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
72
Genetic Nutrition: Nutritional issues in older adults:
the involuntary loss of > 5-10% of older adults usual weight during 1 year = what
increased risk for mortality
Genetic Nutrition: Nutritional issues in older adults:
involutary weight loss is generally r/t 1 or a combo of what 4 conditions
- inadquate dietary intake
- Appetite loss (anorexia)
- Muscle atrophy
- Imflammatory effects of disease
Genetic Nutrition: Nutritional issues in older adults:
inadequate dietary intake can be r/t what issues
social
psychospcial
medical
physiological
Genetic Nutrition: Nutritional issues in older adults:
what isi teh most prevelent condition that causes weight loss in the older adult
depression
Genetic Nutrition: Nutritional issues in older adults:
what is te 2nd most common cause of weight loss
Cancer
Genetic Nutrition: Nutritional issues in older adults:
sarcopenia (a degenerative loss of muscle mass) is often r/t what?
testosterone and estroge reductions
increase in insulin resistance
Genetic Nutrition: Nutritional issues in older adults:
if a DM pt is having issues with weight, do you place them on a diabetic diet still
fuck no, just monitor them closer
Genetic Nutrition: Nutritional issues in older adults:
should you treat w/ appetite stimulamnts such as megestrol and dronabinol?
nope they show no benefits
Genetic Nutrition: Nutritional issues in older adults:t
15% of ppl > 60 have what vit def
B12
Electrolyte changes…..TURP:
the study recomend checking what levels in prop for TURP pt’s
K+
Na+
Ca++
Electrolyte changes…..TURP:
why o you want to optimize their electrolytes b4 sx
to prevent serious and fatal complications
Electrolyte changes…..TURP:
normally there is a fall of what in Na+ during a TURP?
5-8mEq/L
Electrolyte changes…..TURP:
procedure lasting longer than _____ min and volume of prostate gland greater than ____ could be associated w/ more complication
think 60
60 min
60 ml
Electrolyte changes…..TURP:
limit height of irrigation fluid column to ____cm can provide optimal vision to surgeon and reduce complications of fluid absorption
60 cm
(23-24 inch)
i think bill stated a lower height of 16-18 inches
Electrolyte changes…..TURP:
what is a widely used irrigant, b/c of it’s good optical properties, and non-electrolytic properties that prevent dissipation of diathermy current durrent resection
Glycine 1.5%
Electrolyte changes…..TURP:
is glycine 1.5 % hypo/hyper/or isotonic
slightly Hypotonic
Electrolyte changes…..TURP:
early identification of TURP syndrome and it’s treatment should be based on administration of what?
hypertonic saline
Electrolyte changes…..TURP:
S/S of TURP syndrome CNS
restlessness
H/A
Confusion
Convulsions
Coma
Visual disturbances
N/V
Electrolyte changes…..TURP:
S/S TURP syndrome CV and respiratory
- HTN
- Tachycardia
- Tachypnea
- Hypoxia
- Pulm edema
- Hypotension
- bradycardia
Electrolyte changes…..TURP:
S/S of TURP syndrome metabolic and renal
Hyponatremis
Hyperglycemia
IV hemolysis
Acute renal failure
Perioperative management of pt w/ liver dz:
the conerstone of periop maagement are medical treatment of liver disease complications such as what?
- Coagulapathy
- Ascites
- Encephalopathy
- Malnutrition
Perioperative management of pt w/ liver dz:
what do you want to pay close attention to post op
risk factors for infection
Perioperative management of pt w/ liver dz:
Sepsis, coagulopathy, and emergency sx are most strogly associated w/ what?
post op mortality
Perioperative management of pt w/ liver dz:
what are risk stratification systems?
CTP score
MELD score
ASA
Perioperative management of pt w/ liver dz:
Surgery is contraindicated if what CTP class
C
Perioperative management of pt w/ liver dz:
why should you use sedatives and MR w/ caution
prolonged duration of action
Perioperative management of pt w/ liver dz:
how do you want to optimize Cirrhosis pt’s
- correct coag (PTT w/in 3 sec of NL)
- Goal Plt count > 50-100,000
- Minimize ascites
- Address nutritional status
Perioperative management of pt w/ liver dz:
what narc is prefered
fenatanyl
Perioperative management of pt w/ liver dz:
how do you treat coagulopathy
- Vit K
- FFP if Vit K ineffective
- Cryoprecipitate
- DDAVP if bleeding time prolonged
- goal PT w/oin 3 sec NL
Perioperative management of pt w/ liver dz:
how to treat encephalopathy
- Lactulose
Perioperative management of pt w/ liver dz:h
ow to treat ascites
Diuretics
Fluid restriction
large volume paracentesis
Diagnosing HIT in Cardiac surgical pts…:
Cardiac sugical pts are at increased risk for post op HIT d/t what factors
High dose heparin
platelet activation
CPB
Diagnosing HIT in Cardiac surgical pts…:h
How does HIT occur?
immune mediated response
- teh anticoagulant causes a procoagulant effect via platelet activating antibodies that reconize multimeric platelet factoe 4 (PF4) heaprin complexes on platelet surfaces
Diagnosing HIT in Cardiac surgical pts…:
what are CV pt’s so hard to diagnose?
b/c they have thrombocytopenia for frst 72 hours post op anyways
Diagnosing HIT in Cardiac surgical pts…:
prompt reconition is crucial b/c cessation of haparin and treatment w/ what reduces the risk of thromboembolic events
direct thrombin inhibitor
Diagnosing HIT in Cardiac surgical pts…:
what are 2 types of assays to detect HIT
Functional assays
enzyme imunoassays
Diagnosing HIT in Cardiac surgical pts…:
whaich assay has the highest sensitivity and specificity?
