Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Basics > BASICS Exam 2 > Flashcards

BASICS Exam 2 Flashcards

1
Q

what is normal daily fluid volume required to maintain total body water

A

25-35 ml/kg (2-3L)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how much weight does total body water make up in the body

A

60% (40L)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is total body water volume

A

40L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the breakdown of total body water in intracellular fluid vs extrracellular fluid

A

intracellular= 25L (40% of total body weight)

extracellular= 15L (20% of body weight)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the breakdown of extracellular fluid volumes

A

interstitial fluid= 12L (80%)
plasma= 3L (20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the four transcapillary pressures (starling)

A

interstitial hydrostatic
plasma
interstitial osmotic
capillary hydrostatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is a problem with crystalloids

A

dont always stay in intravascular
Stay in intravascular space for roughly 30 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the four groups of crystalloids

A

balanced
isotonic
hypertonic
hypotonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is a balanced crystalloid

A

LR
plasmalyte
normosol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what solution is nearly isotonic but slightly hypertonic

A

normal saline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

why is NS slightly hypertonic

A

contains more chloride than extracellular fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is a hypertonic crystolloid

A

3% saline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is a hypotonic crystalloid

A

0.45% saline
d5w

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how much of crystalloid remains intravascular and where does the other 2/3 go

A

1/3 intravascular- interstitial compartments (3rd space)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is not an optimal choice if you need to replace a lot of volume

A

crystalloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how much Na in 1L bag NS

A

9g per liter (0.9g per 100ml)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what can giving more than a couple of liters of ns lead to and why

A

acidosis

too much chloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how long does it take a normal adult to excrete 2L NS

A

2-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

why is ns indicated as a replacement fluid in someone with renal failure

A

doesn’t have potassium like LR does

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

in what instances is NS preferred over LR

A

brain injury

hypochloremic metabolic alkalosis

hyponatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what solution is ideal to dilute RBCs

A

NS bc it is nearly isotonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what solution can cause hemolysis at the point of injection

A

3% saline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

which solution function as free water and why

A

D5W
dextrose is metabolized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

which solution is iso-osmotic

A

D5W

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

which fluids are large molecular weight substances

A

colloids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

when should you not give albumin and why

A

sepsis-

capillary membranes enlarge so large molecules go outside of vessel, creating osmotic pressure difference outside of vessel, so then albumin pulls water extra-vascular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

under normal conditions, what fluid will not third space like ns does

A

albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what fluid should you not give in sepsis

A

albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are two conditions to avoid giving propofol

A

aortic stenosis
sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is a condition to avoid giving ketamine

A

head injury

Ppt said ok just give small doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are the risks with dextran

A

anaphylaxis,
reactions with blood products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is the Donnan effect

A

increased plasma osmolality and intravascular volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the effect by which albumin works

A

Donnan effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what can happen in you given propofol in an already intravascularly depleted patient

A

decreased bp
decreased perfusion of organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what does propofol decrease in cardiovascular

A

decreases:
svr
cardiac contractility
preload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what does ketamine increase in cardiovascular

A

increases:
bp
hr
co

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what anesthetic med stimulates sns and inhibits reuptake of norepinephrine

A

ketamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what anesthetic med decreases svr and mildly depresses cardiac contractility and function

A

inhaled anesthetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

which anesthetic gas decreases svr the most/least

A

most= isoflurane
least=desflurane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is go to anesthetic for sick patient

A

etomidate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what effect does positive pressure ventilation have on preload

A

decreases preload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

how does positive pressure reduce preload

A

increases intrathoracic pressure which squeezes heart, has a tamponade effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what is imperative when giving neuraxial anesthesia to a intravascular depleted patinet

A

fluid administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

does neuroaxial anesthesia block PNS or SNS fibers

A

SNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what kind of muscle does neuraxial anesthesia affect in vasculature

A

smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what does neuraxial anesthesia cause dealing with heart and vasculature

A

vasodilation,
decreased preload,
pooling of blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

does positive pressure increase or decrease preload

A

decreases preload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what needs to be taken into account when calculating fluid defecit

A

npo defecit (maintenance rate x fasting hours)
maintenance fluid
evaporative loss
blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

when do you add an additional 1L of fluid to fluid deficit calculation

A

colon prep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what are the ways to assess fluid status

A

vitals: bp/hr
urine output- not accurate
labs
cvp- only half are fluid responsivewhat
skin turgor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what labs monitor fluid status

A

HCT
BUN/creatinine
ABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what is normal urine output

A

0.5ml/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what effect can anesthesia have on urine output

A

decrease it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

true/false: MAP is a reliable index of volume status

A

FALSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what does the 4 in 4-2-1 stand for

A

0-10 kg: 4ml/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what does 2 in 4-2-1 represent

A

11-20 kg: 4ml/kg/hr + 2ml/kg/hr (for every kg >10)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what does 1 in 4-2-1 represent

A

greater than 20kg: 4ml/kg/hr + 2ml/kg/hr (for every kg >10) + 1ml/kg/hr (for every kg > 20)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what is an easy way to calculate fluid requirement for weight >20kg

A

60ml + 1ml/kg/hr >20kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what does 4-2-1 rule calculate

A

maintenance fluid required per hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what calculating fluid replacement, what 4 areas should be considered

A

maintenance fluid (4-2-1)
fluid deficit (maintenance x fast hours)
evaporative (surgical) loss
blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what is the calculation for estimated npo deficit

A

maintenance fluid x fasting hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what is replacement for superficial trauma such as orofacial

A

1-2 ml/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what is replacement for minimal trauma such as herniorraphy

A

2-4 ml/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what is replacement for moderate trauma such as laparascopic abdominal surgery

A

4-6 ml/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what is replacement for severe trauma such as major open abdominal surgery

A

6-8 ml/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

how much crystalloid should be given for blood loss

A

3 ml given for every 1ml blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

how much colloid or blood is given for blood loss

A

1ml for 1ml lost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what is maintenance fluid calculation

A

4-2-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

what is the breakdown for iv maintenance in first hour

A

1/2 NPO + hourly maintenance + estimated blood loss + evaporative loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

what is the breakdown for iv maintenance in second hour

A

1/4 NPO + hourly maintenance + estimated blood loss + evaporative loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what is the breakdown for iv maintenance in third hour

A

1/4 NPO + hourly maintenance + estimated blood loss + evaporative loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

how long does it take to catch up with npo defecit

A

after 3rd hr is completed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

a 65kg patient has been npo for 8 hours undergoing colon resection
ebl first hour= 50ml
ebl second hour = 75ml
ebl third hour= 100ml

A

Hourly maintenance= 60 + 1ml/kg/hr (45)= 105ml
NPO deficit= 105x8 (fasting hours)= 840ml
evaporative loss= major abdominal surgery= 8x65kg= 520
blood loss= 50x3 for 1st, 75x3 for 2nd, 100x3

1st hour= 420 (1/2 npo) + 105 (HM) + 150 (blood loss) + 520 (evap loss) = 1195ml
2nd hour= 210 (1/4 npo) + 225 (HM) + 225 (blood loss) + 520 (evap loss) = 1060ml
3rd hour= 210 (1/4 npo) + 300 (HM) + 300 (blood loss) + 520 (evap loss) = 1135 ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what does evaporative loss depend on

A

type of surgery- more invasive surgery=more evaporative loss= more replacement fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

what law states that as you stretch fibers of the heart you get a more forceful contraction

A

frank starling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

what should be administered to determine preload dependance or independence

A

200-250ml of fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

when giving small volumes of fluid to determine preload, what curve are you assessing the patient’s position on

A

frank starling curve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

what happens when cardiac output and left ventricular end diastolic pressure get too high

A

pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

which quadrant is the safe zone on the frank starling curve graph

A

upper left

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

what are the x and y axis of the frank starling graph

A

x= lvedp
y= cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what does the top right quadrant on frank starling curve graph represent

A

normal cardiac ouptut, raised left atrial pressure leading to pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

which quadrant on frank starling curve graph represents shock

A

bottom left- low cardiac output, low lvedp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

which quadrant on frank starling curge graph represents shock and pulmonary edema

A

bottom right- the most dangerous- low cardiac output but raised left ventricular end diastlopic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

how often should preload responsiveness and oxygen delivery be assessed in perioperative goal directed therapy

A

5-10 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is included in the eras fluid management protocol

