Prodigy Connect Part 1

A patient is suffering from an exacerbation of chronic ventilatory failure and exhibits severe acidosis. You are about to intubate the patient and place him on the ventilator. Should the acidosis be corrected urgently or slowly? Why?

Chronic respiratory acidosis should not be corrected too rapidly because the lungs are able to eliminate CO2 much more quickly than the kidneys can eliminate bicarbonate. If the CO2 is eliminated too quickly, the patient will suffer from a metabolic alkalosis that can lead to neuromuscular irritability and CNS excitation that can lead to seizures.

What serves as confirmation of correct placement of an Eschmann stylet?

Confirmation of appropriate placement of an Eschmann stylet (gum elastic bougie) is made when you feel the stylet travel across the bumpy surface of the tracheal rings, but this sensation may not always be noticed. Although the stylet may strike a surface and stop, this can occur in both the esophagus and the trachea and is not confirmation. Striking a surface should be avoided if possible to prevent a bronchial or tracheal tear. When placed into the trachea, the stylet should be stopped at 25 cm at the lip and held in place.

What are contraindications to the insertion of a nasopharyngeal airway?

Contraindications to the insertion of a nasopharyngeal airway include: anticoagulation, basilar skull fracture, history of nosebleed requiring medical treatment, and nasal or nasopharyngeal deformity.

Why should cuff pressure be monitored in patients undergoing long-term ventilation via an endotracheal tube?

Cuff pressure that is too high can cause ischemia of the tracheal wall. Low cuff pressure in the endotracheal tube increases the risk that material can pass beside the cuff and into the lungs and is associated with an increased risk of pneumonia in patients on long-term ventilation.

What is the indication for using a double-lumen endotracheal tube?

Double-lumen tubes and bronchial blocker tubes possess the ability to direct gas flow to one or another lung during surgery.

What is the most likely cause of respiratory depression in the perioperative period?

Drug-induced depression of ventilation due to opioids or general anesthetics

Which induction agent would be least appropriate for a patient in acute Addisonian crisis?

Etomidate can suppress the HPA axis and even a single dose should be avoided in patients prone the adrenal insufficiency.

What internal diameter cuffed endotracheal tube would be appropriate for a full-term infant? A five year-old?

For a full-term infant, a 3.0 cuffed endotracheal tube or a 3.5-4.0 uncuffed tube would be appropriate. 2.5-3.0 tubes are recommended for premature infants. A five year-old would need a 4.0-4.5 cuffed tube or a 5.0 uncuffed tube.

With what airway device is the risk of high airway pressure the greatest when ventilating with a self-inflating manual resuscitator?

High airway pressure is a hazard when using a self-inflating manual resuscitator if a pressure relief valve is not utilized. The risk is greater with endotracheal tubes than with mask or supraglottic devices such as the LMA or laryngeal tube which tend to leak at a lower pressure than an endotracheal tube. Failure of the pressure relief valve when manually ventilating a patient connected to an anesthesia machine can create a risk for high airway pressures as well.

With relation to HIV, what does the acronym HAART stand for?

Highly active antiretroviral therapy, which represents the current drug regimen used to prevent the advancement of HIV infection into AIDS.

What is another name for normal anion gap acidosis?

Hyperchloremic metabolic acidosis

What are the most common causes of secondary adrenal insufficiency?

Iatrogenic causes are the most common and include administration of synthetic glucocorticoids and pituitary surgery or irradiation.

How would you anesthetize the superior laryngeal nerve?

Injection of 3 mL at the cornu on either side of the hyoid bone anesthetizes the superior laryngeal nerve, which supplies sensation to the airway below the epiglottis.

What is the primary advantage of the video-assisted laryngoscope (ex. Glidescope)?

It can provide equal or better visualization of the airway without manipulation of the head into the sniffing position.

How long after discontinuation of long-term steroid use will it take for adrenal function to return to normal?

It can take 6 to 12 months for adrenal function to return to baseline after chronic exogenous corticosteroid use.

What are the basic components of an automatic implantable cardioverter defibrillator (AICD)?

It contains a pulse generator, a high capacity battery, a capacitor, lead wire, and shock coil in a single unit.

How does the chest xray of a patient with pneumocystis carinii pneumonia appear?

It often appears normal. A 'ground-glass' appearance may be apparent on xray, but often requires high-resolution CT to identify. Pneumothoraces may sometime be present.

