Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anes& Coex > Hematologic > Flashcards

Hematologic Flashcards

1
Q 
Anemia 
#s adult women
A

<11.5 hgb <36 hct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Anemia #s adult men

A

Hgb <12.5 hct <40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Ca02=

A

Arterial oxygen content. (Hgb x 1.39) sa02 + pa02 (.003)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Normal ca 02.

A

16-20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Compensatory mechanisms for anemia: 6

A

Dec blood viscosity, dec SVR, inc CO (inc SV AND hr), blood redist to areas w high extraction ratio, kidney secrete EPO, rightward shift of curve/ inc 2,3 DPG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What shifts curve right

A

Inc temp, inc 2,3 dpg, inc acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What shifts curve left

A

Dec temp dec 2,3 dpg dalkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Anesthesia management: anemia

A

Avoid decreasing CO (etomidate or high opioid induction), avoid left shift (avoid hyperventilation/alkalosis and hypothermia), maximize 02 delivery (inc fio2, prbcs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What happens to VA in anemic pts

A

Less soluble= accelerated intake, but inc CO. Net effect is no OD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When CAD pt needs transfusion

A

Hgb <7 can lead to myo ischemia. Hct 28-30% may req transfusion if significant CAD esp w unstable coronary syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When blood loss requires transfusion

A

15-30% loss= replace w crystalloid. >30% transfuse. >50% MTP:FFP:Plt 1/1/1.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ABL calculation

A

EBV x (pts hct- allowable hct) / pts hct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

EBL in men and women

A

Men 75 ml/kg women 65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What 1 u PRBC does to hgb and hct

A

Hgb inc 1 g and hct 2-3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Clinical signs w 20% ebv blood loss

A

Tachycardia, ortho hypo, CVP change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Signs w 40% acute blood loss

A

Tachycardia, hypotension, tachypnea, oliguria, acidosis, restless, diaphoresis, ecg ischemia, cvp change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What leads to hct decrease 1% every 24 hours

A

Hemolysis or acute blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Acute blood loss induction and monitoring

A

Ketamine or etomidate. Invasive monitoring (CVP, a line), foley- UOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Maintenance for acute blood loss

A

May be unable to tolerate VA. Scopolamine, benzos, opioids, keep warm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Post op considerations in acute blood loss

A

Postop vent from fluid shifts during resuscitation, pulm edema, ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is MTP

A

> 10u PRBC in 24 hrs, replacing blood volume in 24 hrs, replacing >50% in 6 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Consequences of MTP

A

Hypothermia, volume overload, dilutional coagulopathy (no clotting factors in PRBCs), decreased 2,3 dpg, hyperkalemia, citrate toxicity- binds to Ca, glucose-lactate-acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Iron deficiency anemia hgb, ferritin

A

9-12, <30,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Vitamin b12 deficiency presentation

A

Hgb 8-10, large rbc volume, degeneration of spinal cord (paresthesia), thick, large tongue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Anesthesia management b12 deficiency

A

A/w eval and plan b, maintain adequate 02, avoid n20 (oxidizes b12), avoid regional if parasthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Anesthetic management for hereditary hemolytic anemia/spherocytosis

A

Avoid infections, CPB and mechanical valves may lead to accel hemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Management of paroxysmal nocturnal hemoglobinura

A

High risk DVT. Avoid resp depressants, hypoxemia/perfusion, hypercarbia. Hydrate and dvt prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

G6PD management

A

Class V/VI little implication. Avoid oxidative drugs (nsaids/quinolone/sulfa), avoid depression of G6PD (iso/sevo/valium), avoid methylene blue (life threatening), avoid methomoglobinemia causing drugs (lido/prilocaine, silver nitrate), avoid oxidative stress (low temp, acidosis, low bg, infections).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Safe drugs for G6-D 5

A

Codeine, versed, propofol, fentanyl, ketamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What pyruvate kinase deficiency does to curve/body

A

Shifts curve right, accum 2,3 dpg. Requires transfusion at birth. Jaundice.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Hemolytic anemia periop concerns

A

Inc risk hypoxia in tissues, inc infection risk if splenectomy, inc risk VTE, hgb <8 acute drop or chronic <6 need transfusion maybe, preop hydration. Caution methylene blue admin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Acute chest syndrome: happens in who, when, presentation

A

Sickle cell crisis 2-3 days postop. Pna like, pulm infiltrate in one segment, pulm vascular occlusion. Pleuritic CP, dyspnea, fever, pulm htn.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Acute chest syndrome: tx

A

Supplemental 02, inhaled NO to reduce pulm htn, abx, bronchodilators, pain management. Monitor for stroke, pain, and infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Sickle cell disease RFs for periop complication