A

clear liquids up to 2 hours before surgery
avoid bowel prep
avoid excess fluid admin during intraoperative phase
bolus 250-500 ml crysalloid/colloid or vasopressor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what can excessive fluid administration during intraoperative phase contribute to

A

edema of gut, prolonged ileus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

what monitors should you look at for blood loss

A

bp,
hr,
urine output,
ekg,
o2,
abg,
pulse contour,
echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

what should you listen for blood loss

A

suction
surgeon
SpO2 alarm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

what should you look for blood loss

A

suction
sponges
drapes
floor
surgeons gown
arterial spray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

how many cc’s of fluid is in a 1/4 saturated dry lap

A

10cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

how many cc’s of fluid is in a 1/2 saturated dry lap

A

20cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

how many cc’s of fluid is in a 3/4 saturated dry lap

A

40cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

how many cc’s of fluid is in a full saturated dry lap

A

100cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

how many cc’s of fluid is in an over saturated dry lap

A

110 cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

how many cc’s of fluid is in a 1/2 saturated wet lap

A

10cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

how many cc’s of fluid is in a 3/4 saturated wet lap

A

30cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

how many cc’s of fluid is in a full saturated wet lap

A

40-50cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

how many cc’s of fluid is in an over saturated wet lap

A

60cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

how many cc’s of fluid is in a 3/4 saturated dry 4x4

A

5cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

how many cc’s of fluid is in a fully saturated dry 4x4

A

10cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

how many cc’s of fluid is in an oversaturated dry 4x4

A

10cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

how many cc’s of fluid is in a fully saturated wet 4x4

A

5cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

how many cc’s of fluid is in an oversaturated wet 4x4

A

5cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

s/s of 10% blood loss

A

thirst
vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

s/s of 50% blood loss

A

coma
death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

what fluid should blood loss be replaced with

A

crystalloid
colloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

what are the three things the decision to transfuse blood should be based on

A

monitor for blood loss
monitor for transfusion indicators
monitor for inadequate perfusion/oxygenation of vital organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

how long can you replace blood loss with crystalloid/colloid for

A

until danger of anemia or depletion of coagulation factors necessitates administration of blood products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

why do you start with sweating in blood loss

A

trying to concentrate blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

what is blood volume of premature infant at birth

A

90-105ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

what is blood volume of term newborn infant

A

80-90 ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

what is blood volume of infant less than 3 months

A

70-75ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

what is blood volume of child-adult male

A

70ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

what is blood volume of child-adult female

A

65ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

what is blood volume of obese

A

lean body weight plus 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

what is the formula for lean body weight

A

bmi (using ibw) x ht (m2

Ideal body weight x 1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

what is the formula for bmi

A

weight (kg) / height (m^2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

what is the formula for max allowable blood loss

A

estimated blood volume x (orginal hct- lowest acceptable hct/original hct)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

in a healthy individual, what is the lowest acceptable hematocrit

A

21 (7hbg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

in a sick (asa 3-4) individual, what is the lowest acceptable hematocrit

A

30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

what are some questions you could ask before deciding to transfuse

A

are they symptomatic,
are their vitals being affected,
do they have aortic stenosis or other pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

an 80kg man with a preoperative hct of 40% could lose how much blood and still maintain a hematocrit of 30%

A

80x 70ml/kg= 5600 (40-30/40)= 1400ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

what is the universal PLASMA donor

A

AB pos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

what is the universal red cell donor

A

o neg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

what blood type has group a antigen on red cells and b antibody in plasma

A

group A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

what blood type has group b antigen on red cells and a antibody in plasma

A

group B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

what blood type has group a and b antigen on red cells and neither antibody in plasma

A

AB group

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

what blood type has group has neither a or b antigen on red cells and both a and b antibody in plasma

A

group O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

what are agglutinins

A

Antibodies that will attack antigens on RBC’s of a different blood type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

what blood type is the universal recipient

A

AB+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

after how many units of blood should you start thinking about replacing clotting factors

A

2-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

what is an electrolyte that is lacking when you give several units of blood and why

A

calcium

citrate from blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

when are rh antibodies produced

A

2-4 months after first exposure to rh antigens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

when does rh sensitization occur

A

rh positive blood in an rh- person

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

what is the preventative medication for mom for hemolytic disease of newborn

A

rho-gam (anti D, IgG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

when should rho gam be given

A

28 weeks of pregnancy and 72 hours after childbirth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

what is hemolytic disease of the newborn

A

in rh- mom and rh+ baby, RHD enters mom and sensitizes mom to form rhd antibody.

In subsequent pregnancy, rhd antibody cross placenta and cause hemolysis of rh+ blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

what are the components of blood

A

RBCs
platelets
FFP
cryo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

what blood product is used for anemia with surgical blood loss

A

PRBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

how much will 1 unit of prbc increase hct

A

3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

how much will 1 unit of prbc increase hgb

A

1g/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

what is the major goal of prbc administration

A

increase o2 carrying capacity of blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

what ion imbalances can be caused by mtp

A

hyperkalemia-
hypocalcemia- from citrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

what factors are absent in rbc

A

Factor V
Factor VIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

is prbc acidic or alkalotic

A

acidic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

after how many days of refrigerated storage are viable platelets no longer found in prbc

A

2 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

what is ratio for blood loss replacement with crystalloid vs blood (colloid)

A

crystalloid: 3:1
colloid: 1:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

what platelet count should you considered transfusion of platelets

A

less than 50,000 cells/mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

when would you give for platelet count higher than 50,000

A

use of perfusion pump, which uses all of platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

how many cc’s are in prbc

A

250-300cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

what is blood product used for thrombocytopenia

A

platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

what is not present in ffp

A

platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

which coagulation factors are in ffp

A

all of them except platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

when is the only time you should give ffp during surgery

A

when pt or ptt is at least 1.5 x greater than normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

what is a normal pt and ptt

A

PT: 11-16

PTT: 35-40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

what blood product is given for hemophilia A

A

cryoprecipitate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

what factors are in cryoprecipitate

A

1
8
13
vWF
Protein C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

what blood product is given for hypofibrinogenemia

A

cryoprecipitate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

what has more fibrinogen, cryo or ffp

A

cryo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

on frank starling graph, what causes hypertensive pulmonary edema

A

high co and high ledvp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

on frank starling graph, what causes low cardiac output pulmonary edema

A

decreased co, high ledvp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

on frank starling graph, what causes low cardiac output

A

decreased co, low ledvp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

what are most common complications of transfusions

A

bacterial contaminants,

transfusion related lung injury,

abo mismatch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

what are two least common but most feared complications of transfusions

A

infectious disease transmission (hiv or hepatitis)
hemolytic transfusion reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

what is TRALI

A

transfusion related acute lung injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

what is a respiratory distress syndrome occuring within 6 hours of transfusion of prbc or ffp

A

TRALI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

signs and symptoms of TRALI

A

dyspnea

hypoxemia secondary to non cardiogenic pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

how is a diagnosis of trali confirmed

A

pulmonary edema in absence of left atrial htn
pulmonary fluid is high in protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

what is the treatment for trali

A

stop transfusion
treat vitals
sample pulmonary edema and analyze for protein
cbc and chest xray
notify blood bank

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

what are the labs and imaging for trali

A

CBC
CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

what is the single most common transfusion reaction

A

fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

what causes a transfusion reaction fever

A

interaction between patient antibodies and antigens on donor leukocytes/platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

what is treatment for transfusion reaction fever

A

slow infusion,
give antipyretics,
possible d/c infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

what are transfusion allergic reaction s/s

A

increased body temp,
urticaria,
pruritus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

what is treatment for transfusion allergic reaction

A

antihistamines, d/c if necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

what is treatment for hemolytic reaction in transfusion

A

immediate d/c
maintain urine output via crystalloid, mannitol, lasix

Alkalinize urine with sodium bicarb
Send urine/plasma hgb samples to lab
Check platelets, pt and fibrinogen
Send blood back to lab
Support hemodynamics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

what blood type can ab- receive

A

o-,
b-,
a-
ab-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

what blood type can a+ receive

A

o-,
o+,
a-,
a+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

what blood type can a- receive

A

O-
A-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

what blood type can b+ receive

A

O-
O+
B-
B+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

what blood type can b- receive

A

O-
B-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

what kind of blood type can O+ receive

A

O-
O+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

what blood type can o- receive

A

O-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

what are the three types of transfusion reactions

A

immune mediated (hemolytic)
fever (non-hemolytic)
allergic (non-hemolytic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

what reaction can occur when wrong blood type is given

A

hemolytic reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

what does hemolytic reaction usually damage

A

kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

what can mask immediate signs of hemolytic reaction

A

GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

what is evidence of hemolytic reaction

A

free HgB in plasma or urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

when can symptoms appear for hemolytic reaction

A
  1. trali
  2. hemolytic transfusion reaction
  3. transfusion associated sepsis
  4. taco
  5. babesiosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

how is acute renal failure manifested in the kidney in hemolytic reaction

A

hemolyzed rbc in distal tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

what are symptoms of immune mediated transfusion reaction

A

shock,
chills,
fever,
sob,
renal failure,
dic,
trali

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

how long will a person live with complete unresolved renal shutdown

A

7-12 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

what are the 3 causes of a transfusion reaction causing kidney shutdown

A
  1. toxicity from hemolyzing blood causes renal vasoconstriction via hgb binding most nitric oxide
  2. loss of circulating rbc’s + toxins cause circulatory shock
  3. holes are made in rbc by antigen-antibody reaction, hgb leaks out of holes, too much hemoglobin for haptoglobin to break down leads to hgb in glomerular filtrate, when hbg builds up and h2o is reabsorbed, hgb blocks kidney tubules
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

what does haptoglobin do

A

finds free hemoglobin and binds to it in order to recycle it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

what are some s/s of circulatory shock during transfusion reaction that can cause kidney shutdown

A

arterial bp/renal blood flow/urine output bottom out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

what is the process for acute normovolemic hemodilution (autologous donation)

A
  1. pull of 1-2 units of blood
  2. replace blood with crystalloid and colloids
  3. reinfuse blood at end of surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

what are the four strategies to conserve blood

A

intraoperative rbc salvage
rbc alternatives
preop preparation
preoperative autologus donation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

when doing normovolemic hemodilution, what should hct stay above

A

27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

when should you not used rbc salvage- 4 instances

A

cancer
sepsis
c-section (because of amniotic fluid)
any contaminated blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

what are the 3 basic mechanisms for stopping blood loss

A

vascular spasm/vasoconstriction
platelet plug formation
blood clotting (coagulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

what is a fibrin thread formation made up of

A

fibrin molecules combine to form long threads to entangle platelets–building a spongy mass which gradually hardens to form clot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

what is the average time for a clot retraction to happen

A

20-60 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

what are the 5 steps for clot formation

A
  1. severed vessel
  2. platelets agglutinate
  3. fibrin appears
  4. fibrin clot forms
  5. clot retraction occurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

what does platelet activation lead to

A

clot formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

what does platelet dysfunction lead to

A

bleeding problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

what three things does activation of platelets cause

A

release of clotting factors
release of inflammatory mediators
shape change that makes platelets stick to damaged site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

how many days should plavix be d/c before surgery

A

7-10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

when happens to platelet when it is activated

A

changes shape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

where are platelets formed

A

bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

normal platelet level

A

150,000-400,000 microliters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

what helps platelets to become active

A

adp
thromboxane a2
type 4 collagen,
thrombin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

what is megakarycocyte and platelet production regulated by

A

thrombopoietin- produced in liver and kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

where is thrombopoietin produced

A

liver and kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

another name for platelet

A

thrombocyte

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

where does a platelet come from

A

fragment of precursor megakaryocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

where is the hormone produced that regulates megakarycotye and platelet production

A

liver and kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

where are platelets sequestered and how much

A

spleen- 30% by macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

what is the life span of a platelet

A

10 days
8-12 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

true or false: platelet has a nucleus

A

FALSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
220
Q

how big is a platelet

A

2-4 micrometers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
221
Q

which one of fibrinogen and fibrin is soluble and which one is insoluble

A

fibrinogen-soluble
fibrin= insoluble

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
222
Q

what are the three mechanisms of hemostasis

A

vascular spasm
platelet plug formation
blood clotting (coagulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
223
Q

what are the steps to platelet plug formation

A
  1. platelet adhesion
  2. platelet release reaction aka degranulation
  3. platelet aggregation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
224
Q

what are the two things that happen during platelet release reaction

A

change of shape
spill contents of granules (alpha and dense)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
225
Q

what is contained in alpha granules of platelet

A

platelet factor 4
transforming growth factor beta 1
platelet derived growth factor
fibronectin
b-thromboglobulin
vwf
fibrinogen
labile factor, antihemophilic factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
226
Q

what activates factor 2 into factor 2a

A

factor 10a,
5a,
calcium

activate prothrombinase which acts with platelet phospholipids and calcium to turn 2 into 2a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
227
Q

what organizes strands of factor 1a

A

factor 13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
228
Q

what converts fibrinogen to fibrin

A

thrombin and Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
229
Q

what is contained in the dense granules of platelets

A

adp/atp
calcium
serotonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
230
Q

what is also present during platelet release reaction that is not in alpha or dense granules

A

thromboxane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
231
Q

what is the extrinsic pathway initiated by

A

tissue factor from injured tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
232
Q

what is the intrinsic pathway stimulated by

A

contact with negatively charged surface (collagen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
233
Q

what retracts clot to pull skin together

A

actin and myosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
234
Q

what kind of feedback mechanism does clot formation operate under

A

positive feedback

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
235
Q

what helps to dissolve clots

A

plasmin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
236
Q

True or false: plasminogen is circulating at all times

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
237
Q

What converts plasminogen to plasmin?

A

tissue plasminogen activator (tPA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
238
Q

what prevents clots from spontaneously forming along epithelium

A

prostacyclin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
239
Q

what converts fibrinogen to fibrin

A

thrombin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
240
Q

what is the combination of phsopholipids and tissue factor

A

thromboplastin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
241
Q

in the extrinisic pathway, what factors activate factor 10

A

3 and 7a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
242
Q

in the intrinsic pathway, what factors activate factor 10

A

8a and 9a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
243
Q

what is factor 1 and 1a

A

fibrinogen-fibrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
244
Q

what is factor 2 and 2a

A

prothrombin and thrombin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
245
Q

what is factor 3

A

tissue thromboplastin
aka tissue factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
246
Q

what is factor 4

A

calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
247
Q

what is factor 5

A

labile factor- proacclerin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
248
Q

what is factor 7

A

stable factor
prothrombin conversion accelerator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
249
Q

what is factor 8

A

anti hemophilic factor
globulin or factor A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
250
Q

what is factor 9

A

christmas
plasma thromboplastin component
AHF B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
251
Q

what is factor 10

A

stuart factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
252
Q

what is factor 11

A

plasma thromboplastin antecedent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
253
Q

what is factor 12

A

hageman factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
254
Q

what is factor 13

A

fibrin stabilization factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
255
Q

what is prekallikren

A

fletcher factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
256
Q

what is high molecular weight kininogen

A

Fitzgerald factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
257
Q

what is a major clotting factor without a name at the very end of the list

A

platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
258
Q

what converts protein c and thrombomodulin to active protein c

A

protein S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
259
Q

what do protein c and thrombomodulin make

A

active protein C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
260
Q

what is active protein c made of

A

protein C and thrombomodulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
261
Q

what are the two places that active protein c works

A

inhibiting factor 8 to factor 8a
inhibiting factor 5 to factor 5a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
262
Q

what is the cell surface receptor for factor 7a in presence of calcium

A

tissue factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
263
Q

under what condition do endothelia cells express tissue factor

A

exposure to inflammatory molecules such as tumor necrosis factor alpha

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
264
Q

what three cells express tissue factor

A

endothelial cells
platelets
monocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
265
Q

what inflammatory molecule causes endothelia cells to express tissue factor

A

tumor necrosis factor alpha

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
266
Q

what is necessary for the formation of tissue factor-factor 7 complex

A

calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
267
Q

what is necessary for the formation of factor 7a

A

factor 7
tissue factor
calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
268
Q

what converts factor 7 into factor 7a

A

tissue factor (3) which gets released through trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
269
Q

what is necessary for the formation of factor 10a in the extrinsic pathway

A

factor 7a and Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
270
Q

what is expressed by cells which are not normally exposed to flowing blood, when they are exposed to blood

A

tissue factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
271
Q

what is an example of a endothelial cell that is not normally exposed to flowing blood

