2 Flashcards
which blood product contains all coagulation factors?
FFP
the leading cause of death r/t blood transfusion is?
transfusion associated circulatory overload
more likely to happen to pt that are critically ill
what are disadvantages to storing blood?
-progressive decrease in ATP and 2,3 dpg
-results in L shift
-even though admin of hgb will increase ability of blood to transport oxygen, the longer the blood is stored and the more of it that is given, the ore the pt oxyhgb diissociation curve shifts L -> decreasing effectiveness of the blood given
-K in stored blood increases- can be hazardous when lg doses of blood is admin
the recmmended therapeutic dose of plt concentrate is 1 plt concentrate per
10 kg of body mass
in what pt would be admin of uncrossmatched type o, rh pos blood be contraindicated
uncrossed type o rh pos blood can be adminisered to males or females who are not childbearing age who have never recieved o pos blood before.
if the pt is female child bearing age or if pt blood admin hx is unknown- then you should use o neg blood
when are plt transfusions indicated? when plt count drops below
50,000
what does cryo contain
factor VIII, von williebrand, fibrinecton, and fibrinogen
what is the recommended dose of FFP to reverse the effects of warfarn?
5-8 mL/kg
for all other purposes the dose should be 10-20 mL/kg
what is acute normovolemic hemodilution?
alternative to transfuison. whole blood is removed from the pt prior to surgery with replacement of lost volume in the form of crystalloids or colloids. by diluting vascular bed, any blood lost during surgery will have a lower hct. the previous removed blood is then reinfused back into the patient when intraop blood loss has ceased.
allergic rxns to blood transfusions are mediated by what antibodies
igE and donor plasma proteins
a pt with von williebrand disease is experiencing cont bleeding at the site of his surgical incision despite tx with DDAVP. the next treatment you would recommend for this patient is
cryo. this pt should get desmopressin which increases factor VIII- vWF complex and improves coagulation. if desmopressin doesnt work then cryo should be considered
how much should the hgb increase by 1 unit
1 unit should increase hgb by 1 and hct 2-3
a fully soaked laparotomy sponge will hold about __ mL of blood
100-140 mL of blood
common reasons to give cryo
-von williebrand
-pt with low fibrinogen levels (<80)
what issue would you expect to result from a catastrophic failure of the oxygen first stage regulator?
significant loss of oxygen pressure regardless if it was from the oxygen cylinder or the pipeline
when carbon dioxide absorbent is exhausted, what chemical accumulates in the cannister?
carbonic acid accumulates, turning the indicator dye purple
where are bacterial filters on the machine?
at the y piece- serving as both inspiratory and expiratory filters
which diuretics enhance the reabsorption of calcium in the distal tubule and can potentially result in hypercalcemia?
thiazide type diuretics- enhance reabsorption of ca in distal tubule
what device monitors the integrity of the isolated power supply for an operating room?
line isolation monitor
operating rooms often have an isolated power supply- decrease the incidence of inadvertant electrical shock if a pt or healthcare worker come into contact with a single live wire. unless both power lines are contacted, a circuit is not completed, and the risk for electrical shock is minimized. the presence of a faulty piece of equipment can turn an isolated power supply into a traditional, grounded electrical source, and electrical shock becomes a higher risk.
a line isolation monitor constantly evaluated the integrity of the system to produce an alert if this happens
a drug with a high hepatic extraction ratio exhibits a decreased metabolism in elderly patients primarily due to a decrease in
hepatic blood flow
hepatic transaminase levels and hepatic enzyme activity do not normally change with increased age.
hepatic mass does decrease with age, but clearance of drugs with high hepatic extraction ratio relies on hepatic blood flow not hepatic mass
patients with chronic renal failure tend to exhibit
A. hypokalemia
B. hyperventilation
C. hypophosphatemia
D. hypercalcemia
B. hyperventilation
due to chronic metabolic acidosis and increased predisopsition to pulm edema
if not accompanied with an anticholinergic, the admin of neostigmine can produce
A. paralytic ileus
B. tachycardia
C. salivation
D. bronchodilation
C. salivation
profound PNS effects (bronchospasm, salivation, increased bowel mobility)
vapor pressure of des is __ x that of other contemporary inhaled anesthetics
3-4 x
what does des boil at
22.8 c (slightly above rm temp)
what hemodynamic parameter decreases during laprascopic abdominal surgery?
