Occupational exposure to ionizing radiation is mostly from x-rays scattering
Obese and Lungs:
decrease in FRC and ERV (by 60% if BMI increases by 10). Decreases in FEV1, TLC as well. Increase in work of breathing and closing capacity.
Post herpetic neuralgia - usually pain before rash. Give acyclovir class 72 hours after rash starts for reduction in rash duration and pain. Controversial data on whether acyclovir actually decreases post-herpetic neuralgia. Initial rash also treated with prednisone which decreases pain. For PHN, capsaicin is only drug approved by FDA, which depletes substance P.
WTF. Preoperative opioid consumption increase postop painbut also experienced increased respiratory depression in case-control studies.
Careful with interscalene block if pt cannot handle phrenic nerve blockade. It can also cause horner syndrome which consists of ipsilateral ptosis, hyperemia of conjunctiva, and nasal congestion. It can also block recurrent laryngeal nerve and vertebral artery injection.
Celiac block results in blockade of the sympathetic efferents (leaving unopposed parasympathetic) and pain afferents from stomach to splenic flexure of large intestine (including kidneys, adrenals). Adverse affects include diarrhea and hypotension from venous pooling in the gut.
Protamine can cause transient decrease in platelet count and function
2,3-DPG does not degrade in banked blood. It actually does not get produced by offsite branch of glycolysis. So when blood is cold, 2,3-DPG is 0. After returning to normal temp, 2.3-DPG increases back to normal levels at 48 hours. It is 50% at 7 hours in.
Magnesium is effective in overriding ventricular dysrhythmias such as torsad de pointes. Local anesthetics and NMB are potentiated by magnesium. It causes hypotension and in decrease in contractility following rapid transfusion.
Hypoxemia during OLV. Right sided thoracotomy predicts greatest amount of hypoxemia 2/2 size of 3 lobes vs the 2 lobes of the left. Obstructive dz actually improves hypoxemia 2/2 intrinsic PEEP. Pneumonectomies are usually associated with better oxygenation than wedge resections.
Autonomic dysreflexia T6 - hypertension, flushing, sweating above the transection (unopposed parasympathetic) and below the transection, cool pale vasoconstricted skin with piloerection.
- cath the pt if not cathed
- check and unkink the catheter if already in
- check fecal impaction if catheter is fine
- most commonly used antihypertensive meds are nifedipine and nitrates
- spinals and epidurals blunt AD
Metoclopramide increases gastric motility but not colonic motility. It also increases tone of lower esophageal sphincter and relaxes pylorus and duodenal bulb. It does not affect pH at all.
Pheochromocytoma is contraindication to ECT, pregnant is relative contraindication
ASD causes atrial dysrhythmias more than ventricualr ones. You get increased pulm blood flow and possibly PAH, RV overload, and CHF. Closure of ASD in a patient with severe pulm hypertension may result in acute right sided heart failure 2/2 reduction in right sided preload. This may require a heart-lung transplant to fix. Transient reversal can cause paradoxical emboli.
52. HPV is triggered by alveolar hypoxemia from 100mmHg to maximum of 30 mmHg.
Things that impair HPV:
- inhaled anesthetics and NO
- reduced/increased blood flow in OLV
- alkalosis and hypocapnia
- enhanced by hypercapnia and acidosis (as in atelectasis)
- vasodilators
Pectus excavatum is associated with RVOT obstruction and MVP and MR.
Haldane and Bohr both pretain to CO2 and its affects on hemoglobin. Haldane is in your lungs: oxy hemo loses CO2 more rapidly. Bohr is increased CO2 makes loss of O2 easy.
57. Acute herpes use narcotics, gabapentin, lidocaine patch, antivirals, glucocorticoids, but not capsaicin.
59. AFLP most likely happens in 3rd trimester. Associated with long chain 3hydroxyacyl coenzyme A dehydrogenase deficiency in the fetus. Coexists with preeclampsia and HELLP. Jaundice, malaise, n/v, abd pain, and fever w/ long PTT, depressed antithrombin III and high LFTs. Hhpoglycemia, DIC, renal failure, and liver failure are all possible. Treat with supportive care and expeditious delivery.
64. Hemophilia A is deficiency of factor VIII. It ranges from mild (6-30%) to severe (<1% activity). In normal situations, pts should receive recombinant factor VIII to reach activity level of >3%. For surgery, recommended perioperative 100% activity before proceeding with surgery. Continue for 10-14 days.
You can give neuraxial if activity greater than 50%.
If pt has antibodies vs factor VIII, you can give factor VIIa.
Argatroban has HL of 45 min
70.
Early goal directed therapy for treatment of septic shock
CVP 8-12
Hgb > 10
MAP of 65-90
SvO2 >70%
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