Exam 2 Extra Credit Flashcards
Patients who have had heart transplants have no sympathetic or parasympathetic connections to their heart—T/F?
True—the heart has been denervated
If you are doing a spinal on a patient who had a heart transplant, will the baroreceptors detect a decrease in BP (d/t vasodilation that occurs with a spinal)?
Yes, the baroreceptors in a heart transplant patient will detect the decrease in BP and will send signals back up to the brainstem to say hey we need more CO
If you are doing a spinal on a patient who had a heart transplant…once the baroreceptors detect a decrease in BP (d/t vasodilation that occurs with a spinal) and send signals to the brain to increase CO, will there be an increase in CO?
No—even though signals are sent to the brainstem, there is no direct connection between the brain and the transplanted heart, so there will not be an increase in CO
If doing a spinal on a patient with a heart transplant, you would need a/an ___ (alpha/beta) agonist to increase the vascular tone that was lost from doing a spinal
Alpha agonist
Because when you do a spinal, you decrease SVR and vasodilate…an alpha agonist will increase the vascular tone
If you have a heart transplant patient who is bradycardic/hypotensive, giving a vagolytic such as atropine will help—T/F?
False—will not do anything for you
If you have a heart transplant patient who is bradycardic/hypotensive, giving ephedrine or glycopyrrolate will help—T/F?
False
What medication WOULD help a heart transplant patient who is bradycardic/hypotensive?
Epinephrine—want to use a medication that will act directly on the heart muscle because a transplanted heart is DENERVATED…it has no sympathetic or parasympathetic connection to the brain
Whenever you have a patient who has been exposed to a caustic material that may have gotten down into their airway (i.e.: smoke inhalation, someone who drank draino), what is the first thing you should do? Why?
Intubate right away because the airway will become so edematous that you won’t be able to intubate/secure airway later
A person comes in with soot on their face, what should you do?
Intubate them because they likely have inhalation burns
Scenario—Patient comes in with burns, soot on face. You are getting ready to intubate the patient. Should you use succinylcholine or rocuronium for this induction? Why?
You should use succinylcholine because you need to do an RSI (patient is likely a full belly and needs his airway secured immediately).
Some people might argue to use roc bc it is a burn patient and they are worried about increasing potassium levels, but it takes at least 2-3 days for burn to be clinically significant when it comes to use of succs
Even high doses of roc do NOT provide intubating conditions comparable to succs—rocuronium, regardless of dose, could still take upwards of 60 seconds to provide intubating conditions
Acute burns are NOT a contraindication for succs—T/F?
True
Succs should be used for RSI unless there is a firm contraindication to it—T/F?
True
If a patient was burned 2-3 days ago and is going to the OR, you should or should not use succs for induction?
Should NOT use succs for induction since the patient was burned 2-3 days ago
Scenario—Patient suffered severe burns 2-3 years ago. This same patient comes in today with a small bowel obstruction, likely gangrenous bowel. Patient needs to be rushed to the OR for surgery. As you are interviewing patient, he is puking all over the place. What paralytic will you use for induction? Why?
Succinylcholine because need to do RSI
Once the event that has caused a patient to be denervated has passed after 2-3 years (i.e.: a burn patient that is placed on a ventilator for weeks), it is okay to use succs—T/F?
True