A

smooth muscle cells
fibroblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
272
Q

which two steps in the intrinsic pathway do not require calcium

A

12 converting to 12a
12a converting 11 to 11a

273
Q

besides the first two steps in the intrinsic pathway, what is required to promote or accelerate all blood clotting reactions

A

Ca

274
Q

what is total calcium range

A

8.5 to 10.2 mg/dl in plasma

275
Q

which top has heparin to inactivate thrombin

A

green

276
Q

which top has citrate to bind to calcium to inhibit clotting

A

blue

277
Q

what is the speed of the extrinsic vs intrinsic pathway

A

extrinsic= 15 secs
intrinsic= 1-6 mins

278
Q

which pathway generates a thrombin burst

A

extrinsic

279
Q

how are simultaneous and congruent pathways created in clotting cascade

A

tissue damage= extrinsic
collagen contact with factor 12 platelets
-both happening at same time

280
Q

what is clinical relevance of thrombocytopenia

A

increased risk of bleeding

281
Q

which patient type has a higher incidence of coagulation prolongation

A

trauma patients

282
Q

which unit has the most patients with prolonged pt or aptt

A

icu
trauma specifically

283
Q

what patients are elevated fibrin split products often detectable in

A

sepsis
trauma
icu

284
Q

what illness does elevated fibrin split products manifest in 99% of patients

A

sepsis

285
Q

what is an example of a fibrin split product

A

d dimer

286
Q

what are fibrin split products aka fibrin degradation products

A

left over protein after blood clot dissolves- indicate a thrombotic event such as DIC or thrombosis

287
Q

what patients are low levels of coagulation inhibitors (antithrombin and protein c) found in

A

trauma and sepsis

288
Q

name two coagulation inhibitors mentioned in the clotting cascade slides

A

protein C
antithrombin

289
Q

what are two coagulation defects often seen in sepsis patients

A

elevated fibrin split products

low levels of coagulation inhibitors

290
Q

what does elevated fdp indicate

A

thrombotic event

291
Q

what does fdp stand for

A

fibrin degradation products (aka fibrin split products)

292
Q

what two things are consumed during dic which cause bleeding

A

platelets and coagulation factors

293
Q

what is caused by systemic intravascular activation of coagulation

A

DIC

294
Q

what is formed and activated in dic

A

formed= microvascular thrombi
activated= inflammation

295
Q

what can dic lead to

A

organ dysfunction

296
Q

what five factors lead to dic

A

inflammatory cytokines
tissue factor expression
fibrinolysis suppression
intravasculars fibrin formation
platelet and coagulation factor consumption

297
Q

what happens to fibrin, platelets, and coagulation during dic

A

fibrin, platelets, and coagulation factors are used intravascularly to make clots–>microvascular thrombosis and bleeding

298
Q

what patient population is at risk for vitamin c deficiency

A

elderly and alcoholics

299
Q

what deficiency is characterized by bleeding gums, nosebleeds, bruising easily

A

vitamin C

300
Q

what vitamin deficiency causes weak blood vessel walls due to lack of stable collagen

A

vitamin C

301
Q

what kind of organ failure leads to bleeding disorders

A

hepatic failure

302
Q

what clotting factors need vitamin K

A

prothrombin,
7,
9,
10,
protein s, c, and z

303
Q

what is released in massive amounts during DIC

A

thromboxane a2

304
Q

what kind of malabsorption can cause vitamin k defiency

A

fat

305
Q

what is a fat soluble vitamin

A

vitamin K

306
Q

what factor is hemophilia a associated with

A

8

307
Q

what factor is hemophilia b associated with

A

9

308
Q

what does vWF bind

A

platelets
factor 8

309
Q

what is platelet count in thrombocytopenia

A

less than 50,000 microliters

310
Q

what is a test you should check before neuraxial anesthesia with thrombocytopenia and pregnancy

A

platelet level

311
Q

what diseases does the body make antibodies against platelets

A

idiopathic thrombocytopenic purpura
lupus
rheumatoid arthritis

312
Q

what diseases results from premature destruction of rbc which clog the kidneys and low platelet count

A

hemolytic uremic syndrome

313
Q

what is the most common coagulation defect overall

A

vw disease

314
Q

what anticoag is more predictable with fewer side effects

A

LMWH

315
Q

what is an example of a direct thrombin inhibitor

A

dabigatran, argatroban, bivalirudin

316
Q

what is white clot syndrome, when heparin stimulates formation of antibody to platelets

A

HIT

317
Q

what medication depresses 2, 7, 9, 10

A

warfarin

318
Q

what medication competes with vitamin k for binding sites

A

warfarin

319
Q

how much clotting function remains after 12 hours of warfarin

A

50%,

20% after 24 hours

320
Q

how many minutes can heparin increase clotting time

A

6-30 min

321
Q

how long does heparin last for

A

1.5-4 hrs

322
Q

what does heparin activate

A

antithrombin 3, which blocks thrombin

323
Q

what blood test measures intrinsic and common pathways

A

partial thromboplastin time

324
Q

what is normal ptt

A

25-39 sec

325
Q

what blood test measures extrinsic pathway

A

PT/INR

326
Q

what is normal pt/inr and inr on coumadin

A

pt= 10-16
inr= 0.8-1.2
therapeutic inr= 2-3

327
Q

what is minimum safe act for ecmo or cp bypass

A

300sec

328
Q

what is normal act

A

70-120sec

329
Q

what test assess platelet function

A

bleeding time

330
Q

what is normal bleeding time

A

1-6 min

331
Q

what activates factor 10 into factor 10a on the intrinsic pathway

A

8a and 9a

332
Q

what activates factor 10 into factor 10a in the extrinsic pathway

A

7a
Ca

333
Q

when do endothelial cells express tissue factor

A

Trauma unless exposed to inflammatory factors

334
Q

what is a segment of fdp that can indiciate dic

A

d dimer

335
Q

what are some triggering factors of dic

A

sepsis
amniotic fluid embolus

336
Q

what are there massive amounts of in blood during dic

A

thromboxane a2

337
Q

what are some treatment meds for-amniotic-fluid-embolism

A

zofran
toradol
tylenol

338
Q

what is a good blood product for hemophilia a

A

cryo

339
Q

what is the primary cation and anion of ecv

A

cation= sodium
anion= chloride

340
Q

what is the primary cation and anion of icv

A

cation= potassium
anion= phosphate

341
Q

what is standard fluid intake for normal person

A

2-3 L

342
Q

what is fluid exchange between extracellular compartments largely dependent on

A

starling forces

343
Q

plasma concentration

A

na 142
k 4
cl 103
phos 1.4
mag 2
ca 5
ph 7.4
mosm 291

344
Q

plasmalyte concentrations

A

na 140
k 5
cl 98
mag 3
acetate 27
gluconate 23
ph 7.4
mosm 294

345
Q

LR concentration

A

na 130
k 4
cl 110
ca 3
lactate 28
ph 6.2
mosm 275

346
Q

NS concentration

A

na 154
cl 154
ph 5.6
mosm 310

347
Q

what kind of acidosis can NS lead to

A

hyperchloremic metabolic acidosis

348
Q

what lab test can Na increase on ABG

A

base excess

349
Q

what can high levels of chloride from ns admin lead to

A

decreased GFR

350
Q

what patient would LR not be indicated for and why

A

diabetic- because byproduct of lactate metabolism is gluconeogenic

TBI- hypotonic may increase edema

Citrate containing products- risk of coagulation because LR has calcium

351
Q

true or false: LR is mildly hypertonic

A

FALSE
hypotonic

352
Q

t or f: plasmalyte, normosol, and isolyte can be used with blood

A

TRUE

do not have Ca

353
Q

what conditions should albumin be avoided

A

sepsis
hyperglycemia

354
Q

where are catecholamines released from

A

adrenal medulla

355
Q

what 3 measurements are NOT accurate indicators of fluid volume status

A

MAP
CVP
urine output

356
Q

what happens in-response-to left ventricular preload increasing and what describes it

A

increases myocardial contractility- frank starling mechanism

357
Q

what are the goals of eras

A

-optimal fluid therapy
reduce stress response from surgery

non-opioid pain modalities
maintain baseline organ function post procedure
decrease complications and accelerate recovery

358
Q

how can you improve optimization of colorectal surgery patient preoperatively according to eras

A

carbohydrate drink up to 2 hours prior to surgery
avoid mechanical bowel prep

359
Q

what can excess fluid intraoperatively lead to

A

edema of gut wall and prolonged ileus

360
Q

what is a serious risk with hyponatremia

A

cerebral edema

361
Q

what is usually the cause of hypernatremia

A

inadequate water intake

362
Q

what can using a cell saver for a lot of blood replacement lead to

A

thrombocytopenia- need to replace clotting factors

363
Q

what blood product would you give for hypofrinogenemia

A

cryo

364
Q

what blood product would you give for thrombocytopenia or platelet function defects

A

platelets

365
Q

what blood product should be given for reverseal of anticoagulatn effects

A

FFP

366
Q

what blood product would you give to reverse vitamin k deficiency or warfarin

A

FFP

367
Q

what are s/s of delayed hemolytic reactions from blood transfusion

A

jaundice, hemoglobinuria, anemia

368
Q

what are s/s of nonhemolytic transfusion reaction

A

fever
chills
urticaria

369
Q

what are s/s of acute hemolytic reaction

A

hypotension
hemoglobinuria
hemorrhagic episode

370
Q

what is most common cause of transfusion related deaths

A

trali- transfusion associated acute lung injury

371
Q

what is key to address during golden hour of trauma

A

blood loss- need blood to pump o2 to damaged tissue

soft tissue injury- inflammation from trauma

372
Q

what is leading cause of death before age 45

A

trauma

373
Q

after how much blood loss will patient die/go into coma

A

50%

374
Q

which survey is involved with assessing abcde

A

primary survey (resuscitation phase)

375
Q

what is abcde in trauma

A

airway
breathing
circulation
disability
exposure

376
Q

what is involved in secondary survey of trauma

A

after patient is stabilized:
-head to toe assessment
-internal injuries of chest/abdomen/musculoskeletal
-diagnostic studies

377
Q

what test definitively rules out c spine injury

A

ct scan

378
Q

what is involved in tertiary survey

A

avoiding missed injuries
occurs within 24 hours
another head to toe exam
identify every injury

379
Q

what should be initially assumed in every trauma

A

cervical spine injury

380
Q

what should be avoided with airway during c spine precautions

A

jaw thrust maneuver- neck hyperextension

381
Q

in what kind of fracture should nasal intubation or ng tubes be avoided

A

basilar skull fracture

382
Q

what are some ways to secure airway while in c psine

A

ett with in line stabilization during laryngoscopy
nasal intubation
fiberoptic in spontaneously breathing
trach

383
Q

what are the three main ways of intubating during c spine preacuations

A

video laryngoscopy

awake or asleep fiber optic

light wand

384
Q

what is an ion side effect of succinlycholine

A

hyperkalemia

385
Q

why should you avoid succ in trauma patients after 24 hours through 1 year

A

Lethal increase potassium

386
Q

where is a needle decompression performed

A

2nd intercostal space- 14 gauge

387
Q

what is beck’s triad and what does it diagnose

A

JVD, muffled heart sounds, hypotension

diagnoses cardiac tamponade

388
Q

what can flail chest cause in the heart

A

tamponade

389
Q

what is cushings triad

A

hypertension,
bradycardia,
bradpynea

390
Q

why does bp get high and hr get low in cushing’s triad

A

trying to perfuse brain-
so hering’s nerve stimulates brain for hr to get lower to compensate signaling via vagus nerve

391
Q

what two nerves are associated with cushing’s triad responses

A

herings nerve
vagus nerve

392
Q

what are the characteristics of stage 1 shock

A

15% blood loss- <750 ml
normal: pulse, bp, rr, pp, urine output
cns- slightly anxious
fluid replacement 3:1 crystalloid

393
Q

what are the characteristics of stage 2 shock

A

15-30% blood loss (750-1500ml)
pulse 100-120
normal bp
pp decreased
rr 20-30
uop 20-30 ml/hr
cns- mild anxiety
fluid-crystalloid

394
Q

what are the characteristics of stage 3 shock

A

30-40% blood loss (1500-2000ml)
pulse >120
decrease bp, pp
rr 30-40
uop 15-30
cns: anxious/confused
fluid= crytalloid + blood

395
Q

what are the characteristics of stage 4 shock

A

> 40% blood loss (>2000ml)
pulse >140
decrease bp, pp
rr >40
uop negligible
cns: lethargic, confused
fluid: crystalloid and blood

396
Q

what are some of the common pathologies of shock

A

hypoxia
anaerobic metabolism
organ dysfunction
organ failure
death

397
Q

what ph imbalance can hypovolemia lead to and how does it do so

A

carotid body baroreceptors sense decreased o2 which stimulates increased respiratory drive which can lead to respiratory alkalosis

398
Q

how much percentage of blood volume can normal person lose before they won’t compensate bp

A

30%

399
Q

how can large amounts of crystalloid lead to ards/dic

A

break down soluble proteins in endothelial cells, which initiates inflammatory response which can trigger ards/dic

400
Q

how do you treat ards

A

peep,
decrease vt,
increase rr
steroids,
paralyze

401
Q

why is coronary blood flow not intially impacted by hypovolemia

A

autoregulation

402
Q

what happens to myocardial oxygenation use as shock increase

A

increases use of O2

403
Q

what happens to contractility of heart during hypovolemia

A

decreases

404
Q

what does cardiac output rely on during hypovolemia

A

heart rate- stroke volume will be low

405
Q

what does persistent shock shunt blood away from in kidney

A

from renal cortex to renal medulla

406
Q

what can shunting of blood away from renal cortex to renal medulla result in during hypovolemia

A

no blood to nephrons in cortex = acute tubular necrosis

407
Q

when will bun rise back to normal after trauma

A

24 hrs

408
Q

what level of creatinine clearance level indicates acute renal failure in trauma

A

<15ml/hr in 2 and 6 hour test

409
Q

what fluids should be given first for fluid resuscitation

A

albumin, lr, plasmalyte

410
Q

what kind of blood is emergent blood

A

O-

411
Q

which fluid class does not stay intravascular so large quantities are needed

A

crystalloid

412
Q

what fluid can aggravate cerbral edema because it is slightly hypotonic

A

LR

413
Q

which fluid is less likely to cause hyperchloremic acidosis than ns

A

LR

414
Q

what can dextrose solutions exacerbate

A

cerebral ischemia

415
Q

what is not a good fluid and med to give in head injury

A

ketamine and D5W

416
Q

what do you look at on abg to determine fluid level

A

base deficit

417
Q

what base deficit level indicates mild, moderate, severe shock

A

-2 - -5= mild
-6- -9 = moderate
>-10= severe

418
Q

what vasopressor works the best in acidotic state

A

vasopressin

419
Q

what does increase use of crystalloid to restore volume correlate with

A

ards
abdominal compartment syndrome

420
Q

what can rapid bicarb admin cause with acidosis

A

bicarb draws out hydrogen ions and they go through carbonic acid cycle to become co2- which dilates the patient, potentially bottoming them out

421
Q

what should you look at before pushing bicarb very fast

A

base deficit

422
Q

what med can spike etco2 during acidotic state

A

bicarb

423
Q

what fluid is best for restoring intravascular volume

A

colloid

424
Q

what is best blood product for hemorrhagic replacement and what are the cons of use

A

whole blood
but t and cross take 45 mins, and they need more volume to raise hct

425
Q

what is preferred emergency administration blood product and why

A

prbc
t and c takes 5-10 mins
less volume to raise hct

426
Q

why are dextran or hextastarch not used anymore

A

coagulopathy concerns

427
Q

what is the dose/volume per dose/expected response prbc

A

dose- 1 unit
volume- 250-325
response- 1g/dl increase in hgb

428
Q

what is the dose/volume per dose/expected response of plasma

A

dose- 10-15ml/kg
volume- 200ml
response- correction of pt, ptt, inr

429
Q

what is the dose/volume per dose/expected response of platelets

A

dose- 4-6 units from whole blood- 1 from apheresis
volume- 200-250ml
response- increase platelets by 30,000-60,000 mm3

430
Q

what is the dose/volume per dose/expected response of cryo

A

dose- 10 pooled units
volume- 100 ml
response- increase fibrinogen, 8, 13, vwf

431
Q

what is abbreviation for circulatory overload during transfusion

A

TACO

432
Q

what is a new acute lung injury within 6 hours of transfusion

A

TRALI

433
Q

what is a human leukocyte antigen or monocyte antibody reaction with wbc’s during transfusion

