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Board Review part deux

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

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  1. Board Review part deux Karl Wagner MD June 21, 2007

  2. What happens if you tip the vaporizer? • What should you do next?

  3. If you tip it you don’t know how much agent you will give. • Turn O2 up to 10 L for 30 mins.

  4. Volatile anesthetics • How much gas comes from 1 ml of isoflurane?

  5. 200 cc

  6. Quick, someone draw a circle system.

  7. Circle System

  8. Mapleson circuits • Can any one draw them?

  9. Which circuit do we use for spontaneous respiration? • Which do we use for controlled ventilation? • Why does it matter?

  10. A dog can bite. This is a spontaneous event. • Dog bites ache. This is now a controlled situation.

  11. How fresh is fresh? • What does the fresh gas flow need to be for each of these circuits?

  12. 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.

  13. CO2 absorber follow up. • How big does the canister have to be?

  14. Must hold entire Vt.

  15. 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.

  16. What are the wavelengths of the pulse ox?

  17. 940 (oxy) • 660 (deoxy)

  18. What is normal CBF?

  19. 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

  20. Interscalene block • What operations is it good for?

  21. Shoulder, upper arm

  22. Why do all of Rahim’s patients have hemidiaphragm paralysis after his blocks?

  23. You always tank the phrenic nerve. • You can also get the recurrent laryngeal. • What else can happen with these blocks?

  24. They might work, that is good • Some bad stuff includes: spinal, pneumothorax, seizure,

  25. Which nerve is often missed with the interscalene block?

  26. ulnar

  27. Where do intrathecal opiods work?

  28. In the substantia gelatenosa.

  29. Where is my stellate ganglia?

  30. It sits near the origin of the first rib off of the C7 vertebra. • What is Chassaignac’s tubercle?

  31. Process on C6 which is often easier to palpate.

  32. Why would I want to block my stellate ggl?

  33. Sympathectomy to upper extremity. • How do I know it worked?

  34. Horner’s syndrome (ptosis, miosis, anhydrosis) • Nasal stuffiness ipsilateral side • Flushing of conjunctiva and skin • Temp increase on arm*****

  35. Check out these blood vessels. Carotid, jugular and one other?

  36. Don’t forget the vertebral artery. That is the trick for the boards!

  37. Where is my celiac plexus? • The question was purely anatomical….

  38. Anterior to aorta • Medial to IVC • Level L1

  39. Why would I stick a needle there?

  40. Mostly cancer pain, it is sensory and sympathetic fibers. • Used for pain from lower esoph sphincter to splenic flexure. Also liver, PANC, and kidneys.

  41. These patients always get diarrhea, they can also have postural hypotension.

  42. How much local anesthetic can you get?

  43. 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))

  44. For a bonus, which local anesthetic is associated with methemoglobinemia?

  45. Prilocaine • Treat with methylene blue.

  46. Ankle block is good for at least 3 questions

  47. What nerve do I hit if I go through the artery?

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