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Board Review part deux. Karl Wagner MD June 21, 2007. What happens if you tip the vaporizer? What should you do next?. If you tip it you don’t know how much agent you will give. Turn O2 up to 10 L for 30 mins. Volatile anesthetics. How much gas comes from 1 ml of isoflurane?. 200 cc.

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board review part deux

Board Review part deux

Karl Wagner MD

June 21, 2007

volatile anesthetics
Volatile anesthetics
  • How much gas comes from 1 ml of isoflurane?
mapleson circuits
Mapleson circuits
  • Can any one draw them?
slide11
Which circuit do we use for spontaneous respiration?
  • Which do we use for controlled ventilation?
  • Why does it matter?
slide12
A dog can bite. This is a spontaneous event.
  • Dog bites ache. This is now a controlled situation.
how fresh is fresh
How fresh is fresh?
  • What does the fresh gas flow need to be for each of these circuits?
slide14
2-3x Vt, you will note if you look at the circuits that only the A (spont) and the D (cmv) use flows this low. The others use much higher flow rates.
co2 absorber follow up
CO2 absorber follow up.
  • How big does the canister have to be?
how big should the crystals be
How big should the crystals be?
  • Some lonely guy figured you should have a mix of small and large. The small increase surface but also resistance. This concept has been tested. It will be a slam dunk for you.
slide19
940 (oxy)
  • 660 (deoxy)
slide21
50 cc/100 g brain/min
  • At 20 you get brain acidosis and change in eeg
  • At 15 you have isoelectric eeg
  • At 6 you have infarction
interscalene block
Interscalene block
  • What operations is it good for?
slide25
You always tank the phrenic nerve.
  • You can also get the recurrent laryngeal.
  • What else can happen with these blocks?
slide26
They might work, that is good
  • Some bad stuff includes: spinal, pneumothorax, seizure,
slide32
It sits near the origin of the first rib off of the C7 vertebra.
  • What is Chassaignac’s tubercle?
slide35
Sympathectomy to upper extremity.
  • How do I know it worked?
slide36
Horner’s syndrome (ptosis, miosis, anhydrosis)
  • Nasal stuffiness ipsilateral side
  • Flushing of conjunctiva and skin
  • Temp increase on arm*****
slide39
Where is my celiac plexus?
  • The question was purely anatomical….
slide40
Anterior to aorta
  • Medial to IVC
  • Level L1
slide42
Mostly cancer pain, it is sensory and sympathetic fibers.
  • Used for pain from lower esoph sphincter to splenic flexure. Also liver, PANC, and kidneys.
slide45
The ones that matter seem to be Lido (#1) and bupi.
  • Lido 4 mg/kg (7 with epi)
  • Bupi 3.5 mg/kg ((3.5 with epi (notice the trick))
slide47
Prilocaine
  • Treat with methylene blue.
slide51
Which nerve is up?
  • Which nerve is down?
slide52
Medial
  • Ulnar
  • Radial is behind the artery.
slide53
The questions for the upper extremity end up being where do you stick the needle to give rescue blocks? When your ax or interscalene fail now what?
slide54
Block at elbow and wrist.
  • Do you know where to inject?
remember
Remember
  • VC – 60-70 cc/kg
  • Vt – 5-7 cc/kg
  • FRC – 40 cc/kg
dead space is where no one can hear you scream
Dead space is where no one can hear you scream.
  • Vd/Vt = (PaCO2-PeCO2)/PaCO2
  • Why do I care if Douglas has his bag?
  • You will be asked to calculate the ratio of dead ventilation. The norm is what?
slide64
Dibucaine inhibits cholinesterase. When it is 80% inhibited this is normal. If it is 20% then I am screwed. Why?
  • Sux will last longer. How long?
slide68
What should I do when Dr. Brown tells me he just injected Thiopental in the a line? Should I pat him on the back affectionately?
slide69
That can cause severe pain and vasospasm that can lead to gangrene. Flush with saline, give lido and do a sympathetic block to cause vasodilation. Pt is screwed.
slide70
Keep reading.
  • All pictures are from Miller Anesthesia (from MDConsult) or www.NYSORA.com
  • Study hard and remember to tip the waitstaff.