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  1. Board Review2007 Karl Wagner MD June 14, 2007

  2. Things to read… • Hall • Faust • Morgan and Mikhail • Bible • Jensen’s • Do questions

  3. 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

  4. 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

  5. What is the O2 consumption for an adult? Neonate?

  6. 3 cc/kg and 6 cc/kg respectively

  7. Is this a normal gas? Newborn umbilical vein 7.35/40/30

  8. 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.

  9. 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

  10. How do you calculate the dose of bicarb?

  11. 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

  12. How fast does CO2 climb in one of Woodring’s patients?

  13. 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!)

  14. Can you name the six things I listed on the next slide that decrease FRC?

  15. Pregnancy • Ascites • Neonate • GA • Obesity • Supine position • PANGOS

  16. What increases dead space?

  17. Age, anticholinergics • Bronchodilators • Upright position • Hypotension, hypothermia, hypovolemia • Smoking • Pulmonary disease such as PE or decreased perfusion

  18. ACLS SO • Factors that increase closing capacity • Age • Chronic Bronchitis • LV fail • Smoking • Surgery • Obesity

  19. Effects of Hypercarbia (A RIPE) (not breathing enough) • Acidosis, arrythmia • Right shift O2-Hb curve • Intracerebral steel • PA pressure increase • Epi-norepi release

  20. Hypocarbia (AVCO) (breathing too much) • Apnea, alkalosis, airway constriciton • v/q mismatch • Decrease CO, CBF, Coronary BF, Ca2+ • O2-Hb curve to left

  21. Calculate this… I dare you • SVR

  22. (MAP-CVP)/CO*80

  23. Local anesthetics quick • Where are they metabolized? Or do they just go away quietly?

  24. Esters (procaine, tetracaine, chloroprocaine) – plasma cholinesterase • Amides (those with the extra “i”) – liver microsomal enzymes

  25. Calculate this and you will become popular with the ladies… • O2 content in blood

  26. Which is more important? Bound or disolved? • Go to next slide for answer and nirvana

  27. Give these patients Hb • (1.38*Hb*Sat)+(0.003*PaO2)

  28. Trick blood question • What is most common virus passed along?

  29. CMV but no one cares because everyone on planet has this already.

  30. How much CO2 can an absorber hold? Bara and Soda

  31. 26L CO2 per 100g of stuff

  32. What is the only antiemetic you can give a parki?

  33. Ondansetron – do you remember the receptor it binds?

  34. If a patient is taking an oral alpha 2 agonist (name drug now) do you ever stop it pre op? Why or why not?

  35. Clonidine, and no. It causes rebound hypertension

  36. 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?

  37. Platelets only if refractory to random platelets • FFP not crossed • Cryoppt not crossed • PRBC crossed

  38. Which drugs do not cross the placenta? • He is going nowhere soon.

  39. Heparin • Insulin • Glycopyrollate • Nondepolarizors • Succhinylcholine

  40. Why does meperidine cause tachycardia?

  41. The molecule is shaped like atropine. • The question will list a bunch of drugs, probably narcs and ask which causes tachycardia.

  42. 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?

  43. Please remove tube quickly • Don’t forget to stop fresh gas flow

  44. What are effects of retrobulbar block?

  45. ptosis • Akinesia of globe • Anesthesia of globe • Blindness

  46. After Stevens lets you do a retrobulbar and the patients starts to seize, where did you inject?

  47. Artery

  48. 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?

  49. Occular cardiac reflex, probably from retrobulbar hematoma

  50. What happens when we let the medical student do the retrobulbar block and the patient gets all apneic but no cardiac or seizure symptoms?