Clinical Management

Question 1

What is the appropriate treatment for an IDDM pt who is hypoglycemic pt prior to surgery?

Answer 1

Check bllod glucose

treat with glucose D50 (25ml of D50)

Question 2

What factors increase myocardial oxygen consumption?

Answer 2

increased HR, Increased ionotropy (contratility), increased afterload and increased preload all increase myocardial o2 consumption

Question 3

What determines coronarry filling pressure?

Answer 3

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

Question 4

What determines myocardial work?

Answer 4

afterload (MAP) and HR

Question 5

How long should plavix be discontinued before surgery?

Answer 5

Placix blocks ADP receptors on platelets and cause less platelet aggregation 5 days
prodrug with slow onset

Question 6

What is the dose of plavix?

Answer 6

75 mg/day

Question 7

What are the indications for plavix?

Answer 7

reduce rate of strok, MiI, peripheral artery disease, acute coronary syndrome

Question 8

What would you give to a pt on plavix that had to have surgery?

Answer 8

platelets

Question 9

What is the order for inhalational anethetics and matabolism?

Answer 9

Halothane (20%)>Sevoflourane (5%)>Isoflurane (0.2%)>Desflurane (0.1)%>nitrous

Question 10

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?

Answer 10

Portal HTN = hyperdynaic = Low SVR and High CO

Question 11

What is an effect of pt in hepatic failure causing increasing blood ammonia?

Answer 11

encephalopathy

Question 12

If sterile water is uses to dilute one unit of PRBCs, what happens?

Answer 12

hemolysis

Question 13

a pt receives 12 u cell saver and 10 prbc. There are no clots in field and puncture sites begin to bleed . why?

Answer 13

Dilutional thrombocytopenia.

Question 14

What is the eartliest disturbance in massively tranfused pts?

Answer 14

hypofibrinogenemia
fibrinogen < 100
frequently develops after 10-15 units prbs
prolonged PT/PTT despite adequat clotting factors
To increase fibrinogen Cryo must be given

Question 15

How much does cryo increase fibrinogen?

How much fibrinogen is in cryo? FFP?

Answer 15

Raises by 50 mg/dL
contains 10-20mg/ml
ffp- 2-4 mg/ml

Question 16

What is another problem in massivlely transfused patients?

Answer 16

coagulation factor deficiency

prolongation of PT/PTT >1.5 times normal after 8-10 uinits PRBCs

Question 17

At What percetage of coagulation factors are PT/PTT prolonged?

Answer 17

50%

Question 18

What should you consider after 8-10 units PRBCs?

Answer 18

FFP

Question 19

How much does each unit of FFP increase clotting factor activity?

Answer 19

7-8%

Question 20

Each unit of plateslets raises platelet count by _______?

Answer 20

5000-10000

Question 21

What is normal CVP?

Answer 21

2-6 mm Hg

Question 22

Which IV fluid stays in vascular space longest?

Answer 22

Hetastarch–larger than albumen–stays in IV space the longest
24-36 hours

Question 23

Why does hetatstarch lead to coagulopathy?

Answer 23

hemodilution ( if >25% of heme volume in less than 24 hours) and direct inhibitory action on factor VII

Question 24

How is hetastarch excreted?

Answer 24

renal

Question 25

What dose of hetastartch is indicative o fcirculatory overload?

Answer 25

20ml/kg/24 hr

Question 26

what labs should be monitored when giving hetastarch?

Answer 26

hgb, hct, platelet count, prothombin time, and partial thromboplastin time

Question 27

on a pt with ESRD How do you manage fluid loss?

Answer 27

Replace insensible and third space losses only

Question 28

how much glucose is in one liter D5W?

Answer 28

5% glucose=50 mg/ml = 50,000 mg= 50 g in 1 L

Question 29

What acid base disorder is the ruslt of excess LR?

Answer 29

Metabolic Alkalosis ( lactate metalbolized to Bicarb)
use wit caution in pts with hepatic insufficiency)

Question 30

Occlusion of circumflex artery will produce damage to which part of the heart?

Answer 30

lateral wall