Clinical Management Flashcards
What is the appropriate treatment for an IDDM pt who is hypoglycemic pt prior to surgery?
Check bllod glucose
treat with glucose D50 (25ml of D50)
What factors increase myocardial oxygen consumption?
increased HR, Increased ionotropy (contratility), increased afterload and increased preload all increase myocardial o2 consumption
What determines coronarry filling pressure?
Coronary perfusion pressure= arterial diastolic pressure - LVEDP
decreases in arterial diastolic or increases in LVEDP can reduce coronary perfusion
Increases in HR also decreases coronary perfusion pressure since a disproportionally greater reduction in diastolic time
What determines myocardial work?
afterload (MAP) and HR
How long should plavix be discontinued before surgery?
Placix blocks ADP receptors on platelets and cause less platelet aggregation 5 days
prodrug with slow onset
What is the dose of plavix?
75 mg/day
What are the indications for plavix?
reduce rate of strok, MiI, peripheral artery disease, acute coronary syndrome
What would you give to a pt on plavix that had to have surgery?
platelets
What is the order for inhalational anethetics and matabolism?
Halothane (20%)>Sevoflourane (5%)>Isoflurane (0.2%)>Desflurane (0.1)%>nitrous
Which hemodynamic change related to hepatocellular failure is likely to mresent in a pt with mesocaval shunt? bradycardia, CHF, High CO, high SVR, or tricuspid regurgitation?
Portal HTN = hyperdynaic = Low SVR and High CO
What is an effect of pt in hepatic failure causing increasing blood ammonia?
encephalopathy
If sterile water is uses to dilute one unit of PRBCs, what happens?
hemolysis
a pt receives 12 u cell saver and 10 prbc. There are no clots in field and puncture sites begin to bleed . why?
Dilutional thrombocytopenia.
What is the eartliest disturbance in massively tranfused pts?
hypofibrinogenemia
fibrinogen < 100
frequently develops after 10-15 units prbs
prolonged PT/PTT despite adequat clotting factors
To increase fibrinogen Cryo must be given
How much does cryo increase fibrinogen?
How much fibrinogen is in cryo? FFP?
Raises by 50 mg/dL
contains 10-20mg/ml
ffp- 2-4 mg/ml
What is another problem in massivlely transfused patients?
coagulation factor deficiency
prolongation of PT/PTT >1.5 times normal after 8-10 uinits PRBCs
At What percetage of coagulation factors are PT/PTT prolonged?
50%
What should you consider after 8-10 units PRBCs?
FFP
How much does each unit of FFP increase clotting factor activity?
7-8%
Each unit of plateslets raises platelet count by _______?
5000-10000
What is normal CVP?
2-6 mm Hg
Which IV fluid stays in vascular space longest?
Hetastarch–larger than albumen–stays in IV space the longest
24-36 hours
Why does hetatstarch lead to coagulopathy?
hemodilution ( if >25% of heme volume in less than 24 hours) and direct inhibitory action on factor VII
How is hetastarch excreted?
renal
What dose of hetastartch is indicative o fcirculatory overload?
20ml/kg/24 hr
what labs should be monitored when giving hetastarch?
hgb, hct, platelet count, prothombin time, and partial thromboplastin time
on a pt with ESRD How do you manage fluid loss?
Replace insensible and third space losses only
how much glucose is in one liter D5W?
5% glucose=50 mg/ml = 50,000 mg= 50 g in 1 L
What acid base disorder is the ruslt of excess LR?
Metabolic Alkalosis ( lactate metalbolized to Bicarb) use wit caution in pts with hepatic insufficiency)
Occlusion of circumflex artery will produce damage to which part of the heart?
lateral wall
