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B 750 mL Class I hypovolemia is clinically asymptomatic hypovolemia, and this is often seen with 1 to 15% of total intravascular volume loss. At approximately 15% or more, clinical symptoms will present, and this is often resting tachycardia. B Resting tachycardia Oftentimes, the first clinical symptom from acute blood loss/hypovolemia is resting tachycardia. B 20% When patients are hypovolemic, the body will move interstitial fluid into the intravascular space to compensate. Therefore, only approximately 20% of crystalloid fluid volume will remain in the intravascular space. In order to remain electrically neutral, there must be a reduction in sodium concentration, to 130 mEq. B False Twenty-five-percent albumin has a plasma volume expansion ratio of four to five times and while intravascular volume can be repleted, a significant decrease in interstitial fluid volume can occur and the patient may remain significantly hypovolemic even though the parameters normalize. B False Albumin solutions are heat treated and therefore there is not risk of viral transmission through the use of albumin. B False While colloid solutions are better intravascular volume expanders, there is no evidence that confers a survival benefit in these patients compared to those patients who receive crystalloid resuscitation. B Nitroprusside Nitroprusside contains 5 cyanide ions in its molecule and cyanide is released into the bloodstream when the medication breaks down into nitric oxide. In order to be cleared, sulfur from thiosulfate is bound to the cyanide, which forms thiocyanate, which can be cleared by the kidneys. B Electrolyte abnormalities Postoperative atrial fibrillation can be seen and is often caused by electrolyte abnormalities. Beta blockers may have some benefit in decreasing rates of perioperative atrial fibrillation. B False Atelectasis is the collapse of alveoli and leads to a shunt in the respiratory system, not dead space. C 7 to 10 mL/kg While previously tidal volumes of 11 to 15 mL/ kg were used during mechanical ventilation, out of concern for barotrauma standard tidal volumes are now 7 to 10 mL/kg. A True Positive pressure ventilation can reduce ventricular filling due to positive intrathoracic pressure and compression of pulmonary blood vessels. D Respiratory rate End-inspiratory peak pressure is an important factor in mechanical ventilation, and it is calculated by using the inflation volume, the flow resistance, and the elastic recoil of the lung tissue. A True Assist control (A/C) mode on the ventilator allows the patient to trigger breaths but delivers a set inflation volume. If the patient does not trigger a breath in a set amount of time, the ventilator will deliver a breath based on a backup rate. A True A/C mode on the ventilator allows the patient to trigger breaths but delivers a set inflation volume.
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C 80-20 the rule of Harms suggests that 80% of the axial load bearing capacity is borne by the anterior column, while 20% is borne by the posterior column. This becomes important when considering spinal fusion surgery and need for anterior or posterior fusion procedures. C Presence of a cervical collar the nexus criteria were developed to decrease unnecessary C-spine imaging. It includes no midline tenderness, no focal neurologic deficit, normal alertness, no intoxication and no painful distracting injury. When all of these are present, imaging can be avoided with a negative predictive value of 99. B Posterior ligamentous complex injury the McCormack load sharing classification was developed to help surgeons decide whether or not a short segment fusion would be sufficient to fix certain types of thoracolumbar fractures. The classification takes into account degree of fracture comminution, fracture fragment apposition and degree of kyphosis in determining the length of the construct. Type A injuries are often compression injuries, Type B are distraction injuries and Type C are rotational. An easy way to remember this is Type A = Axial (loading), Type B = Bending (forward or backward with distraction) and Type C = Circular (translational injuries). For lumbar disc herniations, there was no difference between conservative and surgical management out to 4 years of follow-up on intention-to-treat analysis, however there was a 22% cross-over between groups, a common criticism of this study Further Reading: Weinstein et al. For lumbar disc herniations, there was no difference between conservative and surgical management out to 4 years of follow-up on intention-to-treat analysis, however there was a 22% cross-over between groups, a common criticism of this study. When the subset as-treated analysis was performed, there was a significant improvement in all outcomes measured in the surgical group compared to conservative management with the exception of return to work. B 50% Many surgeons feel that 50% of the facet joint should remain intact during a simple decompression to preserve stability at that level. D 90% Patients with achondroplasia are at risk for several conditions affecting the spine including foramen magnum stenosis, spinal stenosis and thoracolumbar kyphosis. A Multiple non-contiguous stenotic regions the Patchell study demonstrated that in patients with metastatic epidural spinal cord compression, wide decompression and reconstruction if appropriate can keep patients ambulating and extend life expectancy with several caveats. A Yes the Patchell study demonstrated that in patients with metastatic epidural spinal cord compression, wide decompression and reconstruction if appropriate can keep patients ambulating and extend life expectancy with several caveats. B 0-5 cm the sagittal vertical axis is a measurement taken from a plum line dropped midway through the C7 vertebral body. A measurement is taken from the posterior superior corner of the sacrum to the plumb line to determine the distance.