How does acromegaly affect the respiratory system?

Lung volumes are typically increased and V/Q mismatching may occur.

Which value is primarily increased in metabolic alkalosis and decreased in metabolic acidosis?

Metabolic alkalosis and acidosis are described as alterations where primarily HC03- is shifted up or down, respectively.

Most of the pulmonary manifestations associated with AIDS are due to _____________.

Most of the pulmonary manifestations associated with AIDS are due to opportunistic infections such as pneumocystic jiroveci pneumonia, tuberculosis, lung abscesses, or fungal infections.

What is the indication for using an oral or nasal RAE endotracheal tube?

Nasal and oral RAE tubes possess pre-formed bends that direct the tube away from the surgical field and are especially useful in oral and facial surgeries.

Will an LMA protect against laryngospasm?

No. The LMA is a supraglottic airway. Because it does not stent the cords open as an endotracheal tube would, it is unable to prevent laryngospasm. Additionally, a laryngeal mask airway normally produces a gas leak when air pressures reach 20 cm H2O and would be ineffective in producing the amount of positive pressure required to break a laryngospasm.

What are the two major classifications of metabolic acidosis?

Normal anion gap acidosis and high anion gap acidosis

What are the characteristics of normal anion gap acidosis?

Normal anion gap acidosis is due to an increase in chloride concentration. This usually occurs in instances where bicarbonate is lost, so the kidneys retain chloride ions to maintain electrical neutrality.

What are the five major classes of antiretroviral drugs used in the treatment of HIV?

Nucleoside analogue reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, entry inhibitors, and integrase inhibitors.

How is the musculoskeletal system affected by acromegaly?

Osteoarthritis and osteoporosis are common. Skeletal muscle weakness is a typical finding and may manifest as an increased sensitivity to muscle relaxants.

How does acromegaly affect the peripheral nervous system?

Overgrowth of soft tissue results in trapping of peripheral nerves. Carpal tunnel syndrome is a common finding, as is decreased ulnar artery flow due to compression by soft tissue.

Is the presence of an AICD of special concern in patients undergoing extracorporeal shock wave lithotripsy (ESWL)?

Pacemakers and AICDs are no longer considered contraindications to ESWL. AICD and lithotripter manufacturing companies generally state that AICDs are a contraindication to lithotripsy, but patients with AICDs have been shown to complete the procedure successfully. Older abdominally-implanted AICDs present a greater hazard than transvenous pacemakers. The AICD should be shut off prior to treatment and then reactivated immediately after the procedure.

How is the blood volume affected by cirrhosis?

Patients with cirrhosis have an elevated total blood volume, but much of it is sequestered in the splanchnic bed, leaving the volume in the central circulation lower than normal.

What plasma cortisol level is diagnostic of adrenal insufficiency?

Plasma levels less than 20 mcg/dL indicate adrenal insufficiency

How do the effects of primary adrenal insufficiency differ from secondary insufficiency?

Primary adrenal insufficiency results in the inadequate release of glucocorticoid, mineralocorticoid, and androgen hormones. Secondary adrenal insufficiency results in the inadequate release of glucocorticoid only.

What are the differences between silicone, PVC, polyurethane, and red rubber endotracheal tubes?

Red rubber endotracheal tubes are opaque endotracheal tubes that can be cleaned and sterilized for reuse. They are more prone to kinking, occlusion by secretions, have high-pressure cuffs, and can be a trigger for patients with latex allergy. Polyvinyl chloride endotracheal tubes are transparent, soften when warmed, and are less prone to kinking than red rubber tubes. Silicone endotracheal tubes are more expensive than PVC, soft, and are reusable. Polyurethane tubes are a more recent adaptation. Studies show that endotracheal tubes with a polyurethane cuff have a decreased association with early postoperative pneumonia.

What are the two main factors that determine the resistance to gas flow in an anesthesia circuit?

Resistance to gas flow is a function of the length of the tube and its diameter. The shorter the length and the larger the diameter, the less resistance it offers.

What is the definition of respiratory acidosis?

Respiratory acidosis occurs when alveolar ventilation decreases enough that the PaCO2 rises, leading to a pH less than 7.35

To what family of viruses does HIV belong?

Retroviridae (retrovirus)

What systemic abnormalities may occur with acidosis?

