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ZANDER CNOR > complications > Flashcards

complications Flashcards

1
Q

Hypothermia is defined as temp below what?

A

96.8 (36)

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2
Q

What is normothermia?

A

98.6 (37)

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3
Q

What are 6 prevention strategies for hypothermia?

A
  1. core temps referred (98.6/37C)
  2. Patients lose 3-5 degrees under anesthesia - bc of vascular changes, we are going to cool to match our external environment
  3. use approved warming devices according to manufacturer’s instruction
  4. intermittent use is safest
  5. warm irrigation solutions and blood products
  6. room temp in procedure areas should be 68-75 degrees; humidity 20-60%
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4
Q

We can exceed 75 degree upper limit for what?

A

for one at risk patient

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5
Q

Post op shivering increases o2 consumption by how much?

A

400%

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6
Q

What are 6 complications of hypothermia?

A
  1. post op shivering increases 02 consumption by 400%
  2. myocardial ischemia
  3. cardiac arrhythmias below 90 degrees F (32 C)
  4. increased surgical site infections
  5. acidosis
  6. increased bleeding - hypothermia and acidosis interrupt clotting cascade
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7
Q

There are some scenarios where what is true regarding hypothermia and bleeding?

A

there is decreased bleeding (usually for open hearts)

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8
Q

What are 4 considerations for head and neck procedures?

A
  1. keep trach tray nearby in case of swelling
  2. wire cutters if jaw is wired closed
  3. anticipate dizziness and N/V after ear surgery
  4. send obturator home with trach patients
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9
Q

What 2 things are important to remember with wire cutters for wiring jaws shut in head and neck procedures?

A
  1. The wire cutters go home with the patient not just to PACU, because if they need to be emergently intubated we can
  2. there should be a picture and drawing of wire cutters
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10
Q

For ortho procedures, casts should be removed where?

A

outside of the OR

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11
Q

Wet casts in ortho procedures are handled with what?

A

palms only

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12
Q

Do what with patients who have casts?

A

elevate cast higher than the level of the heart and keep open to air while it is drying

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13
Q

What are 3 considerations for cement (methyl methacrylate)?

A
  1. avoid vapors use scavenger system
  2. let anesthesia know when placing cement into the canal - bone is very vasculature, so it can cause a dip in the blood pressure
  3. dry time for cement effected by room temperature
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14
Q

Can pregnant personnel be in the room when using methyl methacrylate?

A

NO; it crosses placental barrier

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15
Q

What can cause the cement to dry more slowly?

A

making the room extra cold

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16
Q

What can cause the cement to dry more quickly?

A

heating up the room

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17
Q

What is the biggest concern with flap procedures?

A

vasoconstriction

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18
Q

Monitor what with flap procedures?

A

monitor circulation with doppler

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19
Q

Protect a flap site from what?

A

protect site from sharing or pressure

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20
Q

We want to keep the patient what for flap procedures?

A

keep warm

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21
Q

Highest risk of emboli are what?

A

fat emboli

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22
Q

What kind of emboli risk is there after long bone procedures?

A

fat emboli

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23
Q

Prevent what during orthopedic procedures?

A

prevent DVT’s

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24
Q

What are 3 things we can do to prevent DVT’s in ortho procedures?

A
  1. SCD’s - on and running before induction
  2. coumadin/heparin or lovenox
  3. early ambulation - muscle contraction in lower extremities
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25
Q

What additional emboli do we monitor for during ortho procedures?

A

pulmonary emboli

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26
Q

What are 3 symptoms of pulmonary emboli?

A

painful, short of breath, sudden onset

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27
Q

what are 3 components of virchow’s triad?

A
  1. venous staisis
  2. hypercoagulability
  3. endothelial injury
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28
Q

What is virchow’s triad?

A

trifecta of DVT formation

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29
Q

What is venous stasis in virchow’s triad caused by?

A

immobility during surgery

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30
Q

what is one way we can aid venous stasis from immobility during surgery?

A

SCD’s

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31
Q

Why do we have endothelial injury in virchow’s triad?

A

surgery interrupts vascular endothelium

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32
Q

Why do we have hypercoagulatibility in virchow’s triad?

A

clotting cascade triggered

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33
Q

How do we interrupt virchow’s triad?

A

we make sure scd’s are on and running before induction

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34
Q

What are 7 patients at risk for fluid imbalances?

