CEA.

Question 1

carotids

Answer 1

almost identical to coronaries; disease in one is linked to disease in another

Question 2

carotid disease

Answer 2

smooth muscle proliferates, plaque, thrombus - middle cerebral artery

Question 3

s/s

Answer 3

bruit, listen w bell, pt hold breath and turn head slightly toward you; hx of TIA - confusion, dysphagia, unilateral motor weakness, expressive aphasia; amaurosis fugal - monocular blindness: like a shade over the eye

Question 4

dx

Answer 4

with physical exam, carotid doppler, hx: TIA, visual disturbance, numbness, tingling, doppler, MRA

Question 5

tx

Answer 5

check for CAD; if coronary surgery: TIA, if carotid surgery: MI
stent the carotids; plaque will embolize; cath has an umbrella device, then balloon and stent, remove umbrella.

Question 6

post-op complications

Answer 6

stroke - leading cause of disability, 3rd leading cause of death
hemodynamic instability
intra-cerebral hemorrhage
MI

Question 7

procedure

Answer 7

clamp carotids, clean quick, patch w vein or synthetic, some shunt, some use EEG

Question 8

considerations

Answer 8

neuro checks: CN - 5: facial drooping, 7: smile, 9: swallow/gag, 10: talk, 11: shoulder shrug, 12: tongue deviation
bleeding/swelling could compromise airway
choking: eat upright, small bites, liquids
hemodynamic instability: hypotension b/c baroreceptors; htn b/c denervation of the carotid sinus
intra-cerebral hemorrhage
stroke
MI: common to have both diseases

Question 9

NEVER PUT SURGICAL SITE

Answer 9

DOWN B/C GRAVITY

Question 10

NEVER DO BOTH SIDES

Answer 10

AT THE SAME TIME

Question 11

DO THE WORST

Answer 11

SIDE FIRST