1
Q
Mallampati classifications
A
Class I: visualize soft palate, fauces, uvula, anterior and posterior
Class II: visualize soft palate, fauces, and uvula
Class III: only soft palate and base of uvula
Class IV: only soft palate
2
Q
ASA classifications
A
ASA I: normal healthy patient
ASA II: mid systemic disease (no functional limitations)
ASA III: severe systemic disease (some functional limitations)
ASA IV: severe systemic disease with constant threat to life
ASA V: moribund patient who is not expected to survive w/o surgery
ASA VI: brain dead, organs procured for donation
3
Q
Cormack-Lehane View Grades
A
Grade 1: full view of entire glottic opening
Grade 2: posterior portion of the glottic opening is visible
Grade 3: only the epiglottis is visible
Grade 4: neither glottis nor epiglottis seen
4
Q
Normal blood gas pH
A
7.35-7.45
5
Q
Normal blood gas PaO2
A
90-100
6
Q
Normal blood gas PaCO2
A
35-45
7
Q
Normal blood gas HCO3
A
22-26
8
Q
Normal blood gas BE
A
-2 to 2
9
Q
Normal blood gas SaO2
A
95-98%
10
Q
VO2 respiratory formula
A
VO2 = 10 x kg³⁄₄
11
Q
VCO2 respiratory formula
A
VCO2 = 8 x kg³⁄₄
12
Q
Alveolar air equation
A
[FiO2 x (Pb - PH2O)] - PaCO2/0.8
13
Q
Arterial O2 content/dL
A
(Hgb x 1.34 x SaO2) + (PaO2 x 0.003)
14
Q
What is VO2?
A
O2 consumption
15
Q
What is VCO2?
A
CO2 production
16
Q
Male PBW formula (predicted body weight)
A
Male PBW in kg = 50 + 0.91(height in cm - 152.4)
17
Q
Female PBW formula (predicted body weight)
A
Female PBW in kg = 45.5 + 0.91(height in cm - 152.4)
18
Q
MAP formula and normal value
A
MAP = (SBP + 2xDBP) / 3
Normal = 70-105 mmHg
19
Q
Normal CO
A
4-8 L/min
20
Q
Normal CI
A
2.5-4 L/min
21
Q
Normal CVP
A
2-6 mmHg
22
Q
Normal PCWP (pulmonary capillary wedge pressure)
A
8-12 mmHg
23
Q
Normal PVR
A
50-350 dynes/cm/sec^-5
24
Q
Normal SVR
A
700-1400 dynes/cm/sec^-5
25
Normal EF
55-70%
26
Normal PAP
Systolic = 15-30 mmHg
Diastolic = 5-15 mmHg
Mean = 15 mmHg
27
Shock index (SI)
Used to measure how sick pt is
SI = HR/SBP
If SI > 1 = increased morbidity/mortality, increased likelihood of needing MTP
28
Estimated blood volumes (EBV)
Premature infant: 95 mL/kg
Full-term infant: 85 mL/kg
Infant to 12 mo: 80 mL/kg
Adult/child (male): 75 mL/kg
Adult/child (female): 65 mL/kg
Morbid obese (BMI > 40): 60 mL/kg
29
Allowable blood loss (ABL) formula
ABL = ((Hct (initial) - Hct (final) x EBV) / Hct (initial)
30
Hct allowable
Lowest Hct that is considered safe
Usually ~30%
Highly variable
31
Fluid replacement equivalent
Crystalloid: 3 mL/1 mL EBL
Colloids: 1 mL/1mL EBL
Whole blood: 1mL/1mL EBL
PRBC: 0.5 mL/1mL EBL
32
PRBC Hct
70%
33
What is the EBL for a fully soaked "lap"?
100-150 mL EBL
33
What is the EBL for a fully soaked 4x4?
