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LANCE > OR Concepts > Flashcards

OR Concepts Flashcards

1
Q

baroreceptors

A

pressure receptors in aortic arch and carotid sinuses

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2
Q

baroreceptor reflex

A

if it senses low BP then increases cardiac output (and opposite)

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3
Q

reflex bradycardia

A

when vasoconstriction causes the heart rate to decrease (phenylephrine)

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4
Q

relex tachycardia

A

vasodilation causes heart rate to increase (propofol)

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5
Q

carotid sinus

A

contains baroreceptors

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6
Q

carotid body

A

primarily sense hypoxia

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7
Q

Cerebral vascular accident

A

stroke

brain cell death due to loss of blood flow

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8
Q

What are the possible causes of stroke?

A

1- blood clot
2- intracranial hemorrhage
3- prolonged hypotension
4- hypertension

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9
Q

Deep venous thrombosis (DVT)

A

blood clot in a vein

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10
Q

What patients are at risk for developing DVT?

A

bedridden patients

heart arrhythmias that decrease blood flow through the heart

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11
Q

pulmonary embolism

A

DVT moves into the lungs

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12
Q

How do you decrease the risk of developing a DVT during surgery?

A

compression stockings

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13
Q

edema

A

excess fluid in the interstitial space

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14
Q

pulmonary edema

A

excess fluid in the alveolar spaces (usually caused by heart failure)

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15
Q

preload

A

volume that is returned to the right ventricle

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16
Q

afterload

A

resistance the left ventricle has to pump against

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17
Q

Will a patient with hypovolemia have a high or low preload?

A

low

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18
Q

will a patient in REVERSE trendeleburg have a high or low preload?

A

low

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19
Q

How do you monitor preload?

A

central venous pressure

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20
Q

what is the blood pressure in the superior vena cava normally?

A

5-12mmHg

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21
Q

If a patient is hypertensive then will the afterload be high or low?

A

high

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22
Q

If someone was bleeding to death and had low blood pressure would the afterload be high or low?

A

high

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23
Q

transmural pressure

A

the difference in pressure between two sides of a wall or equivalent separator

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24
Q

negative pressure pulmonary edema

A

trying to inhale while airway is obstructed

  • bite on ETT
  • laryngospasm
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25
Q

systemic vascular resistance (SVR)

A

resistance that the left ventricle must pump against

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26
Q

pulmonary vascular resistance (PVR)

A

resistance that the right ventricle must pump against

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27
Q

Is SVR or PVR normally lower?

A

PVR

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28
Q

cautery/bovie

A

cut and burn at the same time

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29
Q

grounding pad

A

used in cautery in order to make a full circuit

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30
Q

list the electrical loop for cautery

A 
machine
bovie
patient
grounding pad
machine
31
Q

should the grounding pad be placed on muscular or non muscular area?

A

muscular area so that it is well perfused to dissipate heat

32
Q

difference between unipolar cautery and bipolar cautery

A

unipolar must have a grounding pad and more current flows through the body

33
Q

advantages of bipolar cautery

A

less current flow through body

control cautery in delicate areas

34
Q

disadvantage of bipolar cautery

A

cauterizes small areas not good for controlling large amounts of bleeding

35
Q

why is it not likely to be electrocuted by cautery?

A

ultra high current frequencies (>200,000 Hz)

36
Q

Can a patient get burned if they have a piercing?

A

yes the current could pass through metal and cause burn

37
Q

what could you do if the patient could not take the piercing out?

A

place the grounding pad away from the metal

38
Q

pneumoperitoneum

A

abnormal presence of air or other gas in the peritoneal cavity

39
Q

implications of laparoscopic surgery (8 things)

A 
1-intubation required
2- atelectasis more likely
3- hypercarbia
4-vagal response common
5- decrease CO
6- BP up or down
7-pain in the shoulder (phrenic nerve)
8- possible pneumothorax
40
Q

When to use a 8.0 ETT?

A

laparoscopic surgery in the Trendelenburg position

it decreases the resistance of ventilation, lowers PIP

41
Q

CO2 gas embolism

A

infusion of CO2 into a vein or artery and results in blockage

42
Q

what is CO2 injected into the abdominal cavity with?

A

veres needle

43
Q

what causes a CO2 gas embolism?

A

misplacement of veres needle

44
Q

subcutaneous emphysema (SubQ)

A

trapped air under the skin

occurs as CO2 diffuses into the subQ space

45
Q

What would happen if you increase the pressure in the abdomen with CO2 above 20mmHg?

A

too high and increase the likelihood of tissue dissection and subQ

46
Q

What is the safe range of pneumoperitoneum pressure?

A

0-20

12-14 recommended

47
Q

What is the clinical significance of subQ?

A

hypercarbia

acidosis

48
Q

Would you extubate a patient that had SubQ?

A

no

49
Q

What are the four purposes of an OG/NG tube

A

1- decompress stomach
2-can vent gases (bowel obstruction)
3- tube feedings
4-empty stomach of poison or drug OD

50
Q

should you use a OG tube during laparoscopic surgeries? Why or why not?

A

yes, decreases the chance of injury upon trocar insertion and improves surgical view

51
Q

ileus

A

gastroparesis as a side effect of surgery

52
Q

T/F NG tubes are indicated for most open abdominal surgeries

A

true, patient is at risk of post op ileus

53
Q

Do OG tubes usually stay in post op? What about NG tubes?

A

OG tubes are temporary and usually come out

NG tubes usually stay in post op

54
Q

What is a contraindication for NG tube?

A

blood thinners

facial fracture

55
Q

What is a dangerous thing that can happen from incorrect placement of an NG tube

A

NG tube in brain if you don’t angle it correctly

56
Q

Do you place OG/NG tubes in patients with prior gastric surgery?

A

no

if you must radiology must aid

57
Q

T/F OG/NG tubes are safe to place in patients with liver failure.

A

false, they could have esophageal varices and could rupture

58
Q

cirrhosis

A

liver failure

59
Q

anaphylaxis

A

excess histamine release

60
Q

what are the two main problems with anaphylaxis?

A

1- vasodilation (leak into interstitial space and cause localized edema (hives))
2-bronchoconstriction

61
Q

anaphylaxis treatments

A

1- subcutaneous epinephrine
2-bronchodilator
3-histamine blocker
4- steroid

62
Q

what is the epi dose for adults and peds for anaphylaxis?

A

adult 100-500mcg

peds 10mcg/kg

63
Q

benadryl

A

histamine blocker

25-50mg

64
Q

compartment syndrome

A

decrease in the blood flow to a body compartment due to increased pressure inside the compartment

65
Q

what is the treatment for compartment syndrome?

A

surgical fasciotomy

66
Q

what are possible causes of compartment syndrome?

A

fracture
infiltrated iv
tight cast

67
Q

vagal response

A

bradycardia

hypotension

68
Q

when can you commonly see the vagal response?

A

laparoscopic surgery
eye surgery
abdominal/uterine surgery

69
Q

stress dose of steroids

A

steroids “enhance” the effectiveness of catecholamines

70
Q

catecholamines

A

hormones released by adrenal glands

-dopamine, NE and Epi

71
Q

what does chronic steroid use do to the catecholamines?

A

decreases their effectiveness if steroids are not taken that day, may decrease the effectiveness of vasopressors

72
Q

What steroids are in our pyxis that can be used for a stress dose?

A

solu-medrol (most common)

solu-cortef

73
Q

abdominal splinting

A

hypoventilation cause from the pain of breathing

74
Q

how do you counteract abdominal splinting?

A

narcotic
nerve blocks
local anesthetic

LANCE (17 decks)

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