Pre-Test (Pre and Post Op, Critical Care) Flashcards
Earliest clinical indication of hypermagnesemia
Loss of DTR (High Mg generally leads to states of neuromuscular depression)
Initial management of hyponatremia
Free water restriction
FeNa of less than 1% in oliguric setting indicates
Pre-renal etiology - aggressive Na resorption in the tubules (look urine Na)
Hypomagnesmia effects
paresthesia, hyperreflexia
Prlonged QT and PR intervals
Normal EKG in pre-op pt with hx of MI
Still do stress test (normal EKG wouldn’t preclude further workup)
When should mix acid-base abnormalities be suspected
When pH is normal, but pCO2 and Bicarb levels abnormal OR
If compensatory responses appear to be excessive
Whenever significant bleeding is noted in early post-op period, first presumption should be
Error in surgical control of blood vessels in the operative field
Goldman’s index risk #1
Recent MI (Up to w/in 6 mo)
In absence of peritoneal signs, dx test of choice for acute mesenteric ischemia
Angiography
Pre-op period tx for vWD
Desmopressin
What do you give with PRBC
FFP - transfusions lead to dilutional thrombocytopenia w/ def in factors V and VII
When do you start enteral nutrition post op
After bowel function if PO
If tube that passes stomach, can start w/in 24 hours
1st step in massive bleeding from retroperitoneal hematoma in post op pt
Immediate reversal of Heparin w/ protamine sulfate
What is referring syndrome? Major Complication?
IV glucose after chronic malnutrition leads to inc insulin levels –> electrolytes shifted back into cells
Hypophosphatemia (also hypokalemia and hypomagnesemia)
Sepsis vs Adrenal insuff
Similar presentations, but sepsis generally associated with hyperglycemia and normal K+
(Adrenal insuff -> hypoglycemia and hypokalemia)
When should FFP to replenish Vit K deep clotting factors be administered prior to OR? Why?
On the call to the OR
Factor 7 half-life is 4-6 hours (most stable clotting factor)
DIC after blood products likely?
Transfusion reaction (hemolytic)
What do you give a hemophilia A pt before surgery
Desmopressin and Aminocaproic acid (inhibitor of fibrinolysis)
FFP has F VIII but not in high enough levels to prevent bleeding in hemophiliacs
Most common cause of Zinc def? Symptoms
Excessive diarrhea
Alopeica, poor wound healing, night blindness, skin rashes
Ratio of NS or LR to replace blood loss
3:1 (3x fluid for 1ml blood lost)
Fluid replacement formula per hour
4 ml/kg/h for first 10 kg
2 for second 10
1 for every additional kg
Non-anion gap acidosis management
Fluid replacement and stool bulking agents
Patients with large ileostomy outputs at risk for?
Dehydration with accompanying hyponatremia, hypokaelmia, and non-anion gap metabolic acidosis
Hemolytic tranfusion reaction treatment
Fluids and mannitol
Indwelling catheter can help and diagnose by showing oliguria and hemoglobinuria
Metabolic rate during starvation
Decreases by 10%
Stress factors relative to basal metabolic rate for routine operation? multiple organ failure or severe injury? >50% burns?
Routine operation: 1.1
Multiple organ failure or severe injury: 1.5
>50% burns: 2
First step if trach starts bleeding bad
Intubate or stop the bleeding before going to OR for median sternotomy
Indications for extubation
- Rapid shallow breathing index b/w 60-105 (ratio of of RR to tidal volume)
- Neg insp force >-20
- PEEP of 5 or less
Major serious complication of hemolysis
Renal damage caused by precipitation of hemoglobin in renal tubules
Anesthetic to avoid in SBO surgery
Nitrous oxide (more absorbable, can increase distention)
3 major physiologic altercations of ARDs
1) hypoxemia unresponsive to elevations in O2 conc
2) Dec pulmonary compliance
3) Dec FRC
3 major things that shift the O2 curve to the right
Acidosis, rise in PaCO2, and elevation of temperature
Also 2,3-BPG
How does TRALI manifest
Respiratory distress, hypoxemia, and bilateral pulmonary infiltrates not due to volume overload
Agent of choice in cardiogenic shock
Dobutamine
Cardiac index formula
Cardiac output / Body surface area
Tx for acalculous cholecystitis
Percutanous drainage of gallbladder
Hemodynamics of septic shoc
Hyper dynamic state with increase in CO and decrease in peripheral vascular resistance
relatively normal central pressures
How does PEEP improve oxygenation
Increases FRC by keeping alveoli open at the end of expiration
Tx for neurogenic shock
IV fluid bolus followed by presser (Phenylephrine or dopa)
Prolonged paralysis after intubation likely from? Don’t use what drug?
Pseudocholinesterase def
Don’t use succinylcholine or Mivacurium
3 criterion for acute transfusion reactions
- Haptoglobin levels 5
3. + Coombs test (but takes 2-10 days)
O2 content variables
Hb, O2 sat, and PaO2 (in that order for contribution)
Highly reliable indication of alveolar ventilation
PcO2 (inc means not good alveolar ventilation)
Ideal respiratory quotient
0.75-0.85
What do you give pre-op pt’s w/ VWD (besides desmopressin)
Cryoprecipitate (Has vWF and Factor VIII)
Who is not a candidate for ECMO
Babies with hypoplastic lungs –> not enough surface area for gas exchange
What is indicated for aspiration pneumonitis if there is particulate matter in tracheobronchial tree
Bronchoscopy
Tx for malignant hyperthermia besides dantrolene
Hyperventilate with 100% O2
Lab values for cholesterol atheroembolism
Eosinophilia
Microscopic hematuria or proteinuria
FeNa >1
Metabolite abnormality that succinylcholine can cause
Hyperkalemia (worse in burn patients)
Warfarin factors
II, V, VII, X, C and S
What does thrombin time measure
Qualitive abnormalities in fibrinogen and presence of inhibitors to fibrin polymerization
What can measure both amount of and nature of hypotesion
Pulmonary artery cath
Measurement of HTN after CEA
Art line for beat to beat measurement
