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149 Cards in this Set
- Front
- Back
with a Co2 laser what type of protection should be worn
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ordinary eyeglasses with sideguards
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with a Nd-YAG laser what type of protection should be worn
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opaque green eyewear or clear lenses with special coating
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with a KTP laser what type of protection should be worn
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special eyewear with a red filter
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with a argon laser what type of protection should be worn
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special opaque orange goggles/eyewear
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what type of damage can occur from a CO2 laser
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*tissue destruction is proportional to water content
*corneal injury |
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what kind of damage can occur from a Nd-YAG laser
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retinal damage
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what kind of damage can occur from a KTP laser
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retinal damage
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what kind of damage can occur from a argon laser
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retinal damage
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what is the order of increasing dead space with ETT, face masks and LMA
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face mask > LMA > ETT
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what is the order of decreased resistance with ETT, face masks and LMA
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face mask < LMA < ETT
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what medications should be continued up to time of anesthesia and surgery
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*HTN drugs
*meds for angina *meds for arrythmias *meds for CHF *meds for endocrine disorders |
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when should oral hypoglycemics be discontinued for surgery
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withhold day of sx
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when shoud ASA and NSAIDs be discontinued for sx
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withold for 3-7 days
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when should heparin be discontinued for surgery
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stop it 4-5 hrs before sx and check PTT
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when should coumadin be discontinued before surgery
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3-5 days before sx and check PT
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when should plt inhibitors like Plavix be discontinued before surgery
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7-14 days
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what effect on anesthesia drugs can aminoglycosides have
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can potentiated neuromuscular block
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what effect can MAO inhibitors have on anesthesia drugs
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*increase catecholamine stores
*HTN response to pressor agents *increased response to ephedrine |
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what is the regimen for steriod therapy for pts who have received corticosteriod therapy for at least 1 month in the last 6-12 months
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*admin 25mg of hydrocortisone pre-op then give IV infusion of 100mg over next 12-24 hrs
*100mg hydrocortisone IV before, during and after sx |
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if the pharmokinetics of an herbal supplement is UNKNOWN how long should the supplement be discontinued prior to sx
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2 weeks
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what possible s/e does echinacia have
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*activation of cell-mediated immunity
*may caused decreased effectivenessof immunosuppresants |
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what s/e does ephedra have
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*increased HR and BP
*may increase risk for myocardial ischemia, stroke and dysrhythmias *depletion of endogenous catecholamines with long term use |
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how long prior to sx should ephedra be discontinued
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at least 24 hrs
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what is garlic used for
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to prevent atheroslcerosis, HTN and decrease thrombis formation and lipid levels
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what s/e can garlic have
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*inibition of plt aggregation, increased fibronolysis and possible antihypertensive activity
*may increase risk of bleeding and potentiate other anti-platelet meds |
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how long prior to sx should garlic be discontinued
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at least 7 days
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what is ginkgo bilobo used for
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to decrease symptoms of cognitive disorders, tinnitus, erectile dysfunction and altitude sickness
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what are the s/e of ginkgo bilobo
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*inhibition of plt-activating factor
*may increase risk of bleeding and potentiate other anti-platelet meds |
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how long prior to sx should ginkgo bilobo be discontinued
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at least 36 hrs prior to sx
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what is ginseng used for
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to prevent stress and improve cognitive function
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what are the s/e of ginseng
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*lowers blood glucose
*inhibits plt aggregation *may cause hypoglyemia *risk of bleeding *may decrease anticoagulation effect of warfarin |
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how long prior to sx should ginseng be discontinued
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at least 7 days
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what is kava used for
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to decrease stress and as a sedative
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what are the s/e of kava
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*sedation and anxiolysis
*may increase sedative effect of anesthetics |
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how long prior to sx should kava be discontinued
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at least 24 hrs
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what is saw palmetto used for
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symptoms of BPH
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what are the s/e of saw palmetto
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*inhibition of 5-a reductase and cyclooxygenase
*may increase risk of bleeding |
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what is st. johns wort used for
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mild to moderate depression
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what are the s/e of st. johns wort
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*inhibition of NT reuptake
*increased induction of CYP450 *delayed emergence |
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how long prior to sx should st. johns wort be discontinued
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at least 5 days
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what is valerian used for
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sedative and insomnia
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what are the s/e of valerian
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*sedation
*may increase sedative effects of anesthetics *BZD-like acute withdrawal (insomia, anxiety, hallucinations, HA) |
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what is the MAC of halothane
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0.76-0.87
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what is the blood gas solubility of halothane
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HIGH- 2.4
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what is the blood gas solubility of sevoflurane
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LOW- 0.69
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what is the MAC of sevoflurane
