Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced > 1 > Flashcards

1 Flashcards

1
Q

A-line wave from central to periphery

A
  • steeper upstroke, high systolic peak, later dicrotic notch, more prominent diastolic wave and lower end-diastolic pressure
  • overall higher systolic, lower diastolic (increase PP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

a line and pathology

A
  • AS: late systolic peak and small amplitude (tardus and parvus)
  • AR: bisferious wave form (beating twice)
  • HOCM: spike and dome appearance
  • Cardiac tamponade: pulsus paradoxus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CVP wave form

A
  • ACV peaks, XY decents
  • A: atrial contraction
  • C: isovolumic ventrical contraction
  • V: systolic atrial filling
  • X: relaXation of atria
  • Y: tricuspid opening and early ventricular filling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Measurements from Swan Ganz

A
  • CVP, PAP, temp, PCWP, MVO2, SVR, PVR, CO, CI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Contraindication of PA catheters

A
  • Absolute: LBBB as you can cause complete heart block with placement (induce a RBBB)
  • Relative: WPW, Ebsteins anomaly (likely to induce a malignant ventricular tachyarrhythmia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Insertion of PA catheter

A

1) go 17-20cm then inflate balloon
2) 20-25 cm tip is in RA (1-5 mmHg, mean of 3)
3) 25-30 cm tip is in RV (increase in systolic 15-30 mmHg mean of 25)
4) 35-45 cm tip in is pulmonary artery (diastolic step up to around 12)
5) wedge the balloon (flattens around previous diastolic)
6) deflate balloon and withdraw 1-2 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Heart pressures

A
  • RA: 5/1
  • RV: 25/5
  • PA: 25/10-12
  • LA: 10-12/2
  • LV: BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Complications of PA catheters

A
  • ventricular dysrhythmias
  • heart block (preexisting LBBB)
  • bacteremia/endocarditis
  • thrombogenesis
  • valve injury
  • air emboli
  • PA rupture (really rare but 50% mortality)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PA catheter indications

A

1) Patient: ASA 4 or above (not indicated for low or moderate risk patients
2) Procedure: high risk procedures (heart, lung, kidney, liver or brain)
3) Practice: skilled proceduralist and support staff to not misinterpret date

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CO Thermodilution

A
  • fixed amount (10cc) of cold or room temp injected through proximal port and subsequent temperature change detected by thermistor on PA catheter tip
  • Plot: X time, Y delta T
  • CO = integral of area under the curve
  • high CO correlates to small changes
  • low CO correlates with large changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CO thermodilution requirements

A
  • flow of blood, volume and PA temp are constant
  • absence of intracardiac shunt
  • absence of significant valvular disease
  • temperature and volume of solution is acurate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CO themodilution errors

A
  • Over estimate CO: smaller volume or warmer solution

- Under estimate CO: larger volume or colder solution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Mixed venous O2 sats

A
  • samples in the PA (mix of superior/inferior vena cava and coronary sinuses)
  • normal 70-75% (25-30% extracted)
  • SvO2 = SaO2- (VO2 / Q X 1.34 X Hgb)
  • VO2 = oxygen consumption ml/min, Q = CO (L/min)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Arterial O2 content

A

CaO2 = (1.34 X Hgb X SaO2) + (0.0003 X PaO2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How much O2 consumption can occur

A
  • 50-60%
  • after maximal oxygen extraction occurs it become supply dependent
  • anaerobic metabolism, acidosis and multi-organ failure can occur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Decreased SvO2

A
  • insufficient O2 delivery: hypoxia, decreased CO, anemia or abnormal Hgb
  • increase O2 consumption: shivering, fever, exercise, pain, hyperthyroid, malignant hyperthermia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

increase SvO2

A
  • decrease O2 consumption (commonly in vasodilatory shock)
  • L to R shunt
  • impaired tissue uptake (CN or CO)
  • hypothermia
  • sepsis
  • increased CO
  • sampling error
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Non invasive CO measurement

A
  • cardiac cycle changes in thorax and aortic blood volume alters electrical impedance across the chest wall
  • changes in electrical conductance are proportional to changes in blood volume and can be used to calculate a SV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Coagulopathies result from which etiologies

A

1) failure in primary hemostasis (platelet plug formation: requires functioning platelets and endothelial damage)
2) incompetent coagulation cascade
3) excessive fibrinolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tests of primary hemostatis

A

1) CBC for platelet quantity
2) Bleeding time/ platelet aggregation tests ect.
3) TEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Prothrombplastin time (PTT)

