AAA: Case Presentation Flashcards
How do you set up the OR for a AAA? (5)
Large ETT
Transducers (double or triple)- Art, Swann, Central lines
Fluid warmers
NG tube
Albumin available?
What drugs do you need during a AAA?
Uppers (3)
Downers (3)
Uppers: Norepi, Epi, Vasopressin
Downers: NTG, Nicardipine, Esmolol
What does high creatinine indicate?
Renal insufficiency
For patients with a pacemaker, what do you need to do?
Need magnet to place on the device.
What is the normal diameter of the abdominal aorta?
2-3 cm
What do you need to ensure regarding blood prior to surgery?
type and cross
What lab value is important because end organ issues can become a major complication during surgery?
Creatinine!
What induction drugs do you use for renal/heart patients?
Etomidate 20mg
Fentanyl 250 mcg
Cisatracurium 8mg
What are the 3 phases of an AAA?
Dissection
Clamping/Surgical Repair
Unclamping
What hemodynamic effects does clamping present?
Increased BP!!
What hemodynamic changes does surgical repair present?
Increased BP!
PEARL
How do you quickly calculate PaO2?
FiO2 * 5
What does clamping do to afterload?
Increases it.
During clamping phase, what do you need to do? (2)
Check urine output often to ensure renal perfusion!
Turn off lower body Bair hugger to decrease metabolism/O2 requirement!
What is normal urine output?
0.5 - 1.5 cc/kg/hr
When clamping, what 2 drugs should be in line?
NTG–reduces preload
Nicardipine
What lab value can you expect to change when giving albumin?
Calcium decreases.
Note: Also occurs with cell saver.
What does a (-) BE indicate?
Acidic state
When unclamping, what should you do? (3)
Take downers out of line!
Pressors in line.
Give fluids– use pressurized bag.
What should you do if the pt becomes unstable during unclamping?
Reclamp and reassess.
During closing, what should we do? (6)
rewarm;
give protamine (SLOWLY)
check ABG;
fluid & urine status;
call & give ICU report;
BP control for suture lines
What are common post-op complications? (7)
MI, arrhythmia (50% of complications)
Renal failure/insufficiency
Ileus
Ventilation problems (TRALI related)
Pain
Bleeding
Multiorgan failure
what can be a major complication of AAA surgery?
renal failure
what is SIRS and what causes it?
Systemic Inflammatory Response Syndrome
-reperfusion injury: tissue damage when blood returns to previously underperfused areas
name 4 factors that can increase the risk of post-op complications
>74 years
> clamp time
emergency status
heart history
