Otterbein/Grant CRNA Basics Final Review

Reach to drink cold beer

Sitting allows for the best ventilation because in this position, the chest is in an upright position, allowing the diaphragm to move freely and effectively. This allows for optimal lung expansion and ventilation. Additionally, sitting allows for better alignment of the airways, reducing the risk of airway obstruction.

Treat with calcium administration, at least every 4th unit of blood if doing massive transfusion protocol

The correct answer is III because the PA catheter tip should be placed in the pulmonary artery, which is located in the right side of the heart. In the given options, zone III is the only one that corresponds to the correct placement of the catheter tip. Zones I, II, and IV are not accurate locations for the PA catheter tip placement.

The given equation is a conversion formula between Celsius and Fahrenheit temperatures. It states that to convert Celsius to Fahrenheit, you multiply by 9/5 and add 32, and to convert Fahrenheit to Celsius, you subtract 32 and multiply by 5/9. This equation is true and commonly used for temperature conversions between the two scales.

Remember...CO = HR X SV ;)

The given correct answer is true. When a patient in a sitting position for a craniotomy experiences an increase in end tidal nitrogen, arrhythmias, and a mill wheel murmur, it indicates the presence of a venous air embolus. To treat this condition, the recommended approach is to aspirate the air through a multiorifice central venous catheter. This procedure helps remove the air from the venous system and prevents further complications.

Monitored anesthesia care refers to the administration of anesthesia while the patient remains conscious and able to respond to verbal commands. In this context, maintaining spontaneous ventilation means that the patient is able to breathe on their own without the need for mechanical assistance. This is important because it ensures that the patient's airway remains open and they can continue to oxygenate their body adequately during the procedure. Therefore, the statement "In order for a case to truly be considering monitored anesthesia care, the patient must maintain spontaneous ventilation" is true.

Respiratory variation in arterial waveforms refers to the changes in arterial pressure that occur during the respiratory cycle. A respiratory variation in arterial waveforms greater than 10 mmHg indicates decreased intravascular volume. This means that there is not enough fluid within the blood vessels, leading to reduced blood volume and potentially decreased perfusion to organs and tissues. This can be caused by factors such as dehydration, bleeding, or fluid loss.

The statement explains that there are several contraindications for performing a MAC (Monitored Anesthesia Care) case. These include patient discomfort, patient positioning such as prone, the surgeon being unable to operate safely with the patient being non-paralyzed, and being unable to maintain the patient's airway for the depth of sedation/analgesia indicated. Therefore, the statement is true.

The correct answer is performing surgeries. The PACU, or Post-Anesthesia Care Unit, is a specialized area where patients recover after surgery. Its primary purposes include critical assessment, stabilization, and prevention and detection of post-op complications. However, performing surgeries is not one of its purposes, as surgeries are typically performed in the operating room, not in the PACU.

The statement is true because a train of four is a neuromuscular monitoring technique used to assess the depth of neuromuscular blockade. It involves delivering four consecutive electrical stimuli to a peripheral nerve and observing the resulting muscle twitches. In this case, the patient has only one twitch, indicating that there is still some level of blockade present. The statement further explains that even with four twitches present, up to 75% of the patient's receptors could still be blocked, emphasizing that the presence of twitches does not necessarily mean complete recovery from blockade.

The statement is true because it is important for a patient to be hemodynamically stable, meaning that their blood pressure, heart rate, and other vital signs are within a normal range, before leaving the operating room for the post-anesthesia care unit (PACU). Additionally, the patient should have adequate ventilation and oxygenation, meaning that they are breathing properly and receiving enough oxygen, through a stable and open airway. These criteria ensure that the patient is in a stable condition and ready to recover from the anesthesia in the PACU.

The correct answer is "A male, smoker." PONV stands for postoperative nausea and vomiting, which is a common complication after surgery. Risk factors for PONV include being female, having a history of motion sickness, the use of inhaled agents and opioids, and having a history of PONV. However, being a male and a smoker is not considered a risk factor for PONV.

