Interventions for a L-R shunt?
- Decrease SVR
- Increase PVR
Drugs and their % plasma protein binding:
PDMEK
Propofol 98%
Dexmedetomidine 94%
Midazolam 94%
Etomidate 75%
Ketamine 12%
Bohr vs Haldane effect
Bohr is the effect of CO2 on the oxyhemoglobin dissociation curve
Haldane is the effect of O2 on the CO2 response curve
What twitches do you see using stim on Interscalene confirming correct location?
Too shallow?
Too deep?
- Bicep contraction
- inward shoulder rotation
Shallow;
- phrenic nerve stimulation (Hiccuping)
Deep/Lateral:
- Contraction of Trapezius
Factors that increase risk of hypoglycemia in newborn
- Prematurity
- small for gestational age
- maternal diabetes
term for excess saliva
sialorrhea
High frequency vs low frequency ultrasound transducers
High - shallow penetration
Low - deep penetration
What response is still impaired even at 0.1 MAC?
Etiology?
Ventilatory response to hypoxia
- Type I glomus cells in carotid sinus are impaired by reactive oxygen species (ROS), a byproduct of Volatile anesthetic metabolism. Greatest to least efffect Sevo > Iso > Des
Match TURP fluid with complication:
- Distilled H2O
- Glycine
- Sorbitol
- NaCl
- Distilled H2O - Hyponatremia, hemolysis, hemoglobinuria
- Glycine - Transient vision loss, increased ammonia (decreased LOC)
- Sorbitol - Hyperglycemia, Osmotic Diuresis (similar to mannitol so can cause LV HF in susceptible pt)
- NaCl - monopolar cautery can cause electrical current
Equation for static compliance?
Dynamic compliance?
Tidal volume/ (plateau pressure - PEEP)
Tidal volume/(PIP - PEEP)
Most common comorbidity in pt with sickle cell disease?
Asthma - its presence significantly increases M&M
Also:
- Acute chest syndrome can occur in abdominal surgeries
- Pulm HTN
SLE vs RA
SLE:
- HTN
- Thrombocytopenia
RA
- Platelet dysfunction but not decrease
- Sjogrens syndrom (dry eye/mouth)
Both
- Anemia
- Peripheral neuropathy
- Restrictive lung disease
Top (Beta wave)
2nd: Theta - GA, sleeping kid
3rd: Delta - GA, deep sleep, brain injury
4th: Burst suppression(looks like Barbed wire) - GA, hypothermia, CPB, cerebral ischemia
Area where pulmonic stenosis will be heard
Criteria for severe pre-eclampsia?
BP:
- syst > 160
- Diastolic >110
- Headache/blurred vision
- RUQ/epigastric pain
- Pulmonary edema
- HELLP
- 24h Urine <500ml
- Impaired fetal growth
(Mild just HTN, Edema, proteinuria)
Areas of brain?
- Learning and storing info?
- Strong emotion, pain, stress?
- Regulate fine control of movement?
- Hippocampus
- Amygdala
- Basal ganglia (Substantia nigra dopamine deficiency in parkinsons)
Blocks and their uses:
- Thoracic paravertebral block
- Celiac plexus block
- Superior hypogastric plexus block
- Sphenopalatine block
Thoracic paravertebral block (need one block per dermatome)
- breast
- thoracotomy
- rib
Celiac plexus
- Cancer pain of upper abdominal organs: distal esophagus, stomach, liver, pancreas, small intestines, all but descending colon
Superior hypogastric plexus block
- Cancer pain of pelvic organs: uterus, ovaries, prostate, descending colon
Shenopalatine block
- PDPH
samples of K sparing diuretics
SAT
- Spironolactone
- Amiloride
- Triamterene
Examples and S/S of Loop diuretics
Examples:
- Lasix
- Bumex
- Etharcrynic acid
S/S:
- Hypo
- K, Na, Cl, Ca, Mg
- volemia
- Rarely: tinnitis, vertigo, hearing loss
S/S of Thiazide diuretices. Examples?
S/S:
- Hyper:
- Glycemia
- calcemia
Examples: (HIC)
- Hydrochlorothiazide
- Indapamide
- Chlorthalidone
What depresses SSEPs the most?
Nitrous oxide
PNB contraindicated in an anticoagulated patient?
Lumbar plexus block (psoas block)
Neurons of spinothalamic tract (pain and temperature)
- 1st order
- 2nd order
- 3rd order
- Dorsal root ganglion
- Dorsal horn
- RAS + Thalamus
aPTT measures events that occur when?
Also called?
during intrinsic and final common pathway
also called contact activation pathway