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1.7 - 3.3
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what are the s/e of halothane
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*halothane hepatitis
*cardiac depression *myocardial dysrhythmias |
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what are the s/e of sevoflurane
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*small increase in HR
*20-30% decrease in BP *delirium & excitement on emergence *increase in Fl ions |
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what is the formula for proper size UNCUFFED ET tube
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age (years) +16/4= ETT size
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what is the formula for distance of insertion for ET tube
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depth of insertion =
age / 2 + 12 |
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what is the blood gas solubility for nitrous
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0.47
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when should nitrous be AVOIDED
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*tympanoplasty & mastoidectomy sx
*pneumothorax/pulmonary blebs *abd/bowel sx *cyanotic heart dz *venous air embolism |
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what is blood gas solubility for isoflurane
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1.4
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what is MAC for isoflurane
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1.2 - 1.6
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isoflurane has what effect on the myocardium
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minimum
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isoflurane has what effect on baroreceptor reflexes
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decreases them so decrease in arterial BP
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which inhalation agent has favorable cerebral hemodynamics
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isoflurane
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what is the blood gas solubility of desflurane
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0.42
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what is the MAC of desflurane
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6.6 - 9.2
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induction dose for propofol for peds
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2-5 mg/kg
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maintenance dose for propofol for peds
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100-250 mcg/kg/min
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induction dose for CHILDREN of thiopental
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5-6 mg/kg
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induction dose for NEONATES of thiopental
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3-4 mg/kg
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dose for children for methohexital
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1 to 2.5 mg/kg
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ketamine IV induction dose for peds
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2 mg/kg
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etomidate induction dose for peds
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0.2 to 0.3 mg/kg
(0.2) |
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fentanyl dosage for GENERAL surgery for peds
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1 - 5 mcg/kg
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fentanyl dosage for CARDIAC surgery for peds
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75 - 150 mcg/kg
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remifentanil dosage for peds
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0.05 - 0.1 mcg/kg/min
0.25 -0.5 mcg/kg/min |
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sufentanil dosage for peds
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0.2 - 0.5 mcg/kg/hr
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dose of morphine for peds
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0.1 - 0.2 mg /kg
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what age group in pediatrics have greater sensitivity to morphine
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neonates
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dose for demerol for peds
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1 -1.5 mg/kg
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IV dose of succinylcholine for peds
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2 mg/kg
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IM dose of succinylcholine for peds
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4 mg/kg
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what is given with succinylcholine in the pediatric population
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atropine 0.02 mg/kg
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dose of atracurium for peds pt
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0.3-0.5 mg/kg
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dose of cisatracurium for peds
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0.15 - 0.2 mg/kg
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dose of vecuronium for peds
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0.1 mg/kg
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onset of action for atracurium
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2-4 min
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duration of action for atracurium
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20-45 min
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duration of action for succinylcholine
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<2-5 min
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onset of action for cisatracurium
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2-4 min
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duration of action for cisactracurium
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20-45 min
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onset of action for vecuronium
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2-4 min
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duration of action for vecuronium
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20-45 min
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dose of rocuronium for peds
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0.5 - 1 mg/kg
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onset of action for rocuronium
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2-4 min
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duration of action for rocuronium
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20-45 min
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what is an alternative to succinylcholine for RSI
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rocuronium
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what is the dose for pancuronium in peds
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0.05 - .1 mg/kg
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onset of action for pancuronium
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3-5 min
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duration of action for pancuronium
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45-60 min
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dosage for ketorolac in peds
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o.5 mg/kg not to exceed 15 mg for wt less than 50 kg
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dose for zofran for peds
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.1- .15 mg/kg
(.15) |
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dose of metoclopramide in peds
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0.15 mg/kg
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what is the amt of ml/kg needed for a sacral block
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0.50ml/kg
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what is the amt of ml/kg needed for a lower thoracic block
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1.00/ml/kg
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what is the amt of ml/kg needed for a mid thoracic block
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1.25 ml/kg
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what is the dosage of bupivacaine used for a caudal block
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0.125-0.25%
1ml/kg |
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what is the dosage of ropivacaine used in a caudal block
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0.20%
1ml/kg |
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what is the dosage of duramorph used in a caudal block
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50 to 100 mcg/kg
1ml/kg |
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what is the dosage of clonidine used in a caudal block