10 mL EBL
34
Fluid maintenance requirements (4-2-1 rule)
4 mL/kg/hr for first 10 kg
2 mL/kg/hr for next 10 kg
1 mL/kg/hr for every kg > 20
35
NPO deficit
maintenance rate x # hrs NPO
36
Evaporative loss rates
Minimal: 0.2 mL/kg/hr
Moderate: 2-4 mL/kg/hr
Severe: 4-8 mL/kg/hr
37
BMI formula
BMI = weight (kg) / height (m^2)
38
BMI values
Healthy: 23-25
Overweight: >25
Onset of weight related disease: 28
Obese: ≥30
Morbidly obese: 35-40
Super morbidly obese: >55
39
IBW formulas
Men IBW in kg = height (cm) - 100
Women IBW in kg = height (cm) - 105
40
Tier 1 rescue drugs for hypotension
Ephedrine
Neosynephrine
41
Ephedrine
alpha + beta
Dose: 5 mg
On-hand: 50 mg/mL
42
Neosynephrine
alpha
Dose: 100 mcg
On-hand: 10 mg/mL
43
Tier 1 rescue drugs for hypertension
Labetalol
Esmolol
Hydralazine
44
Labetalol
beta
Dose: 5 mg
On-hand: 5 mg/mL
45
Esmolol
beta1
Dose: 10 mg
On-hand: 10 mg/mL
46
Hydralazine
arterial vasodilator
Dose: 5 mg
On-hand: 20 mg/mL
47
Normal Hct
Male: 42-52 g/dL
Female: 37-47 g/dL
48
Normal Hgb
Male: 14-18 g/dL
Female: 15-16 g/dL
49
Normal WBC
4,000-11,000/µL of blood
50
Normal plts
150,000-450,000/µL of blood
51
K+
3.5-5.0 mEq/L
52
Mag
1.5-2.5 mEq/L
53
Ca++
8.5-10.5 mg/dL
54
Ionized Ca++
1.1-1.3 mmol/L
or
4.8-5.3 mg/dL
55
Phosphate
1.8-2.6 mEq/L
56
Cl-
100-108 mEq/L
57
BUN
10-20 mg/dL
58
Creatinine
0.6-1.3 mg/dL
59
Albumin
3.5-5.5 g/dL
60
PT
11-14 sec
61
PTT
21-34 sec
62
INR
1
63
ACT
80-120 sec
64
FSP (fibrin split products)
< 10 µg/dL
65
Fibrinogen
160-450 mg/dL
66
Plasminogen
62-130%
67
FDP (fibrin degradation products)
< 10 µ/mL
68
D-dimer
< 250 ng/dL
69
TSH
0.4 µ units/mL
70
T3
90-230 ng/dL
71
T4
13 - 15 µ/dL
72
SGOT AST
<35 IU/L
73
SGPT ALT
<35 IU/L
74
Normal blood glucose
70-115 mg/dL
75
How to write out lab values
76
MH triggers and signs of onset
Triggers: halothane, enflurane, isoflurane, sevoflurane, desflurane, succinylcholine
Signs of onset: tachycardia, tachypnea, rapidly increasing ETCO2, skin mottling, arrhythmias, hyperthermia, unstable BP, dark urine, muscle rigidity, masseter muscle spasm
77
MH treatment (8 steps)
1. Stop triggering agent
2. Hyperventilate with 100% O2 at high flow
3. Administer Dantrolene 2.5 mg/kg IV, repeat q5-10 min until symptoms controlled (max 10 mg/kg)
4. Correct metabolic acidosis
5. Correct hyperkalemia
6. Actively cool patient
7. Check labs q15 min until stable
8. Maintain UOP > 2mL/kg/hr with hydration, Mannitol, or Lasix
78
Pediatric ETT sizes
Preemies ≤ 1 kg: 2.5
Preemies 1-2.5 kg: 3
Term neonate (6 mo): 3-3.5
6 mo-1 yr: 3.5-4
