Exam 1-2 Flashcards
Who should have an EKG before surgery?
Anyone over 50 or past cardiac history
When should patients with significant co-morbidities be seen before surgery?
at least 1 week
How long should a patient be seizure free before surgery?
6 months recommended
Why is exercise tolerance an important question to ask?
Could help decide if they need cardiac work-up prior to proceeding with surgery
At what Hgb level would a patient be considered anemic?
<10 g/dl
Who would have a pulmonary function test?
pt with significant pulmonary disease (usually for upper abdominal or intra-thoracic operations
What are the induction does for etomidate, propofol, and ketamine?
etomidate- 0.3mg/kg
propofol- 2mg/kg
ketamine-1mg/kg
What type of induction is typically used for children?
inhalation
What would be signs of chronic volume loss?
Hemoconcetration Increased BUN Decreased skin turgor Thirst Dry mucous membrane
What would be indicators of acute volume loss?
Hypotension Tachycardia Low CVP Diminished heart sounds hypoxemia
What is dehydration?
a concentration disorder of insufficient water compared to sodium levels.
What is the difference between moderate and severe dehydration?
moderate dehydration = 6L behind
severe dehydration = 10L behind
A loss of electrolyte free body water will cause what when considering Na+ levels?
increased serum Na+ levels (ex. inadequate H2O, burns, fever)
What are signs and symptoms of hyponatremia?
moist mucous membranes polyuria low specific gravity CNS signs <120 *lethargy *convulsions *coma
What are symptoms of hypernatremia?
dry mucous membranes increased temp, thirst, blood viscosity, specific gravity tachycardia oliguria muscle weakness tremors hallucinations respiratory arrest
How can general anesthesia predispose pt to hyponatremia?
It causes the release of ADH which increases water retention
Why should Na+ not be replaced rapidly with hypertonic saline?
Na+ is excluded by BBB and will cause shrinking of brain cells (do not replace more than 1-2meq/L/hr
What is myelinolysis?
develops due to rapid correction of hyponatremia (spastic quadriparesis, pseudobublar palsy, mental disorders, death greatest risk hyponatremic >48hrs
What is treatment for hypernatremia?
renal tubular diuretics = increased urinary excretion of Na+ ex. hydroclorothiazide, acetazolamide, spironolactone)
What is treatment for hypocalcemia <4.5meq?
CaCl 15mg/kg or calcium gluconate 10ml of 10% (watch for arrhythmias)
What can cause hypercalcemia?
hyperparathyroidism
neoplastic disorders with bone metastasis
What is treatment for hypercalcemia?
Diuresis, IV fluid*, hyperventilation
What EKG changes are seen with hypercalcemia?
lengthened PR, wide QRS, shortened QT
What are the most common procedures for blood loss?
Orthopedic Vascular Colorectal Cardiac Liver Trauma
How would you a fluid challenge to elderly or cardiac pt?
Give 50-200ml over 10min
How would you give a fluid challenge for adult with no cardiac hx?
500ml over 10min.
How much does 1 unit of PRBC raise Hgb and Hct?
Hgb- 1gm
Hct- 2-3%