A. stroke volume
B. SVR
C. HR
D. MAP
A. stroke volume
map, svr and hr typically all incease
svr decreases
cvp and co may increase or decrease
what is true about the vaporizing pumping effect?
-can result in elevated vaporizer output
-more prominent at high resp rates
-more prominent with low flows, low vaporizer dial settings, low levels of anesthetic in vaporizer chambers
it is an intermittent back pressure caused by pos pressure ventilation of use of oxygen flush valve
advanced directives for pt undergoing anesthesia are typically
suspended and resumed after postop period
where does aldosterone work in the nephron
late, distal convoluted tubule
corticol portion of collecting tubule
activation of plasminogen to plasmin is a major step in
fibrinolysis
what substance is primarily responsible for activating plasminogen
tPA
what is the normal PR interval
120-200 milliseconds
what do you expect to see with addisons?
weakness, anorexia, n, v, hyperpigmentation, chronic hypotension, hypovolemia, hyponatremia, hyperkalemia
protein binding of drugs is lowest among
A. term infants
B. children between 1-3 yrs old
C. adolescents
D. adults
A. term infants
spinal shock is consistent with which of the following?
A. warm, pink extremities
B. exaggerated hyperK response to sux within 3 hrs of injury
C. shock symptoms typically resolve within 6 hrs
D. HTN
A. warm, pink extremities
it disrupts commpensatroy vasoconstricve response
hemorrhagic shock: cool clammy extrem
spinal shock: warm, pink extrem
some ppl will use sux during first 24 hrs b/c upregulation of extrajunctional receptors has likely not occured yet
symptoms usually last 1-3 weeks
what si the meyer overton rule?
lipid solubility of the agent is directly r/t its potency
what nerve fiber classification is associated with pain and touch functions?
a delta
what are a alpha nerve fibers associated with?
motor and proprioception
what is the oil gas partition coefficient of
iso
des
sevo
nitrous oxide
iso= 99
des 19
sevo 50
nitrous 1.4
a poorly controlled hyperthyroid patient is undergoing emerency surgery for an appendectomy. at what point would the patient be most likely to experience a thyrotoxic crisis?
6-18 hours postop
what is the most sensitive indicator of cardiac ischemia during thoracic surgery when the aorta is cross clamped?
TEE
what is most likely to increase the risk of bradycardia during strabismus surgery?
A. hyperventilation
B. hypercapnia
C. presence of cerebral palsy
D. increased depth of anesthesia
hypercapnia
due to oculocardiac reflex- can occur due to traction on ocular muscles
hepatic dysfunction due to biliary tract obstruction would be consistent with which lab finding?
markedly increased alkaline phosphatase levels
biliary stones are considered a posthepatic cause of hepatic dysfunction and are associated with an increased conjugated fraction of bilirubin, normal to slightly increased aminotransferase enzymes and most notably, markedly increased alkaline phosphatase levels
which of the following statements regarding the use of epidural steroids for the tx of low back pain is true?
epidural steroids reduce the degree of leg pain and sensory deficit and the use of opioids during the acute phase of the injury
symptoms of hyperparathyrodisim are primarily r/t
hypercalcemia
which of the following ecg changes are associated with cor pulmonale
R atrial hypertrophy
-peak p waves in leads II, III, aVF
-R axis deviation and R bundle branch block is usually from RV hypertrophy
the underlying cause of organ failure due to DIC is
organ ischemia due to thrombosis
what is the treatment of choice for myasthenia gravis?
thymectomy
after an open colon resection, a patient exhibits liver enzymes that are 2x the normal value
common and should resolve in 48 hours
what is the half life of factor IX concentrate?
18-24 hours
what antiemetic pretreatment medication would be most likely to increase the risk for reflux?
atropine and glyco. -both decrease lower esophogeal sphincter tone and increase the risk for gastric reflux
benefits of a single cannister carbon dioxide absorber system over a double cannister system
typically easier to change
what fibers are the most resistant to anesthetic blockade
a alpha
how does clonidine reduce blood pressure
stimulates alpha 2 receptors and inhibits the release of catecholamines
alpha 2: alpha 1 220:1
the primary site for parathyroid hormone and vitamin d mediated calcium reabsorption is the
distal tubule
what organisms are responsible for the most surgical site infections
staph aures and staphh epidermidis
greatest degree of protein binding: ketamine, etomidate, versed, propofol
propofol > versed > etomidate > ketamine
dx of ht failure with reduced ef is defined as
ht failure associated with ef under 40%
a pt has an allergy to beta lactam antibiotics. what drug would be an inappropriate selection for this patient?
A. vanc
B. penicillin
C. doxycycline
D. flagyl
B. penicillin
what does des do to csf production
increases it
when administered for induction, etomidate may cause a slight decrease in BP. if it occurs this is usually due to a decrease in
SVR
A pt states that he is taking an extended release form of narcan for the treatment of substance abuse disorder. you know this agent should be d/c at least ___ days before opioid administration
30 days
a patient undergoing emergency surgery is revealed to have a serum digoxin level in a toxic range. which drug would be most likely to help protect against the enhanced cardiac automaticity seen with digitalis toxicity?
A. sux
B. ephedrine
C. calcium
D. fentanyl
D. fentanyl
also iso
which of the following surgical conditions is common in pt with acromegaly?
A. carpal tunnel syndrome
B. intussusception
C. subdural hematoma
D. detached retina
a. carpal tunnel syndrome
what is the principal byproduct of deamination of amino acids?
ammonia
what nerve fiber is responsible for transmiting pain, cold temp and touch
a delta
which of the following is a metabolite of succinylcholine?
succinylmonocholine
you are preparing to place an epidural catheter in an obstetric pt who is taking metoprolol. which of the following would be the best formulation for an epidural test dose?
lidocaine and fentanyl- using fentanyl and checking for sedation is an alternative
how will the chronic admistration of an antagonist affect the number and sensitivity of the receptors it antagonizes?
the number and sensitivity of the receptors both increase
the 12 led ecg in a pt in the third trimester will most likely exhibit
L axis shift.
diaphragm rises and shifts ht up and left. also increased tendency of premature atrial contractions, svt and ventricular dysrhythmias
how much csf is normally in subarachnoid space of spinal canal
30-80 mL
what herbal agent would disrupt plt aggregation for the longest period of time after d/c?
A. ginseng
B. garlic
C. st johns wort
D. gingko
B. garlic
up to 7 days after d/c
ginko and ginseng are 36 hours
what nerve travels subcut from lateral side of knee joint and is the terminal brach of the femoral nerve?
A. saphenous
B. superficial eproneal
C. deep peroneal
D. sural
terminal branch of femoral nerve is the saphenous nerve
it provides sensory innervation to skin of medial lower leg and medial side of malleolus
what aortic cross clamp location is associated with the most significant alterations in hemodynamics?
supraceliac - alterations in MAP, pulmonary capillary wedge pressure and EF
what are common complications of peritoneal dialysis?
doesn’t require a graft and the incidence of hypotension is much less
disadvantages: less control over filtraion of solutes, risk of peritonitis, tendency towards hyperglycemia due to glucose in dialysate solution
factors to inhibit hpv include
inhalation annesthetics, very high or very low PA pressures, hypocapnia, beta adrenergic agonists, vasodilators (nitroglycerin and nitroprusside), pulmonary infection, high or very low mixed venous po2 and ccb
what is the standard concentration of epi that is added to LA to prolong duration of epidural block?
