Clinical Management Problems Flashcards
What difference in breathing pattern would you expect to see in a patient with partial obstruction of the upper airway versus the patient with pulmonary edema?
Partial airway obstruction = slow, deep, increased airway resistance
Pulmonary edema = fast, shallow, restrictive (decreased lung compliance) -Hypoxemia, rales on auscultation, airway secretions (“pink froth”)
What difference in breathing pattern would you expect to see in a patient with bronchospasm versus the patient with pneumothorax?
Bronchospasm =slow, deep, increased airway resistance –Expiratory upslopping on capnograph
Pneumothorax = fast, shallow, decreased lung compliance
Which breathing pattern would the patient with abdominal pain have?
fast and shallow
What FiO2 administered intraoperatively will contribute most to the production of postop
atelectasis? Why?
A FiO2 of 100% will contribute the most to postop atelectasis because… The
atmosphere is composed of 78% nitrogen and 21% oxygen. Since oxygen is exchanged at the alveoli-capillary membrane, nitrogen is a major component for the alveoli’s state of inflation. If a large volume of nitrogen in the lungs is replaced with oxygen, the oxygen may subsequently be absorbed into the blood reducing the volume of the alveoli, resulting in a form of alveolar collapse known as absorption atelectasis
What acid-base disorder will result from the administration of an excess amount of lactated ringer solution?
Metabolic alkalosis.
A 52-YO man with ESRD presents for CRT (cardiac resynchronization therapy) as the first case on Thursday. He has been receiving MWF hemodialysis and was last dialyzed on Wednesday. What is the appropriate course of fluid management for this patient?
Replace insensible and third-space losses only
If the goal for fluid resuscitation is to have the IV fluid remain in the vascular compartment as long as possible, which IV fluid should be selected for the first 1-1.5 liters to be administered?
Hetastarch – larger molecule than albumin – stays in the intravascular space the longest!
A trauma patient is undergoing emergent exploratory laparotomy during which he receives 10 cell-
saver units and 12 units of PRBCs. If there are no clots in the surgical field and his venipuncture sites have begun to bleed, what is most likely the cause of this coagulopathy?
dilutional thrombocytopenia
A 54-YO patient had stopped all meds four days prior to surgery except for clonidine. If significant nonsurgical hemorrhage begins intraop, which of the following medications would be the most likely cause: aspirin, clonidine (Catapres), clopidogrel (Plavix), or ibuprofen (Advil)? What blood product, if any, should be administered to treat this patient’s intraoperative bleeding?
clopidogrel (Plavix)
give platelets
A 57-YO man with CAD is undergoing a laparoscopic cholecystectomy when his blood pressure decreases from 144/84 to 135/79 mmHg and is HR increases from 70 bpm to 110 bpm. ST changes are noted in lead V5.
o What is the most appropriate treatment?
Esmolol 5-10 mg. Wait 4-5 minutes before redosing
An IDDM patient admitted for elective surgery goes into the OR at 4 PM, whereupon she is found to be disoriented and uncooperative. What is the most likely cause of her behavioral changes? How do you make a definitive diagnosis? What is the appropriate treatment?
HYPOglycemia due to being NPO – check blood glucose – treat with glucose (25 ml of 50% glucose – dextrose 50%, D50)