Local anesthetics with increased lipid solubility have a stronger affinity for proteins, leading to increased protein binding. This results in higher potency, longer duration of action, and an increased likelihood of severe toxicity, particularly cardiotoxicity.

The ligamentum flavum is a ligament located in the spinal column. When placing an epidural, the ligamentum flavum is pierced by the needle, creating a popping sensation. This ligament is known for its elastic properties, which allow it to stretch and then return to its original shape.

PA catheter indications include evaluating cardiac function, assessing response to fluids/drugs, and diagnosing conditions such as pulmonary emboli, ARDS, COPD, and pulmonary hypertension. However, it is not indicated for pulmonary stenosis.

The symptoms mentioned in the question, such as muscle cramps, tingling, numbness, hyperactive deep tendon reflexes, Trousseau's sign (carpopedal spasm), Chvostek's sign (masseter spasm), laryngeal spasms, convulsions, and prolonged QT/ST segments, are all indicative of hypocalcemia. Hypocalcemia refers to low levels of calcium in the blood, which can lead to these symptoms. Hypercalcemia, on the other hand, refers to high levels of calcium in the blood and is not associated with the mentioned symptoms.

The dicrotic notch occurs during diastole. Diastole is the phase of the cardiac cycle when the heart muscle relaxes and fills with blood. During diastole, the ventricles are relaxed and the aortic valve closes, causing the dicrotic notch to occur. This notch represents a brief increase in aortic pressure as the aortic valve closes and prevents blood from flowing back into the left ventricle. Therefore, the dicrotic notch is associated with the onset of diastole.

The maintenance fluid requirement for a person is determined based on their weight. In this case, the person weighs 85 kg. The answer given, 125, is likely the amount of maintenance fluid required for this individual. However, without additional context or information, it is difficult to provide a more detailed explanation.

The explanation for the given correct answer is that when performing a spinal anesthetic using the midline approach, the layers of anatomy that are traversed from posterior to anterior are indeed skin, subcutaneous fat, supraspinous ligament, interspinous ligament, ligamentum flavum, dura mater, subdural space, arachnoid mater, and finally the subarachnoid space. This is the correct sequence of layers that need to be penetrated in order to reach the desired subarachnoid space for the administration of the spinal anesthetic.

Left IJ CVP insertion is associated with thoracic duct injury. The thoracic duct is the largest lymphatic vessel in the body and is responsible for draining lymph fluid from the lower half of the body, left upper limb, and left side of the head and neck. During left IJ CVP insertion, there is a risk of accidentally puncturing or injuring the thoracic duct, which can lead to leakage of lymph fluid. This can result in complications such as chylothorax, a condition characterized by the accumulation of lymphatic fluid in the pleural space.

When a person is standing, the lung zones are primarily vertical, with the upper lobes located superiorly and the lower lobes located inferiorly. However, when a person changes to a supine position (lying flat on their back), the lung zones shift to a more horizontal orientation. This is because the gravitational forces acting on the lungs change when the body position changes. In the supine position, the lungs expand more evenly, allowing for a more uniform distribution of ventilation throughout the lung fields. Therefore, the statement is true.

The NPO deficit refers to the amount of fluid that a person needs to replace after being restricted from taking anything orally. In this case, the person has been NPO (nothing by mouth) for 6 hours. To calculate the NPO deficit, we multiply the number of hours by the hourly fluid requirement. The average hourly fluid requirement is 125 mL per hour. Therefore, the NPO deficit would be 6 hours multiplied by 125 mL, resulting in a deficit of 750 mL.

Most alcoholics must really urinate

Regional anesthesia is a type of anesthesia that numbs a specific region of the body, allowing the patient to remain awake and conscious during the procedure. It is often used to avoid the risks and side effects associated with general anesthesia. Obstetric, urology, and orthopedic procedures are commonly performed under regional anesthesia. Additionally, regional anesthesia may be preferred by patients who have pulmonary or cardiac issues that make general anesthesia risky. Therefore, the statement that indications for using regional anesthesia include avoiding general anesthesia, obstetric procedures, urology procedures, orthopedic procedures, patient choice, and pulmonary/cardiac issues is true.