1-2 yr: 4-4.5
>2 yr: (age + 16)/4
79
Pediatric tube length calculation
Tube size x 3
80
Pediatric LMA sizes and max cuff volume (air)
Size 1: wt up to 5 kg, cuff volume up to 4 mL
Size 1.5: 5-10 kg, cuff volume up to 7 mL
Size 2: 10-20 kg, cuff volume up to 10 mL
Size 2.5: 20-30 kg, cuff volume up to 14 mL
Size 3: >30 kg, cuff volume up to 20 mL
Size 4: Adult, cuff volume up to 30 mL
81
Diazepam
Dose: 0.1 mg/kg IV, 0.2 mg/kg PO
Onset: 1-5 min
Duration: 2-6 hr
82
Lorazepam
Dose: 0.04 mg/kg
Onset: 1-5 min
Duration: 6-10 hr
83
Midazolam
Dose: 1-5 mg (0.05 mg/kg)
Onset: 1-5 min
Duration: 15-80 min
84
Flumazenil
Benzo reversal
Dose: 0.2 mg repeat 0.1 mg q1min, max 3 mg
Onset: 1-5 min
Duration: 30 min
85
Morphine
Intra-op: 1-10 mg
Post-op: 5-20 mg
Onset: 10-20 min
Duration: 4-5 hr
86
Fentanyl
Intra-op: 1-3 mcg/kg
Onset: 30-60 sec
Duration 1-1.5 hr
87
Sufentanil
Intra-op: 0.3-1 mcg/kg
Onset: 30-60 sec
Duration: 1-1.5 hr
Infusion: 0.5-1 mcg/kg/hr
88
Remifentanil
Intra-op: Load 0.5-1 mcg/kg over 1 min
Onset: 30-60 sec
Duration: 6-8 min
Infusion: 0.125-0.375 mcg/kg/min
89
Meperidine
Post-op shivering: 12.5 mg
Onset: 5-15 min
Duration: 2-4 hr
90
Hydromorphone
Intra-op: 1-4 mg
Post-op: 1.5-4 mg
Onset: 5-15 min
Duration: 2-4 hr
91
Naloxone
Opioid reversal
Intra-op: 40-80 mcg
Post-op: 40-80 mcg
Onset: 1-5 min
Duration: 30 min
92
Propofol
Induction: 1.5-2.5 mg/kg
Maintenance: 25-100 mcg/kg/min sedation, 100-300 mcg/kg/min TIVA
Onset: 30-60 sec
Duration: 1-8 min
93
Etomidate
Induction: 0.3 mg/kg
Onset: 1 min
94
Ketamine
Induction: 0.5-1.5 mg/kg
Maintenance: 0.2-0.5 mg/kg IV analgesia, 4-8 mg/kg IM
Onset: 1 min
Duration: 10-20 min
95
Midazolam (induction)
Induction: 0.1-0.2 mg/kg
May precede dose w/ Fentanyl 50-100 mcg
Onset: 30-60 sec
Duration: 5-10 min
96
Sevoflurane (MAC %, blood:gas, vapor pressure)
MAC %: 1.8
Blood:gas: 0.69
Vapor pressure: 157
97
Desflurane (MAC %, blood:gas, vapor pressure)
MAC %: 6.6
Blood:gas: 0.42
Vapor pressure: 669
98
Isoflurane (MAC %, blood:gas, vapor pressure)
MAC %: 1.17
Blood:gas: 1.46
Vapor pressure: 238
99
Nitrous Oxide (MAC %, blood:gas, vapor pressure)
MAC %: 104
Blood:gas: 0.46
Vapor pressure: gas 38,770
100
Dexmedetomidine
alpha-2 agonist
On-hand: 200 mcg/2 mL
Mix in NS 48 mL
Concentration: 4 mcg/mL
Bolus: 0.5-1 mcg/kg over 10 min
101
Succinylcholine (Anectine)
Dose: 1-1.5 mg/kg
[ ]: 20 mg/mL
Onset: 30-60 sec
Duration: 5-10 min
102
Cisatricurium (Nimbex)
Dose: 0.1 mg/kg
[ ]: 2 mg/mL
Onset: 2-3 min
Duration: 40-75 min
103
Vecuronium (Norcuron)
