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41 Cards in this Set
- Front
- Back
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5 contraindication for FOB
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hypoxia
heavy airway secretions not relieved with suction or meds LA allergy for awake attempts inability to cooperate for awake attempts |
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What is the funtion of protein C in hemostasis
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Vit K dependent anticoagulant. Thrombin activates protein C, which promotes fibrinolysis.
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Cause of postop HTN after CEA
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10-66% with HTN
exact mechanism unclear, but all mechanisms involve the carotid sinus baroreceptors. May be from surgical denervation of the ipsilateral carotid baroreceptor, or chemical denervation of barorecptor, or carotid sinus dysfunction from surgical trauma. |
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Rank protein binding of LA from greatest to least
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Bupivicaine.....95
Etidocaine, ropi, tetracaine......94 mepivicaine......77 lido......64 prilocaine.....6 |
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Which LA has 0 protein binding
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chloroprocaine
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Which LA is not metabolized in neonates
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Mepivicaine
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Rank the amides LA, greatest to least, according to ability to cross the placenta
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Mepivicaine
Etidocaine Lidocaine Ropivicaine Maternal Elevated Locals are Risky to Baby |
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What are the 4 major and 7 minor signs of fat embolism. What is required to diagnose?
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Major - axillary/subconjunctival petechia, hypoxemia, CNS depression, pulmonary edema.
Minor- fast HR, hyperthermia, retinal fat emboli, urinary fat globules, uneplained decrease platelets or HCT, increased ESR, fat globules in sputum. Must have at least 1 major and 4 minor to diagnose with fat emboli |
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classic triad of s/s that strongly indicates fat emboli syndrome
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arterial hypoxemia (dyspnea)
mental confusion petechiae (neck,shoulders) |
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What is another name for metabolic acidosis with a normal anion gap? What is the mechansim for metabolic acidosis
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Hyperchloremic acidosis.
Occurs when bicarb is lost from the body fluids thru GI or renal mechanims and is effectively replaced with chloride ions |
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Will either Lactic acidosis or ketoacidosis produce hyperchloremic acidosis?
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no, both produce a metabolic acidosis but with a high anion gap because bicarb ions are used to buffer H ions from the excess production of metabolic acids
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Identify implanted devices that are strong contraindications to MRI
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vascular clips, stents, pacemakers, AICDs, implanted insulin pumps
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Define critical incident
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an event that causes or has potential to cause injury if not noticed and corrected in a timely manner
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Is a ventilator disconnect a critical incident or sentinel event
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critical incident
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What is the indicidence of post op delirium in elderly
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10-15%
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What surgery is post op delerium most common in elderly
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orthopedic
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What type of delirium is most common in elderly
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interval delirium..occurs after a lucid interval of 1 or more days after operation
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What is the most common type of delirium in kids
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emergence delirium, occurs within minutes of regaining consciousness
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What are the benefits to cessation of smoking 12-24 hours preoperatively?
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reduces carboxyhemoglobin levles and nicotine levels. 12 hours increases P50 and reduces plasma carboxyhemoglobin
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Which exam test best assess hepatocellular damage?
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5 NT
if 5 NT not there, GST If 5 NT or GST not there go with ALT (SPGT) |
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What is the major potential complication of a D & C
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perforation and hemorrhage
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What is venous saturation of coronary blood, in other words what is the oxygen extraction level of coronary blood
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30% (PaO2 18-20)
O2 extraction 70% assuming 100% sat |
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In steep trendelenburg, most of lungs are in what zone?
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Zone 3 or 4
Zone 4 susceptible to pul interstitial edema |
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Pt taking lithium, what preop labs are of concern
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lithium levels, Na
Low Na will decrease renal excretion of lithium. Avoid fluid restriction and excessive diuresis |
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What type of hypoxia is caused by carbon monoxide poisoning
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tissue hypoxia, CO binds 200 more times than oxygen, reducing o2 carrying capacity of hemoglobin....functional anemia
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What is the best assessment of adequacy of CO
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mixed venous oxygen tension......elevation in response to increased demand reflecting inadequate tissue perfusion
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describe anatomy of portal triad
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portal vein, an hepatic artery, and a bile duct in the liver
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What type of anesthesia maching should be tested with a negative leak test
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all with check valves
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How do you do a negative leak test
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suction bulb attached to the common gas outlet, collapse bulb, assure remains collapsed for 10 seconds
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What reflex best explains bradycardia after spinal
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brainbridge relfex relates to the paradoxical slowing of the HR after spinal. Usually blockade of T1-T4 with unopposed PS stimulation.
BUT, with spinal more clearly R/T arterial hypotension than height of block due to decrease in venous return. low venous return sensed by barorecptors |
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identify local mediators released in response to hypoxia/ischemia in the kidneys
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renal ischemia, hypotension, stress stimulated production and release of prostaglandins and bradykinin. Prostaglandins maintain RBF and Na and water excretion
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Can PGE2 protect the kindeys from hypoxic injury
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yes
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during radical neck dissection, QT prolonged, why
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trauma to the right stellate ganglion and cervical ANS ...lowers threshold for V Fib
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What risk is associated with dysfunctional flush valve
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sticking in open position, barotrauma
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describe etiology of idiopathic thrombocytopenia purpura
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autoimmune thrombocytopenia....persistent thrombocytopenia caused by antiplatelet antibodies that bind to platelet membranes, causing premture rupture of platelets
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compared to skeletal muscle, what protein is not found in smooth muscle
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both have actin and myosin\
smooth does not have regulatory troponin complex |
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mannitol, osmotic diuretic, what volume or electrolyte imblances may occur after administration
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hypovolemia
hypokalemia hypernatremia should not alter BG |
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what is "tail coverage"
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liability insurance protection for claims filed after the insured is no longer covered by the insurance policy, necessary b/c a majority of malpractice suits filed 1-3 years after event
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during repair of CDH, SaO2 suddenly falls to 65% and HR increases 50 beats, what is cause and what should be done
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any sudden decrease in lun compliance, HR, SAT, or BP suggests tension pneumothorax..
insert chest tube |
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at waht age are MAC highest for VA
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1-6 months old
sevo is highest in neonates 0-30 days |
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is pneumothorax a potential complication of infraclavicular block
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yes
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