9. Delayed clamping of umbilical cord in preterm babies decreases risk of intraventicular hemorrhage. Sequelae IVH can result in life-long neurological deficits, specifically cerebral palsy, developmental delay, and seizures. PVH-IVH is diagnosed primarily through the use of brain imaging studies, usually cranial ultrasonography. Two major factors that contribute to the development of PVH-IVH are loss of cerebral autoregulation and abrupt alterations in cerebral blood flow and pressure. Incidence of PVH-IVH in infants of very low birth weight (< 1500 g) or infants of less than 35 weeks' gestation has been reported to be as high as 50%. most hemorrhages occur when the neonate is younger than 72 hours, with 50% of hemorrhages occurring on the first day of life. Presents with A sudden unexplained drop in hematocrit levels, Possible physical findings related to anemia (eg, pallor, poor perfusion) or hemorrhagic shock, A sudden and significant deterioration associated with anemia, metabolic acidosis, glucose instability, respiratory acidosis, apnea, hypotonia, and stupor is present. Treatment include Correction of anemia, acidosis, and hypotension, as well as ventilatory support, might be required in those neonates who present with acute deterioration. Serial lumbar puncture, although once used to prevent progressive hydrocephalus, is not indicated. Because most patients with hydrocephalus following PVH-IVH demonstrate spontaneous resolution within weeks of onset, surgical intervention is usually unnecessary. Ventriculoperitoneal and ventriculosubgaleal shunting remain the definitive treatments for posthemorrhagic hydrocephalus requiring surgical intervention.
12. Signs of bladder perf after TURB: hypotension, bradycardia, dilution of plasma from irrigation, restlessness, diaphoresis, hiccups. Spinal should be T9-10 as below may be uncomfortable and above may mask signs.
13. Newborn HR is 120. 1 month gold HR is 160. By 12 months, BP should be 90/60
Leukocyte reduction reduces alloimmunization, CMV infections, platelet transfusion refractoriness, nonhemolytic febrile reduction.
23. CO2 absorbers problems
Compound A - sevoflurane degrades in CO2 absorber (not liver) with baralyme rather than soda lime, low flow rather than high flow, higher temperature and fresher absorbent. Not shown to have clinical affect in humans.
CO is formed with degradation of all volatiles in CO2 absorber. Desflurane > en > iso >> sevo = halothane. More than dry baralyme in higher temp and lower gas flows. Happens mondays.
Fires with sevoflurane more likely with dry baralyme and soda lyme, first case of the day.
25. The statins inhibit p450, which can affect degradation of lidocaine. Also tumescent liposuction is due with SQ injection of very dilute lidocaine (.1%) up to 35-55mg/kg. Peak levels at 8 hrs.
26. Misoprostol associated with high risk of uterine rupture during VBAC
38. SIADH vs cerebral salt wasting:
SIADH
Serum [Na+] (mmol/L): 128
Serum Osmolality (mOsm): 270
Urine [Na+] (mmol/L): 40
Central Venous Pressure (mm Hg): 12
CSW (volume contraction)
Serum [Na+] (mmol/L): 128
Serum Osmolality (mOsm): 270
Urine [Na+] (mmol/L): 40
Central Venous Pressure (mm Hg): 4
44. Neonates have high chest wall compliance so they have increased work of breathing to push and pull their chest wall.
51. 2,3-DPG is decreased in preserved blood products
52. Refeeding syndrome causes hypokalemia, hypophos, hypoglycemia, hypomagnesemia
55. femoral nerve block vs PCA for knee arthroplasty - reduces morphine consumption, reduces pain scores with activity but not at rest. Does not reduce urinary retention.
63. Superficial cervical block for entarterectomy is better in all ways to deep cervical block except higher chance of Horner syndrome.
64. After aspiration, suction intubate and then bronch
76. Insulin requirements in pregnancy decrease in first trimester and increase in 2nd and 3rd. Mother experience great decrease in requirements after giving birth. Diabetics have bigger babies, more premature babies, more birth defects. Neonates are at risk for hypoglycemia.
Myotonic dystrophy causes muscle rigidity with succinylcholine. In advanced cases, it can cause hyperkalemia.
80. Burn victims have increased metabolic demand, third spacing, vascular permeability throughout their body and low output renal failure from prerenal. However they have decrease CO! Also keep body temp at 38.5!
81. Parkland formula is 4ml*kg*%burned.
82. LSD: include elevated temperature, hypertension, tachycardia, mydriasis, agitation, anxiety, increased production of saliva, hyperreflexia, hyperglycemia, and increased wakefulness.
85. Pulm HTN: Prevent and aggressively treat hypotension, Phenylephrine, vasopressin, and norepinephrine are recommended to treat hypotension, Maintain adequate preload and cardiac contractility, Prevent hypoxia, hypercapnia, acidosis.
continue drug therapy directed at decreasing PAP: prostacyclin (epoprostenol, treprostinil, iloprost), endothelin receptor antagonists (bosentan), phosphodiesterase-5 (sildenafil). Give CCB in pts response to vasodilators. Consider nitric oxide.
88. Acute Liver Failure mortality major cause is cerebral edema and increase in ICP. Pt do not have time to develop varices, hepatopulnonary syndrome. Tylenol causes metabolic acidosis. Possible renal failure and ARDS.
89. During the reperfusion phase of liver transplant, ICP can have fatal elevations. Dysrhythmias and hypotension can lead to cardiac arrest. Pulm HTN may worsen.
90. Inhalers: need to increase albuterol dose when intubated because it ahdheres to tracheal tubes. LMA decreases airway resistance than tracheal intubation. Propofol with metabisulfite causes increase in airway resistance than calcium edetate.
95. Airway laser/fire. All plastic tubes including red rubber and silicone are flammable. PVC is most, silicone is least. Cuff needs to be filled with water and double cuffed and metal tubes are better. Jet venitlation is most effective way to prevent airway fire as it avoids tracheal tube which is flmmable material. Risks of jet ventilation: barotrauma, pneumothorax, subcutaneous emphysema, and gastric distention.
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