Not First
Block cart, 4th drawer, right-hand side.
Where do we keep the Intralipid?
A supportive device, first used in 1889, which 'might be reasonable to adjust the postition of ... instead of remove'
What is a bra?
This dose of dexamethasone has been shown to decrease nausea and vomiting at 24 hours, reduce the need for rescue antiemetics for up to 72 hours and does not increase adverse events.
What is 8mg IV?
Receiving handover in ER from an excellent ER doc about an 80 year old gentleman with GI upset with some ongoing vomiting; no further workup; discharged according to handover plan; next call about this gentleman was from the coroner. He had a classic cardiac presentation.
Can you give me an example of anchoring bias?
After neuromuscular blockers and antibiotics, a frequent source of intraoperative anaphylaxis triggered early in an OR -- I'm somewhat embarrassed to not have known this, given that I use it all the time.
What is chlorhexidine?
A drug to be avoided when treating isolated hypotension -- stick with fluids and epinephrine boluses.
What is vasopressin?
Not yet a recommendation but this might be better than BMV if you are a neonate greater than 34 weeks GA.
What is an LMA?
An effective (non-benzo) drug for pre-operative anxiolysis at a dose of 3-10mg po/SL, 30-90 minutes before surgery.
What is melatonin?
Case from our OR went to the CMPA. Anesthetist gave Ancef in a 'penicillin allergic' patient. Patient experienced anaphylaxis. Surgery was cancelled and the patient went to the ICU. CMPA settled out of court in favour of the patient.
Can you give me an example of confirmation bias?
One of the main criteria for diagnosing anaphylaxis but usually somewhat hidden and only present in 20-30% of cases.
What are cutaneous manifestations of anaphylaxis?
The elderly, the very young those with small muscle mass and those with pre-existing heart disease.
What groups are at increased risk of systemic toxicity?
NRP: A current practice to decrease the risk of anemia in neonates and give them a boost of stem cells. It means that oxygenation tables now start at 2 minutes instead of 1 minute post delivery.
What is delayed cord clamping?
This is the maintenance fluid rate for most patients undergoing colorectal surgery.
What is 3mL/kg/hr of Ringer's Lactate?
Your chronic pain patient in the endo suite, who struggled with IV insertion (and indeed fainted once during the insertion) complains of excessive pain while injecting the propofol. After 15cc you notice a large swelling in their wrist.
Can you give me an example of attribution bias?
A common cause of anaphylaxis at the end of a case, especially now that it is more available to us.
What is sugammadex?
The ideal dose of 20% intralipid for a 70kg person.
What is 100 mL?
The minimum acceptable MAP in post-resuscitative care.
What is 65mmHg?
An important part of multimodal analgesia for patients undergoing colorectal surgery, but maybe a drug to discuss with surgery, especially if using the non-selective form.
What is NSAID?
You're a SKH pediatric anesthetist. The visiting anesthesia rube from Orillia identifies a 'swinging' pleth on the patients SpO2 waveform. He expresses concern that the patient appears to be obstructing the airway. You reassure the rube that everything is fine, because you were just in there and also the oxygen saturation is 100%.
What is overconfidence bias?
Medicine given that also acts as prophylaxis for biphasic reactions.
What is epinephrine?
Often the first symptom of LAST. Even with bupivicaine, 50% will present with this minor sensation.
What is perioral numbness?
Energy setting for the synchronized cardioversion of Atrial Fibrillation.
What is 200J?
One: the definition of oliguria in renal medicine0. Two: the target for intra and postoperative urine output to avoid excess crystalloid administration. (And if you look closely the question is in the answer.)
What is 0.2mL/kg/hr?
If no signs of hypovolemia. Use 4 hour averages if possible.
The rube just won't go away. You tell him that the MRI machine is likely producing some interference and that when there is a break between runs you will see that the pleth returns to normal. At the break in runs, you see that the pleth doesn't really look any differently, but you note, 'See, looks better?'
What is confirmation bias?
The lab test and when to draw it to confirm your suspicion of anaphylaxis.
What is serum tryptase at 2 hours after reaction onset?