A
  • tracks intrinsic coagulation cascade

- extremely sensitive to heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Prothrombin time (PT)

A
  • tracks extrinsic pathway
  • warfarin
  • INR= PT sample/PT normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Anti-Xa activity test

A
  • tracks the effects of LMWH or unfractionated heparin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Reptilase time

A
  • measures deficiencies in fibrinogen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Hemophilia A/B

A
  • A is deficient in factor VIII: need >30% of factor VIII for minor surgery, 100% for major
  • B is deficient in IX
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

ACT

A
  • normal is generally 80- 120 seconds
  • level of 300-400 for CPB
  • hypothermia increases ACT in a dose-dependent fashion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Inadequate rise in ACT to therapeutic doses of heparin

A
  • most likely etiology is a deficiency in function AT-III levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Reaction time (R)

A
  • time in minutes elapsed from the start of test until clot moves the pin enough to produce a 2-mm amplitude on the tracing
  • reflects activity of the coagulation cascade (coagulation deficiency)
  • if prolonged give FFP
  • normal depends on type of clotting factor used
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

alpha angle

A
  • measure in degrees the speed of clot formation
  • 45-55 degrees is normal
  • ## decreased angle = low fibrinogen = give cryoprecipitate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Coagulation time (K)

A
  • minutes from end of R to when tracing amplitude reached 20 mm
  • depends on type of clotting factor used
  • if prolonged = low fibrinogen = give cryoprecipitate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Maximum amplitude (MA)

A
  • point f maximum clot strength in millimeters
  • normal is 50-60 mm
  • if decreased means there is thrombocytopenia and or platelet dysfunction
  • give platelets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Lysis index 30

A
  • percentage reduction in MA after 30 minutes.
  • Higher fibrinolytic activity produces a greater Ly30
  • normal 7.5-8%
  • if elevated = hyperfibrinolysis
  • give TXA or amicar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Pacemaker code

A

1) Paced (A, V or D)
2) Sensed (A,V, or D)
3) Response ( I inhibited, T triggered or D)
4) rate modulation (R)
5) Multisite pacing ( A,V, or D)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

OPMR1 receptor

A

mutation can cause a resistance to morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

MH

A
  • results from abnormal excitation-contraction coupling in skeletal muscle leading to uncontrolled release of Ca2+ from the sarcoplasmic reticulum
  • mutation in RYR1 channel
  • triggers volatiles and succinylcholine
  • hypercarbia, tachy, masseter spasm, rhabdo, rigidity, hyperthermia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

treatment of MH

A
  • stop tiggering agent
  • dantrolene 2.5 mg/kg IV
  • get access
  • a line
  • foley for UOP monitoring
  • hyperventilate
  • monitor for 24 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Pseudocholinesterase (PCE) deficiency

A
  • autosomal recessive disorder cause by atypical or absent PCE
  • dibucaine number 80% is inhibited in normal, 20-60 in heterozygous and < 30 in homozygous
  • avoid pancuronium, metoclopramide, esmolol, chlorpromazine, bambuterol and acetylcholinesterase inhibitors
38
Q

Prolonged QT syndome

A
  • corrected QT male > 470 millisecond and > 480 millisecond for females
  • correct al electrolyte abnormality
39
Q

Methadone

A
  • long active opioid agonist with some NMDA activity

- do not use in patients with prolonged QT interval

40
Q

Buprenorphine

A
  • partial mu-opioid agonist
  • suboxone is combination with nalaxone preventing ability to inject
  • high affinity for mu-receptors, will displace more potent drugs causing difficult with analgesia
41
Q

Stellate ganglion block

A
  • face, neck, arm and upper arm pain, vascular insufficiency of the arm (extravasation of noxious meds)
  • lies anterolateral to the vertebral body just anterior to the transverse process
  • inferior to chassaignacs tubercle (transverse process of C6)
  • success will cause Horner’s syndrome, nasal congestion/ flushing of the face
  • complications include RLN or RLN blocks, phrenic paralysis, pneumothorax, trachea or esophagus puncture, epidural or spinal injections
42
Q

Celiac plexus block

A
  • pain from upper abdominal viscera, pancreatic cancer
  • ganglia located anterior to the aorta near the celiac arterial trunk at T12-L1
  • complications include diarrhea, cramping and orthostatic hypotension
  • risk for hematoma, IV injection, vascular injury, kidney puncture
43
Q

Lumbar sympathetic block

A
  • LE pain or vascular insufficiency
  • anterolateral to the L2 vertebrae inside a fascial sheath, posteriorly to the psoas muscle
  • genitofemoral neuralgia (burning groin pain) is a complication
44
Q

