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Board Review2007 Karl Wagner MD June 14, 2007
Things to read… • Hall • Faust • Morgan and Mikhail • Bible • Jensen’s • Do questions
Adult pt had GA with ETT. He is now waking at the end. RR 29, VC 12 cc/kg, MIF -15. Do you extubate? • no
Criteria for extubation • Mechanics -- RR <30, VC >15cc/kg (adult), >10cc/kg (child), MIF greater than -20 • Oxygenation – PaO2 70mmHg on 40% fiO2, A-a grad <350 with fiO2 100 • Ventilation – PaCO2 <55, Vd/Vt <0.6 • Also afebrile, no pressors, stable vitals, awake and alert
ABG’s • They will just show you a gas and ask what you should do. Nothing, intubate, give bicarb, leave room. • Uvein as before, Uart 7.28/50/20 (remember the weird fetal circ), 60 mins 7.35/30/60, 24 hrs 7.35/30/70, Adult and child 7.4/40/100.
How much blood does Vera have? • Neonate 0-30 days -- 85cc/kg • Infant 1-12 months – 80 cc/kg • Child 1-12 years – 75 cc/kg • Adult 70 cc/kg
They will tell you the patients base deficit (deviation of bicarb from 24) is x and ask you to choose the appropriate dose of bicarb. • Kg x be x 0.2 • Note: if infant use 0.4
6 the first min and 3 every min after. • They will just give you the PaCO2 and ask how long the patient has been apneic (don’t forget they start at 40!)
Pregnancy • Ascites • Neonate • GA • Obesity • Supine position • PANGOS
Age, anticholinergics • Bronchodilators • Upright position • Hypotension, hypothermia, hypovolemia • Smoking • Pulmonary disease such as PE or decreased perfusion
ACLS SO • Factors that increase closing capacity • Age • Chronic Bronchitis • LV fail • Smoking • Surgery • Obesity
Effects of Hypercarbia (A RIPE) (not breathing enough) • Acidosis, arrythmia • Right shift O2-Hb curve • Intracerebral steel • PA pressure increase • Epi-norepi release
Hypocarbia (AVCO) (breathing too much) • Apnea, alkalosis, airway constriciton • v/q mismatch • Decrease CO, CBF, Coronary BF, Ca2+ • O2-Hb curve to left
Local anesthetics quick • Where are they metabolized? Or do they just go away quietly?
Esters (procaine, tetracaine, chloroprocaine) – plasma cholinesterase • Amides (those with the extra “i”) – liver microsomal enzymes
Calculate this and you will become popular with the ladies… • O2 content in blood
Which is more important? Bound or disolved? • Go to next slide for answer and nirvana
Give these patients Hb • (1.38*Hb*Sat)+(0.003*PaO2)
Trick blood question • What is most common virus passed along?
If a patient is taking an oral alpha 2 agonist (name drug now) do you ever stop it pre op? Why or why not?
This can not be learned, only tatooed before exam time. • Which blood products need (or don’t need) to be cross matched before giving them to our patients?
Platelets only if refractory to random platelets • FFP not crossed • Cryoppt not crossed • PRBC crossed
Which drugs do not cross the placenta? • He is going nowhere soon.
Heparin • Insulin • Glycopyrollate • Nondepolarizors • Succhinylcholine
The molecule is shaped like atropine. • The question will list a bunch of drugs, probably narcs and ask which causes tachycardia.
What do you do when Trang goes “who knew that was flamable” while he is using his “laser” in the airway and smoke starts pouring out?
Please remove tube quickly • Don’t forget to stop fresh gas flow
ptosis • Akinesia of globe • Anesthesia of globe • Blindness
After Stevens lets you do a retrobulbar and the patients starts to seize, where did you inject?
A guy gets a retrobulbar block and like five minutes later you are reading your wall street journal and the patient brady’s down to asystole. Note: They can go right to asystole they don’t really need the brady part. What just happened?
What happens when we let the medical student do the retrobulbar block and the patient gets all apneic but no cardiac or seizure symptoms?