article reviews- Josh Flashcards
ARF Postop:
what are 2 main prerenal faliure causes?
Diminished CO
Volume depletion
ARF Postop:
with prerenal cause of Diminished CO, what are some couses of the decreased Co
- CHF
- Cardiogenic shock
- Acut MI
- Dysrhythmia
ARF Postop:
with prerenal causes what causes volume depletion
- hemorrhage
- Spsis
- GI blood/fluid loss
- Hypoalbuminemia
- 3rd spacing
ARF Postop:
what are 3 postrenal causes
ureteral obstruction
Bladder neck obstruction
Vascular obstruction
ARF Postop
w/ post renal failure, what causes the ureteral obstruction?>
- surgical ligation
- Papillary necrosis
- calculi
- Blood clot
ARF Postop:
w/ post renal failure what are some causes of Bladder neck obstruction?
prostate enlargement
Bladddr calculi
Urethral stricture
ARF Postop:
w/ post renal failure what are some causes of vascular obstruction
- Renal vein thrombosis
- Surgical ligation
ARF Postop:
what are 3 causes of intrarenal failure?
tubular damage
Interstitium damage
Vascular damage
ARF Postop:
w/ intrarenal failure what causes tubular damage?
- ATN
- Endogenous toxins
- Exogenous toxins
ARF Postop:
w/ intrarenal failure what causes interstitium failure?
- Drugs (abx, NSAIDS)
- Infections
ARF Postop:
w/ intrarenal faliure what causes Vascular failure?
drugs
thrombotic states
initially hypercalemia causes hyperexcitability of cellular membranes how?
by moving the resting membrane potential closer to the threshold potential, thus a smaller stimulus is needed to initiate a contraction
initially hypercalemia causes hyperexcitability of cellular membranes by moving the resting membrane potential closer to the threshold potential, thus a smaller stimulus is needed to initiate a contraction eventually the Na-K ATPase pump begins to fatigue from excessive depolarizations, and the cellular membrane becomes what?
less excitable
what does hyperkalemia due to NMB induced by muscle relaxants
it potentiates the NM blockade by decreasing the excitability of the skeletal muscle
remember (
initially hypercalemia causes hyperexcitability of cellular membranes by moving the resting membrane potential closer to the threshold potential, thus a smaller stimulus is needed to initiate a contraction eventually the Na-K ATPase pump begins to fatigue from excessive depolarizations, and the cellular membrane becomes less excitable)
what are major presentations of residual NM blockade?
- airway obstruction
- hypoventilation
- hypoxemia
Hyperkalemia can contribult to residual what? (r/t MR)
muscle weakness
Hemostasis:
how is a platelet plug made?
- plts activated at site of injury to form a platelet plug that provides the initial hemostatic response
Hemostasis:
what the primary events of Clot formation
- exposure to tissue factor (III) at the site abd it’s interaction w/ Factor VII and the Factor X (hagman factor)
Hemostasis:
what are the primary events for termination of clot
- involves factor antithrombin, tissue factor pathway inhibtor, and protein C pathway
Hemostasis:
whay is there clot lysis?
restore vessel patency
Hemostasis:
steps for clot lysis
- plasminogen binds fibrin to tpa
- activate proteolytic plasmin
- cleaves fibrin, fibrinogen, and a variety of plasma proteins and clotting factors
what is the impairment of hemostasis and activation of fibrinolysis that occurs d/t severe injury
Acute traumatic coagulopathy (ATC)
ATC:
what are standard test?
- PT/INR
- aPTT
- finrinogen level
- plt count
ATC:
pt’s w/o preexisting coag defects that have a prolonged PT and/ot PTT > _____ x’s normal have ATC
> 1.5x’s normal
ATC:
what type of coag monitoring is useful for monitoring ongoing resuscitation in injured pts
Thomboelastography
what test measure the VISOELASTIC properties of clot formation providing information on clot initiation, clot strength, and fibrinoysis
TEG
ATC:
what is plasma based resuscitation for a pt dx w/ ATC
PRBCs
FFP
PLT
ATC:
what are 3 hemostatic agents for severe coagulopathy?
Factor VIIa
Prothrombin complex concentrate
antifibrinolytic agents
what is a metalloprotease that cleaves vWF within developing platelet-rich thrombi to prevent hemolysis, thrombocytopenia, and tissue infarction
ADAMTS13
Most adult cases of ITTP are d/t acquired antibodes that inhibit what?
ADAMTS13
ITTP:
805 of pt’s respond to what treatment?
plasma exchange
(removes antibody and replinishes ADAMS13)
ITTP:
Immunosupression w/ what drug may be as effective as salvage therapy
rituximab
what is teh most frequent complications that require admission r/t Sickle Cell Disease (SCD)
acute bone problems
painful vaso-occlusive crises and osteomyelitis
Bone Involement in SCD:
what complication startes in late infancy and continues throughout life
Vaso-occlusive crises
Bone Involement in SCD:
what is a complex pathogenisis that involves the activation and adhesion of Leukocytes, plts, endotheliel cells, and HgbS, can occur in any organ but most common in bone marrow?
microvascular occlusion
Bone Involement in SCD:
Osteolyelitis is thoought o be caused by what?
Hyposplenism
Bone Involement in SCD:
what bacteria is most commonly the cause of osteomyelitis list fom most to least common
Salmonella
staph A
Gram neg enteric bacilli
Bone Involement in SCD:
what is the most disabling chronic bone d/o
osteonecrosis
GERD and It’s effect in DL and Intubation:
changes at the cellular level can produce ____ and subglottic ______ making the airway difficult
edema
stenosis
GERD and It’s effect in DL and Intubation:
Hx of what should alert you to ptential abnormalities from GERD and erosion of laryngotracheal mucosa
Chronic cough
hoarseness
throat clearing
dysphagia
GERD and It’s effect in DL and Intubation:
if GERD causes occult aspiration it can mimic what other diseases
Asthma
Bronchitis
GERD and It’s effect in DL and Intubation:
subglottic edema seen w/ GERD can be dramatically decreased w/
preop meds
GERD and It’s effect in DL and Intubation:
what ttype of drugs are cimetidine, Famotidine, nizatidine, rantididine?
H2 antagonist
GERD and It’s effect in DL and Intubation:
what type of drugs are alka-selzwer, di-gel, gavison, maalox, mylanta, riopan plus, rolaids, tums
antacids
GERD and It’s effect in DL and Intubation:
what type of drugs are cisapride, Metoclopramide?
Gastrokinetics
GERD and It’s effect in DL and Intubation:
what type of drug is omeprazole
PPIs
GERD and It’s effect in DL and Intubation:
combos of the previous drugs should be started at least ___ hours before anticipated GA
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