The advantage of rapid cooling is the shortening of cardiac bypass time

Severity is dose related, causes respiratory depression

In hypotensive anesthesia, blood loss is related to mean arterial pressure (MAP). MAP represents the average pressure in the arteries during one cardiac cycle and is a key determinant of tissue perfusion. When MAP decreases, blood flow to tissues decreases as well, leading to reduced oxygen and nutrient supply. Therefore, a lower MAP during hypotensive anesthesia can result in decreased blood flow and potentially increased blood loss. Cardiac output and central venous pressure may also be affected by hypotensive anesthesia, but they are not directly related to blood loss.

During an Allen's test, the ulnar artery is temporarily occluded to assess the collateral circulation in the hand. After releasing the pressure on the ulnar artery, the color should return to the hand within 5 seconds. The prompt also provides the word "five" as an alternative way of expressing the number 5.

The perception of pain occurs in the cerebral cortex. This is because the cerebral cortex is responsible for processing sensory information, including pain signals. When we experience pain, nerve signals are sent to the brain where they are interpreted and processed in the cerebral cortex. This region of the brain allows us to perceive and localize pain, as well as to interpret its intensity and quality. Therefore, it is accurate to say that the perception of pain occurs in the cerebral cortex.

660/2000 = 0.33 x 500 = 165/10 = 16.5

Shivering is a physiological response to cold temperatures, which causes muscle contractions to generate heat. This increased muscle activity leads to an increase in oxygen consumption and metabolic demand, which in turn increases the oxygen extraction from the blood and decreases the systemic venous oxygen saturation (SVO2). Therefore, shivering would decrease SVO2 rather than increase it.

The prone position is associated with a better matching of ventilation and perfusion (V/Q) and improvement in oxygenation. In the prone position, the patient lies on their stomach, which helps to redistribute the blood flow and ventilation to the posterior lung regions. This allows for improved matching of ventilation and perfusion, leading to better oxygenation of the blood.

A leftward shift of the oxyhemoglobin curve indicates an increased affinity of hemoglobin for oxygen, meaning that hemoglobin will bind to oxygen more strongly. This would result in increased oxygen saturation in the blood, leading to an increase in SVO2. Therefore, a leftward shift of the oxyhemoglobin curve would not decrease SVO2.

The CVP waveform is a measurement of the pressure in the central venous system. The C wave in the waveform represents a slight increase in pressure caused by the contraction of the ventricles. This occurs when the tricuspid valve closes after ventricular systole, causing a small backflow of blood into the right atrium. Therefore, the C wave in the CVP waveform represents ventricular contraction.

Hypothermic operative technique involves lowering the body temperature, which leads to a significant decrease in oxygen consumption. This reduction in oxygen consumption is beneficial during surgeries as it allows for a longer duration of anesthesia without causing harm to the brain. Additionally, hypothermia provides an increased margin of safety for cerebral vascular accidents, as it slows down the metabolic processes and reduces the risk of ischemic injury to the brain. Therefore, hypothermic operative technique offers advantages of decreased oxygen consumption and improved safety for cerebral vascular accidents.

During surgery, it is important to maintain fluid balance and prevent dehydration. The amount of fluid to be administered depends on various factors such as the patient's weight and the duration of fasting. In this case, the patient weighs 85 kg and has been NPO (nothing by mouth) for 6 hours, indicating a need for fluid replacement. The answer of 1180 mL suggests that this is the anticipated amount of fluid to be administered in the first hour of surgery to ensure proper hydration and maintain the patient's fluid balance.

When epinephrine is added to a local anesthetic, it causes vasoconstriction, which means that the blood vessels in the area constrict or narrow. This narrowing of blood vessels reduces blood flow and decreases the amount of the anesthetic drug that is carried away from the site to be metabolized. As a result, the drug stays in the area for a longer period of time, increasing the length of time that the block is effective. Therefore, the correct answer is 50%, indicating that the addition of epinephrine increases the effectiveness of the block by 50%.

IV>tracheal>intrapleural, intercostal>Caudal>paracervical>epidural>brachial plexus>subarachnoid,sciatic,femoral>subcutaneous

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