ABA/ITE question help

[cockblockandrun]

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I hate the machine questions but here is one that has stumped us:

Oxygen 100ml/min is bubbled through a vaporizer containing an anesthetic with a vapor pressure of 150mmHG and this mixture is added to fresh gas flow of 5L/min. The delivered anesthetic concentration is:
a. 0.25%
b. 0.5%
c. 1%
d. 2.5%
e. 5%

 

[Idiopathic]

should be b, i think.

Output = Carrier gas X vapor pressure/barometric pressure - vapor pressure

Output = 100 X 150/750-150 = approx 25 ml/min (vapor)

25 ml/min output / 5000 ml/min FGF - 0.005 or 0.5%

 

[cockblockandrun]

should be b, i think.

Output = Carrier gas X vapor pressure/barometric pressure - vapor pressure

Output = 100 X 150/750-150 = approx 25 ml/min (vapor)

25 ml/min output / 5000 ml/min FGF - 0.005 or 0.5%

B is correct. Thanks. Do you know what section of Miller or Barash I can find this info? Been looking all over and can't find a good explanation

 

[Idiopathic]

The formula is the key, and its fairly standard. I dont know specifically where it is in Miller, etc

 

[wine thief]

i believe i've seen that formula in big blue or the hall question book.

 

[nycitygas]

i believe i've seen that formula in big blue or the hall question book.

Hall question book

 

[cockblockandrun]

A patient with low cardiac output following CABG is transferred to ICU where a chest Xray confirms proper placement of the pulmonary artery catheter. Serial pulmonary artery occlusion pressures are then measured. Immediately following inflation of the balloon with 1.5ml of air in the wedged position, brisk bleeding is noted from the endotracheal tube.

The most appropriate immediate management is to:
a. withdraw pulmonary artery catheter
b. perform endobronchial intubation
c. apply 15-20 cm H2O PEEP to airway
d. administer FFP rapidly
e. decrease BP rapidly with nitroprusside

 

[cockblockandrun]

This one has stumped me....

After receiving excessive intraopertive blood replacement, a patient anesthetized with fentanyl, diazepam and nitrous oxide develops acute pulmonary edema. The drug most likely to help him acutely is:

a. isoflurane
b. nitroprusside
c. digoxin
d. nitroglycerin
e. furosemide

 

[Bertelman]

A patient with low cardiac output following CABG is transferred to ICU where a chest Xray confirms proper placement of the pulmonary artery catheter. Serial pulmonary artery occlusion pressures are then measured. Immediately following inflation of the balloon with 1.5ml of air in the wedged position, brisk bleeding is noted from the endotracheal tube.

The most appropriate immediate management is to:
a. withdraw pulmonary artery catheter
b. perform endobronchial intubation
c. apply 15-20 cm H2O PEEP to airway
d. administer FFP rapidly
e. decrease BP rapidly with nitroprusside

I'd deflate the balloon, but I'm not sure if that is what A is saying. Certainly wouldn't withdraw the thing if it is still inflated.

Out of the others, I would probably bury the tube (B), but chances are your PAC is in the Rt PA, and your ETT will go down the Rt, so before I spent to much time ventilating I would get a scope down and see if that's the bleeding side.

 

[cockblockandrun]

I'd deflate the balloon, but I'm not sure if that is what A is saying. Certainly wouldn't withdraw the thing if it is still inflated.

Out of the others, I would probably bury the tube (B), but chances are your PAC is in the Rt PA, and your ETT will go down the Rt, so before I spent to much time ventilating I would get a scope down and see if that's the bleeding side.

The answer is B. But I am not sure why.

 

[Bertelman]

The answer is B. But I am not sure why.

You've got bronchial hemorrhage from a ruptured PA due to balloon inflation. One indication for double-lumen tube placement (or in this case simply bronchial intubation) is to control pulmonary hemorrhage. You want to save good lung tissue for ventilation.

 

[Idiopathic]

100% B. Requires you to realize that PA rupture is a known complication of PAC manipulation/placement, and how its likely to present. None of the others are reasonable emergent treatments of PA rupture.

 

[Idiopathic]

This one has stumped me....

After receiving excessive intraopertive blood replacement, a patient anesthetized with fentanyl, diazepam and nitrous oxide develops acute pulmonary edema. The drug most likely to help him acutely is:

a. isoflurane
b. nitroprusside
c. digoxin
d. nitroglycerin
e. furosemide

Seems pretty straightforward so it must not be. I say E because of the acute pulmonary venodilation that you get with lasix (moreso than the diuretic effect). I suppose nitroglycerin could be a good choice as well in this patient who is volume overloaded, but I go with E.