7/12 Ace 2011 8A x

4. #thoracic After surgery for fixture of bronchopleural fistula, extubate to lower airway pressures and facilitate healing

13. #OBGYN sensory block necessary for C-section goes from T4 to S4.

15. #OBGYN epidural in laboring women may increase temp but its hard to isolate whether this is a direct effect or difficult labors require epidurals. This increase in temp is not associated with neonatal sepsis.

22. #OBGYN #Cards Obstetric hemorrhage secondary to uterine atony may be treated with 15-methylprostaglandin F2alpha (Hemabate). Administration can result in an acute increase in pulmonary artery pressure and is contraindicated in patients with pulmonary hypertension.

35. #Regional Axillary block: Median superior, ulnar inferior, radial posterior

44. #Peds Physiologic anemia in newborns. Polycythemia at birth 2/2 hypoxemia stimulating erythropoiesis. Decreased production of new RBC and shortened RBC survival (80-100d compared to 120d) causes Hgb of 8-9 during 8-12 weeks.The hemoglobin concentration at the nadir in premature infants is lower than in those born at full term. This anemia, sometimes termed the anemia of prematurity, occurs as a result of the decreased EPO levels present in infants,coupled with an even shorter red blood cell survival (60–80 days) and iatrogenic blood loss from recurring phlebotomy. Interestingly, transfusion of a premature neonate has been demonstrated to result in a lower hemoglobin concentration at the nadir. This has been attributed to increasing the percentage of HbA, which results in a right-shifted oxyhemoglobin dissociation curve.

47. #general In cirrhotic pts, maintain hepatic blood flow with volatiles, which maintain or increase hepatic blood flow. Propofol, neuraxial techniques do not work by decreasing preload.

48. #cards crawford classification for TAAA:
I - all thoracic aorta and top abdominal aorta
II - all descending aorta and all of abdominal aorta
III: lower portion of descending thoracic aorta and all of abomdinal
IV: only abdominal

53. #OBGYN air embolism presents with hemodynamic collapse. Supportive care plus clotting factors 2/2 coagulopathy develops from AFE.

55. #general Vision loss
cardiac surgery, swollen optic disc: anterior ischemic optic neuropathy
neck and head surgery, normal fundoscoptic exam: posterior ischemic optic neuropathy
Temporal arteritis, a form of arteritic ION, is characterized by painful visual loss in the setting of inflammation and thrombosis. Treatment with high-dose corticosteroids is recommended.

59. #neuro Remember that myasthenia gravis has fatiguability to repetitive test while LES has increased muscle activity. MG is resistant to sux but sensitive to NMB. LES is sensitive to both.

60. #general baclofen is GABAB agonist while benzos are GABAA agonists.

71. #general Treat TCA toxicity (dysrhythmias, VTs) with sodium bicarbonate which increases the gradient of sodium into the cell, to overcome the Na blocking caused by TCAs.

73.#general Treatment of C1 esterase deficiency or angioedema.
Dental/simple procedures
Attenuated androgens 2 days before surgery
C1 esterase inhibitors 24 hours before surgery
Fresh frozen plasma 6–12 hours before surgery
Tracheal intubation:
daily administration of an anabolic steroid (eg, danazol) 5–7 days before surgery
administration of fresh frozen plasma on the day of surgery
administration of the C1 esterase inhibitor Berinert P on the morning of surgery

76. #general circumcision in children, no difference in rescue meds or PONV for caudal vs dorsal penile block vs parenteral meds. There is less motor block in dorsal penile block

77. #general
L2-3 lumbar radiculopathy - back, butt, lateral thigh, groin pain. Does not extend past knee. Epidural shot may be helpful after NSAIDs.
L2 especially goes to groin by teh genitofemoral nerve.
Entrapment of thelateral femoral cutaneous nerve (a purely sensory nerve) will not result in upper buttock pain, weakness, muscle wasting, or groin symptoms. Therefore, a steroid injection at the
anterior superior iliac spine would not produce pain relief.
Compression of the L4 nerve root will usually refer symptoms below the knee in the distribution of the saphenous nerve.

79. #general CRPS can cause tremors and other motor dysfunction. Sympathetic dysfunction is key inclduing sudomotor (sweating), pilomotor (goosebumps), and vasomotor.

82. #OBGYN: pregnant women have higher tidal volume. Vital capacity and TLC is generally unchanged. CC is unchanged as well. FRC and ERV are decreased.

90. #Neuro: After intubation a patient who has blunt head trauma causing neurogenic pulmonary edema, what to do next to treat NPE? Lower ICP!

92. #General In carcinoid syndrome, avoid medications that release serotonin such as mivacurium, atracurium, sux, thiopental. Also many of the catecholamines like epi, norepi, dopa. Ondansteron has been used to treat the diarrhea in carcinoid syndrome.

99. #OBGYN
Trial of labor after c-section
1 c-section should be considered for TOLAC. Epidurals can be used. Misoprostol should not be used for women w/ previus c-section or previous uterine surgery.
Even twins or 2 previous c-sections can still undergo TOLAC. Spontaneous labor and previous successful VBAC increases chances of success.
In terms of outcomes. TOLAC vs elective c-section show:
decreased mortality from TOLAC and same hysterectomy risk and transfusion risk. Duration of hospitalization is lower for TOLAC. It will lower risks of previa, accreta in future pregnanies. There is an increased risk of uterine rupture and infections though. Surgical risks are similar.