A
  1. burns
  2. congestive heart failure
  3. pediatrics
  4. neuro patients
  5. liposuction
  6. diabetes insipidus
  7. renal patients
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35
Q

Day 1 and 2 of having a burn is characterized by what kind of fluid shift?

A

fluid shifts cause hypovolemia. Fluid is moving out of the vasculature and into the tissue, otherwise known as third spacing

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36
Q

What would a patient look like day 1 and 2 of having a burn?

A

edematous, puffy, wet weeping wounds, juicy

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37
Q

What would a patient need on day 1 and 2 of having a burn?

A

give IV fluid

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38
Q

Day 3 of having a burn is characterized by what kind of fluid shift?

A

fluid shifts back to vascular causing hemodilution

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39
Q

CHF patients are prone to what?

A

fluid overload

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40
Q

CHF patients tend to become what under anesthesia?

A

tend to become vasodilated

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41
Q

Pediatrics have small what which leads to small what?

A

small volumes equates to small margin of error

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42
Q

Fluid overload in neuro patients can cause what?

A

increase ICP

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43
Q

Dehydration in neuro patients decreases what?

A

cerebral perfusion

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44
Q

Autonomic dysfunction from cord injury causes what?

A

loss of vasomotor tone

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45
Q

Why are neurogenic or cord injury patients prone to fluid imbalances?

A

the area below the injury down does not have any vascular tone at all, so they vasodilate. If the vascular system expands, pressure goes down and they look hypovolemic

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46
Q

What does neurogenic mean?

A

reason neuro

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47
Q

Liposuction patients are prone to what kind of volume change?

A

prone to hypovolemia, because if you take a bunch of adipose tissue a bunch of fluid wants to go into that area.

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48
Q

What medications do we give to help with fluid shifts in liposuction patients?

A

lidocaine and epi for tumescence. The lidocaine for pain, epi for post op patient control. Since it shrinks the vasculature, it helps with the fluid shift

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49
Q

What is diabetes insipidus?

A

trauma/surgery to pituitary gland or hypothalamus causes decrease in ADH

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50
Q

What do we treat diabetes insipidus with?

A
  1. treat with vasopressin or DDAVP
  2. ML/ML urine output of fluid resuscitation
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51
Q

What is DDAVP?

A

synthetic analog of ADH

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52
Q

What is more commonly given vasopressin or DDAVP?

A

DDAVP

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53
Q

Renal patients are prone to what with fluid imbalances?

A

prone to fluid overload

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54
Q

What is a question we want to ask our renal patients?

A

when was the last time you went to dialysis

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55
Q

What are 7 signs of fluid overload?

A
  1. edema
  2. dyspnea
  3. rales
  4. weight gain - couple of kg over nigh
  5. neck vein distention
  6. increased CVP and BP
  7. bulging fontanelle***** - fluid overload bulging fontanelle if they are dehyrdated they have a sunken fontanelle
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56
Q

What are 7 signs of hypovolemia?

A
  1. postural hypotension
  2. decreased BP
  3. increased pulse
  4. dry mucous membranes
  5. decreased urine output
  6. dizziness or fainting
  7. sunken fontanelle
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57
Q

What is normal range of sodium?

A

135-145

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58
Q

What are 4 causes of hyponatremia?

A
  1. irrigation fluid absorbed into venous sinuses
  2. results from fluid overload
  3. hysteroscopies and TUR procedures
  4. glycine and sorbitol leave behind free water after metabolism
59
Q

What are 2 actions you want to take with hysteroscopies and TUR procedures?

A
  1. monitor I and O of irrigation on these cases
  2. report to anesthesia and surgeon if defiicency occurs
60
Q

Hyponatremia causes fluid to shift into or out of tissues?

61
Q

What are s/sx of hyponatremia?

A
  1. N/V, irritability (cerebral edema)
  2. slowed breathing
  3. headache, blurred vision (cerebral edema)
  4. edema
  5. muscle twitching, cramping
62
Q

what are 3 hyponatremia treatments?

A
  1. restrict fluids
  2. diuretic
  3. hypertonic salines
63
Q

what is the rule of thumb for electrolyte and muscle?

A

any electrolyte that doesn’t start with letter p, then the muscle and electrolyte are going in the opposite direction. I.E. hyposodium - hyper muscle twitching and cramping

64
Q

What is the main cause of HYPERnatremia?