A

Old age, frequent sickling episodes, end organ damage (low baseline 02, elevated creat, cv dysfunc, stroke) and infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Sickle cell disease. Operations that are low risk, moderate risk, and high risk

A

Low: extremity/minor procedures. Moderate: intraabdominal. High: IC, intrathoracic, hip replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Sickle cell disease: periop concerns, what you might do pre op w high risk sx, goal

A

End organ damage, cv dyfunc, infection. Transfuse to hct 30% pre op if high risk sx. Goal to dec hgb s w transfusion to <30%. Avoid hypoxemia, acidosis, hypovolemia, stasis

37
Q

Sickle cell disease periop management

A

Supplemental 02, pre op hydration 12h, avoid resp depression, regional good for pain control but concern w stasis, aggressive pain management/tolerance, avoid tourniquets, keep warm, maintain high CO, prevent stasis while positioning

38
Q

Thalassemia major complications that affect us

A

Hematopoiesis (maxillary and frontal bone overgrowth), splenomegaly/inc infec if removed, CHF/dyspnea/orthopnea, r side HF from jaundice, arrhythmia, sensitive to dig, SC compression

39
Q

Anesthesia management thalassemia major: cardiac related

A

CHF common, arrhythmias, use cardiac sparing drugs

40
Q

Thalassemia major anesthesia: blood risks

A

Coagulopathy, may not do regional. Thrombocytopenia from hypersplenism

41
Q

Thalassemia major: complications from iron loading tx we worry about

A

DM (monitor bg), adrenal insufficiency (dec resp to pressors), coag abn/liver dysfunc, hypothyroid, ecg (arrhythmias), R HF (ECHO)

42
Q

Methemoglobinemia: does what to curve and 02 delivery

A

Shifts left, little 02 delivered to tissues

43
Q

Methemoglobinemia: % that causes complications

A

<30% none. 30-50% s/s of 02 deprivation. >50% coma and death

44
Q

Agents that oxidize normal hgb and lead to methemoglobinemia 4

A

NO, nitrates, LA: prilocaine and benzocaine

45
Q

What pulse ox does in methemoglobinemia pts

A

Typically reads 85%. Underestimates spo2 when sa02 >85 and over, overestimates it when its <85

46
Q

Emergency tx of toxic methemoglobinemia

A

Avoid tissue hypoxia/left shift. 02. 1-2 mg/kg methylene blue 1% sol over 3-5 min, repeat in 30 min. A line for abg and levels. Correct acidosis. Monitor ekg for ischemia.

47
Q

Aplastic anemia pre op needs

A

CBC/plt/wbc low. May need pre op transfusion, meds.

48
Q

Drugs associated with marrow damage: 13

A

Abx, antidep, seizure meds, anti-inflam, anti-arrhythmics, antithyroidal, diuretics, bp meds, antimalarials, hypoglycemics, plt inhib, tranquilizers

49
Q

Aplastic anemia anesthesia consid

A

Steroid stress dose if on roids, reverse isolation, prophylactic abx, hemorrhage (GI/IC), LV dysfunction from high output state, co-ex fanconi anemia (cleft palate and cv defects), difficulty cross matching blood after several transfusions

50
Q

Aplastic anemia pre induction and induction considerations

A

Transfusions before induction. A/w hemorrhage possible w intub. Avoid nasal intub. Regional depends on clotting. Labile hemodynamic response to induction (avoid decreases in CO)

51
Q

Aplastic anemia maintenance considerations

A

PEEP helps use less fio2 (avoid depressing BM), avoid NO, maintain normothermia

52
Q

Aplastic anemia extub/postop consid

A

Period of greatest 02 demand, monitor coag status

53
Q

4 hemostasis steps

A

Vascular spasm, primary hemostasis (plt plug), secondary hemostasis (coag and formation of fibrin), fibrinolysis

54
Q

Plt adhere to exposed ___ in endothelium which also releases __ __ which activates ___ which then release __ and __. Leads to ___ and plt plug

A

Vwf, tissue factor, platelets, adp and txa2, aggregation

55
Q

Secondary hemostasis=

A

Coagulation and fibrin formation

56
Q

Secondary hemostasis factors. Which factor essential in all pathways

A

1-13 except for 6. Factor 4= calcium, essential in all

57
Q

Extrinsic pathway: activated when, timing, factors, labs

A

Cascade initiated outside of IV space. Fast, 15 sec. 3 and 7. PT/INR

58
Q

Intrinsic pathway: activated when, timing, factors, labs

A

Cascade inside of IV space, slow 6 mins, 8/9/11/12, PTT/ACT

59
Q

Final common pathway factors

A

I, II, V, X, XIII

60
Q

Fibrinolysis

A

Plasminogen via TPA converted to plasmin breaks down fibrin

61
Q

How heparin works. Pathways, measurement of it.