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1-2 mcg/kg
1ml/kg |
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how is fluid replacement calculated based on the 4/2/1 system
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4cc/kg/hr = 1-10 kg
2cc/kg/hr = 10-20 kg 1cc/kg/hr = 20 kg & more |
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crystalloid replacement for blood loss should be approximately what
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3 ml/kg
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what is the formula for max allowed blood low (MABL)
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MABL=
EBVx(pts hct-min accept hct) -------------------------------------------- pts hct |
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what is the value for hypoglycemia in neonates
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< 30 mg/dl
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what is the value for hypoglycemia in children
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< 40 mg/dl
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what is the estimated blood volume of a premature infant
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90 to 100 ml/kg
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what is the estimated blood volume of a full term infant
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80 to 90 ml/kg
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what is the estimated blood volume of an infant 3 mo to a 1 y/o
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70 to 80 ml/kg
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what is the estimated blood volume of a child > 6 y/o
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65 to 70 ml/kg
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in the 1980's what was identified as an early sign of malignant hyperthermia
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end tidal CO2
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1990's found what receptor is responsible for almost all cases of swine MH and perhaps 50% of human MH
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ryanodine receptor
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MH is transmitted as what kind of trait
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autosomal dominant trait
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MH is most common in what age group
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older children and young adults
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MH is primarily a mutation of what receptor
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ryanodine receptor (RYR1)
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mutations of the RYR1 gene are responsible for a form of the MH condition known as what
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MHS1
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what is the most common form of MH (accounts for most cases)
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MHS1
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MH susceptibility has been linked to what chromosome primarily
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chromosome 19
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what is the ryandodine receptor the site for
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it is the site at which Ca++ stored in the SR is released into the sarcoplasm to initiate muscle contraction
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what are the consequences of hypermetabolism
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*muscle rigidity
*increased ATP production and usage *increased O2 consumption *increased production of lactate, Co2, lactic acid & heat *leakage of K, Ca, CK & myoglobin from muscle cells as ATP is depleted *increase in catecholamine levels *DIC |
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what are the clinical signs of MH
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*increasing ETCo2
*unexplained tachycardia, vent arrythmias *masseter muscle spasm or generalized rigidity *tachypnea *metabolic & resp acidosis *increased temp 1-2 C q 5 min *myoglobinuria *DIC |
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what is the appropriate treatment regiment with dantrolene for MH
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2.5 mg/kg IV and repeat as needed to control signs of MH
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what is the appropriate treatment regiment with NaHCO3 for MH
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1-2 mEq/kg to control metabolic acidosis as guided by ABG
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what is the mnemonic for treatment of MH
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Some-stop all triggering agents
Hot- hyperventilate w100% 02 Dude- dantrolene 2.5 mg/kg Better- bicarb 1-2 mEq/kg Get- glucose & insulin Iced- IV fluids/cooling blanket Fluids- furosemide,mannitol Fast- tachycardia, arrythmias |
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dantrolene does what to calcium
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blocks the release of calcium from the sarcoplasmic reticulium
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what is the onset of action for dantrolene
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2-3 min
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what is the half life for dantrolene
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4-6 hrs
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what is the elmination time for dantrolene
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12 hrs
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how is dantrolene absorbed from the GI tract
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poorly
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what effect does dantrolene have on cardiac and smooth muscle
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little effect
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how does dantrolene come packaged
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20 mg vial of lyophylized powder
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how is dantrolend prepared
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reconstituted with 60 ml STERILE WATER
**do NOT reconstitute with D5W or normal saline** they can hinder dissolution |
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what are the side effects of datrolene
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*muscle weakness
*pain/phlebitis at injection site *nausea |
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what is the shelf life of dantrolene
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36 months
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what is the "gold standard of testing for MH
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caffeine-halothane contracture test
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where is the APL located
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on the EXPIRATORY limb
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what do you attach the PEEP valve to
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the EXPIRATORY limb
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where is the fresh gas inlet located
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*UPstream of INSPIRATORY unidirectional valve
*DOWNstream of absorber |
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where is the reservoir located
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*DOWNstream of EXPIRATORY unidirectional valve
*UPstream of the absorber |
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where are the unidirectional valves located
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on the absorber column
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where is the oxygen monitor located
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on the INSPIRATORY limb
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where is the respirometer located
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EXPIRATORY limb
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where is the airway pressure sensor located
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*close to pt connection
*to measure PEEP it should be on the same side of the EXPIRATORY undirectional valve as the PEEP valve |
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with a circle system the PaCO2 depends on what
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VENTILATION
(not FGF) |
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how is Co2 gotten rid of in a mapelson system
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it must be "washed out" with FGF
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what is absent in a mapelson system
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*unidirectional valves
*Co2 absorber |
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which system circle or mapelson is there no clear separation of inspired and expired gases
|
mapelson
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