Basics exam 2 Flashcards
Lactic acidosis due to hypoperfusion should be treated with what before administering bicarbonate? (2)
- fluid resuscitation
2. oxygen
A positive base excess indicates what acid base disturbane?
Metabolic alkalosis
What is the correct formula for administration for bicarbonate (dose calculation) :
Dose of sodium bicarbonate=body weight (kg) X deviation of plasma bicarbonate concentration from 24 mEq/L X extracellular fluid volume as a fraction of body mass (0.2
What disease involves the renin-angiotensin system and potassium ion concentration.
hyperaldosteronism
What disease is characterized by increased reabsorption of Na+ and loss of potassium and H+ ions?
hyperaldosteronism
A decrease in CO and a left shift in the oxyhbg dissociation curve can be associated with what metabolic state?
metabolic alkalosis
In metabolic alkalosis, which direction would you see the oxyhbg dissociation curve shift?
left
Where is there (anatomically) high ventilation but no perfusion (dead space)?
trachea
What are the s/s of nerve damage in the lateral recumbent position?
Brachial plexus - burning sensation and weakness in arm and hand
What physiological changes would you expect to see in a pt who is in the lateral recumbent position?
- Increase in HR (85 to 97)
- Decrease in MAP
*dr. hammon accepted both
How would you prepare a pt to prevent ulnar nerve damage in the supine position? (2)
1-Avoid excessive pressure on the post condylar groove of the humerus
2- Hand and arm position will need to be either supinated and/or in the neutral position.
What physiological change happens in your body at first when you are put in trendelenburg position?
- 1Min: 9% increase in CO
- 10min: CO returns to baseline
Compression or stretch injury to the ______ is common in Trendelenburg position.
Brachial plexus
When in prone position and your arms are up by the head; your shoulders should be :
< 90 degrees
While the patient is in prone position, proper padding and rotation of the arms is essential for prevention of what major complication?
Ulnar Nerve Compression
Invasive arterial blood pressure should be monitored at what level in the sitting position?
External auditory meatus to optimize cerebral perfusion pressure
As a SRNA you are well aware of the risk factors associated with the sitting position, so when your patient develops a venous air embolism, you remain calm and do the following. Select all that apply:
A. Discontinue N2O immediately and deliver 100% oxygen with anesthetic inhalation
B. Attempt to aspirate central venous catheter to retrieve entrained air
C. Implement Bilateral jugular vein compression
Major Risk for sitting position:
Venous Air Embolism
Formula for EBV =
Female = 65ml x kg Obese = 70ml x kg Male = 75 ml x kg Infant = 80ml x kg Full Term = 85ml x kg Preterm = 95ml x kg
Volume associated with a surgical lap:
100-150ml
volume associated with a 4x4:
10ml
What sources of loss to you look to for calculating EBL?
- Laps
- 4x4’s
- Suction canisters
- blood on floor/drapes, etc
- subtract irrigation
How would you know if the suction canister is all blood loss?
ask the circulator /tech how much irrigation was used
Formula for ABL =
[EBV x (starting HCT - Target HCT)] / Starting HCT