-
how is speed of induction related to MAC
- typically inversely
- i.e Nitrous is fast acting but with a high MAC
-
effects of inhalational agents
- anesthesia
- amnesia
- +/- analgesia
-
inhalation agent that can cause szs
enflurane
-
highest level of myocardial depression of all inhalation agents
halothane
-
continuous infusion of etomidate leads to
adrenal suppression
-
how is propofol metabolized
liver and plasma cholinesterases
-
why should you avoid propofol in children
prolonged use has been associated with metabolic acidosis and death
-
IV induction agent contraindicated in head injury
ketamine
-
s/e of ketamine
- hallucinations
- catecholamine release with increase pCO2, HR, airway secretions
-
mcc of sudden increase ET CO2
alveolar hypoventilation
-
how do you tx myoclonus seen in serotonin syndrome
- benzodiazepines
- cyproheptadine for overall syndrome
-
malignant hyperthermia is caused by
a defect in the ryanodine receptor on SR
-
mc s/e of pancuronium
tachycardia
-
s/e of cis atracurium
histamine release
-
lidocaine max dosage
5mg/kg, 7 with epi
-
bupivicaine max dosage
2mg/kg, 3 with epi
-
2nd sx of lidocaine toxicity
visual and auditory hallucinations
-
what level epidural effects the heart
T5
-
decreased motor in legs after epidural
mc is medication overdose so decrease and follow if no response then do w/u for hematoma
-
categories for revised cardiac risk factors
- high risk surgical procedures
- histor of ischemic heart dz
- hx of CHF
- hx of Cerebrovascular dz
- preop insulin need
- preop Cr > 2
-
largest risk factor for cardiac complication
uncompensated CHF> recent MI
-
when is no preop testing needed in a pt who has had a CABG or PTCA
- if no return of sxs and
- CABG with in 5 yrs
- PTCA within 2 yrs
-
how do you manage a pt who needs an emergency non cardiac procedure and has a hx of cardiac dz
- maximize wedge pressure 15-20
- beta blocker
- nitropaste as pressure tolerates
- Hct 30 and above
- fi02 of 100%
- inotropes for decrease CO
-
tx for myasthenia gravis
- pyridostigmine
- steroids
- plasmapharesis
- azathioprine
- IVIG
-
when operating on a pt with myasthenia gravis what neuromuscular blocker should you use
succ
-
what is the blood supply to the thymus
ima and inf thyroid
-
what are the effects of cholinergic crisis
depolarization blockade
-
-
main determinant of intracellular and extracellular osmotic pressure
Na
-
composition of LR
- Na 130
- K 4
- Ca 2.7
- Cl 109
- lactate 28
-
calculate plasma osm
2NA + (glucose/18) + (BUN/2.8)
-
-
k requirement
0.5 - 1 mEq/kg/day
-
amt of insensible losses/day
10cc/kg/day
-
D51/2NS at 125 provides how much glucose/cal per day
-
type of secretion with the highest amount of K
saliva
-
calculate free water deficit
(0.6 x weight) x [(Na/140) -1]
-
tx of hyponatremia in DKA
nothing just treat underlying illness
-
top three drugs to treat hyperkalemia
- 1 amp Calcium gluconate
- 1 amp NaHCO3
- insulin/dextrose
-
mcc of hypermagnesium
renal failure plus pt taking laxative/antacids or burn/trauma
-
-
MCC of hypophosatemia
refeeding syndrome
-
causes of anion gap met acidosis
- methanol
- uremia
- DKA
- propylene glycol
- infxn/INH
- Lactic acidosis
- Ethylene glycol
- Salicylates
-
types of non gap met acidosis
- gi loss of bicarb
- over diuresis
- dilutional
- lactulose
- hyperparathyroid
- RTA
-
tx of DKA
- treat underlying precipitants
- NS 10cc/kg/hr
- insulin 10 U then 0.1 u/kg/hr until gap normal
- add k to drip if <4.5
-
amount of kcal needed per day
25 kcal/kg/day
-
calories/protein needed with burns
- 25 + (30/day x % burn)
- 1 + (3g x % burn)
-
harris benedict equation uses what to calculate BMR
-
what are micelles
aggregates of bile salts, long chain FFAs, monoacylglyderides, and cholesterol
-
major component of chylomicrons
TAGs
-
lipoprotein lipase are located where
endothelium
-
located on cell membrane and helps to transport FAs into cell
fatty acid binding protein
-
carry newly synthesized TAGs and cholesterol from liver to adipose tissue
VLDL
-
majority of total body cholesterol
is synthesized
-
what are two essential fatty acids
linolenic linoleic
-
obligate glucose users
- peripheral nerves
- adrenal medulla
- rbcs
- wbcs
-
primary glycogen storage areas
-
what are the non essential aas
those that begin with A G C + serine, proline, tyrosine, histidine
-
what are the essential aas
- leucine, isoleucine
- valine
- lysine
- methionine
- phenylalanine
- threonine
- tryptophan
-
aas that can be metabolized by muscle outside liver
branched chain leucine, isoleucine, valine
-
-
major fuel source is short chain FAs
-
major fuel source is glutamine
stomach, small bowel, pancreas, spleen
-
neoplastic cells prefer what fuel source
glutamine
-
RQ = 0.8
protein metabolism
-
RQ that resembles balanced feeding
0.825
-
acute indicators of nutritional status
- pre albumin
- transferrin
- retinal binding protein
- total lymphocytes
-
maximum glucose concentration in TPN
3g/kg/hr
-
composition of TPN
- 20% protein
- 30% fat
- 50% dextrose
-
FFA oxidation occurs where
inner mitochondrial space
-
precursors for gluconeogenesis
- alanine
- lactate
- pyruvate
- glycerol
-
only amino acids to increase with stress
-
main cause of trace mineral def
TPN
-
vit E def leads to
neuropathy, spinocerebellar ataxia
-
szs, cheilitis, peripheral neuropathy
pyridoxine def
-
def of essential fatty acids causes
- thrombycytopenia
- dermatitis
- poor wound healing
-
often 1st manifestation of trace mineral def
poor wound healing
-
trace mineral def associated with cardiomyopathy
selenium
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