A

hypovolemia - dialysis, dehydration, burns, diurectis, DI

65
Q

What is the main cause of hypernatremia?

A

hypovolemia - dialysis, dehydration, burns, diuretics, DI

66
Q

Hypernatremia causes the fluid to shift where?

A

out of tissues and into the vascular system

67
Q

What are the main signs and symptoms of hypernatremia?

A

thirst, concentrated urine, muscle weakness, seizures, coma

68
Q

Treat hypernatremia with?

A

treat with fluid

69
Q

What are the 5 causes of hypokalemia?

A
  1. lost by diuretics
  2. bowel prep
  3. vomiting or diarrhea
  4. laxative abuse
  5. alkalosis
70
Q

What are the 4 s/sof hypokalemia?

A
  1. abdominal distention
  2. loss of bowel sounds
  3. weakness or paralysis
  4. hypotension**
71
Q

What do we treat hypokalemia with?

A

treat with potassium replacement

72
Q

What is the order in which electrolytes leave the body?

A
  1. potassium
  2. calcium
  3. magnesium
73
Q

What are 2 main causes of hyperkalemia?

A
  1. too much in IV fluid
  2. intracellular potassium - meds, MH, crushing syndrome
74
Q

What is normal range of potassium?

75
Q

What 3 things are huge pals when it comes to electrolytes?

A

potassium, hydrogen ion and glucose are pals

76
Q

What 3 systemic issues do you see where potassium, hydrogen ion and glucose are noticeably friends?

A
  1. diabetic ketoacidosis
  2. burns
  3. addison disease
77
Q

What are s/sx of hyperkalemia?

A
  1. intestinal cramping
  2. elevated T wave
  3. hypertension
  4. spastic paralysis
  5. cardiac standstill
78
Q

What is one of the treatments for hyperkalemia if we gave too much?

A

kayexalate

79
Q

How is kayexalate given?

A

NG, PO, enema - it is going through the GI system

80
Q

How long does kayexalate take to work?

A

several hours

81
Q

What is the ideal treatment for hyperkalemia? but with what condition

A

D50 with insulin, but only works if it is hyper within the cell

82
Q

Regardless, we want to treat what with hyperkalemia?

83
Q

what is the normal serum value for calcium?

84
Q

What is normal ionized value of calcium?

85
Q

What is serum calcium?

A

bound calcium to albumin

86
Q

If we have a low albumin, what electrolyte do we disregard?

87
Q

What are the 4 causes of hypocalcemia?

A
  1. multiple banked blood transfusion - citrate (keeps blood fresh while in storage) but citrate binds with calcium
  2. hypoparathyroidism
  3. parathyroid regulates ca and phos levels - so if you have hypoparathyroid you will have hypocalcemia
  4. diuretics
88
Q

You can only find ionized calcium on what 2 tests?

A

CMP or a blood gas with electrolytes

89
Q

What are s/sx of hypocalcemia?

A
  1. twitching
  2. laryngospasm
  3. cramping
  4. arrthythmias
  5. positive chvotstek’s sign and trousseau’s sign
90
Q

What is chvotstek’s sign?

A

when you tap the facial nerve that is right in front of the nerve, and the whole side of the face twitches up

91
Q

What is trousseau’s sign?

A

a BP cuff is left on too long but their thumb starts twitching

92
Q

Treat hypocalcemia with what?

A

replacement

93
Q

What are 4 causes of hypercalcemia?

A
  1. medically - TPN
  2. hyperparathyroidism
  3. bone cancer/multiple myeloma
  4. sarcoidosis
94
Q

What does sarcoidosis do to calcium?

A

increases GI absorption of dietary Ca++

95
Q

What are symptoms of hypercalcemia?

A

neuromuscular depression and arrhythmias

96
Q

What are 2 treatments for hypercalcemia?

A
  1. mithramycin - anti-tumor drug
  2. most common - phosphate replacement
97
Q

What is normal value of phosphorus?

98
Q

What are 4 causes of hypophosphatemia

A
  1. hypercalcemia
  2. hyperparathyroidism
  3. bone cancer/multiple myeloma
  4. sarcoidosis
99
Q

What are symptoms of hypophosphatemia?

A

neuromuscular depression and arrhythmias

100
Q

What are 2 treatments for hypophosphatemia?