1:200,000 aka 5 mcg/mL
what is the single biggest predictor of problematic intubation in morbidly obese patients
neck circumference
which is true about inspiratory and expiratory valves?
A. the inspiratory valve closes during inspiration
B. the expiratory valve closes during expiration
C. the valve must open with little pressure and close rapidly
D. the inspiratory valve can be mounted anywhere in the inspiratory side of the circuit
D
it does say the valves must open and close rapidly with little to no backflow?
the movement of fluid into a cell through the formation of vessicles at the cell membrane is known as
pinocytosis- if a cell brings in a liquid solution it is called this
if it is bringing in particulate matter aka cellular debris- it is called phagocytosis
what is the oral dose of precedex in a peds pt
2-4 mcg/kg
what anticholinesterase cross the blood brain barrier?
physostigmine (teritary amine)
which would be most useful in the treatment of uremic bleeding?
desmopressin
when inserting a PA catheter via RIJV. at what distance would you expect it to reach RA?
15- 25 cm
the internal volume of an anesthesia circuit is typically between ___ mililiters per meter of length
400-500
where is a myelomeningocele typically located?
lumbosacral region
when bp decreases from 120/60 to 90/60 what happens to cbf
it stays the same! (when map is 60-140) as map decreases cbv dilate to keep the blood flow the same
what are the 2 most prominent effects of increased age on the pulmonary system?
-devrease in the stiffness of lung parenchyma
-increase in the stiffness of the chest wall
what arrhythmia would you most likely see in a patient following surgical repair of tetralogy of fallot?
RBB
what is the formula for the relationship between flow, pressure and resistance
flow= pressure/ resistance
the extrinsic pathway of the hemostatic response is iniated by the release of a group of proteins known as?
tissue factor (forms a complex with factor VII)
what fluid should be avoided in a patient undergoing renal transplant?
LR- b/c of the K in the solution
normal saline and plasmalyte are both ok. excessive NS -> hyperchloremic met alkalosis
most patients femoral nerve is located where in relation to the femoral artery
about 0.5 cm lateral to the artery
what phase 1 reaction is characterized by reactions that remove electrons from a molecule
oxidation
which of the following is true about versed (pick 2)
A. it preserves cerebral autoregulaion
B. the appropriate iv dose is 0.08-0.1 mg/kg
C. it is formulated in propylene glycol
d. it decreases the swallowing reflex
a. it preserves cerebral autoreuglation
d. it decreases swallowing reflex
dose is 0.02-0.04 mg/kg
it is water soluble an formulated in an acqueous solution causing minimal pain on injection
what is a potential disadvantage of frequent tracheal suctioning?
disadvantages:
-it can cause atelectasis due to negative pressure
-can decrease fio2 due to entrainment of room air
benefits:
-can remove secretions and result in improved oxygenation and ventilation
what law states the diffusion of gas is inversely proportional to the square root of its molecular weight
-grahams law
what is the most common cause of an acute increase in deadspace in the acute care setting?
decreased cardiac output (decreases perfusion to well oxygenated alveoli)
what opioid can produce acute dystonic reactions in pt with untreated parkinsons disease?
alfentanil (possibly due to disruption of central dopaminergic transmission)
you are performing an epidural block and begin threading the catheter. the pt describes tingling in her L leg. you encounter no unusual resistance as you thread the catheter. what should you do?
tell the patient this is a normal sensation and proceed
semi closed and closed anesthesia circuits are reliant on ___ to maintain safe operations
carbon dioxide absorption
the gaba receptor is an example of what type
ligand gated ionophore
what will happen to gas flows on anesthesia machine with electronic flowmeters if the machine loses all power?
the gas will continue to flow
the graphical output depends on electrical supply
how long does it take for vitamin k to improve PT
6-8 hours