A

Increases antithrombin 3 action, inhibits intrinsic pathway. Measured w ptt/act. Works on common pathways through inhibiting activated factor 10

62
Q

How Coumadin works

A

Inhibits vit k factors (2,7,9,10), factor 7 extrinsic pathway, blocks this path. Measure pt/inr. Intrinsic, extrinsic, and final inhibited

63
Q

What cryo contains

A

8, 13, vwf, fibrinogen

64
Q

Hemophilia a. Deficiency, labs

A

Factor 8, ptt prolonged (intrinsic path) , normal pt

65
Q

Hemophilia a: what happens pre op

A

Factor 8 infusion. 50 u/kg repeated q8-12 hrs to bring plasma levels near 100% before surgery. Ffp and cryo. Desmopressin 0.3 mcg/kg if mild heme a

66
Q

Hemophilia b deficiency and labs

A

Factor 9. Prolonged ptt normal pt

67
Q

Heme b anesthesia management. Use what for mild bleeding. Increased risk of what.

A

Recomb factor 9. 100 u/kg q12-24 hrs. Keep 9 >50% levels. Risk of thromboembolic complic since agents contain activated clotting factors. Ffp.

68
Q

VWF disease. Types 1-3, when DDAVP works. What labs look like

A

1- quantitative, DDAVP works. 2- qualitative. 3- no vwf. Plt count normal. Bleeding time >10 min. May have prolonged ptt d/t low factor 8

69
Q

VWF anesthesia management: avoid what, what you can give

A

Avoid nasal intubation. DDAVP for minor bleed (0.3 mg/kg in 50 ml nacl over 10-20 min to avoid tachycardia and hypotension). Intranasal 300 mcg DDAVP. Cryo if severe bleed. Ffp- just be careful of volume

70
Q

Drug induced plt inhibition by what

A

Asa, nsaids, pcn/cephalosporin, dextran, hetastarch >2L

71
Q

Pt factors that lead to plt dysfunction

A

Hypothermia <35c, acidosis <7.3, uremia, liver disease

72
Q

Tx plt dysfunction

A

If mild-mod give desmopressin. Cryo for vwf. Plt transfusion

73
Q

Dilutional thrombocytopenia tx

A

Ffp to restore pro coagulants, maybe platelets

74
Q

What leads to marrow damage and failure of platelet production: 7

A

Radiation, chemo, chemical exposure, thiazides/etoh/estrogen, cancer, viral hepatitis, b12 deficiency

75
Q

DIC lab levels

A

Plt <50l, prolonged PT/PTT, FSPs/D diners, low factor 8, decreased fibrinogen

76
Q

DIC tx

A

Treat underlying disorder. Give plt, ffp, cryo, rbc if indicated. Give heparin to block thrombin formation which blocks further consumption of clotting factors

77
Q

Vit k deficiency: lab levels and treatments

A

Prolonged PT, normal PTT. Vit K (if not emergent-takes 6-24h to work), FFP if active bleed

78
Q

Plt ct normal

A

150-400 k

79
Q

Bleeding time, what it assesses

A

3-10 min, plt func

80
Q

PT: time, what it measures

A

10-12 sec, 2, 3, 5, 7, 10, fibrinogen

81
Q

PTT: time, what it measures

A

25-35 sec, 2, 5, 7, 8, 9, 10, 11, 12. Fibrinogen.

82
Q

ACT: time, what it measures

A

90-120 sec. 8, 9, 11, 12. Monitors heparin action.

83
Q

Thrombin time, what it measures

A

9-11 sec, fibrinolysis. Prolonged w low fibrinogen

84
Q

Fibrinogen time

A

160-350 sec

85
Q

Hypercoagulability anesthesia consid

A

SQ heparin, compression stockings, ASA, vena cava filter, hydration. Regional unless on LMWH

86
Q

What to do for Coumadin pt pre op. Emergent reversal

A

Hold for 5 days. Measure INR 1 day pre op. If >1.8 give 1 mg vitamin k sq. Emergent reversal give 7 ml/kg ffp

87
Q

How to manage high risk w/o anticoag pt on warfarin

A

Start IV or SQ hep 3d after stopping warfarin. Turn heparin off 6h before surgery. If INR <1.5 can do surgery

88
Q

Regional: what meds need to be stopped

A

LMWH (24 hrs), plavix (7d), sq heparin (2-4 hrs), Coumadin 7-10 days INR >1.5

Anes& Coex (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions