Hypotension

Question 1

Hypotension in pts under GA:

Answer 1

drop in blood pressure greater than 20% from baseline

Question 2

Pulmonary causes of Hypotension: (3)

Answer 2

hypoxia
hypercarbia
tension pneumothorax

Question 3

Hypovolemia causes of hypotension: (2)

Answer 3

fluid deficit, acute blood loss

Question 4

Cardiac causes of hypotension: (9)

Answer 4

rate/rhythm abnormality
inotropic failure
myocardial ischemia
contusion 
tamponade 
rupture
congestive heart failure 
cardiomyopathy 
valvular injury

Question 5

Shock causes of hypotension: (3)

Answer 5

hypovoleia, cardiogenic, septic

Question 6

Surgical causes of hypotension: (2)

Answer 6

Surgical compression of the heart, aorta, inferior vena cava, or abdominal contents
Laparoscopy: hypercarbia, dysrhytia, increased vagagl tone from excessive stretching of peritoneum

Question 7

Electrolyte and hormonal abnormalities for hypotension: (5)

Answer 7

hypoglycemia
hypocalcemia
adrenal insufficiency 
ADH supression 
hypermagnesemia

Question 8

Anaphylaxis reasons for hypotension: (3)

Answer 8

Meds (abx, muscle relaxants especially esters, opioids, ACEI’s)
Latex
Transfusion

Question 9

Anesthesia causes for hypotension:

Answer 9

deep analgesia

drug overdose

Question 10

Temp causes for hypotension

Answer 10

hypothermia

Question 11

When a patient is hypotensive, always administer what?

Answer 11

100% Oxygen

Question 12

Whenever a patient is hypotensive-always confrim what?

Answer 12

Confirm the pressure!!!!

Question 13

Things to KIM and say when pt is hypotensive:

Answer 13

Validate pressure 
ask about sxs
physical exam 
palpate pulse 
look at mucus membranes 
check temp 
provide supplemental oxygen
IV fluids
12 lead EKG 
ABG 

Review anesthesia record
check rates and rhythm

Question 14

NOrepi works on which receptors? Causes an increase in what? Reflex decrease in _____

Answer 14

alpha 1, alpha 2, beta 1
causes an increase in SVR, contractility, and afterload
reflex decrease in HR

Question 15

Dopamine for hypotension-moderate doses vs high doses and what they cause?

Answer 15

moderate (2-10 mcg/kg/min) cause B1 receptor stimulation 
Higher doses (10-20 mcg/kg/min) cause Alpha 1 recepotr defect

Question 16

Dobutamine: how does it work:

Answer 16

B1 agonist

Question 17

Milrinone: how does it work, what happens to SVR?

Answer 17

decrease in SVR

Phosphodiesterase inhibitor=increase in cAMP=increase in myocardial contractility and cardiac output

Question 18

Hypotension Causes: 
Decreased preload: 
Decreased afterload 
Rate 
Rhythm
Contracitlity

Answer 18

Decreased preload: hypovolemia, hemorrhage, decreased venous return due to PTX, PEEP, tamponade, gravid uterus, PE, VAE, fat emboli
Decreased afterload: sepsis, anaphylaxis, vasodilating drugs, or unclamping the aorta
Rate: too fast or too slow
Rhyth: a fib, a flutter, v fib, v tach, PEA
Contractility: Myocardial depression from ischemia or volatiles

Question 19

What rhythms provide the most perfusion?

Answer 19

Sinus>A aced>A-V paced>V paced