A

TRALI

434
Q

what is the term for immunosuppression after transfusion

A

transfusion related immunomodulation

435
Q

what are the ion imbalances created with transfusion

A

hypocalcemia,
hyperkalemia,
acidosis

436
Q

what blood product has the most citrate

A

7x higher in platelets/plasma

437
Q

t or f- it is appropriate to pressure bag blood

A

False technically

438
Q

is rocuronium dose higher or lower for rsi vs general paralysis

A

higher

439
Q

what paralytic should not be used 24 hours after trauma

A

succinylcholine

440
Q

what sedative should be avoided in head injuries

A

ketamine

441
Q

which has less vasodilatory affect, nitrous or isoflurane

A

nitrous

442
Q

what anesthetic med should be avoided with potential closed air spaces such as pneumothorax, pneumocephalus, or obstructed bowel

A

N2O

443
Q

what is only anesthetic gas that provides pain relief

A

N2O

444
Q

what is placental abruption and when will it occur after trauma

A

premature separation of the placenta from the uterine wall- usually within 6 hours

445
Q

what has more devastating effects- knife wound or gunshot wound

A

gunshot wound- more penetrating, more wound channels

446
Q

what does etco2 look like from air embolism

A

gradually decreases- c-section it is common

447
Q

what position should patient be in during air embolism

A

higher than level of heart
-left lateral trendelenburg to try to localize

448
Q

what do hemopericardium and pneumopericardium require and how soon

A

immediate pericardiocentesis to relieve tamponade

449
Q

what are eye opening response on gcs

A

4- spontaneous
3- to speech
2- to pain
1- none

450
Q

what are motor responses on gcs

A

6- obeys verbal commands
5- localizes to pain
4- withdraws from pain
3- decorticate flexion
2- extensor response
1- none

451
Q

what are verbal responses on gcs

A

5- oriented
4- confused
3- inappropriate words
2- incomprehensible sounds
1- none

452
Q

how should you control icp with in brain injury/head and spinal cord trauma

A

mannitol 0.5 mg/kg,
restrict fluids,
avoid tachycardia and htn during intubation

453
Q

how do you calculate cerebral perfusion pressure

A

map - icp
map - cvp

454
Q

tbi classification

A

gcs 8 or less
pupillary dilation
hypotension
hypoxia
hypothermia
increased icp

455
Q

what is the point where blood flows to in abdomen and what is it located between

A

morrison’s pouch- kidney and liver

456
Q

what may be beneficial in preventing ischemia induced injury from head trauma

A

mild hypothermia

457
Q

what kind of trauma should hyperglycemia be avoided in

A

head/spinal

458
Q

how is pneumothorax differentiated from hemothorax

A

perussion dullness and silent lung fields
also morrison’s pouch with pocus

459
Q

what type of ventilation is cautioned with hemothorax

A

jet ventilation- can cause crepitus- air embolisms

460
Q

how is myocardial contusion diagnosed and what do they produce increased risk of

A

diagnosed: st elevations, enzymes, echo
-heart block, afib

461
Q

what is the most accurate way to diagnose a pneumothorax

A

pocus- lung point

462
Q

where is air in simple pneumothorax

A

between parietal and visceral pleura

463
Q

s/s of simple pneumo

A

vq mismatch,
hypoxia,
decreased breath sounds,
hyperresonnant to percussion

464
Q

what almost always happens with 100% long bone fracture

A

fat emboli

465
Q

what can fat emboli cause

A

PETECHIAE,
pulmonary insufficiency,
dysrhytymias,
aloc in 1-3 days,
decreased etco2

466
Q

what do most people die of from burns

A

sepsis

467
Q

a burn of greater than how much of your body is considered major

A

20%

468
Q

what affect can burn have on co and why

A

decreases within 30 mins as a response to vasoconstriction

469
Q

t or f- fluid is encouraged in burns unlike trauma

A

true

470
Q

which pneumothorax does air enter through a one way valve in lung or chest wall during inspiration and cannot get out during expiration

A

tension pneumothorax

471
Q

what can tension pneumo do to trachea

A

shift mediastinum and trachea to other side

472
Q

what is an indicator of tracheal shift

A

distended neck veins

473
Q

what can a lung laceration from jagged rib fracture cause

A

arterial air embolism

474
Q

what should a patient with multiples rib fractures tried to be treated with for anesthetics

A

regional anesthesia

475
Q

what can an incision with abdominal trauma cause

A

profound hypotension due to lack of tamponade effect by blood

476
Q

what should you try to do before making an incision in patient with abdominal trauma

A

rapid fluid/blood resuscitation before

477
Q

what is damage control resuscitation

A

1:1:1 ratio of rbc, ffp, and platelets during trauma

477
Q

what are two things to assume of all trauma patients

A

c spine injury
full stomach

478
Q

which is greater risk for trauma patient taco or trali

A

TACO

479
Q

what age groups are trauma a leading cause of death

A

under 20 over 70

480
Q

what kind of tube is used during trauma that has a cuff inflate in the supraglottic airway and a tube that hopefully goes further down into trachea

A

king supralaryngeal device

481
Q

in a trauma, what may abrupt cardiovascular collaps shortly after beginning mechanical ventilation indicate

A

pneumothorax- treat with thoracostomies second intercostal space, midclavicular line

482
Q

what is the fast exam

A

focused assessment with sonography for trauma

483
Q

how does trauma induced coagulopathy work on the clotting cascade

A

hypoperfusion causes thrombomodulin release which binds to thrombin and stops it from binding to factor 1 (fibrinogen).

Additionally, it also activates protein c which inhibits factors 5 and 8

also induces hyperfibrinolysis by indirectly increasing tissue plasminogen activator

484
Q

what is a med that can be given to combat trauma induced coagulopathy

A

TXA (anti-fibrinolytics)

485
Q

what blood type is usually given in a trauma

A

o negative

486
Q

what happens when blood products are adminstered at a rate greater than patients cardiac output

A

transfusion associated circulatory overload
TACO

487
Q

when is a taco most likely to occur

A

unrecognized control of the source of bleeding

488
Q

what drug should be considered for induction of profoundly hemodynamically unstable patient

A

scopolamine 0.4 mg

489
Q

t or f- all blood products can be warmed

A

false do not warm platelets

490
Q

what is key to give to promote clotting during mtp

A

Ca

491
Q

during trauma, why should vasopressors not be used if possible until source of bleeding is controlled

A

raising bp may disrupt fresh clots

492
Q

what are the top two priorities during trauma resuscitation

A

surgical control of bleeding
dcr (blood admin)

493
Q

what is any trauma patient with aloc assumed to have until proven otherwise

A

TBI

494
Q

what is the most common brain injury requiring emergency surgery and has highest mortality

A

acute subdural hematoma

495
Q

what are two keys in mitigating effects of tbi

A

avoid hypoxia and hypotension

496
Q

when should you give fluids for second degree burn

A

greater than 20% tbsa involved

497
Q

what is a major burn

A

> 20% tbsa, can be second or third degree

498
Q

what fluid is preferred for burns

A

crystalloid

499
Q

what is a common respiratory problem with burns

A

carbon monoxide poisoning

500
Q

what does the temperautre of all burn care environments need to be

A

40 degree C

501
Q

what is most difficult thing for burn patients to maintain

A

body temp- always cold

502
Q

when should succ not be used after a significant burn and why

A

48hrs-2 years, life threatening hyperkalemia

503
Q

what is the most important component of general anesthesia

A

amnesia- inability to recall events

504
Q

define sensitivity

A

the percentage of people who test positive for a disease that have the disease

505
Q

define specificity

A

the percentage of people without the disease who test negative for that disease

506
Q

what can a high sensitivity test rule out

A

those who do not have the disease

highly sensitive test often used as screening tests

507
Q

what can highly specific tests do

A

can help rule in those that have the disease

508
Q

what are sensitive and specificity tests measured against

A

gold standard tests

ex: fine needle biopsies

509
Q

formula for sensitivity

A

number of people who test positive (a) divided by the total number of people with the disease (a+c)

a / (a +c)

510
Q

formula for specificity

A

the number of people who test negative (d) divided by the whole number of people without the disease ( b+d)

d / (b + d)

511
Q

What does sensitivity of test tell you

A

Ability to rule out disease if test is negative

Few false negatives; think d dimer

512
Q

What does specificity of test tell you

A

Ability to rule in a disease if test if positive

Few false positives
Think strep test

513
Q

What’s normal serum osmolarity

A

275-290 mOsm/kg H2O

514
Q

what is the most common electrolyte imbalance

A

hyponatremia

515
Q

signs and symptoms of hyponatremia

A

headache
confusion
NV

SEVERE: vomiting, somnolence, seizures, card/resp distress, brain herniation

516
Q

what should eval of hyponatremia include

A

serum osmo (rules out SIADH)
urine sodium (renal vs non renal)
clinical status (symptomatic?)

