Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
134 Cards in this Set
- Front
- Back
|
What is MAC?
|
minimum alveolar concentration = smallest concentration of inhalation agent at which 50% of patients will not move with incision
|
|
|
What does a small MAC mean?
|
more lipid soluble = more potent
|
|
|
Speed of induction is inversely proportional to ____
|
solubility
|
|
|
Which inhalation agent is fastest but has high MAC (low potency), also minimal myocardial depression?
|
Nitrous oxide
|
|
|
Which inhalation agent is slow, higest degree of cardiac depression and arrhythmias; least pungent; which is good for children?
|
Halothane
|
|
|
What are the sx of Halothane hepatitis?
|
fever, eosinophilia, jaundice, increased LFTs
|
|
|
Which inhalation agent can cause seizures?
|
Enflurane
|
|
|
Which inhalation agent is good for neurosurgery but has higher cost?
|
Isoflurane
|
|
|
Which inhalation agent has less myocardial depression, fast onset/offset, less laryngospasm; higher cost?
|
sevoflurane
|
|
|
Which induction agent is a fast acting barbituate with side effects of decreased cerebral blood flow and metabolic rate, decreased blood pressure.
|
sodium thiopental
|
|
|
Which induction agent has very rapid distribution and on/off; amnesia; sedative. Not an analgesic. Metabolized in liver by plasma cholinesterases. Do not use in patients with egg allergy.
|
Propofol
|
|
|
What are the side effects of propofol.
|
hypotension and respiratory depression
|
|
|
Which induction agent has dissociation of thalamic/limbic systems; places pt in a cataleptic state (amnesia, analgesia). No respiratory depression.
|
Ketamine
|
|
|
What are the side effects of Ketamine?
|
hallucinations, catecholamine release (increased carbon monoxide, tachycardia), increased airway secretions, and increased cerebral blood flow
|
|
|
When is ketamine contraindicated?
|
pts with a head injury
|
|
|
Which induction agent has fewer hemodynamic changes; fast acting. Continuous infusions can lead to adrenocortical suppression.
|
Etomidate
|
|
|
What is the last muscle to go down and 1st muscle to recover from paralytics?
|
diaphragm
|
|
|
What is the first muscle to go down and the last to recover from paralytics?
|
neck muscles and face
|
|
|
What is the only depolarizing agent?
|
succinylcholine
|
|
|
What is the 1st sign of malignant hyperthermia?
|
increased end-tidal CO2
|
|
|
Tx for malignant hyperthermia?
|
Dantrolene inhibits Ca release. cooling blankets, bicarb, glucose
|
|
|
Do not use succinylchoine in pts with what?
|
burn pts, neurologic injury, neuromuscular disorders, spinal cord injury, massive trauma, acute renal failure
|
|
|
What can happen if pt with open-angle glaucoma gets succinylcholine?
|
it can become close angle glaucoma
|
|
|
Atypical pseudocholinesterases
|
cause prolonged paralysis with succinylcholine (Asians)
|
|
|
How do nondepolarizing paralytic agents work?
|
inhibit neuromuscular junction by competing with acetylcholine
|
|
|
Which paralytic undergoes Hoffman degredation. Can be used in liver and renal failure. Histamine release.
|
Cis-atracurium
|
|
|
Which paralytic is fast, short acting; degradation by plasma cholinesterases. Histamine release.
|
Mivacurium
|
|
|
Which paralytic is fast, intermediate duration; hepatic metabolism.
|
Rocuronium
|
|
|
Which paralytic is slow acting, long-lasting; renal metabolism. Most common side effect is tachycardia.
|
Pancuronium
|
|
|
What two drugs can be given for reversing nondepolarizing agents and what is their MOA?
|
Neostigmine and Edrophonium, they block acetylcholinesterase, increasing acetylcholine
|
|
|
___ or ___ should be given with neostigmine or edrophonium to counteract the effects of generalized acetylcholine overdose
|
atropine or glycopyrrolate
|
|
|
Local Anesthetics work by increasing action potential, preventing ____
|
Na influx
|
|
|
How much lidocaine can you use?
|
0.5 cc/kg
|
|
|
Relative length of action of bupivacaine, lidocaine, procaine
|
bupivacaine > lidocaine > procaine
|
|
|
Name conditions where you cannot use epinephrine with local anesthetics.
|
arrhythmias, unstable angina, uncontrolled hypertension, poor collaterals (fingers, toes, penis, nose, and ear), uteroplacental insufficiency
|
|
|
How to tell the difference between the amides and the esters?
|
Amides all "i" in the first part of the name: lidocaine, bupivacaine, mepivacaine
Esters: tetracaine, procaine, cocaine |
|
|
What is the biggest difference between the amides and the esters?
|
Amides rarely have allergic reactions. Esters have increased allergic reactions secondary to PABA analogue
|
|
|
Name 4 opioids?
|
Morphine, fentanyl, Demerol, codeine
|
|
|
Where are the opioids metabolized and excreted?
|
metabolized in liver and excreted by kidneys
|
|
|
Avoid use of narcotics in patients on MAOIs can cause ____
|
hyperpyrexic coma
|
|
|
Morphine, Demerol and Fentanyl which one causes histamine release?
|
morphine
|
|
|
Fentanyl is ___x the strength of morphine
|
80
|
|
|
sufentanil, alfentanil, remifentanil
|
very fast-acting narcotics with short half-lives
|
|
|
Versed, Ativan, Valium what are their generic names and short or long acting
|
Versed (midazolam) short acting
Ativan (lorazepam) long acting Valium (diazepam) long acting |
|
|
Morphine in epidural can cause ___
|
respiratory depression
|
|
|
Lidocaine in epidural can cause ___
|
decreased HR and BP
|
|
|
Tx for acute hypotension and bradycardia with epidural?
|
turn epidural down; fluids; phenylephrine; atropine
|
|
|
T-___ epidural can affect cardiac accelerator nerves
|
5
|
|
|
Epidural contraindicated with ___, ____ -> can get inadvertent spinal anesthesia.
|
hypertrophic cardiomyopath, cyanotic heart disease
|
|
|
Good for pediatric hernias, and perianal surgery.
|
Caudal block
|
|
|
Epidural and spinal complications
|
hypotension, headache, urinary retention, abscess/hematoma formation, neurologic impairment
|
|
|
High spinal can cause ____
|
respiratory depression
|
|
|
Spinal headache tx and what makes worse?
|
rest, increased fluids, caffeine, analgesics; blood patch to site persists >24 hrs.
Headache worse sitting up. |
|
|
What two conditions are associated with them most postoperative hospital mortality?
|
CHF and renal failure
|
|
|
May have no pain or EKG changes; can have hypotension, arrhythmias, increased filling pressures, oliguria, bradycardia
|
Postop MI
|
|
|
Patients who need cardiology workup.
|
Angina, previous MI, shortness of breath, CHF, walks <2 blocks due to SOB or CP, FEV1 <70%, aortic stenosis murmur, PVCs > 5/min, age > 70, patients undergoing major vascular surgery
|
|
|
List the ASA classes with description
|
I - healthy
II - mild disease without limitation (controlled HTN, obesity, DM, older age) III - severe disease (angina, previous MI, poorly controlled HTN, DM with complictions, moderate COPD) IV - severe constant threat to life ( unstable angina, CHF, renal failure, liver failure, severe COPD) V - moribound (ruptured AAA, saddle pulmonary embolus, ascending aortic dissection with HF) VI - donor E - emergency |
|
|
Biggest risk factors for postop MI
|
age > 70, DM, previous MI, CHF and unstable angina
|
|
|
Best determinant of esophageal vs. trachael intubation?
|
end-tidal CO2
|
|
|
Intubated patient undergoing surgery with sudden transient rise in ETCO2. Most likely Dx? Tx?
|
alveolar hypoventilation
increase tidal volume (most likely due to atelectasis) or increase respiratory rate |
|
|
Intubated patient with sudden drop in ETCO2. List 3 likely reasons
|
disconnected from vent, PE or significant hypotension
|
|
|
ET tube should be placed ___ cm above carina
|
2
|
|
|
Most common PACU complication
|
N/V
|
|
|
Roughly ___ of the total body weight is water (men); ___ have a little more body water, ____ have a little less
|
2/3, infants, women
|
|
|
2/3 of water weight is located where? and the other 1/3?
|
intracellular (mostly muscle), extracellular
|
|
|
2/3 of extracellular water is located where? and the other 1/3?
|
interstitial, plasma
|
|
|
What determines plasma/interstitial compartment osmotic pressures? what about intracellular/extracellular?
|
proteins, Na
|
|
|
Most common cause of volume overload? what is the first sign?
|
iatrogenic, weight gain
|
|
|
What is the meqs in 0.9% NS?
|
Na 154 and Cl 154
|
|
|
Lactated Ringer's has the ionic composition of plasma, what is it?
|
Na 130, K 4, Ca 2.7, Cl 109, bicarb 28
|
|
|
How to calculate plasma osmolarity and what is the range of normal?
|
(2 x Na) + (glucose/18) + (BUN/2.8)
280-295 |
|
|
How to estimate volume replacement in cc/kg/hr
|
4 cc/kg/hr for first 10 kg
2 cc/kg/hr for second 10 kg 1 cc/kg/hr each kg after that (110 cc/hr for 70 kg man) |
|
|
What is the best indicator for adequate volume replacement?
|
urine output
|
|
|
During open abdominal operations, fluid loss is ___ L/hr unless there are measurable blood losses
|
0.5-1.0 L/hr
|
|
|
Usually do not have to replace blood lost unless it is >____ cc
|
500
|
|
|
Insensible fluid losses is ___ cc/kg/day, 75% skin, 25% respiratory (pure water)
|
10
|
|
|
IV replacement after major adult GI surgery:
During operation and 1st 24 hours use ____. After 24 hrs switch to ___ 5% dextrose will stimulate ___, resulting in amino acid uptake and protein synthesis (also prevents protein catabolism) |
LR
D5 1/2 NS with 20 mEq K |
|
|
D5 1/2 NS @ 125 /hr provides 150 g glucose per day (____ kcal/day)
|
525
|
|
|
Stomach secretes ___ L/day
|
1-2
|
|
|
Biliary system secretes ___ mL/day
|
500-1000
|
|
|
Pancreas secretes ___ mL/day
|
500-1000
|
|
|
Duodenum secretes ____ mL/day
|
500-1000
|
|
|
Normal K+ requirement is ___ mEq/kg/day
|
0.5-1.0
|
|
|
Normal Na+ requirement is ___ mEq/kg/day
|
1-2
|
|
|
Which bodily fluid has the highest concentration of K+
|
saliva
|
|
|
Primary electrolyte(s) lost in the:
Stomach? Pancreas? Bile? Small Intestine? Large Intestine? |
Stomach H+, Cl-
Pancreas HCO3- Bile HCO3- Small intestine HCO3-, K+ Large intestine K+ |
|
|
Gastric losses should be replaced with which fluid?
|
D5 1/2 NS with 20 mEq K+
|
|
|
Pancreatic/biliary/small intestine losses should be replaced with which fluid?
|
LR with HCO3-
|
|
|
Large intestine (diarrhea) losses should be replaced with which fluid?
|
LR with K+
|
|
|
GI losses should generally be replaced ___ ?
|
cc/cc
|
|
|
UO should be kept at least ___ cc/kg/hr; should not be replaced usually a sign of normal postoperative diuresis?
|
0.5
|
|
|
Normal range of K+
|
3.5-5.0
|
|
|
Initial finding of hyperkalemia on EKG?
|
peaked T waves
|
|
|
Tx for hyperkalemia:
____ membrane stabilizer for heart ____ causes alkalosis, K enters cell in exchange for H ____ K driven into cells along with glucose ___ binder ___ if refractory |
Calcium gluconate
Bicarb 10 U insulin and 1 ampule of 50% dextrose Kayexalete Dialysis |
|
|
EKG with hypokalemia?
|
t waves disappear
|
|
|
Hypokalemia tx: may need to replace ___ before you can correct K+
|
Mg+
|
|
|
Normal range of sodium?
|
135-145
|
|
|
What are the sx of hypernatremia?
|
restlessness, irritibility, ataxia, seizures
|
|
|
Correct hypernatremia with ___ slowly to avoid ___
|
D5W, brain swelling
|
|
|
Formula for total body water?
|
0.6 x patient's weight
|
|
|
Formula for total free water deficit
|
TBW x (([Na+]/140) -1)
|
|
|
Formula for water requirement in hypernatremia
|
Water requirement = (desired change in Na+ over 1 day x TBW) / desired Na+ after giving the water requirement
For a 70 kg man with Na 165 = (16 x 42)/149 = 4.5 L |
|
|
In hypernatremia change Na at ____ mEq/h
|
0.7
|
|
|
Sx of hyponatremia
|
headaches, delirium, seizures, nausea, vomiting
|
|
|
Formula for Na deficit in hyponatremia
|
Na deficit = 0.6 x weight in kg x (140 - Na)
|
|
|
What is the first tx for hyponatremia? second? third?