Cervical plexus block

A
  • cervical plexus is composed of the anterior rami of C1- C4
  • CEA, neck dissection, tracheostomy, thyroidectomy,
  • superficial and deep needed
45
Q

Eye blocks

A
  • retrobulbar vs peribulbar
  • retrobulbar requires less because its deposited directly in the cone.
  • complications” retrobulbar hematoma, globe perforation. optic nerve damage. intra-arterial or intra optic nerve sheath (direct to brain), and oculocardiac reflex
46
Q

Airway block

A
  • need glossopharyngeal, superior laryngeal and recurrent laryngeal (trigeminal if nasal intubation)
47
Q

Supplemental blocks for labor

A
  • paracervical- 1st stage

- pudendal - 2nd stage

48
Q

Psysiologic effects of HBOT

A

1) increased barometric pressure (contraction of gas)
2) increased partial pressure of O2
3) Increased partial pressure of nitrogen (more potent)
4) high pressure nervous syndrome (15-20 ATA: tremor, ataxia, nausea and vomiting
5) Pressure reversal of anesthesia (not seen in elevations of HBOT)

49
Q

HBOT

A
  • carbon monoxide poisoning
  • Gas embolism/ decompression sickness
  • infections
  • arterial oxygenation
  • O2 transport in severe anemia
50
Q

Carbon Monoxide poisoning

A
  • nausea, vomiting, headache, dizziness, myocardial ischemia, AMS and absence of cyanosis
51
Q

Oxygen toxicity

A
  • directly related to the Po2 of inspired gas
  • lungs, eyes and CNS at risk
  • lungs” chest pain, cough or throat irritation, rarely reduced vital capacity and ARDS
  • CNS: nausea, numbness and twitching, rarely seizures
52
Q

Aveolar gas equation

A

PaO2= FiO2 *(Patm-PH2O)- Co2/RQ

53
Q

Adaptation to high altitude

A
  • Initially increased RR and CO

- overtimes: increase 2,3DPG, increased erythropoesis, renal compensation for the alkalosis of hypocarbia

54
Q

Altitude sicknesses:

- Acute mountain Sickness (AMS)

A

: headaches, nausea, anorexia. sleep disturbances and peripheral edema
- decrease altitude, rest, hydration, analgesic, acetazolamide, dexamethasone and O2 therapy

55
Q

Altitude sickness:

- High- altitude pulmonary edema (HAPE)

A
  • form of right heart failures caused by exaggerated hypoxemic pulmonary vasoconstriction and high CO2
  • dyspnea, tachypnea, CP, rales, tachycardia, dry cough, pink frothy sputum
  • rapid descent, supplemental O2, PEEP or BiPap
  • nidedipine, NO, hydralazine, phentolamine, sildenafil
56
Q

ALtitude sinckness

- high altitude cerebral edema (HACE)

A
  • increased cerebral blood flow and alterations in the blood-brain barrier permeability due to severe hypoxemia
  • gross CNS dysfunction
  • immediate rapid decent, O2 therapy, dexmethasone, and diuretics
57
Q

Cerebral metabolism

A
  • 3.5mlO2/100g of brain
  • 60% of cerebral metabolism is linked to neuronal depolarization = can decrease CMRO2 by 60% with anesthetics
  • gray matter consumes twice as much O2 as white
58
Q

glucose consumption of brain

A

5mg/100g brain/min

59
Q

temperature and CMRO2

A

decrease in temperature decreases CMRO2 by 6%

60
Q

EEG waves

A

Delta <4 Hz
Theta 4-8
Alpha 8-13
Beta > 13

61
Q

Somatosensory Evoked Potentials

A
  • via peripheral nerve, up posterior columns of the spinal cord to dorsal column nuclei at the cervical medullary junction, then medial lemniscus to thalamus onto sensory cortex
62
Q

Motor evoked potentials

A
  • monitor the ventral spinal cord
63
Q

Phenytoin

A
  • decreases excitatory glutamate release due to inhibition of sodium channels.
  • fosphenytoin is given (IV) to prevent significant hypotension and severe dysrhythmias
64
Q

Carbamazepine

A
  • trigeminal neuralgia, seizures
  • binds Na channel in inactive state
  • secondarily modulates calcium channels
65
Q