517
Q

what does urine sodium >20 mEq/L suggest

A

renal salt wasting; problem with kidneys

518
Q

what does urine sodium <10mEq/L suggest

A

renal retention of sodium to compensate for extrarenal fluid loss (problem other than kidneys)

519
Q

what is isotonic hyponatremia

A

serum osmo 284-295 mosm/kg

occurs with extreme hyperlipidemia and hyperproteinemia

treatment cut down on fats

520
Q

what is hypotonic hyponatremia

A

serum osmo <280; state of body water excess

diluting all body fluids
1. need to assess if patient is hypovolemic or hypervolemic
2. if hypovolemic, assess where hyponatremia is due to extrarenal salt losses or renal salt wasting

521
Q

what is hypertonic hyponatremia

A

serum osmo >290

hyperglycemia: usually from HHNK

osmo high and Na is low (high tonicity)

522
Q

what are the correction rates for hyponatremia

A

min Na 4-8 meq/L per day

max Na 8-10mEq/L per day

523
Q

what is the number of photons in an xray called

A

kvp

524
Q

what is the time for xray and what does it measure

A

mAs: amount of exposure
miliamp seconds

525
Q

what is best view for x-ray because it provides more accurate dimensions

A

posterior anterior

526
Q

the ______________ photons absorbed by the plate, the _____________ the image

A

less
brighter

527
Q

what absorbs photons from least to most

A

air, fat, water/soft tissue., bone/metal

528
Q

t or f- standing provides better views for chest x ray

A

true

529
Q

what can help detect a pneumothorax on an x ray

A

expiration

530
Q

what is a pneumomediastinum

A

air in the space between the lungs

531
Q

do you want inhalation or exhalation during x ray

A

inhalation usually

532
Q

true or false: apex of the lung should be above the clavicle on xray

A

true

533
Q

what are the ways to make sure the patient posture is correct on xray

A

clavicle vs vertebral spinous processes
lung apex above clavicle

534
Q

how do clavicles and spinous processes help ensure correct posture

A

clavicles should be equi-distant from spinous processes on both sides

535
Q

what is the problem if your xray film is under exposed

A

KVP too low or mAs too short

536
Q

what is the problem if your xray film is over exose

A

KVP too high
Mas too long

537
Q

abcdefgh of xray

A

airway
bone
cardiac
diaphragm
effusions/extra-thoracic soft tissue
foreign bodies
gastric bubble
hila/mediastinum

538
Q

what are two things to compare when evaluating x ray

A

compare to previous film and physician exam

539
Q

what are the four indications for xray

A

support diagnosis
assess/monitor progress
monitor for complications
guide therapy like ventilations

540
Q

how many ribs should see in patient with adequate lung volume on xray

A

10 ribs

541
Q

what is indicative of a fully expanded lung on xray

A

thin white lines going out to peripheries

542
Q

what is the bottom corner of the chest wall and diaphragm

A

costaphrenic angles

543
Q

what is between the stomach and diphragm

A

gastric bubble

544
Q

what is underneath diaphragm on right and left slide

A

right= liver
left= stomach

545
Q

t or f- free air in the abdomen is called gastric bubble

A

False

546
Q

what shows up in ap view xray that helps diagnose lobular pneumonia

A

horizontal fissure

547
Q

why is taking lateral x ray beneficial when looking for pleural effusion

A

might be hiding in low lobe behind diaphragm in posterior costaphrenic angle

548
Q

what is an increase in brightness of areas normal radiolucent (darker)

A

opacification

549
Q

what is fluid or mucous buildup in passages around small airways

A

peribronchial filling

550
Q

t or f- consolidation vs infiltrate generally means the same thing

A

True

551
Q

what means too many lines

A

reticular

552
Q

what means too many dots

A

nodular

553
Q

what means too many lines and dots

A

reticulonodular

554
Q

is left lower lobe anterior or posterior

A

posterior

555
Q

what kind of pna hides left heart border

A

left upper lobe

556
Q

what kind of pna hides left diaphragm

A

left lower lobe

557
Q

what kind of pna hides right diaphragm

A

right lower lobe

558
Q

what kind of pna hides right heart border

A

right middle lobe

559
Q

what kind of pna hides ascending aorta

A

right upper lobe

560
Q

what is the spine sine

A

decreased lucency/increased opacification on lateral view on spine as you go down the spine

561
Q

what does a chest x ray look like in early ards (exudative)

A

bilateral diffuse infiltrates
starts peripheral and patchy

562
Q

what does a chest x ray look like in proliferative ards

A

intense parynemal opacification (white out)

563
Q

what does a chest x ray look like in fibrotic stage

A

residual fibrosis (reticular pattern)

564
Q

t or f- ards usually respects lobular boundaries

A

f- opacities are everywhere

565
Q

what is a common finding on x ray in ards

A

air bronchograp

566
Q

what is an air bronchogram

A

air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white)

567
Q

what is the deep sulcus sign and what does it help diagnose

A

affected side- costaphrenic angle is dark and deep
pneumothorax

568
Q

what is a dependent opacity and why is it called that

A

pleural effusion- fluid moves with gravity- so standing it’s at base of lung

569
Q

what can large pleural effusions cause

A

tracheal shift

570
Q

what pathology causes blunting of the costophrenic angle (top of fluid border is u shape)

A

pleural effusion

571
Q

what pathology cuases lateral sloping of meniscus shaped contour

A

pleural effusion

572
Q

what ratio is indicative of cardiomegaly

A

> 50%

573
Q

whats the cardiothoracic ratio

A

maximum horizontal cardiac width/maximum horizontal thoracic width

574
Q

what view gives more accurate view of cardiomegaly

A

posterior anterior

575
Q

besides cardiothoracic ratio, what else can signify cardiomegaly

A

-carina angle greater than 90 degrees
-double density of atria

576
Q

what is left atrium usually parallel to on xray

A

right atrium- won’t be able to differentiate on normal x ray

577
Q

where do you look for right ventricular enlargement

A

retrosternal space- lateral view

578
Q

what are the pericardial effusion signs

A

water bottle- large silhouette with sagging margins (looks like water bottle top)
oreo cookie sign- hyperlucent layer between hypolucent layers

579
Q

what kind of trauma does pneumopericardium happen

A

neck trauma

580
Q

what is air around the heart

A

pneumopericardium

581
Q

what is gold standard of aortic aneurysm detection

A

CT scan

582
Q

t or f- constipation is an indication for x ray

A

false- only 50% sensitive

583
Q

what is most sensitive to abdominal x ray

A

abdominal free air, foreign bodies

584
Q

where is air trapped during abdominal free air

A

underneath diaphragm and above liver. look at right side as left side may be gastric bubble

585
Q

what is a large floppy sigmoid colon that kinks itself off

A

volvulus- coffee bean sign

586
Q

how should cvc line placement x-ray be filmed and positioned

A

ap view, semi fowlers

587
Q

where should tip of cvc be placed for right sided cvc

A

at level of carina or slightly above

588
Q

where should tip of cvc be placed for left sided cvc

A

a little lower in svc than right sided- tip should be verticle

589
Q

where is svc in relation to carina

A

right lateral

590
Q

how deep can hemodialysis catheters be placed

A

into right atrium

591
Q

what are the three aspects of documenting normal x ray cvc findings

A

relationship to clavicle (with subclavian)

carina orientation within chest (vertical 1.5cm above carina)

s/s of pneumothorax or hemothorax

592
Q

what is a consideration with a picc line

A

potentially have it at level of carina since it is more long term- want to avoid erosion of vessel wall-make sure it is verticle

