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VASCULAR SURGERY > General Surgery > Flashcards

General Surgery Flashcards

1
Q

What happens to intestinal blood flow during shock?

A

Large arteriolar vasoconstriction and small arteriolar vasodilatation which provides preservation of flow the mucosa but decrease flow the muscularis propria.

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2
Q

What happens to intestinal perfusion after initial resuscitation after shock?

A

Intestinal perfusion is still diminished

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3
Q

What is the order of highest to lowerst potassium secreting organs?

A

Colon > Saliva > Gastric > Bile

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4
Q

What patient medical history would make you not want to use succinylcholine for fear of hyperkalemia?

A

Burns, Trauma, spinal cord injury, and neurogenic disorders

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5
Q

How much potassium is in the body?

A

50meq/kg which equals about 3500meq.

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6
Q

How much potassium loss occurs when there are only 3meq/L on labs? 2meq/L?

A

Deficit of 100-200 meq/L for K of 3, and 300-600 meq/L for K of 2

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7
Q

What are the clinical manifestations of metabolic acidosis?

A

Oxygen dissociation curve shift to the right, increased catecholamine release, decreased cardiac contractility, peripheral arterial dilatation

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8
Q

What are the ECG changes for hypokalemia?

A

ST depression, flattening T waves, U waves

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9
Q

When do ECG changes occur for hypokalemia?

A

Under 3meq/L

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10
Q

What is the concentration of NA, K and Bicarb in the pancreas?

A

140, 5, and 100 because it has the same concentration of Na and K as there is in plasma and its alkalotic due to the centroacinar and intercalated duct cells

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11
Q

Can you get hyperkalemia in a patient with normal kidney function?

A

No because 90% of ingested potassium is excreted in urine

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12
Q

What muscles are affected by potassium changes?

A

Cardiac, skeletal and smooth muscle

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13
Q

What does hyper and hypokalemia interfere with?

A

membrane depolarization and repolarization

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14
Q

What ECG changes can you see with mild hyperkalemia?

A

Peaked T waves and shortened QT interval

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15
Q

What ECG changes can you see with severe hyperkalemia?

A

Flattened P waves, prolongation of QRS complex, deep S waves

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16
Q

What is the feared complication of hyperkalemia?

A

Ventricular fibrillation and cardiac arrest

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17
Q

What can you do to treat hyperkalemia temporarily?

A

10-20% calcium gluconate, glucose and insulin, or Sodium bicarbonate

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18
Q

What is the dosing for calcium gluconate and calcium chloride for hyperkalemia?

A

1000mg over 2-3minutes with cardiac monitoring. Lasts for 60 minutes

19
Q

Which calcium can go in the periphery and which in central vein for hyperkalemia?

A

Calcium chloride goes in the central vein and calcium gluconate goes in the periphery

20
Q

How do u dose the insulin and glucose for hyperkalemia?

A

10U regular insulin and 25g of glucose (50amps of D50) or 10U in 500ml of 10% dextrose

21
Q

What is considered hypophosphatemia?

A

0.8 mmol/L

22
Q

What conditions are at risk for hypophosphatemia?

A

DKA, alcoholism, Sepsis, malnutrition with carbohydrate feeding

23
Q

How does hypophosphatemia manifest?

A

Affects diaphragm contractility leading to respiratory failure

24
Q

Who should you evaluate for hypophosphatemia?

A

Patients you are weaning from vent and those with COPD

25
Q

What is the formula for FeNA?

A

(UNa x Pcr/Pna x Ucr) x 100

26
Q

What value of UNa suggests hypovolemia?

A

Una of 10-15 mEq/L

27
Q

What value of UNa suggests ATN?

A

UNa of 20meq/L

28
Q

What FeNa is considered for prerenal azotemia?

A
29
Q

What is the physiological response of renal hypoperfusion

A

Renin secretion from juxtaglomerular cells on afferent arterioles which produces angiotensin II, which promotes Na and H2o resorption and aldosterone secretion, and arteriolar vasoconstriction

30
Q

What fluid is best for hemorrhagic shock?

A

isotonic crystalloid solution

31
Q

What are the main symptoms of hyperkalemia of 7 or 8 meq/L

A

muscle weakness and cardiac arrhythmias

32
Q

What are the primary causes for decreased urinary excretion of potassium?

A

hypovolemia, hypoaldosteronism, renal failure, and drugs like spironolactone and NSAIDs

33
Q

Why do you get peaked T waves with hyperkalemia?

A

The increase potassium concentration causes a faster repolarization

34
Q

Why do you get flattened P waves with hyperkalemia?

A

Hyperkalemia prevents the Na channels from opening to get depolarization by decreasing the membrane potential

35
Q

What are the three things that will counterbalance hyperkalemia?

A

hypercalcemia, hypernatremia, and alkalosis

36
Q

How long does it take for IV sodium bicarb work to antagonize hyperkalemia?

A

30-60 minutes to raise pH

37
Q

How long does it take for IV insulin and glucose to work? and how much does it bring the potassium down?

A

1 hour for 0.5-1meq/L decrease

38
Q

How long does kayexalate take to work and how much does it decrease the potassium?

A

2-4 hours and by 0.5 - 1 meq/L with 50g of kayexalate.

39
Q

How does the kidney compensate for acid load? and how long does it take?

A

secreting ammonia and 2-4 days

40
Q

How long does ventilatory compensation for metabolic acidosis occur?

A

12 to 24 hours

41
Q

What should you do while treating a DKA patient with insulin and fluids?

A

Replace potassium

42
Q

How much albumin ends up in the interstitial space?

A

50%

43
Q

Why is dextrose added to hypotonic solutions?

A

to increase their tonicity and prevent red blood cell lysis

44
Q

How many meq of Sodium is in lactated ringers?

A

130meq/L

VASCULAR SURGERY (8 decks)

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