MOCK Exam #1 Notes Flashcards
Prophylaxis for infective endocarditis no longer required for 4 procedures
Unrepaired cardiac valve disease
CABG
Coronary stenting
GI or GU procedures
Dental procedures involving _______and ________ requires prophylaxis for infective endocarditis?
Gingival manipulation and or damage to mucosal lining
Respiratory procedures requiring ABT prophylaxis for infective endocarditis
Those that perforate the mucosal lining with incision or BIOPSY
Congenital heart procedures requiring ABT prophylaxis for Infective endocarditis
Unrepaired cyanotic congenital heart defect
Repaired congenital heart defect within 6 months or with resideual defects near repair or graft. (this inhibits endotheliazation.
For heart transplant patient what is an anesthetic consideration for CO?
CO is more dependent on PRELOAD than on HR.
The transplanted heart is devoid or severed from what?
Severed from AUTONOMIC influence, meaning t
HR is determined by the
INTRINSIC RATE OF PHASE 4 depolarization which the TRANSPLANTED heart is not under that since they are severed from autonomic influence
In transplants patient the HR is
Fixed
In transplant patient the CO adjusts according to the
Position of the starling curves, increasing preload augment CO until it gets to a point where the ventricular myocytes becomes overstretched and CO falls
How does atropine reduces vagal tone
By acting as a competitive antagonist of the M2 receptor.
In the absence of vagal input as in ________, atropine has no effect.
Heart transplant
What drugs can be used to manipulate myocardial performance with the transplant patient?
Epinephrine
Transplant patient anesthetic consideration include
Maintain adequate preload to optimize the frank starling mechanism
Medications that should readily be available to augment the HR of transplant patient is
Isoproterenol and diluted epinephrine.
Ephedrine and Heart transplant patient
Indirect acting vasopressors, such as ephedrine, partially rely on endogenous catecholamines stores in the post synaptic sympathetic neurons and are therefore less effective.
With Heart transplant patient, will cholinesterase inhibitors cause bradycardia?
NO they won’t but they will still cause s/s of parasympathetic NS activation else where in the body.
With heart transplant patient, do you need to administer and anticholinergic with reversal
Yes.
what might you see on the ECG with a patient with a heart transplant?
May see 2 P waves, one for the recipient’s intrinsic rate of SA node and one from the donor heart.
For heart transplant the SA node of the native heart may
Still react to fluctuation in autonomic input, but this will not affect cardiac function.
For every 1 unit of PRBCs administered, the hgb and Hct should increase by
1g /dL
How can you estimate Hgb from Hct?
hct / 3
The spinal circulation consists of
2 posterior spinal
1 anterior spinal artery
Posterior spinal arteries arise from the
cerebella arteries
The cerebellar arteries supplies what region of the cord?
Dorsal (sensory) region of the cord
The anterior spinal artery arises from the
Vertebral arteries
Vertebral arteries supply what region of the cord?
Ventral (Motor) region of the cord
Both Anterior and posterior arteries received
collageral from the intercostal arteries in the thorax and the lumbar arteries in the abdomen. These
2 most appropriate intervention for “can’t ventilate and can’t intubate” Scenario
Surgical cricothyrotomy
Transtracheal Jet ventilation
Intubation technique best used when ventilation is possible?
Retrograde intubation
This airway technique Has no place in emergency airway management
Tracheotomy
Supraglottic , double lumen device place in the hypopharynx
Combitude
The proximal balloon of the combitude occlude the ______while the distal occludes the ______
Hypopharynx
Esophagus
With the combitude, if the tip is placed in the esophagus can the lung be ventilated
Yes
Should be release when placing the combitube?
Cricoid pressure.
At what point during laparoscopy cholecystectomy is a gas embolism most likely to occur?