Severe acidosis is associated with decreased cardiac contractility, decreased responsiveness to catecholamines, sensitization to re-entrant tachydysrhythmias, lowered threshold for ventricular fibrillation, hyperkalemia, hyperventilation, insulin resistance, and inhibition of anaerobic glycolysis.

What type of lymphocyte is destroyed by the AIDS virus?

T-helper lymphocytes (also called CD4 T cells)

What are the advantages and disadvantages of the Bullard laryngoscope?

The Bullard laryngoscope is quicker to use than a flexible, fiberoptic scope. It is useful in patients with limited neck or oropharyngeal mobility. It results in less dental trauma and has a lower risk of failed intubation than traditional laryngoscopy and is more resistant to problems with secretions. It does not accommodate double-lumen or metallic laser tubes well and using an endotracheal tube larger than 7.5 mm can result in posterior displacement of the introducing stylet.

What FiO2 range would expect a nasal cannula to deliver?

The FiO2 delivered by a nasal cannula can vary significantly, but the ranges you can predict that would be delivered by varying flow rates are: 2L/min: 0.26 and 4L/min: 0.36

How do you choose the appropriate size LMA?

The LMA comes in several sizes: 1 for infants less than 5 kg, 1.5 for 5-10 kg, 2 for children 10-20 kg, 2.5 for children 20-30 kg, 3 for children and small adults between 30-50 kg, 4 for 50-70 kg, 5 for 70-100 kg, and 6 for patients greater than 100 kg.

Which endotracheal tube stylet allows the stylet angle to be adjusted during laryngoscopy?

The Schroeder stylet is a plastic, disposable stylet that allows the stylet angle to be adjusted while performing the laryngoscopy.

What nerve provides sensory innervation to the airway between the epiglottis and the vocal cords?

The airway between the epiglottis and the vocal cords derives sensory innervation from the internal branch of the superior laryngeal nerve.

What is the indication for using an anode (also known as armored or reinforced) endotracheal tube?

The anode (or armored) tube contains an embedded wire that is designed to prevent kinking when the tube is bent.

What is meant by zero, low, medium, and high-capacity oxygen delivery devices?

The capacity of an oxygen delivery device refers to the size of the built-in oxygen reservoir. A nasal cannula is a zero-capacity device as it has no oxygen reservoir. A tracheostomy mask or pediatric face mask is considered a low capacity device. A simple face mask and an aerosol face tent are both considered medium capacity devices. A nonrebreather mask is a high capacity device.

What are the cardiac manifestations of acromegaly?

The chronic hypertension results in ventricular dysfunction, enlarged heart, congestive heart failure, ischemic heart disease, and dysrhythmias.

An HIV-positive patient takes zidovudine and corticosteroids. What complication might this produce?

The combined use of zidovudine and corticosteroids can result in myopathy and respiratory muscle dysfunction.

What is the only laryngeal muscle that does not receive its motor innervation from the recurrent laryngeal nerve?

The cricothyroid muscle, which is innervated by the external laryngeal nerve.

A patient with metabolic acidosis has a sodium of 148 mEq/L, a chloride of 103 mEq/L, and a bicarbonate level of 19 mEq/L. Is this a normal anion gap acidosis or a high anion gap acidosis?

The formula for the anion gap is: [Na+] - ([Cl-] + [HCO3-]). In this instance, the anion gap is 26 mEq/L. The normal anion gap is 7 to 12 mEq/L, so this is a high anion gap acidosis.

How is an AICD implanted?

The generator is typically placed in a pectoral pocket on either side of the chest and the lead and shock coil are placed in the right atrium and ventricle. The lead ad shock coil are inserted transvenously. The procedure is typically performed under sedation with local anesthesia but may be performed under general anesthesia.

How is a glossopharyngeal block performed?

The glossopharyngeal block is performed by having the patient open their mouth, then using a 25-gauge needle to inject 2 mL of local anesthetic bilaterally at the base of the palatoglossal arch (also called the anterior tonsillar pillar). This blocks the lingual and some of the pharyngeal branches of the glossopharyngeal nerve that provide sensation to the posterior third of the tongue and oropharynx.

What are the most common clinical features of acromegaly?

