36. Vascular/Pericardial Simulation Flashcards
1
Q
MI occurs when
A
O2 supply < O2 demand
2
Q
PMI ECG changes
A
Q wave (leads V1-V3)
>40 ms wide
>2 mm deep
>25% depth of QRS
ST segment abnormality
3
Q
Septal ST segment
A
V1-2
4
Q
anterior ST segment
A
V3-4
5
Q
Lateral ST segment
A
1+aVL
V5-6
6
Q
Inferior ST segment
A
2
3
aVF
7
Q
right ventricular ST segment
A
V1
V4R
8
Q
posterior ST segment
A
V1-3 depression
9
Q
most common ECG abnormality
A
ST segment
10
Q
Right Coronary Artery ECG lead
A
2
3
aVF
11
Q
RCA myocardial area affected
A
RA
RV
SA node
inferior LV
AV node
12
Q
circumflex CA ECG lead
A
1
aVL
13
Q
Circumflex myocardial area affected
A
lateral LV
14
Q
LAD ecg lead
A
V3-5
15
Q
LAD myocardial area affected
A
anterolateral aspect of LV
16
Q
high risk surgery
A
abdominal aortic aneurysm
peripheral vascular
thoracotomy
major abdominal
17
Q
ischemic heart disease
A
hx of MI
hx of positive exercise stress test
angina
nitrates
Q wave
18
Q
congestive heart failure
A
hx of CHF
hx of pulm edema
hx of paroxysmal nocturnal dyspnea
rales
S3 gallop
CXR w/pulm vascular redistribution
19
Q
cerebrovascular disease
A
hx of VA
hx of TIA
20
Q
renal function
A
pre-op Cr >2mg/dL
21
Q
diabetes
A
insulin dependent
22
Q
PMI management
A
prevent MI
avoid hyperventilation
baseline HR/BP
avoid sympathetics
23
Q
events that decr O2 delivery
A
decr coronary BF
tachycardia
hypotension
hypocapnia
CA spasm
decr O2 content (FiO2)
anemia
arterial hypocemia
Left shift O2-Hb curve
24
Q
events that incr O2 requirements
A
sympathetics
tachycardia
HTN
incr inotropy
incr afterload
incr preload
25
when do you treat PMI
1mm change in ST segment
26
PMI medications
NTG
esmolol
inotropics
27
what do you give for elevated afterload
NTG
28
what do you give to lower O2 demand
esmolol
29
what do you give for hypotension
inotropics
30
PMI post-op avoid:
shivering
pain
hypoxemia
hypercarbia
sepsis/infection
hemorrhage/anemia
31
aneurysms are asociated with
marfans
ehler danos
bicuspid aortic valve
family history
32
threshold for aortic aneurysm operations
> 5cm
33
aortic dissection is associated with
HTN
bicuspid aortic valve
TOF
atherosclerosis
trauma
bypass
pregnancy
weight lifting
34
abdominal aortic aneurysm rupture triad
hypotension
severe back pain
pulsatile abdominal mass
35
what improves survival from aortic aneurysm
short time from rupture to OR
36
ascending aorta dissection treatment
surgery
37
aortic arch dissection treatment
surgery
bypass if innominate involved
38
what artery requires bypass if dissected
innominate artery
39
descending aorta dissection treatment
medical management unless rupture is imminent
40
cause of anterior spinal artery syndrome
aortic cross clamping
41
anterior spinal artery syndrome symptoms
flaccid paralysis
motor dysfunction
acute back pain
autonomic dysfunction
42
ways to decrease anterior spinal artery syndrome
limit cross clamp to <30 min
incr BF
43
aortic cross clamp: SVR proximal
incr SVR proximal to clamp
44
aortic cross clamp: HR
no change
45
aortic cross clamp: volume
venous vasoconstriction
incr CVP
incr PAP
incr PAWP
46
aortic cross clamp: distal SVR
decr distal SVR
47
what is perfusion dependent on in aortic cross clamp?
proximal pressure
48
MAP above cross clamp
100mmHg
49
MAP below cross clamp
50 mmHg
50
vasodilators during aortic cross clamp
incr ICP
decr distal PP
51
SEPs
sensory neurons
dorsal cord
52
MEPs
motor neurons
ventral cord
53
LP drain/monitor
< 10 cmH20
promotes BF
54
aortic clamping
vasocnostriction
incr venous return
incr lung volume
incr intracranial blood vol
HTN
55
aortic un-clamping
peripheral blood pooling
central hypovolemia
decr venous return
hypotension
56
mannitor
incr renal BF
incr GFR
57
risks during unclampiong
cold
acidosis
clot formation
58
should you use a bair hugger during aortic cross clamping
no lower body
59
what should you minimize during aortic cross clamping
sympathetics
60
what type of aortic endovascular repair is more difficult
thoracic
61
why is thoracic endovascular repair difficult?
greater pressure
tortuous anatomy
higher complication risk
62
optimal fluid and BP state for aortic cross clamp
euvolemic
normotension
63
cerebral blood flow
2 internal carotid
2 vertebral arteriesw
64
hat do the vertebral arteries combine to form
basilar artery
65
where is the highest amount of plaque build up
carotid bifurcation
66
what has the majority of cerebral blood flow
internal carotids
67
hemorrhagic stroke cause
vascular deformity
trauma
coagulopathy
68
ischemic stroke cause
thrombotic
embolic
69
what type of stroke is most common with carotid disease
ischemic
70
when is surgery indicated for carotid artery stenosis
70-99% occlusion indicates carotid endarterectomy
71
carotid artery stenosis diagnosis
auscultation
angiography
CT
MRI
doppler
72
pts with carotid artery stenosis will present with what during auscultation?
carotid bruit
73
CEA pts usually have what
severe CAD
-- incr intraop MI risk
HTN
74
CEA regional
real time neuro assessment
cervical plexus block
75
CEA general
mx hemodynamics
76
carotid sinus body cranial nerves
CN IX
CN X
77
stump pressure
art line in common carotid placed by surgeon
78
cerebral oximetry measures
tissue O2 saturation
79
tissue O2 saturation reflects
Hb saturation in arterial, venous, and capillaries
80
tissue Hb is _____% venous and ____% arterial in the cerebral cortex
tissue Hb is 70% venous and 30% arterial in the cerebral cortex
81
CAE cardiac complications
HTN
hypotension
MI
82
CAE neuro complications
stroke
thrombosis
hypoglosssal dysfunction
recurrent laryngeal dysfunction
superior laryngeal dysfunction
83
hypoglossal dysfunction
motor efferent to tongue
84
recurrent laryngeal dysfunction
vocal cord paralysis
hoarness
change in pitch
noisy breathing
85
superior laryngeal dysfunction
phonation changes
86
pericardial sac
fibrous sac that produces fluid to lubricate movement of heart
87
normal pericardial sac volume
15-50 mL
88
is the pericardial sac essential for life?
no
89
pericarditis
recurrent frictional rub of pericardial sac
90
how can you differentiate between pericarditis and MI
pericarditis does not improve with NTG
91
pericardial effusion
accumulation of fluid within the pericardial sac
92
causes of pericardial effusion
cancer
infection
MI
trauma
drugs
radiation
autoimmune
93
cardiac tamponade
fluid pressure = cardiac pressure
94
cardiac tamponade is independent of
volume of fluid
95
what determine physiologic manifications of tamponade
timeframe of fluid accumulation
96
cardiac tamponade symptoms
incr CVP
pulsus paradoxus
equalization of cardiac filling P
hypotension
blunted ECG
sympathetic activation
97
esophageus compression
dysphagia
hiccups
98
tracheal compression
dyspnea
hoarsness
deviation
99
lung compression
cough
100
cardiac tamponade diagnosis
chest XRay
CT
TTE/TEE
101
kussmaul's sign
distension of jugular veins during inspiration
102
beck's triad
muffled heart sounds
incr jugular venous pressure
hypotension
103
pulsus paradoxus
exaggerated ventricular interdependence
decr >10 mmHg SBP during respiration
104
cardiac tamponade echo sizes
small: <10 mm
med: 10-20 mm
lg: > 20 mm
105
mild/small cardiac tamponade treatment
observation
106
symptomatic cardiac tamponade treatment: emergent
pericardiocentesis
107
symptomatic cardiac tamponade treatment: chronic
pericardial window
108
should you do GA in emergent tamponade pt
No - needle decompression first, then surgery
109
cardiac tamponade goals
good CO
inotropy
chronotropy
mx SV
110
cardiac tamponade avoid
myocardial depression
hypovolemia
hypervolemia
arterial vasodilation
bradycardia
PPV
111
what induction drug is best for cardiac tamponade
ketamine
112
pericardial decompression syndrome
profound hypotension
acute HF
pulm edema