Functional assay
Diagnosing HIT in Cardiac surgical pts…:
why is the functional assays not used ofter?
impractical due to being very time intensive and lack of avilability
Diagnosing HIT in Cardiac surgical pts…:
what are 2 ex of funtional essays
HIPA (Heparin induced platelet activation assay)
SRA (serotonin release assays)
Diagnosing HIT in Cardiac surgical pts…:
so the enzyme immunoassays (EIA) also have a high sensitivity and rapid result but what is bad about them?
a high number of false positives
Airway management w/ ALL:
ALL is the most comon malignancy in who
children
Airway management w/ ALL:
pulmonary comlications
- PNA’oulm leukostasis
- malignant pleural effusion
- upper airway obstrction
Airway management w/ ALL:
what isteh malignancy of blast cells d/t failure of cell maturation leads to accumulation of useless cells at the expense of normal hemopoietic cells
Acute leukemia
Airway management w/ ALL:
S/S
fatique
bone/joint pain
fever w/o infection
weightloss
abnormal masses
splenomegaly
leymphadenopathy
hepatomegaly
sternal tenderness
anterior mediastinal masses
petechiae/purpura
mucus membrane bleeding
fundal hemarrhage
CNS involbement
ARF
Airway management w/ ALL:
diagnosis of ALL is made how
demostration of 20% lymphoblasts in teh bone marrow
Airway management w/ ALL:
in kids why is there a difficult airway?
> compression of upper airway and inability of narrower lumen to accomadate edema =airway obstruction
Airway management w/ ALL:
what med has been used w/o abx in oropharyngeal obstruction
Dexmethasone
Society for ambulatory ……. Management of PONV:
can antiemetic prophylaxis eliminate PONV
nope but it can reduce it
Society for ambulatory ……. Management of PONV:
sorry McD but 5-HT3 receptor antagonist are more effective in prophylaxis when given when
at end of sx
Society for ambulatory ……. Management of PONV:
decadron is recomended at a dose of ___ at the induction to decrease PONV
4 mg
Society for ambulatory ……. Management of PONV:
adults at a _____ risk for PONV should receive combination therapy w/ oone or more prophylactc drugs from different classes
moderate
Society for ambulatory ……. Management of PONV:
when a rescue therapy is needed what type of antiemetic should be given
one from a defiierent class than used for prophylaxis
Society for ambulatory ……. Management of PONV:
if PONV occurs w/in ___ hours postop pts should not receive a repeat dose of prophylactic antiemetic
6 hours
Society for ambulatory ……. Management of PONV:
if it has been more the ____ hours an emetic episode can be treated w/ any of the g=drugs used for prophylaxis except decadron and scopolamine
6
Society for ambulatory ……. Management of PONV:wh
at are the pt specific risk factors
- female
- Nonsmoker
- hx of PONV
- Motion sickness
Society for ambulatory ……. Management of PONV:
what are anesthestic risk factors
VAAS
N2O
intrap/postop opioids
Society for ambulatory ……. Management of PONV:
what are surgical risk factors
- Duration of sx (each 30 min increases risk by 60 %)
- type of sx (lap, laparotomy, breast, stribismus, plastic sx, maxillofacial, gyn, abd, neuro, opthalmic, and uro)
Anticancer…anesthesia implications:
Chemo agents can cause ____ and _____ complications in the lungs
pneumontis and
Pulmonary fibrosis
Anticancer…anesthesia implications:
what is a red flag for the development of pneumonitis and pulm fibrosis
dyspnea at rest
Anticancer…anesthesia implications:
pt’s eho had bleomycin should not receive ____ inspired O2 and _____ (a type of fluids) should be used during and after sx
high
Colloids
Anticancer…anesthesia implications:
____toxicity occurs w/ most anticancer drugs
hepatotoxicity
Anticancer…anesthesia implications:
what drug class can reduce the excretion of methotrexate
NSAIDs
Anticancer…anesthesia implications:
________ causes central and autonomic nervous sytem toxicity and peripheral neuropathies thus regional anesthesia is contraindicated
Vincristine
Renal:
the thick ascending loop gets close to the glomerulus (cortex) and cuddles next to the afferent arteriole. thsi part of the loop is called the what?
MACULA DENSA
Renal:
the macula densa has specialized cells and the arteriole has specialized cells and together these celles are called the what
juxtaglomerular apparatus
Renal:
the juxtaglomerular apparatus has an important role in the excretion of what?
renin
Renal:
renin secretion is stimulated by what 2 things
- renal hypoperfusion
- SNS stimulation
Renal:
what are the 2 major systemic effects of ATII
- systemic vasoconstriction
- by enhancing NE release
- Na+ and H20 retention
Renal:
aldosterone is released from where?
the adrenal cortex
particulary the zona glomerulose
Renal:
in the collecting tubules there is 2 type of cells?
- principle cells
- reabsorb Na+, Cl-, and secrete K+
- Intercalated Cells
- secrete H+ or HCO3 and reabsrb K+
that is I am done there is more but I am done with flash cards for this test I am whooped
shoot me in the head