The increased growth hormone levels stimulate the release of insulin-like growth factor I. These two hormones result in an increase in the proliferation of cartilage, bone, protein synthesis, and lipolysis. It also decreases insulin sensitivity and promotes the retention of sodium. As a result of these effects, common manifestations include enlargement of the jaw, hands, and feet as well as hypertension and diabetes mellitus.

What are some of the limitations of the traditional flexible fiberoptic laryngoscope? How can they be overcome?

The lens of the scope can become fogged, making visualization difficult. This is more common if the scope is cold, so soaking it in warm saline prior to the procedure helps prevent fogging. The fiberoptic strands in the scope are fragile and can become broken easily. As strands break, visualization can become limited. Care must be taken to protect the instrument from damage and it should be stored in a safe, secure location. Secretions and blood can obstruct the view of the scope. It contains a suction channel that runs the length of the scope that can be irrigated with normal saline to wash secretions out of the viewing area.

Which is the most potent endogenous glucocorticoid and produced by the adrenal cortex?

The most potent endogenous glucocorticoid produced by the adrenal cortex is cortisol.

What is the most potent mineralocorticoid produced by the adrenal gland?

The most potent mineralocorticoid produced by the adrenal gland is aldosterone.

What nerves provide sensation to the mucous membranes of the nose?

The mucous membranes of the nose are innervated by the opthalmic division of the trigeminal nerve (V1) anteriorly and the maxillary division of the trigeminal nerve (V2) posteriorly.

How does acidosis affect the oxyhemoglobin dissociation curve?

The oxyhemoglobin dissociation curve shifts to the right in acidosis to allow for a greater unloading of oxygen from the hemoglobin in the tissue bed. Other factors that shift the oxyhemoglobin dissociation curve to the right include: increased 2,3 DPG, fever, elevated CO2, and low carbon monoxide levels.

When using the Henderson-Hasselbach equation, what number is used to represent the pKa of carbonic acid?

The pKa of carbonic acid is 6.1. This value is used when implementing the Henderson-Hasselbach equation.

A patient with AIDS has a positive acid-fast bacillus test. What does this signify?

The patient is positive for tuberculosis.

How would you anesthetize the posterior 1/3 of the tongue?

The posterior 1/3 of the tongue and tonsillar pillars can be anesthetized by blocking the lingual and pharyngeal branches of the glossopharyngeal nerve with 2 mL of local anesthetic at the base of the palatoglossal arch.

What are the primary causes of respiratory acidosis?

The primary causes of respiratory acidosis can be divided into two categories: those due to alveolar hypoventilation and those due to increased CO2 production. Factors that impair CO2 elimination such as pulmonary diseases, neuromuscular disorders, chest wall abnormalities, and obtundation can potentially result in alveolar hypoventilation. Factors such as intense shivering, malignant hyperthermia, prolonged seizure activity, thyroid storm, and extensive burns result in an increase in CO2 production.

What are the metabolic side effects of antiretroviral therapy?

The primary metabolic side effects of anti-retroviral agents are lipodystrophy, dyslipidemia, and insulin resistance.

What nerve provides sensation to the larynx below the vocal cords?

The recurrent laryngeal nerve provides sensation to the larynx below the vocal cords.

When using the Henderson-Hasselbach equation, what number is used to represent the solubility coefficient in blood of carbon dioxide (C02)?

The solubility coefficient in blood of C02 is 0.03. This value is used when implementing the Henderson-Hasselbach equation.

What are the factors that determine the patient's minute volume when being ventilated by a self-inflating manual resuscitator?

The tidal volume, respiratory rate, and operator skill level are the determinants of the patient's minute volume when being ventilated by a self-inflating manual resuscitator. The operator must be able to maintain an open airway and adequate seal when using the device to deliver adequate minute ventilation.

What are the two types of adrenal insufficiency?

There are two classifications of adrenal insufficiency: primary and secondary. In primary adrenal insufficiency the adrenal glands cannot produce enough hormones. Secondary adrenal insufficiency is due to suppression or disease of the hypothalamic/pituitary axis. Addison's disease is the idiopathic autoimmune destruction of the adrenal gland and is a form of primary adrenal insufficiency.

What are the salient anesthetic implications of the protease inhibitors such as ritonavir and saquinavir?

They both inhibit the cytochrome P450 pathway and can significantly alter the duration and effect of sedatives and anesthetics such as benzodiazepines, fentanyl, meperidine, and lidocaine.

What interventions can an AICD perform?

