Facts to Know Flashcards
Describe key features of the ERAS protocol
- Enhanced Recovery after Surgery (ERAS®) refers to patient-centered, evidence-based, multidisciplinary team developed pathways for a surgical specialty and facility culture to reduce the patient’s surgical stress response, optimize their physiologic function, and facilitate recovery.
What is superior vena cava syndrome?
- Symptoms that occur when the blood flow through the superior vena cava is blocked or compressed. These symptoms include breathing problems, lightheadedness, and swelling in the upper body.
Key diagnostic criteria for Pre-eclampsia?
mnemonic: “PRE”
- Proteinuria : defined as >300 mg/24 hour
- Rising Blood Pressure: sudden in onset >140/90
- Edema: swelling, weight gain particularly in face and hands
What is neurogenic shock?
- Neurogenic shock is a combination of both primary and secondary injuries that lead to loss of sympathetic tone and thus unopposed parasympathetic response driven by the vagus nerve. Consequently, patients suffer from instability in blood pressure, heart rate, and temperature regulation
Lambert Eaton syndrome (myasthenic syndrome) sensitive or resitant to neurmuscular blockade?
- IgG antibodies to voltage-gated Ca++ channels in the musculature, which leads to increased sensitivity to both SCh and nondepolarizing muscle relaxants.
- Beware gastroparesis and orthostatic hypotension in these patients
Patients with Myasthenia Gravis and Neuromuscular blockade
- Are unpredictably sensitive to nondepolarizing NMBAs and are resistant to succinylcholine, a depolarizing NMBA
Describe mechanism of action of Digoxin
Inhibits Na/K ATPase to subsequently induce an increase in intracellular sodium that will drive an influx of calcium in the heart and cause an increase in contractility.
EKG findings of patient on Digoxin
ECG findings are:
- ↑ PR
- ↓ QTc
- ST segment depression
- Diminished amplitude or inversion of T waves
Factors that enhance toxicity of Digoxin therapy
Excessive intracellular calcium may cause delayed after-depolarizations, which may result in premature contractions & trigger arrhythmias
Digoxin has a narrow therapeutic window & the following factors can affect concentrations or enhance toxicity:
- Renal impairment
- Hypovolemia
- Hypokalemia
- Hypomagnesemia
- Hypernatremia
- Acidosis
- Drug interaction
- Poisoning/ingestion
- MI
ECG findings are:
- ↑ PR
- ↓ QTc
- ST segment depression
- Diminished amplitude or inversion of T waves