Dose: 0.1 mg/kg
[ ]: 1 mg/mL
Onset: 2-3 min
Duration: 45-90 min
104
Rocuronium (Zemuron)
Dose: 0.6-1.2 mg/kg
[ ]: 10 mg/mL
Onset: 2-3 min
Duration: 35-75 min
105
Pancuronium (Pavulon)
Dose: 0.1 mg/kg
[ ]: 2 mg/mL
Onset: 2-3 min
Duration: 60-120 min
106
Neostigmine
Dose: 0.04-0.07 mg/kg
Onset: 5-10 min
Duration: 60 min
Anticholinergic: Glycopyrrolate 0.2 mg per mg of Neostigmine
107
Sugammadex
Dose: 2-16 mg/kg
Onset: 1-4 min
Duration: 1.5-3 hrs
Anticholinergic: none
108
If TEG-ACT > 140, transfuse _____
FFP
109
If R time > 10, transfuse _____
FFP
110
If K time > 3, transfuse _____
Cryoprecipitate
111
If α angle < 53, transfuse _____
Cryoprecipitate +/- plts
112
If MA < 50, transfuse _____
(MA = maximum amplitude)
Plts
113
If LY30 > 3%, transfuse _____
Tranexamic acid (TXA)
114
How to remember ester vs amide
Amides have 2 "i's"
115
Lidocaine
(Classification, w/o epi max dose, w/ epi max dose)
Amide
w/o Epi max: 5 mg/kg
w/ Epi max: 7 mg/kg
116
Prilocaine
(Classification, w/o epi max dose, w/ epi max dose)
Amide
w/o Epi max: 6 mg/kg
w/ Epi max: 8.5 mg/kg
117
Mepivacaine
(Classification, w/o epi max dose, w/ epi max dose)
Amide
w/o Epi max: 5 mg/kg
w/ Epi max: 7 mg/kg
118
Bupivacaine
(Classification, w/o epi max dose, w/ epi max dose)
Amide
w/o Epi max: 2.5 mg/kg
w/ Epi max: 2.5 mg/kg
119
Ropivacaine
(Classification, w/o epi max dose, w/ epi max dose)
Amide
w/o Epi max: 3 mg/kg
w/ Epi max: 4 mg/kg
120
Procaine
(Classification, w/o epi max dose, w/ epi max dose)
Ester
w/o Epi max: 7 mg/kg
w/ Epi max: 8.5 mg/kg
121
Chloroprocaine
(Classification, w/o epi max dose, w/ epi max dose)
Ester
w/o Epi max: 6 mg/kg
w/ Epi max: 14 mg/kg
122
Tetracaine
(Classification, w/o epi max dose, w/ epi max dose)
Ester
w/o Epi max: 3 mg/kg
w/ Epi max: 3 mg/kg
123
CSE labor analgesia meds (6)
Bupivacaine
Ropivacaine
Lidocaine w/ epi
Fentanyl
Sufentanil
Morphine
124
Bupivacaine
(Epidural vs spinal)
Epidural: 0.0625 - 0.125%
Spinal: 1.25 - 2.5 mL
125
Ropivacaine
(Epidural vs spinal)
Epidural: 0.08 - 0.2 %
Spinal: 2.5 - 4.5 mL
126
Lidocaine w/ epi
(Epidural vs spinal)
Epidural: 2% in 5 ml bolus
Spinal: n/a
127
Fentanyl
(Epidural vs spinal)
Epidural: 50 - 100 mcg
Spinal: 10 - 25 mcg
128
Sufentanil
(Epidural vs spinal)
Epidural: 5 - 10 mcg
Spinal: 1.5 - 5 mcg
129
Morphine
(Epidural vs spinal)
Epidural: n/a
Spinal: 0.1 - 0.2 mg
130
Antiemetic drugs (7)
Droperidol
Promethazine
Ondansetron
Dexamethasone
Metoclopramide
Scopolamine
Propofol
131
Droperidol
Dose: 0.625 mg
Onset: 1-5 min
Duration: 2-3 hr
132