Gabapentin and pregabalin

A
  • GABA analogs with antiepileptic action on calcium channels
66
Q
  • Ethosuxamide
A

absence seizures

67
Q

GABA modulation for seizures

A
  • phenobarbital, valproic acid, clonazapam
68
Q

Levetiracetam

A
  • blocks sodium channels and modulates intracellular synaptic vesicle release
69
Q

SSRI

A
  • prevent the uptake of serotonin for neuronal clefts
  • citalopram, escitalopram, fluoxetine, sertraline
  • serotonin syndrome
70
Q

Serotonin Syndrome

A
  • use of concomitant medications possessing serotonergic effects
  • antidepressants
  • valproate, ondansetron, metoclopramide, sumatriptan, dextromethorphan, drug abuse, lithium, st johns wort
71
Q

TCA

A
  • amitrptylinem clomipramine, doxepin,
72
Q

SNRIs

A

-venlafaxine, duloxetine, milnacipran

73
Q

MOAs

A

deprenyl, phenelzine, selegiline, tranylcypromine

74
Q

Metoclopramide

A
  • dopamine receptor antagonist

- worsening extra pyramidal symptoms in parkinsonian patients; can treat with diphenhydramine

75
Q

laudanosine

A

-metabolic of atracurium that has seizure provoking potential

76
Q

Autonomic dysreflexia

A
  • frequent above T6 however is possible until T12
  • exaggerated autonomic response to pain below the level of the spinal cord injury
  • hyperhydrosis, severe headaches, vasodilation above the level
77
Q

Tetanus

A
  • anaerobic, gram negative bacillus Clostridium tetani
  • bacteria releases tetanolysin and tetanospasmin (which enters peripheral nerves and travels intra-axonally/retrograde to CNS)
  • binds to presynaptic inhibitory nerves and block the release of inhibitory neurotransmiters by degrading synaptobrevin
  • dysphagias, neck stiffness, jaw stiffness
78
Q

Tetanus treatment

A
  • human tetanus immunoglobulin
  • immunixation
  • antibiotics (metronidazole IV or penicillin G)
  • surgical debridement to eliminate source may be needed
79
Q

Laplace’s law

A

P=2T/r

pressure equals two times the tension/radius

80
Q

Aneurysm

A
  • peak incidence at ages 40-60
  • male to female 2:3
  • most in circle of willis at anterior communicating artery
81
Q

SAH

A
  • worst headache of life
  • nausea, emesis, photophobia
  • can include meningism
82
Q

Hunt and Hess classification of SAH

A

1) asymptomatic, mild headache, slight nuchal rigidity
2) moderate/severe headache, nuchal rigidity, cranial nerve palsy
3) drowsiness/confusion, mild focal neurological impairments
4) stupor, hemiparesis
5) coma, decerebrate posturing

83
Q

Vasospasm (SAH)

A
  • peak incidence at 7 days
  • nimodipine, calcium channel blocker
  • Triple H: hypertension, hemodilution hypervolemia
  • SBP 160-200 for clipped, 120-150 without clipping
84
Q

Wada test

A
  • anesthetic is injected into either left or right carotid and tests what side speech and memory occurs in the brain
85
Q

Diabetes Insipidus

A
  • decreased ADH after pituitary surgery
  • polyuria (>2 cc/kg/hr), hypovolemia and hypernatremia
  • increased serum osmolality >295 mOsm/kg
  • decreased urine osmolality <300 mOsm/kg
86
Q

Resistance

A

R= 8viscositylength/Pi R^4

87
Q

West lung zones

A

1) PA (alveolar)> Pa (arterial) < Pv (venous) {top}
2) Pa > PA > Pv
3) Pa> Pv > Pa

88
Q

Dead space calulation

A

Vd/Vt = (PaCO2 X PeCO2)/ PaCO2

89
Q

Test prior to lobectomy

A

15/30/40 rule

1) Vo2 max
2) ppoFEV1
3) ppo DLCO

90
Q

VO2 max (lobectomy)

A

1) > 15 ml/kg/min
- can approximate with ability to climb 5 flights of stairs or >2000ft in 6 minute walk test
2) < 10 mg/kg/hr is predictive of poor outcome

91
Q

ppoFEV1

A

= preoperative FEV1 * (19- segments to be removed/19)
RU: 3 , RM: 2 RL: 5
LE: 3, Lingula:2, LL 4
- <30% predictive of poor outcome (>40% good outcome)

92
Q

ppoDLCO

A

ppoDLCO = preoperative DLCO x (1 – %functional lung tissue removed/100)

  • single strongest predictor of complications and mortality after lung resection
  • < 40% is correlated with increased cardiopulmonary complications

Advanced (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions