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Su: Sim Lab 2 > 38. Embolism > Flashcards

38. Embolism Flashcards

1
Q

VAE requirements

A

open vein
pressure in vein > subatmospheric pressure

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2
Q

VAE surgical position

A

can occur in any position

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3
Q

higher incident rate of VAE

A

sitting craniotomies

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4
Q

VAE presentation is dependent on

A

volume entrained
rate of air entrainment
presence of R-to-L shunt

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5
Q

as rate of air entrainment increases, what happens?

A

incr PAP
decr CO
RV overload
decr LV preload

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6
Q

nitrous and VAE

A

rapidly increases severity of VAE

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7
Q

VAE definitive diagnosis

A

Echo

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8
Q

VAE signs/symptoms

A

decr EtCO2 (stair step)
decr O2
tachycardia
hypotension

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9
Q

monitors to detect VAE

A

TEE
precordial doppler over RA

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10
Q

precordial doppler placement for VAE

A

over RA
between 3rd and 6th ribs

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11
Q

VAE treatment

A

prevent further entrainment
stop N2O
100% FiO2
aspirate air bubbles from CVC
give crystalloid to incr CVP
give vasopressor to correct htn
incr PEEP
head down/left tilt (durant’s)

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12
Q

polymethymethacrylate

A

exothermic
expansion
intramedullary pressures > 500mmHg

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13
Q

bone cement can cause embolism of

A

fat
bone marrow
cement
air

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14
Q

bone cement signs/symptoms

A

hypoxia
hypotension
arrythmias
PHTN
decr CO

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15
Q

bone cement embolism treatment

A

incr FiO2
euvolemia
adequate BP

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16
Q

rhabdo is associated with tourniquet inflation over _____ hrs

A

> 2hrs

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17
Q

pt experiences tourniquet pain after

A

60 mins

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18
Q

inflate tourniquet to _____

A

100mmHg above SBP

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19
Q

when are fat embolisms common

A

with long bone fractures

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20
Q

fat embolism signs/symptoms

A

dyspnea
confusion/coma
petechia
clotting dysregulation
hypoxia
resp failure
ST changes
decr EtCO2

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21
Q

signs/symptoms of RV strain

A

acute incr PHTN
pulm vasodilators
milrinone

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22
Q

fat embolism treatment

A

stabilization of frature
O2 therapy
hypotension correction

23
Q

ARDS

A

disruption of cap-alveolar membrane
albumin leak into alveolar space resulting in fluid in the lungs causing inflammation

24
Q

Acute lung injury

A

PaO2/Fio2 ration < 300

25
Q

ALI causes

A

trauma
sepsis
aspiration

26
Q

ARDS

A

PaO2/FiO2 ratio < 200

more severe than ALI

27
Q

ARDS treatment

A

fix the cause

28
Q

ARDS mgmt: Plat P

A

< 27 cmH2O

29
Q

ARDS: TV

A

4-6 mL/kg

30
Q

ARDS: FiO2

A

< 50%

31
Q

ARDS: RR

A

< 30 breaths per min

32
Q

ARDS: PEEP

A

<15 cmH2O

33
Q

ARDS: drugs

A

NO
prostacyclin
PGE1

34
Q

DVT

A

blood clot in vein that becomes thrombotic
more common in lower extremities

35
Q

DVT risk factors

A

obesity
Age > 60
sx > 30 mins
tourniquet use
LE fracture
immobilization > 4 days
blood clotting disorders (Factor 5)

36
Q

LE orthopedic risk of DVT

A

40-80% without prophylaxis

37
Q

DVT pharmacological prophylaxis

A

LUFH
warfarin
LMWH (lovenox 40 mg)

38
Q

DVT mechanical prophylaxis

A

IPC
SCD
compression stockings

39
Q

what might lower risk of DVT

A

neuraxial anesthesia

40
Q

DVT treatment

A

anticoags
thrombotics
IVC filter
thrombectomy/embolectomy

41
Q

AFE incidence rate

A

1:20,000

42
Q

AFE mortality

A

86%

43
Q

AF composition

A

fetal debri
prostaglandins
leukotrines

44
Q

____ indicates severity of AFE

A

volume of entrainment

45
Q

AFE is a _____ response

A

immune

46
Q

AFE signs/symptoms

A

tachycardia
cyanosis
shock
generalized bleeding

47
Q

AFE phase 1

A

pulmonary vasospasm
hypoxia
resp acidosis

48
Q

AFE phase 2

A

LV failure
pulm edema
uterine atony
DIC

49
Q

AFE phase 3

A

seizure
coma

50
Q

AFE treatment: pulm embolism

A

aspirate
max PaO2
CPR

51
Q

AFE treatment: hemodynamics

A

aggressive fluid resuscitation
direct vasopressor (phenylephrine)
milrinone after adequate resuscitation

52
Q

AFE treatment: uterine atony

A

oxytocin
methergine
prostaglandin
hemabate
misoprostol

53
Q

AFE treatment: DIC

A

transfusion

54
Q

AFE treatment: seizures

A

benzos

Su: Sim Lab 2 (18 decks)

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