593
Q

what vertebrae is carina near

A

T5-T7

594
Q

where should ett placement correspond to on spinal cord

A

T2-T4

595
Q

what is ett position measurement dependent on

A

position of the head

596
Q

flexed head ett position relative to carina

A

3 cm above carina

597
Q

neutral head ett position relative to carina

A

5cm above carina

598
Q

extended head ett position relative to carina

A

7cm above carina

599
Q

children ett position relative to carina

A

1.5cm above carina

600
Q

if you can’t see the carina on xray, where should ett be around

A

T2-T4

601
Q

what can cervical accessory rib cause

A

thoracic outlet syndrome

602
Q

what does T1 ariculate with

A

first rib

603
Q

how do you count vertebrae to find t5 for carina level

A

find first rib, it should articulate with t1

604
Q

what will you see near diaphragm in esophageal intubation

A

large air bubble

605
Q

what should tip of feeding tube clearly be below

A

diaphragm

606
Q

what should tip of feeding tube be 10cm beyond

A

gastroesophageal junction

607
Q

Pt normals

A

11-13
Therapeutic 1.5-2reference
Tests extrinsic

608
Q

INR

A

0.8-1.1 normal
Therapeutic 2-3

609
Q

PTT

A

Normal 25-35 sec
Therapeutic 3x normal

610
Q

ACT

A

Normal 70-120 sec
Therapeutic 160-600

611
Q

Fibrinogen

A

Normal 200-400 g/Dl
Critical <100 g/dl

612
Q

Fibrin degradation

A

Normal < 10 mcg/ml
Critical >40 mcg/ml

613
Q

How much will 1 unit of platelet increase platelet count

A

5000-10000/mm3

614
Q

What are the six things that have to be fixed immediately

A

Airway obstruction
Flail chest
Open pneumothorax
Massive hemothorax
Tension pneumothorax
Cardiac tamponade

615
Q

What is increased potential for c spine injury

A

LOC at scene
Intoxication
Any neurological s/s
Neck pain
Severe distracting injury (ex:leg cut off)

616
Q

Priorities to restore circulation

A

Stop bleeding
Replace volume

617
Q

Fluid resuscitation points

A

Pressure bag
LR at 30ml/kg IBW
After 2-3L crystalloids go to PRBCs

618
Q

AMPLE

A

Allergies
Medications
Past medical
Last meal
Events

619
Q

Fat emboli points

A

Seen with pelvic/long bone fractures
Pulm insufficiency
Skin petechia
Dysthymias
Mental deterioration 24-72hr post event

620
Q

First degree burn

A

Pain
Erythema

621
Q

Second degree burn

A

Red
Blisters
Weeping
Painful

622
Q

3rd degree burn

A

Painless
White
Leathery
Full thickness

623
Q

Parkland formula

A

4ml x BSA x kg

1/2 in first 8 hrs
1/2 over next 16hrs

Time starts at the time of burn

624
Q

When can you give succs in head/spinal trauma

A

Safe in the first 48 hrs

625
Q

Dose of methylprednisolone in head/spinal trauma

A

30mg/kg
Then 5.4mg/kg/ hr for 23 hrs

626
Q

Autonomic hyperreflexia

A

Lesions above T5

627
Q

Txa dose

A

1g over 10 min

628
Q

What’s the target fibrinogen level in mtp

A

> 150-200mg/dL

Can give cry or fibrinogen concentrate

629
Q

Max allowable blood loss equation

A

MABL=EBV x (starting hgb - target hgb) / starting

630
Q

What’s the target hct

A

24 usually

631
Q

What products are highest risk for Trali

A

FFP and platelets

632
Q

Treating hyponatremia too quickly is risk for

A

Central pontine myelinolysis

633
Q

Treating hypernatremia too quickly may cause

A

Cerebral edema

634
Q
A

mild K 5.5-6.5

peaked t waves
prolonged pr segment

635
Q
A

moderate 6.5-8.0 K

loss of p wave
prolonged qrs complex
st segment elevation
ectopic beats and escape rhythms

636
Q
A

severe >8.0 k level

progressive widening of QRS
sine wave
vfib
asystole
axis deviations
BBB
fasicular blocks

637
Q

what drugs can cause hyperkalemia

A

succs (0.5 meq/l increase after admin)
ace
BB
spironolactone
NSAIDs
cyclosporin

638
Q

does acidosis cause increase or decrease in K

A

increase

639
Q

Anesthesia considerations for HYPERnatremia

A

increased MAC requirements
replace volume (replace with free water)

640
Q

how to treat central DI

A

DDAVP 1-2 mcg IV BID

641
Q

what are three major mechanisms for hypernatremia

A

increase renal water losses (DI, med, renal disease)
extrarenal water losses (sweating, fever, burns, GI loss)
excessive Na intake (bicarb)

642
Q

Hyponatremia anesthesia considerations

A

decreases MAC requirements
decreased LOC
cerebral edema, central pontine myelinolysis
seizures

643
Q

Right ventricular hypertrophy signs

A

Tall R in v1
RV strain in V1-V3
Prominent S wave in V5-V6

644
Q

Total body water

A

60% weight

645
Q

Intracellular fluid volume

A

40% body weight

646
Q

Interstitial fluid volume

A

80% of extracellular volume

647
Q

Extracellular fluid volume

A

20% body weight

648
Q

Plasma volume

A

20% of extracellular volume

649
Q

Lean body weight equation

A

Ideal body weight x 1/3

650
Q

Ideal body weight male equation

A

Height (cm) - 100

651
Q

Ideal body weight equation female

A

Height cm- 105

652
Q

Burn % of adult

A

Face 9
Arms 9
Front 18
Back 18
Legs 18 each

653
Q

Burn % of peds

A

Face 18
Front 18
Back 18
Arms 9 each
Legs 14 each
Peri area 1

654
Q

what causes metabolic acidosis with anion gap

A

o Methanol
o Uremia
o DKA / Starvation Ketosis
o Pyroglutamic Acid
o INH (Isoniazid)
o Lactic Acidosis
o ETOH
o Renal Dysfunction
o Salicylates

655
Q

what can cause non anion gap metabolic acidosis

A

o Renal Tubular Acidosis
o Diarrhea (loss of HCO3 through stool)
o Acetazolamide
o Excess Normal Saline administration
o Aldactone

656
Q

what is another way to calculate anion gap

A

3 x albumin level

657
Q

what is winters formula

A

(1.5 x HCO3) + 8 (+/- 2)

658
Q

What is the shelf life for FFP

A

1 year at -18C

659
Q

What is the shelf life of PRBCs

A

42 days at 1-6*C

660
Q

What is the shelf life of platelets

A

5 days at 20-24*C

Valley 1-2 days

661
Q

What is shelf life for Cryo

A

1 year at -18C

662
Q

Pre renal disease diagnostics

A

bun: creat >10:1
Urine Na <20 mmol/dl
Spec grav > 1.015
Urine sed normal
FENA <1

663
Q

Intra renal disease diagnostics

A

Bun:creat 10:1
Urine Na >40mmol/dl
Spec grav <1.015
Urine sed white casts
FENA 3

664
Q

Post renal diagnostics

A

Bun: creat 10:1
Urine Na >40 mmol/dl
Spec grav <1.015
Urine sed normal
FENA >3

665
Q

How often should Ca be given with PRBCs

A

1g Ca for every 3 PRBCs

666
Q

Changes in banked blood

A

Depleted 2,3 DPG
Shifts oxy hemoglobin curve left
Decreased ATP
Decreased pH
Increased K
Impaired ability to change shape
Hemolysis
Increased pro inflammatory mediators

667
Q

Leukoreduction

A

Removes WBCs from banked RBCs and platelets

Decrease HLA reactions

668
Q

Washing

A

Prevents anaphylaxis in IgA deficient pts

669
Q

Irradiation

A

Prevents graft host disease

670
Q

Hypercalcemia ECG signs

A

Shortened QT

671
Q

Hypocalcemia ECG signs

A

Prolonged QT segment

672
Q

Hypokalemia ECG

A

Prominent U waves

673
Q

Posterior MI

A

V1-V2

Posterior descending

674
Q

Inferior wall MI

A

II, III, aVF

Right RCA

675
Q

Anterior wall, septum MI

A

I, aVL, V1-V4

LAD

676
Q

Lateral Wall MI

A

I aVL V5-V6

Left circumflex

677
Q

What are the best leads to look at for ST segment depression or elevation

A

V3
V4
V5
III
aVF

678
Q

What is lead II used to assess

A

Assessment of Narrow qrs complex rhythms

Basics (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions