1. SSEPs test the posterior column in upper limbs but actually anterior column in the lower limbs
5. Naproxen is safer than diclofenac and ibuprofen in risk of myocardial infarction
6. Sevoflurane reduces respiratory resistance by 40% while desflurane does not reduce at all.
9. After ondansterone, diphenhydramine is good antinausea medication for parkinsons. Its antihistamine and anticholinergic. Remember compazine is antihistamine but has antidopaminergic effects.
10a. Succinylcholine induces hyperkalemia, rabhdo, possible MH in glycogen storage diseases.
b. Hyperkalemic periodic paralysis is triggered by exercise. Hypokalemic period paralysis is triggered by glucoseinsulin infusions.
c. Myotonic dystrophy does not cause hyperkalemia. It causes muscle contraction, cardiac abnormalities.
13. Postpolio syndrome is a constellation of signs that occur 15-40 years after initial polio infection. Generealized fatigue, muscle weakness, dysphagia, increased sensitivity to sedatives, OSA, respiratory weakness.
14. Hypogastric plexus blockade alleviates pelvic pain associated with cancer. Afferent fibers coming from pelvis travel with sympathetic nerves through hypogastric plexus.
Celiac plexus block relieve visceral pain in upper abdomen
Lumbar sympathetic block relieves pain in lower extremities such as claudication
Pudendal blocks result in analgesic of penis, peri-anal area, and posterior surface of scrotum
15. Asthma, left to right shunts, polycythemia, hemmorhage increase DLCO
16. Pregnant women have same tidal volume, vital capacity. Residual volume, FRC, and ERV are decreased.. Airway resistance doesn't change because prostaglandin E (bronchodilation) and prostaglandin F2a (Hemabate/carbaprost) keeps things unchanged.
In obese pts, FRC, ERV, VC are all decreased. Closing capacity is increased. Dead space is unchanged. FEV1 and FVC are decreased a great deal.
20: Heparin-induced thrombocytopenia mostly results in thrombosis and PE not bleeding. Criteria is platelets less than 50% of baseline or 100,000 after exposure to heparin. Thrombosis (75%).
21. Steeple sign = croup/laryngotracheobronchitis, thumb sign is epiglottitis
Smoking cessation - first 48-72 hrs, increased secretions and more reactive airways. Acute cessation decreases carboxyhemoglobin and increases oxygenation. Other benefits take 2-4 weeks. 4-6 weeks immune function normalize. 12 weeks improvement in mucociliary transport and small airway function.
VA study shows increased pulmonary complications within 4 weeks of smoking cessation. CABG pts may need 8 weeks.
25. Determining brain death. Exclude: metabolic, temperature, hypotension, drugs/paralysis. Cause of coma should be known and irreversible. Absence of relfex and CO2 drive. Spinal reflexes (plantar responses, muscle stretch reflexes, abdominal reflexes, and finger jerks ) do not exclude brain death.
33. SVC syndrome use armored tube....
36. Graft vs host disease is fatal disease caused by T-Lymphocyte of donor proliferativing in immunocompromised recipient. More likely in elderly and in similar donors such as family (directed donor blood). Symptoms occur 2-6 weeks afterwards and appear like autoimmune hepatitis. Reduced by irradiation.
39. Methohexital has little to no effect on seizure duration, which is related to efficacy of ECT. Propofol and ketamine reduces length while etomidate increases length.
31. PCI stent surgery decision, if elective wait 12 months. If urgent a decision is made to continue which antiplatelet therapy. If risk is low/intermediate and <12 months, continue both. If risk is high than discontinue plavix and continue aspirin.
44. In upright position, 1 cm vertical distance from BP cuff to brain is approximately an increase of 0.77 mmHg in BP. This means ~30-37 mmHg from arm cuff to circle of Willis. More than 45% of adults have incomplete circle of Willis.
50. Mediastinoscopy most frequently compresses the inominate artery so put a-line in RUL
51. Lung resection risk factors "three legged stool" =
lung mechanics parenchymal function cardiopulm reserve
FEV1 < 40% DLCO <40% VO2 max >15
PaO2 >60, PaCO2 < 45 stair climb, exercise SpO2 <4%
Other factors that influence hypoxemia during OLT:
COPD increases oxygenation
Right thoracotomy decreases oxygenation
Wedge has greater hypoxemia than pneumonectomy 2/2 reduced perfusion (from central tumors)
56. Carcinoid syndrome - serotonin excretion causes flushing, diarrhea, right sided heart problems, bronchoconstriction. The syndrome is in only 20% of pts with the tumor. GHRH may result in acromegaly and intrathoracic carcinoid tumors can release ACTH or CRH resulting in Cushings. Octreotide of somatostatin treat carcinoid.
64. Moderate sedation vs minimal sedation vs deep sedation
67. Line isolation monitor provides protection against macroshocks on the order of 100-300mA, whihc can cause VF. Microshocks are at an order of 100 to 300 mA.
69. If a patient survives intracranial SAH aneurysm bleed, the greatest cause of mortality and morbidity is Delayed cerebral ischemia (DCI = vasospasm). DCI presents 3-14 days after initial hemorrhage. DCI is treated with nimodipine triple H therapy (HTN, hypervolemia, hemodilution).
71. Serotonin and norepinephrine are metabolized by the lung. MAO-A break down serotonin, norepi, epi. Both MAO-A and B breakdown dopamine, tyramine, tryptamine. Remember that MAO-A inhibitors are used for psychiatric reasons and MAO-B inhibitors are used for Alzheimer's and Parkinson's.
MAOI inhibit breakdown of dietary amines such as tyramine and pts suffer hypertensive crisis. Tyramine displaces norepinephrine from storage vesicles. Avoid foods like liver, fermented substances, alcoholic beverages, aged cheeses, broad beans. Rememeber linezolid is weak MAOI.
COMT also break down dopamine, norepi, and epi. Rememeber levodopa is broken down by COMT so entacapone (COMT inhibitor) and carbidopa (inhibitor of dopa decarboxylase) is standard triple therapy.
72. Cough reflex - superior laryngeal nerve afferent
laryngospasm reflex - superior laryngeal nerve afferent
Swallowing - glossopharyngeal nerve
74. Refeeding syndrome leads to muscle weakness and trouble with vent weaning
PEEP, I to E ratio, FiO2 may increase PaO2 as part of vent strategy
75. High altitude leads to higher MV, decreased PaCO2 and higher PaO2 in the first 30 minutes but this is not sustained. Then PaO2 drops again. After 1 week, a patient go through a slow acclimatization that leads to a sustained increase in ventilation. Remember that acetazolamide, a carbonic anhydrase inhibitor leads to secretion of bicarb in urine (alkalinization) and metabolic acidosis. Body's reponse will be hyperventilation, speeding up acclimatization.
80. Nadir of physiologic anemia of infancy newborn is 3 months Hgb of 8
84. Pyloromyotomy for pyloric stenosis is not emergent and anesthesia should correct for fluids, electrolytes. Good things to do would be anticholinergic administration, gastric decompression with OG before induction, RSI, minimal opioids, awake extubation. Succinylcholine is ok. Mask induction not ok.
No comments:
Post a Comment