EM, ICU, and surgery 3

Question 1

When is posted MI risk the highest?

Answer 1

first 48hrs

Question 2

A patient with renal insufficiency is going to have a surgery that will include using contrast. Other than fluids, what else can be given to decrease concerns?

Answer 2

Acetylcysteine

Question 3

A patient had an epidural placed during surgery. How long should you wait to restart LMWH? Why?

Answer 3

At least 2 hours to prevent epidural hematoma

Question 4

Can atelectasis cause a fever?

Answer 4

NOPE…used to think it could, but now we don’t think that anymore

Question 5

A patient is in the OR and surgery was just about to begin when the patient became rigid, cyanotic, tachycardic, and febrile…and becoming more febrile. What could have caused this? What are treatment options?

Answer 5

This is malignant hyperthermia secondary to halothane, succinylcholine or another anesthetic

Evaporative cooling (spray w/ water and fans), cold inhaled O2, cold GI lavage, cool IV fluids
Dantrolene*
Stop offending agent*

Question 6

HLA is more important when it comes to which transplants?

Answer 6

Kidney and pancreas

Less important for heart and liver

Question 7

Other than rejection, what are other possible complications of transplantation?

Answer 7

Infection (secondary to immunosuppression)
Cancer* (skin , B-cell lymphoma, oral SCC, cervical, vaginal)
Infertility

Question 8

Transplant patient has rejection w/in 24 hours. What caused it? How is it treated?

Answer 8

Hyperacute transplant rejection is caused by antidonor antibodies in the recipient

Untreatable…avoided by proper crossmatching

Question 9

Transplant patient has rejection w/in 1 yr. What caused it? How is it treated?

Answer 9

Acute transplant rejection is caused by antidonor T-cell proliferation in recipient

Frequently reversible through immunosuppressive agents

Question 10

Transplant patient has rejection after 1yr. What caused it? How is it treated?

Answer 10

Development of multiple cellular and humoral immune reactions to donor tissue

Usually untreatable
Immunosuppression may help

Question 11

Bone marrow transplant patient develops a maculopapular rash, abdominal pain, n/v, diarrhea, recurrent infections, and easy bleeding. What is likely going on? What caused it?

Answer 11

Graft-vs-Host disease

Reaction of donor immune cells…host is immunocompromised and can’t fight back

Question 12

How is graft versus host disease treated? What can happen if unsuccessful?

Answer 12

Corticosteroids, tacrolimus, and mycophenolate for GVH response
Thalidomide and hydroxychloroquine for chronic disease

Chronic disease with skin sclerosis, hepatic insufficiency, GI ulceration, and pulmonary fibrosis