board review 2007 karl wagner md june 14, 2007. things to read… hall faust morgan and mikhail...
TRANSCRIPT
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!)
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
Esters (procaine, tetracaine, chloroprocaine) – plasma cholinesterase
Amides (those with the extra “i”) – liver microsomal enzymes
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?
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?
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?
You will have to calculate the fluid balance for someone. Either child or adult. Remember the 4,2,1 rule. They will just say a patient had this procedure and had this fluid was it adequate?
Give KCl and go to OR. Dig tox comes from: Hypokalemia (hey how fast can you give this
stuff?) Hypothyroid Hypomagnesemia Hypercalcemia Renal failure (#1 answer Bob)
Classic
Old guy s/p chole or colectomy or something. He is having ischemic ST segment changes and is shivering in PACU. BP 220/120 HR 120. What are you going to do first?
ECHO, these guys die from heart failure. They have cardiomyopathies and atrophy of cardiac muscle.
The second important system is pulm. They can not cough because they are too weak. They also die from pnuemonia.
At least one airway question.
How can I block it so I can do my awake fiberoptic without all that messy lidocaine nebulization?
Glossophyngeal Superior laryngeal Recurrent laryngeal
Secret nose nerve for Dr. Gordon and our friends at the ABA.
Hey doc, got a minute?
Ask me about the circle system and the circuits that I for sure will have to identify at my exam.