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MTSA Orientation Test 2 > Orientation Test 2 > Flashcards

Orientation Test 2 Flashcards

1
Q

S/S of 15% fluid defecit

A 
Mucous Membranes---Parched
Sensorium---Obtunded
Orthostatic changes---HR >15 bpm, BP >10mmHg
Urinary Flow---Marked decrease
Pulse rate--->120bpm
BP---decreased
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2
Q

Fluid maintenance requirement

A

4ml/kg/hr for first 10kg
2ml/kg/hr for next 10kg
1ml/kg/hr over 20kg

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3
Q

How to calculate preexisting fluid deficit

A

Multiply normal fluid maintenance by the length of fast (NPO,etc)

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4
Q

Factors associated with increased evaporative loss

A

Losses are proportionate to

  • –the surface area exposed
  • –duration of surgical procedure
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5
Q

Sources of information used when estimating blood loss

A
  • -Suction cannisters (subtract irrigation used)
  • -Lap pads
  • -Sponges
  • -Blood on floor
  • -Surgeon
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6
Q

Calculate how much crystalloid and colloid should be used to replace a given amount of blood loss

A

3-4ml crystalloid per ml blood loss

1ml colloid/blood per ml blood loss

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7
Q

Crystalloid most commonly used in OR for fluids replacement

A

LR

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8
Q

Crystalloid most commonly used for RF pts and blood administration

A

NS–lowest pH of all commonly used crystalloids

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9
Q

Comorbidities which indicate an early use of colloid instead of crystalloid

A
  • large blood loss
  • large protein loss (burns)
  • severe hypoalbuminemia

Other uses-bacteremia,RI,trauma

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10
Q

Advantages of using hespan instead of albumin

A
  • inexpensive
  • stays in circulation 24hours

Can use up to 1000ml

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11
Q

disadvantages of hespan instead of albumin

A
  • -muscle aches/flu-like s/s

- -high doses assoc with dilutional thrombocytopenia, Renal Insufficiency

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12
Q

Negatives to colloid/albumin

A
  • Can cause allergic reaction
  • can contract Creutzfeldt-Kakob dz
  • max dose 10-20ml/kg
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13
Q

Compare HCT of cell saver blood to blood bank

A

cells are washed (PCV 50-60%)

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14
Q

Clinical situations that preclude the use of cell saver

A
  • -malignant tumor

- -sepsis of operative site

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15
Q

HCT that indicates possible transfusion

A

21-24%

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16
Q

Methods of measuring HCT

A
  • -serum Hgb (coulter counter)
  • -Hemocue
  • -iStat
  • -IL-Gem
  • -Masimo continuous Hgb
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17
Q

What is the anticoagulant used in blood bank and a consideration with transfusion?

A

CPDA-1(citrate phosphate dextrose adenine)

binds Ca-watch levels

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18
Q

What is the appropriate storage temp of blood bank and how long does it last?

A

1-6 degrees Celsius

35 days

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19
Q

PLT count during surgery which indicates transfusion

A

<50,000 –assoc with increased blood loss during surgery

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20
Q

What medications are used to pretreat PLT infusion?

A 
H1 gastric (reglan)
H2 antagonist (antihistamine)

Steroids

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21
Q

Indications for FFP administration

A

-isolated factor deficiencies
-reversal of coumadin therapy
-coronary artery bypass
-correction of coagulopathy associated with
liver disease

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22
Q

Potential complications of massive transfusion

A
  • dilutional thrombocytopenia
  • dilution of other coagulation factors
  • citrate toxicity and hypocalcemia
  • hypothermia
  • alkalosis from citrate, lactate
  • hyperkalemia
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23
Q

Lab test which may indicate hypovolemia

A
  • -Serial Hct’s—increase (shows concentrated)
  • -Arterial pH—increased metabolic acidosis
  • -Lactate—increased
  • -Urine Specific Gravity/Osmolality—>1.010
  • -Urine Na/Cl concetration (450)
  • -Serum Na-increased
  • -Serum BUN:Cr ratio—>10:1
24
Q

SCOM(ladig)

A

Suction, Stethoscope
Circuit
Oxygen
Monitor

25
Q

(scom)LADIG

A 
Laryngoscopes (and blades)
Airways (nasal,oral, LMA, ETT)
Drugs
IV pole (and clamps)
Gloves and Goggles
26
Q

How do you know suction is strong enough?

A

It will stay suctioned to your thumb

27
Q

Where does the ETCO2 connect in circuit?

A

port closest to pt

28
Q

What is the amount an adult reservoir bag holds and how much does a child bag hold?

A

adult: 3L
child: 1L

29
Q

What airway rescue device must be on every cart?