Initial Abdominal insufflation
Gas embolism creates what?
air lock in the right heart and obstructs forward flow
Signs and symptoms of gas embolism
Decrease EtCO2 Increase EtN Increase PAP pulmonary edema Decrease BP,
Mill wheel murmur is associated with
Gas embolism
Most sensitive indicator of gas embolism
TEE
Aging what happen to lung elastic recoil, what is the implication
Lung elastic recoil is loss leading to an Increased lung compliance. Lung elastic recoil is vital in maintaining airway diameter. Losing that ability lead to collapse of the lung prematurely. Causes trapping which increases RV
2 first signs of PE
Precipitous fall in EtCO2
Tachycardia
Most of the reported cases of retrograde intubation described its use in patient with
Cervical spinal injuries.
This block anesthetize the vocal cords prior to an away intubation?
transtracheal
This reflex forces LA on the vocal cord during a transtracheal block?
cough reflex
What is the most reliable method to reduce postop pulmonary compications
Smoking cessation.
Anesthesia for VATS for removal of bullae preferred ventilation strategies? Why>
Small TV and High RR (it minimizes intra-alveolar pressures, HFJV is an alternative to PPV)
They are large air-filled spaces in the lung that result from damage to normal alveolar tissue?
Bullae
If bullae are ruptured, it can lead to ?
Pneumothorax
Tension pneumothorax
Cardiovascular collapse
To reduce the risk of rupture bullae the patient should be allowed to
Spontaneously ventilate until the chest is opened.
This ventilation can increase tension and may result in rupture of the bullae>
Positive pressure
Unilateral vagus nerve injury lead to
Hoarseness
Bilateral vagus nerve injury lead to
Aphonia
Unilateral External branch of the SLN injury
Min effects
Bilateral External branch of the SLN injury
Hoarseness, easily fatigue
Bilateral Internal branch of the SLN injury
NO effect BECAUSE IT IS SENSORY ONLY
Bilateral RLN injury
Stridor, dyspnea (acute) aphonia (chronic)
Sizing below 3 of LMA
< 5kg = 1
5-10 = 1.5
10-20 = 2
20-30 = 2.5
Inspiratory pacemaker is the
Dorsal respiratory center
Primarily responsible for caring active exhalation
Ventral respiratory center
Triggers inhalation
The apneustic center stimulates the DRC
Triggers END of inhalation
Pneumotaxic center inhibits the DRC
Le Fort that are associated with basilar skull fractures
Le Fort 2 and 3
Le Fort that are associated with Disruption of the cribriform plate
Le Fort 2 and 3
When should you not attempt a nasal intubation?
When there is a CSF lead in the nose or the ears
Raccoon eyes
Periorbital edema
Classic presentation of the oculocardiac reflex is
Profound bradycardia
Hypotension
What is a potential side effect of losartan?
Hyperkalemia
What type of medication is losartan?
Angiotensin II receptor antagonist
2 hypertensive medications that can increase maternal and fetal mortality
Losartan and ACEI
2 hypertensive medications that can cause post-induction hypotension (vasoplegia)? How do you treat it
ACEIs
Losartan
Consider vasopressin 0.5 - 1 units
OR methylene blue (1-2mg/kg)
Cardioversion initial fist shock is
50-100 Joules
A shock delivered on the ___________ or _ wave can lead to v-tach or v-fib
Relative refractory period
T-wave
Based on the 2016 ACC/AHA guidelines, elective surgery should be postponed for at least ________after a Current generation DES is placed
6 months
Elective surgery should be postponed for at least ________after a BARE METAL STATE is placed
30 days (1 month)
Name drugs that interfere with SSEPs
BDMNP Barbiturates Diazepam Midazolam Nitrous Propofol
Name drugs that DO NOT interfere with SSEPs
KEDOD Ketamine Etomidate Dexmedetomidine Opioids Droperinol
Drugs the interfere with the accuracy of SSEPs tend to ______amplitude and ___latency
Decrease amplitude
Increase latency
What does decrease amplitude mean?
The intensity of the stimulus
What does increase latency mean?
Time it takes for the stimulus to travel from point A to point B
Resume at question 30
Resume at question 30
