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Su: Sim Lab 2 > 36. Vascular/Pericardial Simulation > Flashcards

36. Vascular/Pericardial Simulation Flashcards

1
Q

MI occurs when

A

O2 supply < O2 demand

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2
Q

PMI ECG changes

A

Q wave (leads V1-V3)
>40 ms wide
>2 mm deep
>25% depth of QRS
ST segment abnormality

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3
Q

Septal ST segment

A

V1-2

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4
Q

anterior ST segment

A

V3-4

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5
Q

Lateral ST segment

A

1+aVL
V5-6

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6
Q

Inferior ST segment

A

2
3
aVF

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7
Q

right ventricular ST segment

A

V1
V4R

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8
Q

posterior ST segment

A

V1-3 depression

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9
Q

most common ECG abnormality

A

ST segment

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10
Q

Right Coronary Artery ECG lead

A

2
3
aVF

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11
Q

RCA myocardial area affected

A

RA
RV
SA node
inferior LV
AV node

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12
Q

circumflex CA ECG lead

A

1
aVL

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13
Q

Circumflex myocardial area affected

A

lateral LV

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14
Q

LAD ecg lead

A

V3-5

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15
Q

LAD myocardial area affected

A

anterolateral aspect of LV

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16
Q

high risk surgery

A

abdominal aortic aneurysm
peripheral vascular
thoracotomy
major abdominal

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17
Q

ischemic heart disease

A

hx of MI
hx of positive exercise stress test
angina
nitrates
Q wave

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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

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19
Q

cerebrovascular disease

A

hx of VA
hx of TIA

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20
Q

renal function

A

pre-op Cr >2mg/dL

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21
Q

diabetes

A

insulin dependent

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22
Q

PMI management

A

prevent MI
avoid hyperventilation
baseline HR/BP
avoid sympathetics

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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

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24
Q

events that incr O2 requirements

A

sympathetics
tachycardia
HTN
incr inotropy
incr afterload
incr preload

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25
Q

when do you treat PMI

A

1mm change in ST segment

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26
Q

PMI medications

A

NTG
esmolol
inotropics

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27
Q

what do you give for elevated afterload

A

NTG

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28
Q

what do you give to lower O2 demand

A

esmolol

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29
Q

what do you give for hypotension

A

inotropics

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30
Q

PMI post-op avoid:

A

shivering
pain
hypoxemia
hypercarbia
sepsis/infection
hemorrhage/anemia

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31
Q

aneurysms are asociated with

A

marfans
ehler danos
bicuspid aortic valve
family history

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32
Q

threshold for aortic aneurysm operations

A

> 5cm

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33
Q

aortic dissection is associated with

A

HTN
bicuspid aortic valve
TOF
atherosclerosis
trauma
bypass
pregnancy
weight lifting

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34
Q

abdominal aortic aneurysm rupture triad

A

hypotension
severe back pain
pulsatile abdominal mass

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35
Q

what improves survival from aortic aneurysm

A

short time from rupture to OR

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36
Q

ascending aorta dissection treatment

A

surgery

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37
Q

aortic arch dissection treatment

A

surgery
bypass if innominate involved

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38
Q

what artery requires bypass if dissected

A

innominate artery

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39
Q

descending aorta dissection treatment

A

medical management unless rupture is imminent

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40
Q

cause of anterior spinal artery syndrome

A

aortic cross clamping

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41
Q

anterior spinal artery syndrome symptoms

A

flaccid paralysis
motor dysfunction
acute back pain
autonomic dysfunction

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42
Q

ways to decrease anterior spinal artery syndrome

A

limit cross clamp to <30 min
incr BF

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43
Q

aortic cross clamp: SVR proximal

A

incr SVR proximal to clamp

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44
Q

aortic cross clamp: HR

A

no change

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45
Q

aortic cross clamp: volume

A

venous vasoconstriction
incr CVP
incr PAP
incr PAWP

46
Q

aortic cross clamp: distal SVR

A

decr distal SVR

47
Q

what is perfusion dependent on in aortic cross clamp?

A

proximal pressure

48
Q

MAP above cross clamp

A

100mmHg

49
Q

MAP below cross clamp

A

50 mmHg

50
Q

vasodilators during aortic cross clamp

A

incr ICP
decr distal PP

51
Q

SEPs

A

sensory neurons
dorsal cord

52
Q

MEPs

A

motor neurons
ventral cord

53
Q

LP drain/monitor

A

< 10 cmH20
promotes BF

54
Q

aortic clamping

A

vasocnostriction
incr venous return
incr lung volume
incr intracranial blood vol
HTN

55
Q

aortic un-clamping

A

peripheral blood pooling
central hypovolemia
decr venous return
hypotension

56
Q

mannitor

A

incr renal BF
incr GFR

57
Q

risks during unclampiong

A

cold
acidosis
clot formation

58
Q

should you use a bair hugger during aortic cross clamping

A

no lower body

59
Q

what should you minimize during aortic cross clamping

A

sympathetics

60
Q

what type of aortic endovascular repair is more difficult

A

thoracic

61
Q

why is thoracic endovascular repair difficult?

A

greater pressure
tortuous anatomy
higher complication risk

62
Q

optimal fluid and BP state for aortic cross clamp

A

euvolemic
normotension

63
Q

cerebral blood flow

A

2 internal carotid
2 vertebral arteriesw

64
Q

hat do the vertebral arteries combine to form

A

basilar artery

65
Q

where is the highest amount of plaque build up

A

carotid bifurcation

66
Q

what has the majority of cerebral blood flow

A

internal carotids

67
Q

hemorrhagic stroke cause

A

vascular deformity
trauma
coagulopathy

68
Q

ischemic stroke cause

A

thrombotic
embolic

69
Q

what type of stroke is most common with carotid disease

A

ischemic

70
Q

when is surgery indicated for carotid artery stenosis

A

70-99% occlusion indicates carotid endarterectomy

71
Q

carotid artery stenosis diagnosis

A

auscultation
angiography
CT
MRI
doppler

72
Q

pts with carotid artery stenosis will present with what during auscultation?

A

carotid bruit

73
Q

CEA pts usually have what

A

severe CAD
– incr intraop MI risk
HTN

74
Q

CEA regional

A

real time neuro assessment
cervical plexus block

75
Q

CEA general

A

mx hemodynamics

76
Q

carotid sinus body cranial nerves

A

CN IX
CN X

77
Q

stump pressure

A

art line in common carotid placed by surgeon

78
Q

cerebral oximetry measures

A

tissue O2 saturation

79
Q

tissue O2 saturation reflects

A

Hb saturation in arterial, venous, and capillaries

80
Q

tissue Hb is _____% venous and ____% arterial in the cerebral cortex

A

tissue Hb is 70% venous and 30% arterial in the cerebral cortex

81
Q

CAE cardiac complications

A

HTN
hypotension
MI

82
Q

CAE neuro complications

A

stroke
thrombosis
hypoglosssal dysfunction
recurrent laryngeal dysfunction
superior laryngeal dysfunction

83
Q

hypoglossal dysfunction

A

motor efferent to tongue

84
Q

recurrent laryngeal dysfunction

A

vocal cord paralysis
hoarness
change in pitch
noisy breathing

85
Q

superior laryngeal dysfunction

A

phonation changes

86
Q

pericardial sac

A

fibrous sac that produces fluid to lubricate movement of heart

87
Q

normal pericardial sac volume

A

15-50 mL

88
Q

is the pericardial sac essential for life?

A

no

89
Q

pericarditis

A

recurrent frictional rub of pericardial sac

90
Q

how can you differentiate between pericarditis and MI

A

pericarditis does not improve with NTG

91
Q

pericardial effusion

A

accumulation of fluid within the pericardial sac

92
Q

causes of pericardial effusion

A

cancer
infection
MI
trauma
drugs
radiation
autoimmune

93
Q

cardiac tamponade

A

fluid pressure = cardiac pressure

94
Q

cardiac tamponade is independent of

A

volume of fluid

95
Q

what determine physiologic manifications of tamponade

A

timeframe of fluid accumulation

96
Q

cardiac tamponade symptoms

A

incr CVP
pulsus paradoxus
equalization of cardiac filling P
hypotension
blunted ECG
sympathetic activation

97
Q

esophageus compression

A

dysphagia
hiccups

98
Q

tracheal compression

A

dyspnea
hoarsness
deviation

99
Q

lung compression

A

cough

100
Q

cardiac tamponade diagnosis

A

chest XRay
CT
TTE/TEE

101
Q

kussmaul’s sign

A

distension of jugular veins during inspiration

102
Q

beck’s triad

A

muffled heart sounds
incr jugular venous pressure
hypotension

103
Q

pulsus paradoxus

A

exaggerated ventricular interdependence
decr >10 mmHg SBP during respiration

104
Q

cardiac tamponade echo sizes

A

small: <10 mm
med: 10-20 mm
lg: > 20 mm

105
Q

mild/small cardiac tamponade treatment

A

observation

106
Q

symptomatic cardiac tamponade treatment: emergent

A

pericardiocentesis

107
Q

symptomatic cardiac tamponade treatment: chronic

A

pericardial window

108
Q

should you do GA in emergent tamponade pt

A

No - needle decompression first, then surgery

109
Q

cardiac tamponade goals

A

good CO
inotropy
chronotropy
mx SV

110
Q

cardiac tamponade avoid

A

myocardial depression
hypovolemia
hypervolemia
arterial vasodilation
bradycardia
PPV

111
Q

what induction drug is best for cardiac tamponade

A

ketamine

112
Q

pericardial decompression syndrome

A

profound hypotension
acute HF
pulm edema

Su: Sim Lab 2 (18 decks)

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