiply that by the number of hours they have been NPO.

Front 34

Reasons why hypothermia is no bueno for el cuerpo.

Back 34

arrhythmias/ischemia
increased PVR
Left shift
reversible coagulopathy
altered mental status
impaired renal function
decreased drug metabolism
poor wound healing
higher infection rates

Front 35

Hypothermia interventions

Back 35

Humidify air
warmed crystalloids
cutaneous warming- forced air is best.