They can treat bradydysrhythmias via pacing and sensing cardiac electrical activity, use overdrive pacing to treat tachydysrhythmias, cardiovert, and defibrillate.

What agent is a carbonic anhydrase inhibitor used in the treatment of metabolic alkalosis?

Treatment for metabolic alkalosis can include administration of acetazolamide. Acetazolamide is a carbonic anhydrase inhibitor that causes the renal excretion of bicarbonate.

Can unipolar electrocautery be used in a patient with an AICD?

Unipolar cautery may produce electrical interference that may be interpreted as a ventricular dysrhythmia by an AICD. This could potentially trigger a defibrillation pulse. It is best to consult with someone who has experience with the specific device prior to surgery or place a magnet over the device to temporarily disable it.

What are the symptoms of Addison's disease?

Weakness, anorexia, nausea, vomiting, hyperpigmentation, chronic hypotension, hypovolemia, hyponatremia, and hyperkalemia.

How should the endotracheal tube be positioned when performing a nasal intubation?

When performing a nasotracheal intubation, the tracheal tube should be inserted into the nares at an angle perpendicular to the face with the bevel directed away from the turbinates.

How would rapid expansion of the extracellular volume with normal saline affect acid-base balance?

When the extracellular volume is expanded rapidly via the infusion of a fluid that does not contain any bicarbonate (like normal saline), the HCO3- in the plasma decreases as the extracellular HCO3- gets diluted. This results in a hyperchloremic metabolic acidosis.

Does an LMA protect the airway from pharyngeal secretions?

Yes. It does not, however, protect the airway from gastric secretions. Aspiration is a possibility in patients who experience reflux during the anesthetic.

what are some early symptoms associated with acetaminophen-induced liver damage?

abdominal pain, diarrhea, nausea, and vomiting

How effective is intravenous acetaminophen in treating postoperative pain?

intravenous acetaminophen has been shown to provide approximately 4 hours of analgesia in 37 percent of patients with postoperative pain.

What is the half-life of acetaminophen?

2-3 hours

Pneumocystic carinii pneumonia usually doesn't develop until the CD4 T cell count reaches what level?

200 cell/mL

What is the adult oral dose of acetaminophen in the treatment of fever and acute pain?

325-650mg every 4-6 hours

According to ASTM standards, what is the minimum FiO2 a self-inflating manual resuscitator should be able to deliver when connected to an oxygen source?

40%

Where are T-helper lymphocytes predominantly located?

98% of all T-helper lymphocytes are located within the lymph nodes.

What are the concerns one may have when using a first generation LMA?

A first generation LMA doesn't protect against gastric secretions. Ventilation requiring pressures in excess of 20 cm H2O may result in inflation of the stomach. It can become malpositioned, resulting in an inability to ventilate. It is contraindicated in pharyngeal pathology such as tumor or abscess. Pathology at or below the level of the LMA may make it an ineffective means of ventilation.

How does high anion gap acidosis occur?

A high anion gap acidosis occurs when a fixed acid is introduced into the extracellular space. As the acid dissociates, the hydrogen ion bonds with bicarbonate to form carbonic acid. It is the drop in bicarbonate that produces the anion gap. The causes of a high anion gap acidosis can be remembered with the mnemonic: SLUMPED = Salicylates, Lactate, Uremia, Methanol, Paraldehyde, Ethanol and Ethylene Glycol, and Diabetic Ketoacidosis.

What are the advantages and disadvantages of a low-volume, high-pressure cuff on an endotracheal tube?

A low-volume, high pressure cuff offers increased visibility during intubation because the cuff lies flat against the tube when not inflated. It also offers greater protection against aspiration. Because it requires a high intracuff pressure to overcome the decreased compliance of the cuff wall, it is difficult to assess how much pressure is being applied to the tracheal wall. Because this results in an increased risk for tracheal ischemia it is not suitable for long-term intubations.

Is a manual resuscitator with a self-inflating bag a good choice for spontaneously breathing patients? Why or why not?

A manual resuscitator with a self-expanding bag is not the ideal choice for spontaneously breathing patients because if the patient cannot exert a sufficient negative pressure to open the inspiratory port they may inhale room air via the expiratory port.

How is a transtracheal block performed?

