10. Mannitol should be given over 30 minutes to decrease ICP. Initial effect in 15 min, max effect in 1 hr, lasts 6 hrs. Can temporarily increase ICP with rapid administration but NOT hypertension. Serum osmolarity goal with mannitol administration should target 300-320.
18. Lithium prolongs both nondepolarizing NMB and succinylcholine.
31. Mitral regurgitation 2/2 ischemia is NOT most likely due to papillary muscle rupture. It does however portend increased risk of cardiac death as even small amount of regurg can lead to pulm HTN.
32. When you see late decels: oxygenation, left lateral decubitis, give pressors for hypotension, stop oxytocin and given terbutaline if signs of uterine overstimulation. If not successful, c/s.
33. Parturtients may be more resistant to opioid induced respiratory depression 2/2 progesterone stimulating RR.
41. Aminoglycosides can cause nephrotoxicity (ATN) with neomycin being most likely, gentimicin moderate and streptomycin weakly. Risk can be reduced with coadministration of beta-lactam, also giving calcium or calcium channel blockers. Antioxidants proven in animals but not humans. Give less total dose and less frequent dosing.
42. To distinguish between somatic (musculoskeletal) vs visceral (stretching of organs) pain, you can give intercostal blocks. Also celiac plexus blocks are not as long lasting for noncancer pancreatic pain. Pain control from celiac plexus is from afferent sensory fibers, not as much sympathetic efferent fibers.
44. Stellate ganglion is made up of inferior cervical ganglion fused with T1, located anterior to transverse process of C7 or T1. The stellate ganglion contains sympathetic nerves to the face and arm. A typical stellate block to anterior process of C6 will cause Horner's syndrome (ptosis, miosis, nasal stuffiness, scleral hyperemia) with sympathetic block of the face. Temperature rise in the arm is required to insure that the block as affected the upper extremity.
45. Correctly done stellate block results in phrenic nerve and recurrent laryngeal nerve blockage.
51. In older people, SV increases while HR and CI decreases. This makes sense because pulse pressure increases in older people and pulse pressure approximates SV.
53. Glossopharyngeal block - extraoral approach - line drawn from angle of mandible to mastoid process. Styloid process lies below midpoint of this line. Hit styloid 3cm needle and walk off posteriorly, inject. Close to IJV and ICA. Accessory nerve and vagus nerve are more posterior. LA will block all 3 nerves.
56. Remifentanil in high doses can isolate epileptogenic areas but decreasing EEG activity in normal brain and increasing single and repetitive spike burst activity in epileptogenic areas.
63. Penile block consists of ring block or dorsal penile nerve block. The latter aims to anesthesize nerves deep to the fascial plane under Scarpa's fascia. Two injections lateral to the midline inferior to the symphsis pubis is required.
66. Croup vs epiglottitis. Croup is in younger kids (1 year) who barks and has low grade fever and triangle positioning. Epiglottitis is in older children without viral prodrome with higher temperature. Also the kid is drooling, dysphagia, and distress. Usually a muffled voice.
Croup rx - cool mist doesn't benefit, give corticosteroids, racemic epinephrine, heliox,
72. SvO2 decreases with pulm embolism, pulm edema, and MI (decreased CO). It increases with cyanide, hypothermia, and shunts or AV fistulas.
77. Suboxone is combination of buprenorphine/naloxone to be used sublingually. The Suboxone has very little absorption through this route but prevents abuse by IV.
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