Promethazine
Dose: 6.25-25 mg
Onset: 1-5 min
Duration: 4-6 hr
133
Ondansetron
Dose: 4 mg
Onset: 10 min
Duration: 4-9 hr
134
Dexamethasone
Dose: 4 mg
Onset: 10-30 min
Duration: 2-10 hr
135
Metoclopramide
Dose: 10-20 mg
Onset: 10 min
Duration: 2 hr
136
Scopolamine
Dose: Patch
Onset: 2-4 hr
Duration: 72 hr
137
Propofol (anti-emetic)
Dose: 10-15 mg IV, followed by 10 mcg/kg/min gtt
138
PONV risk factors
Female
Age < 40
Hx PONV or motion sickness
Vertigo
Surgeries: laparotomy, laparoscopy, major breast, strabismus, intraocular, middle ear, tonsils, adenoids, neuro (intracranial), gynecologic, testicular, scrotum, kidney stones
139
PONV treatment algorithm
0 risk factors: 10% chance of PONV, tx: non-pharmacologic
1 risk factor: 20% chance, tx: 1 drug
2 risk factors: 40% chance, tx: 2 drugs
3 risk factors: > 60% chance, tx: 3+ drugs
140
Non-opioid analgesics (3)
Acetaminophen (Ofirmev)
Ketorlac (Toradol)
Ibuprofen (Caldor)
141
Acetaminophen (Ofirmev)
(Dose, max)
Dose: 1000 mg q4-6h
Max: 3000-4000 mg/day
142
Ketorlac (Toradol)
(Dose, max)
Dose: 15-30 mg q6h
Max: 60-120 mg/day
143
Ibuprofen (Caldor)
(Dose, max)
Dose: 200-800 mg q6h
Max: 3200 mg/day
144
Signs of LAST (8)
1. Analgesia
2. Light-headedness
3. Tinnitus
4. Tongue/circumoral numbness/tingling/funny taste
5. Seizures
6. Unconsciousness
7. Respiratory arrest
8. Cardiovascular arrest
145
Lipid rescue for LAST protocol
If unresponsive to standard therapy, in addition to standard CPR:
-Bolus intralipid 20% IV 1.5 mL/kg over 1 min
-Intralipid 20% 0.25 mL/kg/min gtt
-Continue chest compressions to circulate lipids
-Repeat bolus q3-5 min up to 3 mL/kg total dose until circulation is restored
-Increase infusion to 0.5 mL/kg/min if BP declines
-Continue infusion until hemodynamically stable
-Max total dose: 8 mL/kg
146
°C formula
°C = (5/9) x (°F -32)
147
°F formula
°F = [(9/5) x °C] + 32
148
Practice: What is 94.1°F in °C?
34.5°C
149
Practice: What is 40°C in °F?
104°F
150
What is ROTEM?
Rotational Thromboelastometry
(similar to TEG)
151
ROTEM protocol
152
For ROTEM: What to give if CT is prolonged, indicating delayed clot formation?
FFP or PCC
(PCC = Prothrombin Complex Concentrate)
153
For ROTEM: What to do if MCF is too low, indicating weak clot?
Check FIBTEM MCF and ROTEM Platelet if available.
If FIBTEM MCF = low: give cryo
If FIBTEM MCF = normal or ROTEM Platelet = low: give plts
154
For ROTEM: What to give if L130 is too high, indicating too much lysis?
TXA
Clinical Pharm Exam
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