A

ambu bag

30
Q

What is the numeric value we should look for with the BIS monitor for general anethesia?

A

40-60

31
Q

What is the BIS monitor based on and what does it tell us?

A

EEG waveform-helps us to know pt is adequately unaware

32
Q

What are two things to check on the laryngoscope before use?

A

light works

bulb is tightly screwed in

33
Q

How to size nasopharyngeal airways

A

Avg female/short male–6
Avg Male/tall female-7
Tall male-8

34
Q

When do you not use an LMA?

A

pts with risk of aspiration

-does not protect the trachea from aspiration

35
Q

What are indications for an LMA

A
  • -rescue intubation for difficult mask and failed intubation
  • -alternative to ett in appropriate pt
  • -conduit to ETT (some LMA’s help with intubation
36
Q

What are the most common sizes of LMA’s?

A

3,4,5

37
Q

What 5 things should be written on a label?

A 
name of drug
concentration
date drawn up
time of day drawn up 
---(all ok for 24hrs except prop=6hrs
initials
38
Q

When is it ok to not label a drug?

A

if drawing up for immediate use

(i.e. atropine for bradycardia)

39
Q

How many IV poles do you need and why?

A

2 IV poles with clamps

- one for IV pump
- one to hold up surgical drape
40
Q

Which 7 drugs are good to have prepared before a case?

A 
Versed 
Fentanyl
Lidocaine
Anectine
Diprivan
Ephedrine
Neosynephrine
41
Q

How do you reconstitute Neosynephrine to 100mcg/ml?

1st dilution

A

10,000 mcg/ml

  • –take 10ml NS vial and remove 1 ml
  • -add the 1ml of 10,000mcg/ml to vial

(10,000/10=1,000)

42
Q

How do you reconstitute Neosynephrine to 100mcg/ml?

2nd dilution

A

Using a 10ml syringe

  • take a new bottle of NS and remove 9ml
  • take the diluted vial of Neo and remove 1ml and place in the 9ml syringe of NS

(1,000/10=100mcg/ml)

43
Q

List the four type of airways needed when setting up a room and there most common sizes

A

Oral (8,9,10mm)
Nasal (6,7,8mm)
LMA (3,4)
ETT (7.0, 8.0)

44
Q

List the functions of IV access

A
  • -Admin of anxiolytics, induction/maintenance/ emergent agents
  • -Admin of antibiotics, electrolytes, blood
  • -Fluid Resuscitation
  • -Blood sampling for venous labs
45
Q

What is the smallest gauge IV recommended for blood administration?

A

18 gauge

46
Q

What 3 things should ALWAYS be done regarding IV in preop?

A

–assess pt for IV access issues before taking to OR room
–visually inspect IV started by another provider
–make sure IV flows freely before taking into
OR room

47
Q

List complications of IV insertion

A 
Infiltration
Hematoma
Air embolus
Phlebitis/ thrombophlebitis
Extravascular/ intraarterial injection
Medication error
48
Q

List contraindications of IV access

A
  • -Massive edema, burns, injury in extremity
  • -Severe abdominal trauma (place in upper ext)
  • -Infection/ cellulitis
  • -Indwelling fistula
  • -Lytics
  • -??Mastectomy
49
Q

List things to consider for IV consideration

A

Ease of access
Use of non-dominant extremity
Avoid joint locations
Avoid lower extremeties

50
Q

What is the location of the intern vein?

A

portion of the cephalic vein in the region of the radial styloid

51
Q

What things should you consider when selecting a lower extremity vein?

A
  • -Lower ext veins tend to collapse and are difficult
  • -Not ideal for placement
  • -Can be more painful than upper extremity

Any vein in the foot large enough to accept catheter is ok to use

52
Q

What are the landmarks for locating the EJ?

A

Originates near the angle of the mandible and courses over the sternocleidomastoid muscle

Proximal to the clavicle

53
Q

What are the predictors of difficult IV access?

A
  • -Dehydration/intravascular depletion
  • -Chronic illness w/ venous scarring
  • -IV drug use
  • -Obesity
  • -Significant edema, burns
  • -Tortuous fragile veins
  • -Thin vessel walls
54
Q

What are techniques for promoting vasodilation?

A
  • -Tourniquets/BP cuff
  • -Warming
  • -Topical anesthetics
    • EMLA cream
    • SQ Lido 27-30g
55
Q

How do you thread a difficult IV?

A

lower and advance catheter

posterior wall penetration

56
Q

List sources of flow interruption in a functional IV

A

Tubing Kinks
Remove T-connector
Suspect old IV’s

57
Q

List steps or maneuvers associated with missing an IV

A

Go slow

Lower angle

MTSA Orientation Test 2 (2 decks)

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