A transtracheal block is performed by injecting 3-5 mL of 2% lidocaine through a needle penetrating the cricothyroid membrane into the trachea. The needle is advanced until air is aspirated. At the end of expiration, the lidocaine is injected. This will usually precipitate a cough, which will spread the anesthetic throughout the airway.

How does acetaminophen differ from salicylates?

Acetaminophen does not cause gastric irritation, affect platelet aggregation, or have anti-inflammatory properties.

What drug is administered in the treatment of acetaminophen toxicity?

Acetylcysteine. It is most effective if administered within the first 8 hours of overdose.

What are the major cardiac effects of acidosis and at what pH does this occur?

Acidosis decreases myocardial contractility. The effects are usually not clinically evident until the pH is less than 7.2 when the ability of the heart to respond to catecholamines is decreased. It is more evident, however, in patients with impaired left ventricular function, those on beta-blockers, or patients under general anesthesia.

What are the most common causes of a normal anion gap acidosis?

Acidosis with a normal anion gap can be produced by increased gastrointestinal losses of HCO3- from diarrhea, fistulas, or ingestion of CaCl2 or MgCl2. Other factors that can produce a normal anion gap acidosis include hypoaldosteronism, renal tubular acidosis, carbonic anhydrase inhibitors or the administration of large volumes of bicarbonate-free intravenous fluids. Conditions that result in an increased production of nonvolatile acids such as renal failure, ketoacidosis, nonketotic hyperosmolar coma, and rhabdomyolysis or the ingestion of toxins such as salicylates, methanol, paraldehyde, and ethylene glycol can result in an acidosis with an increased anion gap.

What is acromegaly and what is the most common cause?

Acromegaly is the excessive release of growth hormone. It is most commonly due to an adenoma in the anterior pituitary gland.

What airway abnormalities are associated with acromegaly?

Acromegaly results in numerous anatomical changes that can complicate airway management including prolonged mandible, overgrowth of pharyngeal tissue, recurrent laryngeal nerve damage, macroglossia, and decreased subglottic diameter. Hoarseness or stridor are indications that the upper airway is probably involved. Tracheal compression and deviation can occur due to thyroid enlargement. Sleep apnea is often present. The risk of respiratory failure is three times higher in patients with acromegaly.

How does acromegaly affect the integumentary system?

Acromegaly results in thick, oily skin and hyperhidrosis.

Which cuff should be inflated after insertion of a Combitube?

After inserting a Combitube, you should inflate both the proximal and distal cuffs. The Combitube will be placed within the esophagus in 95% of insertions in which case ventilation through the blue tube will force air through the side perforations and into the larynx. If the Combitube enters the trachea, ventilation can proceed by connecting the circuit to the shorter, clear tube.

What are the anesthetic implications of a patient taking a non-nucleoside reverse transcriptase inhibitor

All of the NNRTIs can prolong the half-life and effects of drugs such as diazepam, midazolam, fentanyl, and meperidine.

What are the components on all self-inflating manual resuscitators? What components are optional?

All self-inflating manual resuscitators have a self-expanding bag, a bag inlet valve, and a nonrebreathing valve. Optional components include CO2 detectors, airway pressure monitor, PEEP valve, pressure-limiting devices, and scavenging devices.

What is the most reliable method of confirming placement of the endotracheal tube in the trachea?

Although several factors such as chest rise, oxygen saturation, direct visualization, and breath sounds should be assessed, persistent end-tidal carbon dioxide detection is the most reliable indicator that the endotracheal tube is positioned in the trachea.

What are the advantages of the use of a lighted stylet over traditional laryngoscopy?

Although the success rate in using a lighted stylet such as the Trachlite is similar to that of traditional laryngoscopy, it is less affected by an anterior airway, is less stimulating than laryngoscopy, and results in a lower incidence of sore throat. Although many institutions still have lighted stylets, production on these items stopped in 2009.

What are the potential cardiac complications of AIDS?

An echocardiogram will be abnormal in about 50% of AIDS patients. Approximately 25% will exhibit pericardial effusions. Infections from opportunistic organisms such as cryptococcus, coxsackie B virus, cytomegalovirus, toxoplasmosis, and aspergillus can cause myocarditis with ventricular dilation.

What are the two primary indications for the use of acetaminophen?

Analgesia and antipyrexia

What patients are at risk for adrenal insufficiency?

Any patient on chronic exogenous steroid therapy is at risk for adrenal insufficiency during periods of stress such as surgery.