A
  1. mithramycin - anti-tumor drug
  2. most common - phosphate replacement
101
Q

What are 4 causes of hyperphosphatemia?

A
  1. hypocalcemia
  2. hypoparathyroidism
  3. parathyroid regulates ca and phosphate levels
  4. diuretics
102
Q

What are signs and symptoms of hyperphosphatemia? or hypocalcemia

A
  1. twitching
  2. laryngospasm
  3. cramping
  4. arrhythmias
  5. positive chvotstek’s sign and trousseau’s sign
103
Q

Treat hyperphosphatemia with?

A

calcium replacement

104
Q

What is normal value of magnesium?

105
Q

Magnesium deficiency (hypomagnesemia) can be due to what things?

A
  1. poor nutrition (diagnostic of malnutrition), alcoholism, pancreatitis, diurects
106
Q

What are clinical s/sx of hypomagnesemia?

A

muscle spasms and twitching

107
Q

Magnesium excess (hypermagnesemia) has what kind of effect on the CNS?

108
Q

Magesium is used for what?

A

premature labor and preeclampsia

109
Q

You want to monitor what 2 patients with giving magnesium in obstetrics?

A

mom and baby

110
Q

Magnesium is a treatment for what 2 things cardiac wise?

A

v-fib and torsade’s de pointes

111
Q

What are monitoring mom for with magnesium?

A

rapid onset pulmonary edema (STOP mag drip), hypotension - episodes of low BP, poor deep tendon reflexes - APGAR scores are low

112
Q

What is normal range for RBC’s in men?

113
Q

What is normal range for RBC’s in women?

114
Q

What is RBC’s job?

A

contains hemoglobin

115
Q

What is normal range of hemoglobin for men?

A

13.2 to 17.5

116
Q

What is normal range of hemoglobin for women?

117
Q

What does hemoglobin carry?

118
Q

Can hemoglobin be low even with a normal RBC?

119
Q

what is a normal range of hematocrit for men?

120
Q

What is normal range of hematocrit for women?

121
Q

What is low hematocrit also called?

122
Q

Ideally treat low H&H with what?

A

iron preoperatively

123
Q

If you a patient with rheumatoid arthritis and low hematocrit what do you need to do?

A

send them home

124
Q

What is thrombocytopenia?

A

low platelet count

125
Q

What is a normal range of platelet count?

A

150,000-450,000 uL

126
Q

low platelet count is not a problem for most surgeries above what?

127
Q

What is normal range of WBC’s?

A

normal value: 5000-10,000 cells/nm3

128
Q

What conditions do you see an increase in WBC?

A
  1. infection
  2. autoimmune
  3. leukemia
129
Q

What conditions do you see a decrease in white blood cell?

A
  1. prolonged infection
  2. bone marrow suppression
  3. chemotherapy
  4. radiation
130
Q

What is normal PT?

A

Normal value 11-12.5 seconds

131
Q

What does PT measure?

A

A PT test evaluates the coagulation factors: extrinsic and common pathways

132
Q

What is the extrinsic pathway?

133
Q

What is in your common pathway?

A

X (5), V (10), II (2) and I (1)

134
Q

What does it mean if your PT is out of whack?

A
  1. bleeding or clotting disorder
  2. liver disease - vitamin k to synthesize factor 2, 7, and 10 (measured by PT)
  3. warfarin therapy
135
Q

If you want to know if you are in normal range for coumadin you want to draw what?

136
Q

INR measures what?

A

measures the same thing as the PT. If you have a patient who is anticoagulated on coumadin or warfarin, or apixiban or elequis you can draw INR as well.

137
Q

What is a normal INR if you are anticoagulated?

138
Q

What is normal INR if you are not anticoagulated?

139
Q

What is normal range for PTT?

A

30-40 seconds

140
Q

What does PTT measure?

A

evaluates coagulation factors:
- intrinsic: XII, XI, IX, VIII
- common: X, V, II, and I

141
Q

What does PTT mean?

A
  1. Bleeding or Clotting disorder (intrinsic like DIC)
  2. Heparin therapy
  3. hemophilia
  4. shortened in early DIC - trend bc you are clotting faster and faster and faster
142
Q

What may you do with surgery if unsuspected PTT?

A

cancel case

143
Q

What may you do with surgery if unsuspected PT?

A

cancel case

ZANDER CNOR (15 decks)

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