|
water restriction, diuresis, NaCl replacement
|
|
|
Why is Na corrected slowly In hyponatremia and what is the rate?
|
avoid central pontine myelinosis, 1 mEq/h
|
|
|
What is the formula for correcting Na in pseudohyponatremia caused by hyperglycemia?
|
for each 100 increment of glucose over normal add 2 points to the Na value
|
|
|
What is the normal Ca range?
|
8.5-10.0
|
|
|
Most common malignant cause of hypercalcemia?
|
breast CA
|
|
|
What drug causes retention of Ca2+ and should not be given to patient with hypercalcemia?
|
thiazides (also LR contains Ca2+)
|
|
|
What is the tx for hypercalcemia?
For malignant disease? |
NS at 200-300 cc/hr, Lasix
mithramycin, calcitonin, alendronic acid, dialysis |
|
|
Main sx of hypercalcemia?
|
lethargic state
|
|
|
Sx of hypocalcemia?
|
hyperreflexia, Chvotstek's sign (tapping on face produces twitching), perioral tingling and numbness, Trousseau's sign (carpopedal spasm), prolonged QT
|
|
|
In hypocalcemia, may need to correct ___ before being able to correct Ca
|
Mg
|
|
|
Protein adjustment for Ca
|
(4.0 - serum albumin) * 0.8
|
|
|
Normal range of Mg
|
2.0-2.7
|
|
|
Sx of hypermagnesemia? What type of pts?
|
lethargic state
burn, trauma and dialysis pts |
|
|
Tx for hypermagnesmia
|
Ca
|
|
|
Signs and sx of hypomagnesmia are similar to what?
|
hypocalcemia
|
|
|
Formula for anion gap and normal range
|
Na - (HCO3 + Cl)
<10-15 |
|
|
Mnemonic for anion gap acidosis
|
MUDPILES
methanol, uremia, diabetic ketoacidosis, paraldehydes, isoniazid, lactic acidosis, ethylene glycol, salicylates |
|
|
Normal gap acidosis usually due to loss of ____/____
Seen with? |
Na/HCO3
ileostomies, small bowel fistulas |
|
|
Tx for metabolic acidosis is underlying cause; keep pH > ___ with bacarbonate; severely decreased pH can affect ____
|
7.20, myocardial contractility
|
|
|
Metabolic alkalosis is usually the result of ____
|
contraction alkalosis
|
|
|
Nasogastric suction results in what electrolyte abnormality and what is the urine?
|
hypocholoremic, hypokalemic, metabolic alkalosis
paradoxical aciduria |
|
|
Why is there hypokalemia in nasogastric suction?
and why is there paradoxical aciduria? |
Loss of water causes kidney to resorb Na in exchange for K (Na/K ATPase)
Na+/H- exchange activated in an effort to absorb water along with K+/H- exchanger in an effort to resorb K+ |
|
|
Henderson-Hesselbach equation
pH = pK + log [HCO3−]/[CO2] A pH of 7.4 has a ratio of base to acid (HCO3- to CO2) of ____ |
20:1
|
|
|
What is the best test for azotemia?
|
FeNa
|
|
|
What is the formula for FeNa
|
(urine Na/Cr)/(plasma Na/Cr)
|
|
|
In Pre renal failure. What is the FeNa? urine Na? BUN/Cr ratio? urine osmolality?
|
FeNa <1%
BUN/Cr >20 urine osmolality >500 mOsm |
|
|
In contrast dye induced ARF: What best prevents renal damage? What are 2 others?
|
volume expansion, HCO3-, N-acetylcysteine gtt
|
|
|
Myoglobin is converted to ____ in acidic environment which is toxic to renal cells. Tx?
|
ferrihemate, alkalinize urine
|
|
|
In tumor lysis syndrome there is increased ___ and ___ and decreased Ca. This can result in increased BUN and Cr, EKG changes. Tx?
|
phosphate and uric acid
hydration, allopurinol (decreased uric acid production), diuretics, alkalinization of urine |
