Body As A Whole Flashcards
MCC of urinary obstruction 4 weeks after kidney transplant
Lymphocele, which forms in the retroperitoneal space at the iliac fossa developed for implantation of allograft due to disruption of tiny lymphatics that surround the recipient’s external iliac artery and vein, and the inability of this space to absorb lymph. As lymph collects in peri-nephric space, pressure exerted on the ureter resulting in obstruction qwhich mx as decreased UO. Ultrasound reveals offending fluid collection as a hypo-echoic mass with accompanying hydronephrosis. Percutaneous drainage may be tempted and if unsuccessful creation of a peritoneal window laparoscopically.
Tachycardia and hypotension shortly after insufflation for laparoscopy?
Can be released to decreased VR to right heart, tension pt., or CO2 embolism. The first step is to STOP INSUFFLATION and immediately release the pneumoperitoneum. In the event of gas embolus, examination of pt will reveal a mill wheel murmur due to air bubbling in RV as well as JVD and hypoxemia. Further tx involves positioning pt in left lateral deuce to limit gas bubbles in RA and RV, hyperventilation and if present using a central venous access to extract gas via catheter.
Characteristics of local anesthetic toxicity
Local anesthetics are a class of drugs that produce effect by temporarily blocking nerve conduction by binding to neuronal sodium channels. The progression of action of local anesthetics on nerve function is as follows: blockade of autonomic transmission, blockade of sensory transmission, and blockade of motor transmission. The toxicity is dependent on site of injection and rate of absorption. Inadvertent IV injection will produce peri-oral paresthesias, visual and auditory hallucinations, sedation, unconsciousness, seizures, respiratory depression, cardiac arrhythmias, and CV collapse. Always aspirate before injecting!
Max dose of lidocaine
5 mg/kg of body weight and increases to 7 mg/kg of body weight when epi is included. Addition of epi slows absorption as a result of vasoconstriction but may induce local ischemia.
