CEA. Flashcards
carotids
almost identical to coronaries; disease in one is linked to disease in another
carotid disease
smooth muscle proliferates, plaque, thrombus - middle cerebral artery
s/s
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
dx
with physical exam, carotid doppler, hx: TIA, visual disturbance, numbness, tingling, doppler, MRA
tx
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.
post-op complications
stroke - leading cause of disability, 3rd leading cause of death
hemodynamic instability
intra-cerebral hemorrhage
MI
procedure
clamp carotids, clean quick, patch w vein or synthetic, some shunt, some use EEG
considerations
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
NEVER PUT SURGICAL SITE
DOWN B/C GRAVITY
NEVER DO BOTH SIDES
AT THE SAME TIME
DO THE WORST
SIDE FIRST